Switching from dry cut to compounded liquid K

Hi all...I got stuck dry cutting at .18mg. Every time I tried to go lower my withdrawl sympoms got really narly. I decieded to switch to equivlent liquid K compounded. The exact same amount of liquid as pill form gave me huge withdrawl symptoms.  Has anyone else had experience like this switching from dry cut to liquid K?

following closely

Yes, some people have issues switching from solid to liquid dosage forms.  There are several possible reasons for this (e.g. the bioavailability of the liquid may be different than that of the solid).

 

As a first step, let’s double-check that you switched over to the correct equivalent dose of the liquid (it is not uncommon for members to struggle a bit with this at the beginning) and were stable at that dose.  Here are our questions:

 

(1) What is the total, uncut weight of the tablets you have been using in grams?

(2) What pill weight were you ingesting on the day before you switched to the liquid?  Were you dividing this pill weight into two doses or just taking one dose per day?

(3) Were you stable on the above dose and dosing schedule?

(4) What is the concentration of the liquid?  (This information should be included on the bottle label, expressed as X milligrams of drug in Y milliliters of liquid.)

(5) How many milliliters of the liquid did you ingest?  Did you divide this amount into two doses or just take one dose?

 

Thanks for the response...to answer your questions:

1. the full pill weight was 168g

2. Pill weight on day before was .060g. I was taking this once a day before bed

3. Yes, I have been stable on the above dose for several months.

4.The concentration of the liquid is .02MG/20ML suspension

5. I ingested 18 ML of liquid in one dose at night before bed

 

I'm curious about the bioavailabity piece you spoke about.  I also take a statin and I understand that some statins are broken down by the same enzymes that break down K....so maybe there is a link there.

 

Any thoughts would be appreciated.

 

 

 

 

Your numbers check out.  Well done!

 

I’m going to ask one of our team members who knows more than I do about liquid formulations to stop by to answer your question.

Hello, GolfGirl100.  Pamster asked me to stop by.

 

Let me begin with a tip of the hat for calculating your liquid dose amount correctly.  As Pamster noted, many of our members struggle with liquid measurements.  For example, I recently read about a member who was unwittingly taking a much higher dose of a nasal spray than recommended. 

 

Now … onto your question …

 

Bioavailability refers to the extent and rate at which a drug enters the blood circulatory system and can therefore access the site of action (in the case of benzodiazepines, GABA receptors).

 

Per the Merck Manuals (see link below):

 

Bioavailability of a drug is largely determined by the properties of the dosage form, which depend partly on its design and manufacture. Differences in bioavailability among formulations of a given drug can have clinical significance ….

 

For example, it’s possible for a liquid (whether it’s pharma-grade, compounded, or do-it-yourself) to have different therapeutic effect(s) compared to a solid dosage form. Also, generally speaking, liquids have a more rapid onset of action compared to tablets (see link below). 

 

Can you tell us more about your compounded liquid?  Do you know what ingredients were used and in what proportions?

 

In particular, do you know what the compounding pharmacist used as the drug source — pulverized tablets or bulk powder (the pure active drug substance)?  If tablets were used, were they from the same manufacturer you have been using or a different one?  (Tablets from different manufacturers may contain slightly different amounts of the active drug substance and/or different excipients.)

 

If all is well with your compound, then you might consider making a small increase in dose (say in the 2.5% range) to see if that helps.

 

I’ll close with an observation … at 0.18mg, you are approaching  0.125mg, the lowest strength solid clonazepam dosage form in the US.  Although this sounds like a small dose, the effect on receptor occupancy is still large.  You might consider slowing down your taper rate.  (You impress me as both intelligent and intellectually flexible; consequently I’ve included a link to a video by a benzo-wise psychiatrist that explains the relationship between dose and receptor occupancy as well as its implications for tapering.)

 

Links:

 

Drug Bioavailability - Clinical Pharmacology - Merck Manuals Professional Edition - 2022

https://www.merckmanuals.com/professional/clinical-pharmacology/pharmacokinetics/drug-bioavailability

 

Formulations for children: problems and solutions - British Journal of Clinical Pharmacology - 2013

https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.12268

 

Should I do a Hyperbolic Taper? What You Need to Know

Dr. Josef Witt-Doerring

Hi Libertas..thanks so much for coming on and giving me such useful information.

 

As for the compounded K...I asked for pure powder to be used so I can only assume that is what the pharmacist used. I asked him to use Ora-clear and Ora-sweet for a suspension. He stated that those suspensions had to be kept cold and was only good for two weeks so instead he wanted to use a new suspension that had just been tested with k called "Suspended."  This new suspension is good for six months and doesn't need to be kept in the fridge.  So I agreed to that for use with the powdered K.  So who knows if the new suspension had any effect on bioavailability or not???

 

I could really tell that the liquid worked quickly.  It also felt very clean giving me a very alert feeling soon after I took it. On the flip side it appeared to wear off a lot faster.  With pills I usually didn't feel it wear off till just before bed....the liquid wore off by afternoon.

 

I am going to really slow down my taper rate...I'm planning on using a combination of dry cut pills and this liquid and reduce by a total of only .01mg this month. I'll try and make a cut of .001 mg and hold for three days then make another .001 cut.To go that slow I am going to have to use pill plus .01 or .02 ml of liquid because my scale only measures to .000g.  Hope that makes sense. I'll let you know how it goes.

 

Again thanks for the links.

You’re most welcome, GolfGirl100.

 

It sounds like the suspending vehicle your compounding pharmacist is using may be SyrSpend by Fagron:

 

https://fagron.com/brands/oral-vehicles/

(This page includes a video on SyrSpend dosing accuracy you might find of interest.)

 

It also sounds like your compounding pharmacist is using a stability-tested formulation.  This is good news — stability-tested means the formulation has been professionally analyzed for potency as well as chemical and physical stability over time.

 

You are not alone in reporting that the liquid dosage form has a faster onset of action and shorter duration of action compared to the solid dosage form.  It may well be that you will adjust to these differences.  If not, we can talk about options.

 

I’m delighted to hear you will be monitoring your taper rate as you get lower in dose. Theoretically, once you get past the steeper-part of the dose-receptor-occupancy curve, you may be able to increase your rate again. But the only way to learn if this will be possible in your specific case is via self-experimentation.

 

Re: your earlier question about the possibility that the statin you are taking might be affecting the bioavailability of the clonazepam …

 

Have you checked for interactions between your statin and clonazepam?  If not, I’ve included links to two drug interaction checkers below.

 

Please do keep us posted as to your progress.

 

Links:

 

Drug Interaction Checker - DrugBank

https://go.drugbank.com/drug-interaction-checker

(includes citations to relevant literature)

 

Drug Interactions Checker - For Drugs, Food & Alcohol

https://www.drugs.com/drug_interactions.html

(includes interactions with food as well as a ‘Professional’ tab for in-depth information about the interaction.)

Hi!! This was exactly me…. Hang on!! I thought I made a mistake changing over to compound liquid bc it was rocky initially but I settled in after a few months and it likely saved my life! I also had slowed down to about 5% a month after initially changing over and that might have helped too. I’ve been going .01mg drop a month since last summer and over time some functionality has come back and I’m not bedridden like last year before going to compound liquid.

 

Give a little bit of time and see how next month is and also see how your reduction rate is. I’ll follow back up soon.

Thank you to everyone who has contributed to this extremely informative thread. I am following this  with great interest as I contemplate switching from compounded capsules to liquid in order to do a daily or close to daily liquid microtaper. So grateful for all of you being willing to share this information.

How is it going now??

 

Hi Libertas..thanks so much for coming on and giving me such useful information.

 

As for the compounded K...I asked for pure powder to be used so I can only assume that is what the pharmacist used. I asked him to use Ora-clear and Ora-sweet for a suspension. He stated that those suspensions had to be kept cold and was only good for two weeks so instead he wanted to use a new suspension that had just been tested with k called "Suspended."  This new suspension is good for six months and doesn't need to be kept in the fridge.  So I agreed to that for use with the powdered K.  So who knows if the new suspension had any effect on bioavailability or not???

 

I could really tell that the liquid worked quickly.  It also felt very clean giving me a very alert feeling soon after I took it. On the flip side it appeared to wear off a lot faster.  With pills I usually didn't feel it wear off till just before bed....the liquid wore off by afternoon.

 

I am going to really slow down my taper rate...I'm planning on using a combination of dry cut pills and this liquid and reduce by a total of only .01mg this month. I'll try and make a cut of .001 mg and hold for three days then make another .001 cut.To go that slow I am going to have to use pill plus .01 or .02 ml of liquid because my scale only measures to .000g.  Hope that makes sense. I'll let you know how it goes.

 

Again thanks for the links.