We receive this question almost weekly:

Can I get my Naltrexone filled with the acidophilus filler?

Well, here is our answer:

A filler is expected to be inert. It is inactive. Acidophilus is a live, active substance. Therefore, it is technically not an inert filler.

Almost all brands of acidophilus contain dextran – and they are made by fermentation process that uses corn. Some people are sensitive to corn products and some refuse to use dextran.

The generally available products are freeze-dried. That renders the actives stable until they are exposed to moisture, which obviously takes place during compounding.

That leads to the question about whether acidophilus is really inert. Would the bacteria in any way alter the bioavailability or content of the actives that are mixed with it? Also, would any breakdown byproducts interact with the active – either reducing or increasing its activity?

While the amounts of excipients and extraneous materials may be minuscule, it is unwise to offer them to a customer – without a disclosure.

I conclude that it would probably be inappropriate to use acidophilus as a filler without some documentation about safety, etc. It’s probably irrelevant in most cases, but how would a compounder explain the use of a filler for which he or she did not have documentation – or at least a wide-spread history of use (such as is the case for microcrystalline cellulose (avicel), lactose, methycellulose, etc.)

The whole concept of filler selection can be filled with roadblocks, the vast majority of which are mere pebbles. But, what if???

People who object to microcrystalline cellulose, lactose,  or methylcellulose may be happy with rice powder.

We will use acidophilus as a filler when specifically prescribed by the doctor.

We are not permitted to compound with probiotics (acidophilus included) as it is not something covered by our exemption as a 503a patient specific compounding only pharmacy.