Managing Multiple Sclerosis in Michigan: The Role of Compounded 4-Aminopyridine
Multiple sclerosis (MS) is a chronic, autoimmune/neurological disease that affects the central nervous system (brain and spinal cord) that affects thousands of individuals across Michigan, particularly in the northern regions and the Upper Peninsula.
A 2023 study published data regarding the demographics of the most at-risk cohorts:
“For each racial and ethnic group, the prevalence of MS was higher in the Northeast and Midwest when compared with the South and West regions. MS prevalence was highest in non-Hispanic White individuals followed by those who were non-Hispanic Black, members of other non-Hispanic race and ethnic groups, and Hispanic. ”
Source: JAMA Neurology
In MS, the body’s immune system mistakenly attacks the protective sheath (myelin) that covers nerve fibers. This damage disrupts the communication between the brain and other parts of the body.
Compounded 4-aminopyridine (4-AP) has emerged as a valuable therapy for managing specific MS symptoms. At Healthway Compounding Pharmacy in Saginaw (serving all of Michigan), we are dedicated to providing personalized compounded medications like 4-AP to support our patients’ unique needs.
Understanding 4-Aminopyridine and Its Role in MS
4-Aminopyridine, also known as fampridine or dalfampridine, functions as a potassium channel blocker. By inhibiting these channels, 4-AP enhances nerve signal conduction in demyelinated neurons, which are characteristic of MS. This mechanism can lead to improvements in walking ability, muscle strength, and overall motor function.
“In 2010, prolonged-release 4-aminopyridine became the first drug specifically licensed to improve walking in patients with multiple sclerosis.”
Source: CNS Drugs
Clinical trials of aminopyridine demonstrated that approximately 35% of patients experienced significant improvements in walking speed and lower limb strength.
It works by blocking potassium channels on the surface of nerve fibers, which may improve the conduction of nerve signals in nerve fibers whose insulating myelin coating has been damaged by MS. Please note: patients with a history of seizures or moderate to severe kidney disease should not use 4-AP.
Source: Clinical Neuropharmacology
Why Are Michigan Doctors Prescribing Compounded Aminopyridine for MS?
1. Customized Dosing
Tailored Strengths
- Compounding pharmacies can create custom strengths (e.g., 5 mg, 7.5 mg, or 15 mg) to meet the individual tolerance levels and therapeutic response of each patient.
Titration Flexibility
- Some patients may experience side effects or insufficient benefit at the 10 mg dose.
- Prescribers may want to start with a lower dose and titrate slowly—only possible with compounded formulations.
2. Alternative Dosage Forms
Compounded 4-AP can be prepared as liquid solutions, capsules, or even sublingual preparations for patients who have difficulty swallowing tablets or require faster absorption.
3. Patient Sensitivities or Allergies
- Commercial products contain inactive ingredients such as binders, dyes, or preservatives that may cause adverse reactions.
- Compounding pharmacies can omit allergens or unnecessary excipients, making the medication better tolerated.
4. Clinical Preference Based on Experience or Research
- Some practitioners have decades of experience using compounded 4-AP and prefer its immediate-release profile over the extended-release version.
- Certain peer-reviewed studies have shown benefits with immediate-release 4-AP in symptom relief, such as tremor control, vision improvement, or fatigue reduction .
5. Scientific Rationale
- Immediate-release 4-AP has been studied in conditions beyond walking impairment, such as ocular symptoms, upper limb coordination, and cognition
6. The Importance of Choosing a PCAB-Accredited Compounding Pharmacy
When it comes to compounded medications like 4-AP, the quality and safety of the preparation are paramount. The Pharmacy Compounding Accreditation Board (PCAB) provides accreditation to compounding pharmacies that meet rigorous quality and safety standards.
Healthway Compounding Pharmacy was the first in Michigan to receive PCAB accreditation in 2007 and has maintained this status ever since. This accreditation ensures that our pharmacy adheres to the highest industry standards, including:
- Use of USP-grade chemicals from FDA-approved suppliers
- Routine product testing and quality assurance
- Ongoing staff training and certification
- Compliance with United States Pharmacopeia (USP) guidelines
- Adherence to USP <795> and <800> standards
- High-quality APIs (active pharmaceutical ingredients)
- Sterile and non-sterile compounding expertise
- Validated equipment and rigorous quality control
By choosing a PCAB-accredited pharmacy, patients and healthcare providers can trust that the compounded medications are prepared with the utmost care and precision.
Who Prescribes 4-Aminopyridine?
Neurologists are the primary healthcare providers who prescribe 4-AP for MS patients. They assess the patient’s symptoms, medical history, and overall health to determine if 4-AP is an appropriate treatment option. In some cases, primary care physicians or physiatrists may also be involved in the prescribing process, especially in areas with limited access to specialists.
At Healthway Compounding Pharmacy, we collaborate closely with healthcare providers across Michigan to ensure patients receive the optimal plan of care.
Healthway Compounding Pharmacy: Serving Michigan's MS Community
As Michigan’s first PCAB-accredited compounding pharmacy since 2007, Healthway Compounding Pharmacy is committed to excellence in personalized medicine. Under the leadership of Michael E. Collins, R.Ph., F.I.A.C.P., with over 35 years of compounding experience, we serve patients across northern Michigan, the Upper Peninsula, and the Thumb area.
Our state-of-the-art facility in Saginaw ensures the highest quality standards in compounded medications, including 4-AP. We collaborate closely with healthcare providers to develop individualized treatment plans that address each patient’s unique needs.
Considering 4-AP for MS Management?
If you or a loved one is exploring treatment options for MS, compounded 4-aminopyridine may offer the best option. Consult with your neurologist to determine if 4-AP is appropriate for your condition. For more information on our compounding services and how we can assist in your MS management, contact Healthway Compounding Pharmacy in Saginaw.
If you’re a medical practitioner looking for options catered to patients’ individual needs, work with Healthway to provide an elevated experience for MS patients.
We’re proud to empower patients through personalized care—because every journey with MS is unique. Contact our pharmacy with questions or to learn more about getting started.
References
Dietrich, M., Hartung, H. P., & Albrecht, P. (2021). Neuroprotective properties of 4-aminopyridine. Neurology: Neuroimmunology & Neuroinflammation, 8(3), e976. Link
Hittle, M., Culpepper, W. J., Langer-Gould, A., Marrie, R. A., Cutter, G. R., Kaye, W. E., … & Wallin, M. T. (2023). Population-based estimates for the prevalence of multiple sclerosis in the United States by race, ethnicity, age, sex, and geographic region. JAMA neurology, 80(7), 693-701. Link
Jensen, H. B., Ravnborg, M., Dalgas, U., & Stenager, E. (2014). 4-Aminopyridine for symptomatic treatment of multiple sclerosis: a systematic review. Therapeutic advances in neurological disorders, 7(2), 97-113. Link
Leussink, V. I., Montalban, X., & Hartung, H. P. (2018). Restoring axonal function with 4-aminopyridine: clinical efficacy in multiple sclerosis and beyond. CNS drugs, 32(7), 637-651. Link
Polman, C. H., Bertelsmann, F. W., van Loenen, A. C., & Koetsier, J. C. (1994). 4-Aminopyridine in the treatment of patients with multiple sclerosis: long-term efficacy and safety. Archives of Neurology, 51(3), 292-296. Link
Sedehizadeh, S., Keogh, M., & Maddison, P. (2012). The use of aminopyridines in neurological disorders. Clinical neuropharmacology, 35(4), 191-200. Link
Solari, A., Uitdehaag, B. M., Giuliani, G., Pucci, E., Taus, C., & Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group. (1996). Aminopyridines for symptomatic treatment in multiple sclerosis. Cochrane Database of Systematic Reviews, 2010(1). Link
Stefoski, D., Davis, F. A., Faut, M., & Schauf, C. L. (1987). 4‐Aminopyridine improves clinical signs in multiple sclerosis. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 21(1), 71-77. Link