LIVE from ILADS: Tick Boot Camp sits down with David W. Kazarian, RPh, pharmacist and founder of Infuserve America, for a focused conversation recorded in person at the ILADS Annual Scientific Conference.
In this short-form conference interview, Kazarian explores how compounding pharmacy can give practitioners additional options for Lyme disease and tick-borne illness patients dealing with medication sensitivities, reactions to fillers and excipients, alpha-gal syndrome, absorption challenges, and other complexities. With decades of experience working with the Lyme community, he explains why changing the formulation of a medication — not just the active ingredient — can sometimes become an important part of individualized care.
This interview was recorded live on the conference floor, so you may hear some of the energy and background activity of ILADS throughout the conversation.
What Is Compounding Pharmacy?
Kazarian describes compounding as both a science and an art.
Commercial medications generally come with predetermined doses, capsules, fillers, dyes, and delivery methods. Compounding gives a pharmacist, working with a prescribing practitioner, the ability to customize certain aspects of a medication for an individual patient’s needs.
Depending on the prescription and patient, that can include changes to:
- Medication strength or dosage
- Fillers and excipients
- Capsule materials
- Carrier oils
- Route of administration
- Release characteristics
- Topical or oral formulations
- Sterile or non-sterile preparations
For people navigating complex Lyme disease and other tick-borne illnesses, those details may become particularly important when medication sensitivities develop or change over time.
Excipients, Fillers & Medication Sensitivities
One of the most important topics in this conversation is excipients — ingredients in a medication other than its primary active pharmaceutical ingredient.
Kazarian discusses patients who may have difficulty tolerating ingredients such as dyes, magnesium stearate, titanium dioxide, gelatin capsules, certain carrier oils, animal-derived ingredients, and other fillers.
For a highly sensitive patient, the question may therefore extend beyond "Can I tolerate this medication?" to "Can I tolerate this particular formulation of the medication?"
A compounding pharmacist may be able to work with the prescribing practitioner to explore alternative formulations when appropriate.
Alpha-Gal Syndrome & Animal-Derived Ingredients
The conversation also explores alpha-gal syndrome, a tick-associated allergy that can make mammalian-derived ingredients problematic for some patients.
Kazarian uses capsules as one example. Traditional gelatin capsules may contain animal-derived materials, while alternative formulations can use vegetable-based capsules.
He also discusses carrier oils and other excipients, including MCT, almond, and olive oils, illustrating how even the inactive components of a medication may need to be considered for an individual patient.
For people experiencing unexplained new sensitivities, the discussion provides an important takeaway: the active medication isn’t necessarily the only ingredient worth investigating.
Why Can Medication Tolerance Change?
Many people living with Lyme disease and other complex chronic illnesses report becoming sensitive to foods, supplements, medications, or other substances they previously tolerated.
Kazarian discusses immune dysfunction as one possible piece of this complicated picture and explains why changing medication tolerance deserves investigation.
This is especially relevant for Lyme patients who experience symptoms that change, migrate, or seem disconnected from one another.
Rather than automatically dismissing a new reaction because a medication was previously tolerated, the episode explores why practitioners may need to look more closely at both the patient’s changing health and the medication’s ingredients.
Lyme Disease, Coinfections & Complex Illness
Kazarian prefers looking broadly at tick-borne illness rather than focusing exclusively on Borrelia.
The conversation discusses the polymicrobial nature of tick-borne disease, including coinfections and the potential involvement of immune and inflammatory processes.
That complexity leads to one of the central themes of the interview:
There isn’t necessarily one recipe for every patient.
Patients can present differently, tolerate treatments differently, and require different approaches as their health changes.
Carrier Oils, Microemulsions & Medication Absorption
Kazarian also explains the role of carrier oils and what he describes as microemulsions.
Depending on the medication and formulation, these techniques may be used to influence delivery, absorption, or gastrointestinal tolerance.
He describes the concept simply as surrounding a drug with fat and explains why understanding the chemistry of both the active medication and its delivery system can be an important part of pharmaceutical compounding.
Thyroid Medication as an Example of Precision Medicine
Kazarian uses thyroid medication to demonstrate how individualized investigation and compounding can work together.
The discussion touches on TSH, T3 and T4, free T3 and free T4, reverse T3, iodine, ferritin, medication ingredients, animal-derived ingredients, bioidentical formulations, and sustained-release compounding.
The thyroid discussion serves as a larger example of the questions that can arise with a complex patient: Is the medication itself the problem? Could an inactive ingredient be contributing? Is the formulation appropriate? Is something else in the patient’s clinical picture being overlooked?
These are questions for the patient’s healthcare team to investigate rather than assuming there is a one-size-fits-all answer.
Precision Medicine & the Pharmacist’s Role
A major theme throughout the interview is precision medicine.
Kazarian describes the compounding pharmacist as another resource for the treating practitioner when conventional medication options create challenges.
Depending on the individual situation, a pharmacist and prescribing clinician may consider a different formulation, excipient, dosage form, route of administration, release method, or active ingredient when clinically appropriate.
Kazarian is also clear about something important: the pharmacist does not replace the patient’s practitioner.
Instead, the pharmacist can become another member of the team, helping the practitioner explore additional options when they encounter a medication-related obstacle.
Sterile & Non-Sterile Compounding
Infuserve America provides both sterile and non-sterile compounding.
Non-sterile compounding can include customized capsules, tablets, topical preparations, and other formulations. Sterile compounding includes preparations requiring specialized sterile environments and procedures, including certain injectable and intravenous medications.
With Infuserve America’s background in home infusion, Kazarian also discusses prescribed IV therapies, PICC lines and ports, intravenous medications, nutritional IV preparations, Myers’ cocktails, and high-dose vitamin C.
Giving Practitioners More Tools
Perhaps the most important message from Kazarian is that compounding isn’t about replacing the doctor or allowing patients to prescribe for themselves.
It’s about giving practitioners more tools.
Kazarian describes receiving calls from practitioners who have reached a difficult point with a patient and want to know what other options may be available.
Could an excipient be changed? Could another route of administration work? Could the medication be prepared differently?
Those conversations between practitioners and pharmacists can create possibilities that aren’t available with an off-the-shelf medication.
Patients interested in exploring compounding with their healthcare provider can learn more about working with Infuserve America.
About David W. Kazarian, RPh
David W. Kazarian, RPh is a registered pharmacist and founder of Infuserve America with decades of experience in pharmacy, home infusion, sterile and non-sterile compounding, and working with the Lyme disease community.
His approach emphasizes collaboration between the pharmacist, practitioner, and patient to identify individualized solutions when conventional medication formulations present challenges.
Key Topics in This Episode
Lyme disease, tick-borne illness, compounding pharmacy, David Kazarian, Infuserve America, medication sensitivities, medication intolerance, excipients, fillers, alpha-gal syndrome, precision medicine, personalized medicine, immune dysfunction, carrier oils, microemulsions, thyroid medication, medication absorption, sterile compounding, home infusion, IV therapy, and practitioner-pharmacist collaboration.
About This LIVE from ILADS Interview
This short-form interview was recorded in person at the 2025 International Lyme and Associated Diseases Society (ILADS) Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.
Tick Boot Camp was onsite interviewing doctors, researchers, healthcare professionals, advocates, and innovators working across Lyme disease and vector-borne illness.
Explore all Tick Boot Camp LIVE from ILADS interviews to hear more conversations from the conference.
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