Author Topic: Compound Pharmacy Titration  (Read 398 times)

[Buddie]

Compound Pharmacy Titration
« on: October 30, 2018, 03:46:30 pm »
Good morning all!

I just started a liquid taper from 1mg of Clonazepam to 0.95mg last night. I barely slept and had a couple of major panic attacks. How can such a small difference in dosage cause such a dramatic reaction??

Should I lower my taper to 0.99mg or 0.98mg? My mind is completely fried today, from last night.

Thanks for any help!  :-\
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #1 on: October 30, 2018, 04:28:05 pm »
Hi [...] :smitten:

Quote
liquid taper from 1mg of Clonazepam to 0.95mg
That is a small cut of 5%. If spread over 14 days and reduced each day a small quantity, very likely you won't feel symptoms. Although you might hold for 2 or more weeks after the dose, at the moment the cut could be a little bit abrupt for your organism. As you are already doing Liquid Taper (by the way, which concentration is the solution?) I propose you go for reduction on a daily basis at a reduction pace of 5%/14 days. Have a look here: http://benzo.alwaysdata.net/

All the best.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #2 on: October 30, 2018, 04:37:31 pm »
Hey[...]!

The bottle says 0.1MG/ML (0.95MG) I forgot how many mL is in the bottle that they gave me. I'll have to look at it tonight when I get home. So I guess I'll reduce my dose each day, accordingly, instead of doing straight 5% drops every 30-days. Thank you for the link and all of your help!!
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #3 on: October 30, 2018, 10:50:49 pm »
Good morning all!

I just started a liquid taper from 1mg of Clonazepam to 0.95mg last night. I barely slept and had a couple of major panic attacks. How can such a small difference in dosage cause such a dramatic reaction??

Should I lower my taper to 0.99mg or 0.98mg? My mind is completely fried today, from last night.

Thanks for any help!  :-\

It can't.  Your tablets varied that much or more from day to day.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #4 on: October 31, 2018, 02:12:45 pm »

It can't.  Your tablets varied that much or more from day to day.

I realized last night that I was SO focused on the new Clonazepam titration, that I completely forgot to take my Citalopram 20mg. I wonder if that's why I was so wonky and couldn't sleep?
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #5 on: October 31, 2018, 05:29:00 pm »

I realized last night that I was SO focused on the new Clonazepam titration, that I completely forgot to take my Citalopram 20mg. I wonder if that's why I was so wonky and couldn't sleep?
It think it would have been a good idea if you would not have started immediately lessening the dose, but first had tried the same dose, so 1 mg, to check if you react the same way to your new fluid as to the old medication.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #6 on: October 31, 2018, 07:20:20 pm »
Hi [...] :smitten:

Quote
[...] wrote: It think it would have been a good idea if you would not have started immediately lessening the dose, but first had tried the same dose, so 1 mg, to check if you react the same way to your new fluid as to the old medication.
I think the above suggestion from [...] bears a lot of common sense.

From more and more posts I read in here, when a compound solution is used, users do feel a drop in effects. When you search in BB for the word "bioavailability" you will see that some buddies started to discuss about this phenomenon back in 2014 or even earlier. From these discussions it emerged that taking dry tablets or tablet powder suspended in a compounding solution does NOT give the same result. The compounding loss is evaluated between 5-10% switching to liquid. This drop is mainly attributed to the reduced absorption of the solution by the organism when the digestion system treats differently dry tablets or equivalent powder but suspended in solution made of various ingredients (cellulose, calcium sulfate, citric acid, sodium phosphate, anti-foam emulsion, preservatives...).

Does this topic exist only in this forum or is it a well known thing? In a message from [...]: http://www.benzobuddies.org/forum/index.php?topic=135284.msg2334135#msg2334135 where he reported a text for compounding ORA-SWEET*/ORA-PLUS suspensions from survivingantidepressants.org, there is this passage:
"Calculate the total amount of active ingredient and volume of solution needed to
create a suspension of the proper concentration. (Calculations are provided in the
examples above.) It may be wise to add approximately 10% overage for compound-
ing losses
.
"

To counter the loss knowledgeable buddies recommended to increase the required volume to 5-10%. This is of course NOT and up-dose as the dose absorbed by the body would remain the same after the correction.

It would be therefore cautious to not jump head down in only-compound-liquid right away. Two steps to proceed:
1. Reduce the use of liquid by combining it with tablets. Example: 1/4 in liquid + 3/4 in tablets. Then 1/2 liquid 1/2 tablet and so on...
2. At the beginning of the taper keep the SAME dose in liquid combined with tablets for some time until the body get used to the new situation.

If we gently introduce liquid in this way then symptoms could be mild without having to do the correction.

Wish you stabilize soon.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #7 on: October 31, 2018, 07:28:37 pm »
I am SO glad that I have you guys/gals as support! NONE of my docs/psychs/pharmacists tell me any of this stuff, even if I ask. I'm going to do exactly what was mentioned for the slow introduction of liquid. Tonight, I'm going to do .75mg of my pill, if I can find a micro scale from Wal-Mart or CVS, then I'll do a .25mg dose from my liquid solution. I'll also remember to take my 20mg Citalopram lol.

Thank you all for this critical information and support!  :)
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #8 on: October 31, 2018, 07:41:05 pm »
Hi [...] :smitten:

Quote
if I can find a micro scale from Wal-Mart or CVS, then I'll do a .25mg dose from my liquid solution
With your existing pharma compound solution of 0.1MG/ML, you just draw up 2.5 ml with your syringe to get 0.25 mg of benzo. The scale would not be necessary in this case.

Thanks for your kind words.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.

[Buddie]

Re: Compound Pharmacy Titration
« Reply #9 on: October 31, 2018, 08:12:47 pm »
Hi [...] :smitten:

 
Does this topic exist only in this forum or is it a well known thing? In a message from [...]: http://www.benzobuddies.org/forum/index.php?topic=135284.msg2334135#msg2334135 where he reported a text for compounding ORA-SWEET*/ORA-PLUS suspensions from survivingantidepressants.org, there is this passage:
"Calculate the total amount of active ingredient and volume of solution needed to
create a suspension of the proper concentration. (Calculations are provided in the
examples above.) It may be wise to add approximately 10% overage for compound-
ing losses
.
"

 

Please note that that caution specifically references compounding losses.  Those are instructions regarding a suspension, not a solution. And it does NOT reference "bioavailability".  And there are no compounding losses with solution.
Suggestions, opinions and/or advice provided by the author of this post should not be regarded as medical advice; nor should it substitute for professional medical care. Consult your doctor before making any changes to your medication. Please read our Community Policy Documents board for further information.