Oraplus for lorazepam taper

I’m going to liquid taper.  Is it ok to put the benzo in like 5ml of water first?  I know it doesn’t totally dissolve but it does breakdown into a fine solution.  Oraplus is a suspending agent so I think this will be ok.  I was going to use 50% oraplus - 5% water - and 45% orasweet in the liquid formulation. 

Instructions can be found here:  https://images-na.ssl-images-amazon.com/images/I/91g6td1q7oS.pdf    I'd use the "General Directions for Compounding ORA-Sweet*/ORA-Plus Suspensions."

 

There have been some studies on the stability of various drugs in Ora-'Stuff'.  Many benzos are stable for 30+ days, but Ativan isn't listed as one of them.  You should probably just make a day or two worth of suspension at a time to be safe.  I know of another member who is using Ora-Plus/Sweet for Ativan, and is making a two-day supply.  It seems to be working fine for her. 

 

We can do the spreadsheet via PM, but let's wait a bit and get you stable on the liquid formulation if that's the way you want to do the taper.

I was thinking about the stability of the suspension too earlier.  I found this article:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469120/

 

I wonder how you can tell if the info is reputable?

Yes, the paper (full citation below) is a credible source.  The authors of the paper are pharmacists at the University of Utah College of Pharmacy, Primary Children’s Medical Center and Children’s Hospital of Philadelphia.  The Journal of Pediatric Pharmacology and Therapeutics is a peer-reviewed journal focusing on the safe and effective use of medications in infants and children.

 

This is an interesting and informative paper for multiple reasons.  First, the authors developed a procedure for preparing the suspension that minimizes drug loss due to surface transfer.  Second, the authors found that generics from different manufacturers required different amounts of water (and hence different amounts of OraPlus/Sweet) to disintegrate (not dissolve) the regular lorazepam tablets used as the drug source.  Third, the authors conducted stability studies.

 

The authors reported that “Both lorazepam suspensions were stable for 63 days when stored at 4°C or 22°C, and both were stable for 91 days when refrigerated at 4°C.”  My understanding is that lorazepam is subject to degradation due to hydrolysis, light, and temperature. This suggests that individuals who choose to make more than one-day’s supply of homebrew lorazepam liquid may want to consider storing it in the refrigerator.

 

 

Citation:

 

Wan-Man Ellaria Lee, Ralph A. Lugo, William J. Rusho, Mark MacKay, and John Sweeley. (2004). Chemical Stability of Extemporaneously Prepared Lorazepam Suspension at Two Temperatures. The Journal of Pediatric Pharmacology and Therapeutics: October 2004, Vol. 9, No. 4, pp. 254-258. Accessed online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469120/pdf/i1551-6776-9-4-254.pdf