Compounded liquid Xanax

I have been taking Xan for 21 years. 2 mg ER 2 x per day. Started to taper by cutting pills about 6-7 months ago. Got down to .25 mg 4 x per day. Had agitation, irritability, increased anxiety and rage. But it was bearable. Because I was concerned abt further tapers I asked my dr to give me a suspension. So, he had a compound pharmacy make that. 5 ml supposedly equals .25  4 x per day. I started this on 8/24. Since then I have gone into a downward spiral. The above symptoms are out of control. Plus I have the desire to jump out of my body and run somewhere. Also, I have strange discomfort in my chest. I went to the ER and my heart is ok.

 

The problem is that my dr really is not an expert at this. He is very cooperative and is basically letting me call the shots bec he doesn’t know what to do. I am supposed to see him end of September.

 

Best theory I have is that the compound pharmacy used a generic from a different company than the one I have been getting my pills from. The company that made mine was Sandoz. I would appreciate anybody’s input on this so I can offer something to my dr. Thanks very much.

 

Edit: Changed subject title to reflect current issue.

I have been taking Xan for 21 years. 2 mg ER 2 x per day. Started to taper by cutting pills about 6-7 months ago. Got down to .25 mg 4 x per day. Had agitation, irritability, increased anxiety and rage. But it was bearable. Because I was concerned abt further tapers I asked my dr to give me a suspension. So, he had a compound pharmacy make that. 5 ml supposedly equals .25  4 x per day. I started this on 8/24. Since then I have gone into a downward spiral. The above symptoms are out of control. Plus I have the desire to jump out of my body and run somewhere. Also, I have strange discomfort in my chest. I went to the ER and my heart is ok.

 

The problem is that my dr really is not an expert at this. He is very cooperative and is basically letting me call the shots bec he doesn’t know what to do. I am supposed to see him end of September.

 

Best theory I have is that the compound pharmacy used a generic from a different company than the one I have been getting my pills from. The company that made mine was Sandoz. I would appreciate anybody’s input on this so I can offer something to my dr. Thanks very much.

 

You may be on to something with your theory, I've heard members mention this but I've also seen them struggle when first making the switch to the liquid, there can be a difference in strength.  Did you reduce at all when you started the liquid or hold your previous dose? 

 

There can also be a difference in compounding pharmacy quality, some use better methods than others.  One of our team members has put together a list for determining if a compounding pharmacy is right for this process.  http://www.benzobuddies.org/forum/index.php?topic=270601.msg3396443#msg3396443

Pamster has asked an important question … did you make a reduction in dose at the same time you switched to liquid? 

 

Your hypothesis about the compounding pharmacy using tablets from a different manufacturer is a valid one.  It’s also possible they used the pure drug powder (aka Active Pharmaceutical Ingredient) instead of tablets as the drug source.

 

If you have not already done so, I encourage you to contact the compounding pharmacy to ask for the specific formulation (‘recipe’), they used to make your compounded liquid.  If they used tablets as the drug source, were the tablets regular release and, if so, what was the manufacturer?

 

Given that you have a cooperative prescriber …

 

Are you aware that alprazolam is available in a concentrated 1mg per mL oral solution?  For example:

 

DailyMed - ALPRAZOLAM solution, concentrate

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b945ac6f-796e-41ef-85e9-61007e4a4e9a

 

We have members who dilute prescription solutions for diazepam, lorazepam, and Rivotril (clonazepam) with water to achieve lower concentration liquids.  We may well have members who have done the same with the alprazolam concentrate — I haven’t conducted a search on this topic so don’t know.

 

One last question …

 

You indicated in your opening post that you took 2mg alprazolam ER for 21 years.  Does ER mean Extended Release?  If so, when you started tapering, did you switch to regular release tablets?  I ask because according to DailyMed, Sandoz does not make an Extended Release (ER) tablet:

 

DailyMed - Search Results for alprazolam

https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=alprazolam

 

 

 

Thank you very much for responding. I stayed on same dose. I was taking .25 mg Instant release 4 x per day. Then I switched to 5ml (.25 mg) 4 x per day. No change in dosage. I was not aware that a liquid form of Alprazolam was available. My doctor really doesn’t know much abt this. I have to figure it out for him. Thx

I just looked at the link you sent. Turns out that Pfizer doesn’t distribute liquid Xanax in the US. But article has link to a company that does sell Alprazolam in liquid form. So I will check on it. Thx much.

The answer to your other question is that when I started to taper, the first thing I did was gradually switch from ER (extended release) to IR (instant release) 1 mg tablets by Sandoz.

Thank you for answering our questions. Learning more about the specifics of your case helps us help you.

 

Do you have a supply of regular tablets you could return to using while you investigate why you might be having issues with the liquid?

 

For your consideration, I’ve included questions for the compounding pharmacist below.

 

Also, did the pharmacist provide you with an adapter cap and oral syringes to facilitate measurement of the suspension?  Did the pharmacist advise you to shake the suspension well before measuring your dose?

 

In addition to gathering more information from the compounding pharmacist, you might consider:

 

(1) Asking your doctor if he would be willing to prescribe the commercially manufactured 1mg/mL Alprazolam Intensol™ Oral Solution (Concentrate) manufactured by West-Ward (National Drug Code: NDC 0054-3068-44).

 

(2) Using a combination of regular tablets and the Intensol (or the suspension) for the first phase of your taper.  For example: alprazolam is available from Sandoz in 0.25mg scored tablets. You could split these in half to get a dose of 0.125mg.  You would take 0.125mg four times a day in tablet form and 0.125mg four times a day in liquid form. You would taper the liquid portion to zero as tolerable.  (We can share examples of how members dilute prescription liquids to achieve lower concentrations if you decide to pursue this route.)

 

Questions for the compounding pharmacist:

 

“I am experiencing an uptick in withdrawal symptoms since switching to the compounded suspension and am trying to figure out what might be causing it. Would you please help me by answering these questions?”

 

- What formulation did you use to prepare the suspension?  What are the specific ingredients?  (Might I be allergic to one or more of these?)

 

- What did you use as the drug source - regular tablets or the API (Active Pharmaceutical Ingredient)?  If you used regular tablets what manufacturer and strength did you use?  (I have been using 1mg tablets from Sandoz.)

 

- What is the concentration of the suspension?  (Is it 0.05mg/ml?)

 

- Have you made this formulation before for other patients?  Have they had any issues?

 

- Do you have ideas as to why I might be having issues?