The Olympics has facilitated growth in the pharmacists’ roles in Sports Medicine in specialized areas such as sports pharmacy.
Sports Pharmacy involves the use of medications in athletes whether for therapeutic treatment of injury or performance enhancement. Increasing capacities as members of interprofessional teams explore and treat sports-related injuries & address the special needs of the athlete (especially in the management of neuropathic & musculoskeletal pain). Increased the development of safe, individualized options for treatment. Customized preparations can be tailored to improve clinical outcomes allowing physicians to adjust medications they prescribe to meet specific purposes or standards Not limited to treatment & prevention of injury or exacerbation, but also to specialized drug education, monitoring, and therapeutic selection.
Scope of Sports Pharmacy
Awareness – Awareness of drugs in sports for performance, prevention, and treatment of disease.
Therapy – Knowledge of therapeutic uses to support sports-related illness or injury.
Prevention – Use of pharmacotherapy to prevent illness and maintain well-being.
Optimization – Safe and rational use of nutrition and supplementation to optimize health and
Abuse – Knowledge of drugs for competitive advantage.
Detection – Drugs of abuse, misuse (intended or unintended), adverse events.
One Shoe Doesn’t Fit All
Different athletes may require different doses of medication for the same injury. Different sized bodies, variations in metabolism, comorbidities & concurrent medications increase the need for individualized formulations or preparations which may not be commercially available. FDA approval process is intended for mass-produced and distributed medications but has approved for the use of compounded medications for individuals under the care of a physician to address specific health needs. Some commercially available products are limited in strengths and dosage formulas. Compounding is a means of calibrating an exact dose to a specific patient, which results in increased accuracy in treatment. Quality & Safety are paramount to ensure the practice of good medicine.
Opportunities for Incorporating Topical Medications in Sports Medicine Practice
Topical Medications offer leverage with treatment options. Increased concentrations at the site of injury compared to systemic concentrations. Dosing according to the length of ‘strip’ or pump.
Use of Iontophoresis & Phonophoresis to facilitate delivery of the medication beneath the skin (gels).
Management of Pain & Inflammation
Decrease pathways of tolerance and addiction
Reduce drowsiness, cognitive delay and performance limitations
Antifungal, Antibacterial & Skin Preparations
Blisters, ulcers, tears, rash, eruptions, sun exposure/protection, etc.
Hemorrhoids or other rectal application of medications
Simultaneous internal and external application
Partnerships between Sports Medicine Physicians & Pharmacists
Advanced Pharmacy Practice Experience in Sports Pharmacy.
UCSF 2006 (NCAA sports focus relative to doping, banned substances, testing, counseling, drug
Residency Training with exposure to Athletics, High-Performance Athletes, Sports Medicine.
Practices (growing opportunities for training and collaborations).
Sports Medicine Clinics with contracted compounding services or in house compounding services.
Injury specific topical medications.
Work specifically to address billing and insurance issues.
Variations in clinical practice settings (community-based to orthopedics) requires access to
pharmacists that understand sports and exercise sciences, injury and care of the athlete as a
unique patient population.
Unique Opportunities for Treatment & Collaboration in Care
Altering delivery systems to improve clinical outcomes for athletes increased need for specialized compounding pharmacists with knowledge of sports medicine specialty. Many classes of medications when taken orally may increase GI upset, require special dosing for hepatotoxic or renal issues, have unintended side effects that limit dosing or duration or create adverse effects for athletes and patients.
Bypass the gut (firstpass) bypass the problems.
Topical medications provide a unique delivery route that potentially minimize side effects or eliminate drug interactions by decreasing systemic exposure.
Treating at the site of the injury may lead to improved recovery or response times, facilitate
healing with direct application, and reduce the length of time needed for treatment.