Switch to liquid question

I am trying a compounded Clonazepam. He made it very dense. 1mg/1ml.  I took my first .23mg. I’m worried bc it’s so concentrated and the amount of liquid is so little. Is this going to be ok?

Thanks!!

Just double-checking …

 

Is the concentration of your liquid 1mg/mL or 0.1mg/mL?

 

What measuring device are you using?  An oral syringe?  If so, what is its nominal volume — 0.5mL, 1mL, other?

 

Thank you! It is 1mg/1mL.  The syringe is 1mL.  It’s very tiny, and fits into a hole in the top of the bottle.  I’m going to need magnifying glasses to see the tiny lines.  I wish he would’ve done it less concentrated, but my psychiatrist never called in a liquid benzo before, and thus is what he decided on.i took it. I feel something happening. I hope it works.

Libertas, should I get it remade? I was up all night. Not sure it worked… Took my pill this morning, and brain feels like mush now. The refill of the pills I just got last week is different than my previous pills for some reason…make me feel like I can’t think…maybe stronger.  Ugh!!! I just need to pick something and go with it.  The liquid is so concentrated it worries me bc I don’t know that I’m getting the entire amount in my system… thoughts?  Thank you!

You’ve hit the proverbial nail on the head — you need to decide on a plan of action, implement it, monitor your response, and be prepared to make adjustments.

 

You also are facing an additional challenge in that you have not one but two variables in play related to your taper. One, you got a new fill of your prescription and suspect the new tablets are stronger than those from the previous fill. Two, you have introduced a new dosage form (the compounded liquid) and suspect it may be too concentrated to measure accurately (the author of the article linked below would agree with you - see his comments on using diluted liquids to improve measurement accuracy).

 

ADDENDUM: I just saw your post about trying NAC on the Alternative Therapies & Supplements board.  This means a third variable was in play.  Generally speaking, it’s best to change only ONE variable at a time when tapering.

 

I also get the sense you might benefit from additional research about your liquid compound as well as possibly your compounding pharmacist.  I find it surprising s/he made such a concentrated liquid given your total daily dose and the potency of clonazepam (a concentration of 0.1mg/mL or even lower might be more appropriate; see link below for one such formulation).  I also wonder what formulation s/he is using — what ingredients does it contain, in what amounts? Has it been stability tested? 

 

If I were in your shoes, I would consider returning to using just regular tablets and holding at my current dose in hope I would adjust to the new tablets.  While I was holding, I would use the time to conduct the aforementioned research.  In case you decide you need to vet your current compounding pharmacist or find a new one, I’ve included suggestions below.

 

Links:

the illusion of accuracy

https://connect.ashp.org/blogs/dennis-tribble/2019/03/05/the-illusion-of-accuracy

 

0.1mg/mL Clonazepam Oral Suspension from Nationwide Children’s Hospital

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

 

How to Find a Compounding Pharmacy

https://www.wikihow.health/Find-a-Compounding-Pharmacy

 

Thank you for all of that, Libertas! I only tried the NAC one night, so that variable is gone now, thank God.  I’m definitely doubting this liquid form of K.  I’m thinking I may be better off sticking to the pills, and just dealing with the fact that the refills may be a little off sometimes, I guess.  I don’t think I can handle any more “what ifs”. If I keep changing things, I’ll never be able to move forward.  The compounding pharmacy thing is an issue bc my psychiatrist is not really supportive. I KNOW he will not call it in again any differently.  He was annoyed to do it, and wouldn’t listen to my recommendation, which was how you told me to have it done.  Today, I’ve decided just start cutting down my dose and love forward again. I’ve been holding a month, and even with a slight difference in pill strength, I can’t control that. Maybe I’ll feel better if they’re stronger, once I reduce.  Thank you so much for your help!! You’re so kind!!

FMF