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HELP! Ativan Liquid Titration


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Hi!

 

I am currently at 0.5mg of Ativan at bed time. Since April 4th, I've tapered from 2mg. I have very minimal sxs right now. A little jitters, but exercise takes care of most of that. I'm sleeping like a baby - - - better than I was when taking the original dose.

 

I want to do a daily titration but I am so confused! If I take my 0.5mg and put it liquid, how much water? I'm planning on using a mortar and pestle to crush first.

 

I want to go down 0.01 per day. How much liquid do I remove? How much liquid do I add to 0.5mg?

 

I've watched so many videos and I still don't think I understand how to calculate my precise dosage. I feel like it should be easy but my brain is not catching up.

 

ETA: Alcohol is not an option to mix. Milk is okay, so is water.

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Hi!

 

I am currently at 0.5mg of Ativan at bed time. Since April 4th, I've tapered from 2mg. I have very minimal sxs right now. A little jitters, but exercise takes care of most of that. I'm sleeping like a baby - - - better than I was when taking the original dose.

 

I want to do a daily titration but I am so confused! If I take my 0.5mg and put it liquid, how much water? I'm planning on using a mortar and pestle to crush first.

 

I want to go down 0.01 per day. How much liquid do I remove? How much liquid do I add to 0.5mg?

 

I've watched so many videos and I still don't think I understand how to calculate my precise dosage. I feel like it should be easy but my brain is not catching up.

 

ETA: Alcohol is not an option to mix. Milk is okay, so is water.

 

1)  Just FYI, there is an Rx liquid ativan.  If you doc will write a scrip, that's the best choice.

 

2)  Water is NOT an option.  Ativan is NOT water-soluble.

 

3)  And unlike other benzos, ativan is NOT lipid (fat) soluble, so milk is not an option.

 

4)  I know you say "no alcohol), but do you realize we would be talking about a(one-time) max amount of only 1ml of vodka (.4ml actual alcohol)?

 

5) And ativan IS readily soluble in propylene glycol.

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I've been sober for 5 years. I have worked too hard to get where I am. I am already feeling tricked into taking this medication by my doctors, without breaking my sobriety.

 

Is water titration not possible for Ativan? If so, I will stick to the dry weighing method and shave it.

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Is propopropylene glycol ANTIFREEZE?

 

No.

 

But its in your toothpaste, cake mixes, prepared frosting, salad dressings, skin cream, moisturizer, and dozens of products you probably use every day.

 

Oh, it's also the most commonly used pharma solvent in the world (including the Rx Ativan)

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Is water titration not possible for Ativan? If so, I will stick to the dry weighing method and shave it.

 

No, water titration fir Ativan is NOT possible.

 

So if dry curtting works, then go for it.

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Thank you for your response! I am very overwhelmed with trying to figure out the best way forward and I am so terrified of this process.

 

 

 

Is propylene glycol something that you purchase and mix? I'm not prepared to go to my doctor at this point for the liquid. Not until this prescription is out.

 

ETA : I just looked on Amazon and saw that it is available there. Phew!

 

Okay! How do I use propylene glycol instead of alcohol?

 

 

Thank you!

 

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PG is readily available from Amazon, and also at many major pharmacies.

 

You use it the same way you would vodka...1mg benzo :2ml solvent : 8ml water.  Make approx a 10 day batch, and just lower your dose each day.

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Thank you,Builder! This is extraordinarily helpful.

 

Question: how do I create a titration schedule? I am currently at 0.5 mg daily at bedtime. I want to go down 0.01 daily. How much do I draw out? I don't think I understand and the YouTube videos in the sticky threads are dead.

 

Can you point me in the right direction?

 

Thank you again for your assistance!

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Thank you,Builder! This is extraordinarily helpful.

 

Question: how do I create a titration schedule? I am currently at 0.5 mg daily at bedtime. I want to go down 0.01 daily. How much do I draw out? I don't think I understand and the YouTube videos in the sticky threads are dead.

 

Can you point me in the right direction?

 

Thank you again for your assistance!

 

A "titration schedule" is the same as any taper schedule, youi choose a cut amount and a time frame, you know, like .01mg per day.  ;)

 

Ignore the youtube videos.  Most are filled with false or misleading info, and they all make this appear much more complicated than it is.

 

Combine 5mg ativan + 10ml PG + 40ml water.  This gives you 50ml liquid, .1mg per ml, approx a 10-12 supply.

 

You've really already created your taper schedule (.01mg/day), so here are the amounts day-by-day:

 

5ml                  (.5mg)

4.9ml                (.49mg)

4.8ml                (.48mg)

4.7mg              (.47mg)

etc........

 

You just lower your dose by .1ml (.01mg) each day.

 

These are the amounts you draw from your supply and drink!  You don't throw anything away, you just take the scheduled dose.  (See, I told you those videos are silly!)

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I searched three different pharmacies and spoke with three pharmacists. No propylene glycol, but one pharmacist recommended using 2ml of Kato corn syrup. He said it would dissolve the pills and could be used.

 

Have you ever heard of this? I'm ready go and going to try the corn syrup. Just curious of your thoughts. I'm still a bit nervous. I got the appropriate measurements for syringes. I just want to do this right and get off of these crazy meds.

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Hi happyrunner,

 

The corn syrup was probably suggested because of it's high viscosity, so it would make a suspension instead of a solution.  Actually, I would think it would be too viscous and be difficult to dose with a syringe.  If that were the case, you could always dilute it with distilled water.  Unlike solutions, suspensions cannot guarantee uniform distribution of your benzo.  However, suspensions have been successfully used to taper and are commonly used pharmaceutical vehicles.  More suitable than corn syrup, would be glycerol or Ora-Plus.

 

If you'd like to make an alcohol free solution, here's a link to food grade propylene glycol:  https://www.amazon.com/Propylene-Glycol-Food-Grade-Quart/dp/B005PZBRUC

 

xo,

sierra  :smitten:

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I searched three different pharmacies and spoke with three pharmacists. No propylene glycol, but one pharmacist recommended using 2ml of Kato corn syrup. He said it would dissolve the pills and could be used.

 

Have you ever heard of this? I'm ready go and going to try the corn syrup. Just curious of your thoughts. I'm still a bit nervous. I got the appropriate measurements for syringes. I just want to do this right and get off of these crazy meds.

 

The syrup will NOT dissolve the ativan.  It could be used to make a suspension.  But there are better choices, like OraPlus.

PG is readily available on Amazon.

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Hi!

 

I am currently at 0.5mg of Ativan at bed time. Since April 4th, I've tapered from 2mg. I have very minimal sxs right now. A little jitters, but exercise takes care of most of that. I'm sleeping like a baby - - - better than I was when taking the original dose.

 

I want to do a daily titration but I am so confused! If I take my 0.5mg and put it liquid, how much water? I'm planning on using a mortar and pestle to crush first.

 

I want to go down 0.01 per day. How much liquid do I remove? How much liquid do I add to 0.5mg?

 

I've watched so many videos and I still don't think I understand how to calculate my precise dosage. I feel like it should be easy but my brain is not catching up.

 

ETA: Alcohol is not an option to mix. Milk is okay, so is water.

 

In my opinion and according to my own experience, 1 mg lorazepam is soluble in 100 ml water at room temperature, provided you wait long enough to let it dissolve and shake thoroughly and long enough.

 

I am doing a pure water titration with 1 mg lorazepam myself and had no problems at all with the transition from dry cutting to liquid titration.

 

For more information about the water solubility of lorazepam see this post:

 

http://www.benzobuddies.org/forum/index.php?topic=217524.msg2806791#msg2806791

 

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Just FYI all.  I say over and over, the best taper is the one that works for you.  And that seems to work for John.

 

But as I pointed out on that thread..." 1) Those data points contradict every other published solubility ratio anywhere."

 

Every other medicaL, pharma, academic, etc research says ativan (and most common benzos) is insoluble, or poorly soluble in water.

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Hi happyrunner!

 

Both builder and Sierra have helped me tremendously with my DLMT off Valium. Since you are working with Ativan and it may require more precision given it’s shorter half life, I would PM Sierra and ask her for specific advice on a DLMT off Ativan. She has a wealth of knowledge beyond her own Ativan taper process and could easily help you make sense of yours.

 

Sorry to volunteer you Sierra but you are way too modest.  :)

 

Annie

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With the goal of sharing a variety of different scientifically sound formulating methodologies for creating a benzo solution - of which there are many - here's one I modeled my own on for the second half of my taper:

 

Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug

https://www.sciencedirect.com/science/article/pii/S0928098717300490

 

And, glad I could help you, Annie!  :)

 

sierra  :smitten:

 

 

 

 

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With the goal of sharing a variety of different scientifically sound formulating methodologies for creating a benzo solution - of which there are many - here's one I modeled my own on for the second half of my taper:

 

Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug

https://www.sciencedirect.com/science/article/pii/S0928098717300490

 

And, glad I could help you, Annie!  :)

 

sierra  :smitten:

 

In my post:

 

http://www.benzobuddies.org/forum/index.php?topic=217524.msg2806791#msg2806791

 

I said that Jim Hawk gave a source which gives the water solubility of lorazepam, being 80 mg/liter. It is the article you point to which says:

 

In the case of lorazepam (aqueous solubility 0.08 mg/ml) (O'Neil, 2006), with pKas of 1.3 and 11.5 (Clarke's Analysis of Drugs and Poisons [internet], 2016), pH adjustment is not a feasible method to increase the solubility

 

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With the goal of sharing a variety of different scientifically sound formulating methodologies for creating a benzo solution - of which there are many - here's one I modeled my own on for the second half of my taper:

 

Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug

https://www.sciencedirect.com/science/article/pii/S0928098717300490

 

And, glad I could help you, Annie!  :)

 

sierra  :smitten:

 

In my post:

 

http://www.benzobuddies.org/forum/index.php?topic=217524.msg2806791#msg2806791

 

I said that Jim Hawk gave a source which gives the water solubility of lorazepam, being 80 mg/liter. It is the article you point to which says:

 

In the case of lorazepam (aqueous solubility 0.08 mg/ml) (O'Neil, 2006), with pKas of 1.3 and 11.5 (Clarke's Analysis of Drugs and Poisons [internet], 2016), pH adjustment is not a feasible method to increase the solubility

 

Yes.

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Out of curiosity, I went searching to see if I could find another corroborating source validating benzo solubility in water.  Here's an old quote from fellow BB member SG57 referencing Jouyban, showing benzo water solubility data in the first table row:

 

Just posting this data from Jouyban in table form for reference.

 

The following table shows the solubility of the various benzos in ethanol/water mixtures from 0% (i.e., plain water) to 100% ethanol.  Key: V=Valium; A=Ativan; Lib=Librium; K=Klonopin; X=Xanax.

 

Units = mg/ml

% Alc.  V          A        Lib      K          X

0        0.04    0.05    0.11    0.03    0.04

10      0.11    0.11    0.19    0.04

20      0.21    0.23    0.29    0.08

30      0.57    0.77    0.80    0.20

40      1.90    3.51    2.89    0.60

50      4.76    4.19    7.48    1.43

60    11.17    8.04    12.48    2.64

70    21.31  13.09    22.89    4.22

80    28.67  17.33    31.81    5.65

90    38.36    6.64    31.72    6.18

100  26.07  10.89    19.46    5.11

 

Sources:

Abolghasem Jouyban *#, Javad Shokri †, Mohammad Barzegar-Jalali †, Davoud Hassanzadeh ‡, William E. Acree , Jr.§, Taravat Ghafourian Δ and Ali Nokhodchi Δ, Solubility of Chlordiazepoxide, Diazepam, and Lorazepam in Ethanol + Water Mixtures at 303.2 K, J. Chem. Eng. Data, 2009, 54 (7), pp 2142–2145, April 22, 2009.

 

Ali Shayanfar †, Mohammad A. A. Fakhree §, William E. Acree , Jr.∥ and Abolghasem Jouyban *‡, Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K, J. Chem. Eng. Data, 2009, 54 (3), pp 1107–1109, December 22, 2008

 

  http://www.benzobuddies.org/forum/index.php?topic=97737.40 (scroll down to reply #46)

 

However, the biggest concerns, formulating only with water are 1) propagation of microbial activity, given a lack of any preservative, particularly if left at room temperature for weeks and using tap water with oral syringes dipping into the solution multiple times.  2) drug destabilization due to hydrolysis, which would make the benzo lose it's potency over time. 

 

Only lab testing would prove out details as to how long these issue would take to arise, how much of a problem they would create, etc. 

 

sierra  :smitten:

 

 

 

 

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Out of curiosity, I went searching to see if I could find another corroborating source validating benzo solubility in water.  Here's an old quote from fellow BB member SG57 referencing Jouyban, showing benzo water solubility data in the first table row:

 

Just posting this data from Jouyban in table form for reference.

 

The following table shows the solubility of the various benzos in ethanol/water mixtures from 0% (i.e., plain water) to 100% ethanol.  Key: V=Valium; A=Ativan; Lib=Librium; K=Klonopin; X=Xanax.

 

Units = mg/ml

% Alc.  V          A        Lib      K          X

0        0.04    0.05    0.11    0.03    0.04

10      0.11    0.11    0.19    0.04

20      0.21    0.23    0.29    0.08

30      0.57    0.77    0.80    0.20

40      1.90    3.51    2.89    0.60

50      4.76    4.19    7.48    1.43

60    11.17    8.04    12.48    2.64

70    21.31  13.09    22.89    4.22

80    28.67  17.33    31.81    5.65

90    38.36    6.64    31.72    6.18

100  26.07  10.89    19.46    5.11

 

Sources:

Abolghasem Jouyban *#, Javad Shokri †, Mohammad Barzegar-Jalali †, Davoud Hassanzadeh ‡, William E. Acree , Jr.§, Taravat Ghafourian Δ and Ali Nokhodchi Δ, Solubility of Chlordiazepoxide, Diazepam, and Lorazepam in Ethanol + Water Mixtures at 303.2 K, J. Chem. Eng. Data, 2009, 54 (7), pp 2142–2145, April 22, 2009.

 

Ali Shayanfar †, Mohammad A. A. Fakhree §, William E. Acree , Jr.∥ and Abolghasem Jouyban *‡, Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K, J. Chem. Eng. Data, 2009, 54 (3), pp 1107–1109, December 22, 2008

 

  http://www.benzobuddies.org/forum/index.php?topic=97737.40 (scroll down to reply #46)

 

However, the biggest concerns, formulating only with water are 1) propagation of microbial activity, given a lack of any preservative, particularly if left at room temperature for weeks and using tap water with oral syringes dipping into the solution multiple times.  2) drug destabilization due to hydrolysis, which would make the benzo lose it's potency over time. 

 

Only lab testing would prove out details as to how long these issue would take to arise, how much of a problem they would create, etc. 

 

sierra  :smitten:

 

 

Ativan

 

.05mg/ml

 

Which still contradicts the .08/ml John posted.  And I would contend that .05mg/ml or even .08mg/ml, clearly falls into the category of "poorly soluble in water"

 

Everyone needs to choose a procedure they are comfortable, but I will continue to advocate for any procedure that offers the greatest margin of safety, and the greatest liklihood of success.

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Since the variability of these 2 independent tests is within just .03mg of each other - especially for our purposes - this data confirms benzos are indeed water soluble, albeit poorly so. 

 

One simply needs more water than if they were using ethanol or propylene glycol as a solvent.  It's just a different path to arriving at the same place.  ;)

 

sierra  :smitten:

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[6b...]

Since the variability of these 2 independent tests is within just .03mg of each other - especially for our purposes - this data confirms benzos are indeed water soluble, albeit poorly so. 

 

One simply needs more water than if they were using ethanol or propylene glycol as a solvent.  It's just a different path to arriving at the same place.  ;)

 

sierra  :smitten:

 

Good stuff, Sierra! I’m soooooo glad I’m nearly done with my DLMT. This forces us to be chemists and I don’t WANT TO BE ONE ANY MORE! 😂

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Since the variability of these 2 independent tests is within just .03mg of each other - especially for our purposes - this data confirms benzos are indeed water soluble, albeit poorly so. 

 

One simply needs more water than if they were using ethanol or propylene glycol as a solvent.  It's just a different path to arriving at the same place.  ;)

 

sierra  :smitten:

 

...which is a 60% variation!

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