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Need help with 5% taper


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I am currently on 0.17 of Ativan and have been reducing 5% every 5 days or so with no problem.  I have liquid Ativan 2 mg/ml and have been drawing up my dose, mixing it with 100 mls of water, and drinking 50 ml/day. My next dose will be 0.1615 which I'd round to 0.162. Up until this point, I've been on doses that are easy to draw up in my 0.5 ml syringe, but 0.162 is impossible to draw up. I'm thinking I'll have to draw up a different dose, mix it with water, and only drink part of it, but I'm having trouble figuring out the math. Can anyone help me???

 

Thank you!

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If you mix 0.2 ml of your 2mg/ml solution with 100 ml water, you can drink 40.4 ml per day and get a 0.1615 dose per day.  You'll have a little left over which you can add to the next batch when you make it.  Or you can (responsibly) discard it.

 

Further 5% cuts can be done by simply multiplying your most recent dose (40.4 ml) times 0.95.  So you drink a little less solution with each cut.  You'd always mix 0.2 ml of the 2mg/ml solution with 100 ml water.

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You might want to ask a knowledgeable pharmacist about the advisability of saving any remaining drug/water mixture for later use.  I suggest this based on the following:

 

(1)  The administration instructions for the 2mg/mL prescription lorazepam oral concentrate state that it can be “mixed with liquid or semi-solid food such as water, juices, soda or soda-like beverages, applesauce and puddings.”  However, the instructions also state that the “entire amount of the mixture, of drug and liquid or drug and food, should be consumed immediately. Do not store for future use.”

 

(2) According to a paper authored by a team of pharmacists in The Netherlands (citation below), lorazepam is “sensitive to hydrolysis in both acidic and basic environments and shows temperature-dependent degradation.”

 

 

Citation:

Vossen, A.C. & Velde, I. & Smeets, O.S.N.M. & Postma, D.J. & Eckhardt, M. & Vermes, A. & Koch, Birgit & Vulto, Arnold & Hanff, L.M.. (2017). Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug. European Journal of Pharmaceutical Sciences, pp. 205-210. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0928098717300490

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Thank you, badsocref! That makes complete sense and is easy to follow.

 

Libertas, I discussed the storage of liquid ativan after mixing it with water when I first started this process because I was worried about the same thing. She said it was fine to do and advised I only make enough for the day I'm taking and for the next day. So far, I have not noticed that the 2nd day mixture is any different; I've had no adverse or withdrawal effects to support that it's degraded. I appreciate your concern, as it was mine as well.

 

So far, so good. The 5% cuts every 5 days are much easier on me than the 10% cuts every 8-10 days, and I'm hoping I can keep this up through the end of the taper. Fingers crossed :) The guidance and support on this forum has been really helpful  :smitten:

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