Need help with liquid lorazepam

[[Buddie]]

My psychiatrist prescribed Intensol Lorazepam 2mg/1ml.

I have been holding at 0.375 mg taken 3 times a day. I use a pill cutter to break tabs into 4 quarters then take 3 per day.

The instructions on the liquid states to draw 0.125 ml into the syringe then give under tongue 3 times a day.

It appears they have doubled my dose, correct? If I take .375 ml I will be getting .7 mg of lorazepam.

I called and the nurse said everything is ok but I don't agree.

Can someone confirm this for me please? Also, is it ok to mix the liquid in water?

Thanks

[[Buddie]]

I've read members have diluted with water, just make sure you agitate it well.  I reached out to another member for your liquid question, hopefully they'll be able to confirm this for you.

[[Buddie]]

I agree with you.

I think the nurse is wrong.

(3 doses a day) times (2mg/mL) times (0.125 mL) = 0.75 mg of the drug.

I can only assume it is ok to mix in water because I know others have done it.

[[Buddie]]

Usually it’s a 1mg/ML for lorazepam liquid so prob best to ask pharmacist the formulation. They maybe have a typo on the label (mine has made a mistake before…. Critical they know how important their job is in this). Maybe Dr asked for 2mg/mL in the script so best to discuss with all parties and make sure everyone is on same page.

Hope you can figure it out soon.

[[Buddie]]

[...] has raised an interesting possibility.  Is it possible your prescriber asked the pharmacist to dilute the pharma-grade, commercially manufactured 2mg/mL lorazepam Intensol to 1mg/mL?

[[Buddie]]

Spoke with pharmacist and he states dose as written would be twice my normal dose.

So using the 2mg/1ml means I need to take 0.0625 ml three times a day to stay at my current.

Anyone have a good way to dilute the solution as my dosages get smaller?

Seems tricky

Thanks

[[Buddie]]

Tip of the hat for detecting the dosing issue and then following up with your pharmacist to confirm this.

Have you started to use the liquid?  What is your plan to switch from solid dosage form to liquid (e.g. switch one of your daily doses at a time, switch all of them)?

Can you tell us more about the measuring device you are using?  Is it an oral syringe?  If so, what is its nominal volume (e.g. 0.5mL, 1mL, other)?  How is it calibrated (e.g. graduation marks every 0.01mL, every 0.05ml)?

Given that the amount of liquid you are measuring is quite small, one option to consider to begin would be to measure your entire daily dose at once and then add it to a known quantity of distilled or purified water (e.g. 150mL).  Shake this mixture well, then quickly divide it into 3 glass containers for your 3 daily doses.  To minimize drug loss due to surface transfer, rinse the syringe and any containers you use two or so times with water then ingest the rinse water (or distribute the rinse water into your dosing containers).

[[Buddie]]

Thanks for reply.

The solution comes with an oral syringe that holds 1 ml. The markings are 0.1 ml, 0.2 ml, 0.3 ml and on till 1 ml.

So I will need to pull 0.375 ml and put it in distilled water, mix and divide doses into 3.

Difficult when such small doses. I have been dissolving ativan tab in whole milk. Do you think solution is better?
Will I notice much different switching?

Thanks so much for your help. I got down to 0.19 mg last year doing water taper but WD symptoms just too much so I went back up. Hoping this time is better

[[Buddie]]

Are there marks in between 0.1, 0.2, etc. on your 1mL syringe?  If so, how many?  4?  9?

In terms of obtaining accurate and precise doses, using the pharma-grade liquid is the preferred option.  Why? Because — unlike do-it-yourself liquids made with regular tablets — it is a solution, not a suspension.  This means each and every ‘unit’ of the liquid contains exactly the same amount of drug.

The only way to know how you will react to the pharma-liquid is to try it.  Two of the most common mistakes I’ve seen members make when they switch to a different dosage form are (1) they make a reduction in dose (or some other change) at the same time they make the switch and/or (2) they do not give themselves enough time to adjust to the new dosage form.

[[Buddie]]

Thanks [...].

Only 0.1,0.2 etc on syringe.

This math is tricky. I appreciate your tips.

Keep them coming if you could.