Compounding RX Compounding

 

I am curious, has anyone used a Compounding Pharmacy to liquid taper? As I read several of the taper schedules, I had to question whether I was doing the right thing by using a Pharmacy opposed to preparing my own mixture? My question is the accuracy of the dose and also the syringe that I am currently using. I have been using a 6ml syringe that has me quit confused when I compare my dosage reduction to the majority of titrator's (if that's a word). I'm assuming that because it is in ML's, the syringe that is, it is decreased by tsps. I know what the conversion is , but in order to make micro cuts, I am thinking that I will need to use something different. Amy suggestions? Having a heck of a time....

 

Thanks

dragonfly1

Hi,  People do both.  Some get there liquid made, some make it themselves from pills, and some use prescription liquids made by the drug company.

 

I think the liquid concentration and the equipment you are using need to be matched.  If a solution is more concentrated a finer syringe is needed and if it is less concentrated a bigger syringe would work.

 

I didn't understand your comment about ml's and tsps?

Hi SG57,

 

Thanks for the much needed info.. I am so confused at this point I am beginning to think that I should have never titrated. Perhaps it's my anxiety today that's putting me in this frame of mind. According to the Pharmacist, he is making the suspension himself. I am currently on Librium. I was on Valium tablets until 2mg, then titrating Valium to 1.75mg but had a difficult time transitioning from the tablet to the liquid. I was never stable. I am now on liquid Librium a 1.75mg. Tolerating it just ok, not as good as I expected.

 

As far as the mls & tsps, I guess what I am trying to say is that reading others schedule they are cutting say .090 then .085 and so on. My syringe is labeled 6mls, then 5mls, 4mls, 3mls 2mls and 1ml. Between each ml there are 5 lines with no measurement. How do I measure say 0.85? Please excuse my ignorance, but I apparently I am not understanding the whole titrating process... major anxiety!!

 

I am not using any equipment, the concentration is already measured in a 5ML bottle.. I hope I am making sense at this point

I am starting to have my doubts about how much I am cutting as well. I believe I am cutting way entirely too much. I hope I am making sense. I would appreciate any other information you have to offer... NEED HELP!!

 

 

Thank's so much

 

 

Well, Librium is much weaker than Valium.  Valium is 2.5 times stronger than Librium according to the Ashton manual.  If you changed from 1.75mg of Valium to 1.75mg of Librium, this is a pretty large cut.

 

10mg of Valium = 25mg of Librium according to the Ashton Manual.

 

So, 1.75mg of Valium would roughly equal 4.375mg of Librium.

 

I believe your equivalent dose of the Librium you are taking now, is somewhere around .70mgs of Valium, so this is a substantial cut you took.

 

Librium and Valium are so similar.  I'm wondering why you switched benzos?

Hi Juliea,

 

I apologize, let my clarify. I stopped the liquid Valium at 1.75mg and started taking 5mg of liquid Librium. I made the benzo switch because I could no longer tolerate the liquid Valium. Started titrating the Librium and now at 1.75 of Librium. Yes, I know the Valium is 2.5mg stronger than the Librium, unfortunately I had no other choice but the Librium. That is the scenario as of now...

 

I don't know how to proceed from here if I am to make micro cuts. I simply can not cut each line as that would be too much, I think...

 

Thanks so much for your input, as you can see I am "not getting" the whole titrating process.

 

Any suggestions would be appreciated!

 

Okay, good we got that clear.  Let's simplify this.  First, though Librium is an excellent drug to use for titration.  It is the only one of the common benzos that is water soluble and it is also much weaker than even valium, along with its long life, so all those thinks make it a good one to taper.  I'm surprised it is not used more.

 

So people make L solutions in their kitchen using just water.  So something to remember if you ever need it.

 

But, back to your taper.  You NEED to know your concentration.  It should be on the bottle.  How many mg per ml?

 

Once we know that we can figure the rest.

Hi SG57,

 

Thank goodness... thought I was starting to sound like a babbling idiot. Okay, the concentration is 5mg/5ml. I guess switching over from Valium to Librium was a lucky decision. Great to know it's a good Benzo for titrating. I use the word "good Benzo" loosly. I hope I am using the correct syringe as well.

 

Thanks a bunch!!

Okay that's good info.  Repeating you have...1mg/ml Librium liquid, current dose is 1.75mg.  You are very low in dose so I would be careful to start a low daily cut.  Maybe .025mg/day??  That will be slight even on a 1ml syringe.

 

I'd say you need to do one or two things.  Your current syringe is too big to make the cuts you need accurately, that's for sure.  You need a 1ml syringe with 100 lines on the barrel.  The other thing is it would be good to have a more dilute solution.  Right now a cut of .025mg is 2 1/2 tick marks on a 1ml syringe (.025ml).  You may be able to use this.

Hey SG57,

 

Yes, you got it..1ml/1mg. Ok then I need a 100ml syringe. So you say that 2 1/2 ticks on the syringe barrel is equivalent to .025ml and that is equal to .025mg correct??

 

I have been holding for about ten days sometimes longer and cutting about 10%. Is that what you would recommend as well?

 

How do people measure .09, .08, .07, or 1.74, 146, 1.26 by using a different size syringe? Sorry,  I am just full of questions... gotta get it right.

 

Also should I ask the Pharmacist to dilute the solution?

 

Thank God I found you, what a HUGE help!

 

Dragonfly1

Making sure we are on the same page... you wrote "100ml" syringe.  I think you meant 1ml??  You need a tiny syringe.

 

I may have assumed wrong.  I thought you wanted to do a daily taper?  Or did you plan to cut and hold?  Personally I think we are better off making very small daily cuts, but you can cut as you wish it is your taper.  Something around .025mg per day seems like a good place to start to me at your dose.

 

You may be able to work with this solution, especially if you cut and hold as the cuts will be bigger and more measurable.  If you decide to daily taper it would be good to get it diluted to perhaps .1mg/ml (10X weaker).

Hey SG57,

 

Yes, you are correct, 1ml syringe and not 100ml. I am sorry that I didn't specify, but I have never cut daily. Is that what most of the people do, or did you do when titrating? I would like to cut a safe % and still hold 7-10 days. Oh boy....

You're using a liquid so you have the option of both.  You have great flexibility in dosing.  At your dose I would recommend it, but it is up to you. 

While daily cutting appeals to me, I am concerned. How does ones blood levels stabilize with such short durations? Don't misunderstand, my though was to cut and suffer, because I NEVER stabilized. It is only on this last leg of tapering that I have experienced SOME stabilizing after holding for 14 days. I attribute it to less poison in me. I am sure that tolerance, was the impetus to my increasingly severe panic/anxiety all along.

 

Let me ask you this, is there a safe percent to cut daily?  Obviously the cuts would get smaller as I titrate down. I know it is how comfortable I feel,  but curious to know what you would recommend, if you can.

 

Thanks for all your help,

dragonfly1

Daily tapering is gentler.  Think of it this way...you could remove a bigger cut then hold or you could divide that same cut into many small cuts over the hold period.  You end up in the same place in the same amount of time, but with the daily taper you have left the drug in your body to cover symptoms until your body was ready to deal with the shortage.  With cut and hold you took a large amount out, got symptoms, and recovered.

 

Daily taper does not deal with percents.  Instead there is a daily cut.  At your dose on L you are very low.  Really close to the end so I'd start with .025mg per day and see how it goes.