Looking for clearer skies

hi. sorry for the delay in introduction.  I am a 76 year old male who has been on clorazepate 3.75mg three times a day for about 15 years.  With my advancing years I find it important to significantly reduce my dose due to risk of falling, etc. My doctor is clueless about the need to taper.  I am interested in making a suspension using OraPlus for ease of titration.  anyone have experience with this or any simple method of tritating?

clear sky.

Hello clearsky,

Welcome to BenzoBuddies! Congratulations on your decision to taper off clorazepate.  Yes, doctors are getting pressure not to prescribe benzos and Z-drugs in their older population due to risk of falls and such.  We're so glad you found the forum - you'll find lots of good information, support and encouragement here from others who understand what it's like to go through this process.

It sounds like you're interested in information about taper plans and you will find information and support for that here.  A good place to start is the board on Planning Your Withdrawal. You will learn a lot and when you're ready, you can post questions about your own taper plan:

Planning Your Withdrawal (Taper Plans)

As you consider what plan would work best, you might want to read the Ashton Manual, an excellent resource about benzodiazepine tapering and withdrawal by Dr. Heather Ashton.  Dr. Ashton is an expert in the field - she suggests reducing your dose by no more than 5% or 10% every 1-2 weeks.  Some people find it works better for them to taper even more slowly.

Here is the link for the manual:

The Ashton Manual

Again, we're glad you found us.  Please let us know how we can help you.

Again, welcome,

Kate

Hello, clearsky.

Yes, we have members who have used OraPlus to make a suspension.

Do you have access to a trusted pharmacist?  If so, you might want to ask if it would be safe to disperse your tablets in water for the purpose of titrating your dose. According to DailyMed, clorazepate dipotassium is “... insoluble in the common organic solvents, but very soluble in water. Aqueous solutions are unstable, clear, light yellow, and alkaline.” (If I were in your shoes, I’d want to know what “unstable” means — perhaps only that you would have to make and use the liquid right way; no storage.)

Thanks Kate for the information on the Ashton Manual. It’s a valuable reference source. Her sample tapering schedules involve diazepam and at this point my doctor would be reluctant to switch from clorazepate.

Also, thanks to Libertas for the information on solubility and stability of clorazepate.  I was hoping to avoid making a fresh dose each time.  Unfortunately I live in a small town and do not have access to a good compounding pharmacist.

Thanks for your support.  I’ve started my first reduction (about 8% - 1/4 of tablet). This will give me a clearer idea what to expect in symptoms and how long they last.

clearsky

Hello again, clearsky.

If the 1988/89 patent application from Abbott Labs linked below is correct, formulating a liquid form of clorazepate is challenging because of its aqueous stability problems:

“Vehicles for clorazepate dipotassium are unavailable in liquid form primarily because the drug has significant aqueous stability problems. In the presence of even minute quantities of moisture greater than about 0.3% w/v (i.e. 0.3g/100ml) clorazepate dipotassium rapidly hydrolyzes to nordiazepam. This occurs even more rapidly in an acid environment.”  (As you probably know, OraPlus —  the suspending vehicle you inquired about — contains water.)

“The present invention relates to a liquid suspension for delivering a drug [clorazepate dipotassium]. The suspension is anhydrous, being substantially free of water, and contains oil and suspending agent.”

Just a thought ... you might be able to find a compounding pharmacist who would be willing to consult via phone about liquid formulations.  See link below.  Pharmacists at children’s hospitals also often have experience with compounding liquid medications.

Please know we have many members who dry taper their benzodiazepine. They use a variety of techniques including pill-splitting, pill-shaving/weighing, and powder weighing.

I hope all goes well with your initial reduction.

Links:

Anhydrous oil-based liquid suspension for delivering a medicament.

https://www.freepatentsonline.com/EP0310801.html

Find A Compounder - Professional Compounding Centers of America

https://www.pccarx.com/Resources/FindACompounder

Edit: Added note that OraPlus contains water

Thanks Libertas for the valuable info.  I was looking for an easy way to do the daily dosing.  I might have to bite the bullet and see if I can convince my doctor to switch to diazepam  solution.  Then there is the problem of deciding what is an equivalent amount.

Thanks for your support.

Clearsky

You are most welcome, clearsky.

I just learned about a product you might be able to use to make a homebrew suspension.  It’s an anhydrous oral suspension vehicle designed to be used with lipophilic, water-unstable drug molecules (e.g. Tranxene/clorazepate dipotassium, Librium/chlordiazepoxide HCL).

SuspendRx™ Anhydrous Oral Suspension Base w/Bitter-Bloc Technology:

- pharmaceutical grade

- stability tested

- natural plant-based ingredients

- oxidation resistant

- allergen, dye, gluten, and antioxidant BHT free

- sweetened or unsweetened

For more information:

Suspension Vehicles | SpecializedRx

https://specializedrx.com/collections/suspension-vehicles