Titration of progesterone capsules - ideas please?

I am on 19mgs valium which I am currently tapering with the help of my psychiatrist, which I much appreciate.

That's not the problem.

I have heard on these boards, from many women that they have had trouble tapering progesterone at much smaller amounts than I am on.

Perseverance, a very knowledgeable member posted lots of scientific evidence and many women responded.

Here are her threads warning against taking progesterone and bentos

http://www.benzobuddies.org/forum/index.php?topic=47259.0

http://www.benzobuddies.org/forum/index.php?topic=44150.msg741425#msg741425

I am in the UK and cream is illegal here.

I am on capsules

Suggestions were made by taking a Little bit of the liquid inside out with a syringe but that is unreliable.

I want to taper off these capsules, but cannot find a way.

http://www.galaxypharma.com/og_utrogestan.php I get mine prescribed on the NHS

I wonder if anyone can give me any ideas to titrate off these safely to avoid problems mentioned in the above two threads.

Thanks

Hi journey,

From what I read in the links you shared, it sounds like progesterone needs to be tapered similar to a benzo. Because you are already on diazepam and tapering it, I suggest holding your current dose of progesterone and waiting until you finish your diazepam taper to begin taking progesterone reductions. This is just the classic advice to taper one medication at a time, and often to prioritize the benzodiazepine. Since progesterone is perhaps similar in ways to a benzo, this could make the decision more about which "benzo" to taper first, diazepam or progesterone, and I really can't answer that. But since you're already making progress with diazepam, I suggest sticking with this until it's eliminated.

Regarding tapering the progesterone, it sounds like you have the softgel capsules. Here's an example of the kinds of excipients (not including the gelatin used to make the capsule) that could be in your capsule:

GLYCERIN, HYPROMELLOSE, FERROSOFERRIC OXIDE, LECITHIN (SOYBEAN), PEANUT OIL, PROPYLENE GLYCOL, TITANIUM DIOXIDE.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7d73f08d-2de7-44b6-9e44-2d488fe02517

It appears that peanut oil is a common carrier in capsules, and this implies to me that progesterone is fat soluble, although proplyene glycol is a solvent that I've heard works similarly to alcohol, glycerin does some suspending and perhaps some solvent action, and lecithin is an emulsifier to combine the oil and non-oil ingredients, so there's probably a lot more going on in this capsule than just an oil-based solution.

Progesterone occurs as a white or creamy white, crystalline powder or colourless crystals. It is soluble in alcohol, in acetone, and in dioxane; sparingly soluble in vegetable oils; practically insoluble in water.

https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=7d19df3b-94ed-4681-beae-9caaf137d014

My first thought is purge the capsule of it's contents, and combine this liquid with a fat. I like using organic MCT oil from coconuts for being very easy to digest, clear, and a liquid at both room and fridge temperatures.

Purging the capsules will probably involve an incision of some sort and then a squeezing technique. I would expect some amount of medicine to remain in the capsule despite best efforts, so I would consider just transitioning to purged capsule contents a reduction and holding at this dose for some time until adjusted.

I would maybe make things simple by purging the capsules into a spoon and then swallowing this liquid for the first stage of my taper.

Once adjusted to the full dose of purged capsule capsule contents, I would consider diluting the capsule contents into graduated cylinder, and then diluting with MCT oil to a desired volume for easier measuring.

I have no idea how quickly people taper progesterone, how big a reduction they try to start, or how long they hold between reductions. These are the sort of details that would help me determine just how much to dilute my capsules for easy daily dosing. Good MCT oil can be a little expensive, so I would be inclined to make a more concentrated formula and dose it with a 1ml syringe with 100 gradations.

For example, if my daily progesterone dose was 200mg, after adjusting to the purged capsule contents in full, I might want to dispense 10x 200mg purged capsules into a 10ml graduated cylinder, and then dilute this with MCT oil to 10ml total volume. I would then have roughly a 200mg/ml solution/suspension of progesterone. I would stir this mixture and transfer it to medicine bottle, ideally with a push-in syringe adapter, and store it in the fridge. To dose I would shake or stir this before immediately drawing my dose from the middle of liquid. I would take 1ml for 200mg, I would take 0.99ml for 198mg, 0.98ml for 196mg, etc.

If I got lower in dose and/or needed finer reductions, I would change this dilution to be 5x 200mg purged capsules for 10ml total volume of oil creating roughly a 100mg/ml solution/suspension of progesterone. In this case 1ml would be 100mg, 0.99ml would be 99mg, and so on.

This is just a quick sketch of what I could learn about progesterone in 30 minutes and how I would attempt a reduction of these liquid-filled capsules. Let me know if you have questions or more information that might change the approach needed. Again, unless someone with experience says otherwise, I don't suggest trying to taper this concurrent with your benzo taper. 

Hi journey,

From what I read in the links you shared, it sounds like progesterone needs to be tapered similar to a benzo. Because you are already on diazepam and tapering it, I suggest holding your current dose of progesterone and waiting until you finish your diazepam taper to begin taking progesterone reductions. This is just the classic advice to taper one medication at a time, and often to prioritize the benzodiazepine. Since progesterone is perhaps similar in ways to a benzo, this could make the decision more about which "benzo" to taper first, diazepam or progesterone, and I really can't answer that. But since you're already making progress with diazepam, I suggest sticking with this until it's eliminated.

 

Regarding tapering the progesterone, it sounds like you have the softgel capsules. Here's an example of the kinds of excipients (not including the gelatin used to make the capsule) that could be in your capsule:

GLYCERIN, HYPROMELLOSE, FERROSOFERRIC OXIDE, LECITHIN (SOYBEAN), PEANUT OIL, PROPYLENE GLYCOL, TITANIUM DIOXIDE.

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7d73f08d-2de7-44b6-9e44-2d488fe02517

 

It appears that peanut oil is a common carrier in capsules, and this implies to me that progesterone is fat soluble, although proplyene glycol is a solvent that I've heard works similarly to alcohol, glycerin does some suspending and perhaps some solvent action, and lecithin is an emulsifier to combine the oil and non-oil ingredients, so there's probably a lot more going on in this capsule than just an oil-based solution.

 

Progesterone occurs as a white or creamy white, crystalline powder or colourless crystals. It is soluble in alcohol, in acetone, and in dioxane; sparingly soluble in vegetable oils; practically insoluble in water.

https://dailymed.nlm.nih.gov/dailymed/getFile.cfm?setid=7d19df3b-94ed-4681-beae-9caaf137d014

 

My first thought is purge the capsule of it's contents, and combine this liquid with a fat. I like using organic MCT oil from coconuts for being very easy to digest, clear, and a liquid at both room and fridge temperatures.

 

Purging the capsules will probably involve an incision of some sort and then a squeezing technique. I would expect some amount of medicine to remain in the capsule despite best efforts, so I would consider just transitioning to purged capsule contents a reduction and holding at this dose for some time until adjusted.

 

I would maybe make things simple by purging the capsules into a spoon and then swallowing this liquid for the first stage of my taper.

 

Once adjusted to the full dose of purged capsule capsule contents, I would consider diluting the capsule contents into graduated cylinder, and then diluting with MCT oil to a desired volume for easier measuring.

 

I have no idea how quickly people taper progesterone, how big a reduction they try to start, or how long they hold between reductions. These are the sort of details that would help me determine just how much to dilute my capsules for easy daily dosing. Good MCT oil can be a little expensive, so I would be inclined to make a more concentrated formula and dose it with a 1ml syringe with 100 gradations.

 

For example, if my daily progesterone dose was 200mg, after adjusting to the purged capsule contents in full, I might want to dispense 10x 200mg purged capsules into a 10ml graduated cylinder, and then dilute this with MCT oil to 10ml total volume. I would then have roughly a 200mg/ml solution/suspension of progesterone. I would stir this mixture and transfer it to medicine bottle, ideally with a push-in syringe adapter, and store it in the fridge. To dose I would shake or stir this before immediately drawing my dose from the middle of liquid. I would take 1ml for 200mg, I would take 0.99ml for 198mg, 0.98ml for 196mg, etc.

 

If I got lower in dose and/or needed finer reductions, I would change this dilution to be 5x 200mg purged capsules for 10ml total volume of oil creating roughly a 100mg/ml solution/suspension of progesterone. In this case 1ml would be 100mg, 0.99ml would be 99mg, and so on.

 

This is just a quick sketch of what I could learn about progesterone in 30 minutes and how I would attempt a reduction of these liquid-filled capsules. Let me know if you have questions or more information that might change the approach needed. Again, unless someone with experience says otherwise, I don't suggest trying to taper this concurrent with your benzo taper. 

Hi slownsteady

I really appreciate the work you have done to try to figure out a way to reduce these capsules.

I wonder what would happen if I just stopped taking them, would I really go into such a catastrophic situation, the capsules seem filled with so many ingredients.

Gelatin is water soluble but only at temperatures 35–40 °C - how would I get water as hot as that?

Also, it begs the question, would water as hot as that render the other progesterone useless?

I want to finish my diazepam taper before tapering the progesterone, but it has been weighing on my mind a lot, and it would really help me to figure out a safe say, because now I know a safe way to titrate diazepam I feel more at peace around tapering diazepam.

I'm guessing the progesterone is in the peanut oil, or is that just an exigent?

I read this "Progesterone is soluble in organic solvents such as acetonitrile, ethanol, and methanol, which should be purged with an inert gas." which is worrying, methanol can turn you blind.

acetonitrile is a toxic substance.

Yeah the capsule is complex.

I thought about purging the capsule of its contents, but I think that would be quite hard.

I wonder if I should go on a pill form of progestin and do a daily titration, it might be soluble, however I tapered Seroquel that way, that is not water soluble.

Also, I could use a jewellers scale to grind the pill if I chose instead of water.

While I appreciate your post, I worry how much goo would be left in the capsule, in other words, it might represent a huge cut which could make me ill, especially when cutting the second capsule, as my dose will be lower then.

Thanks for the cocounut suggestion, I hear that monkeys are used to get coconuts from trees, I wonder if there would be another oil, could I buy peanut oil?

Still there is the remaining medicine in the capsule, how to get that out?

Storing it would be a guessing game, olive oil can be stored in the cupboard.

Thanks for spending the 30 minutes on helping me.

I'm happy to help.

The gelatin is just used to form the shell of the capsule; if you cut it open and purge the capsule contents then you don't have to worry about melting the capsule.

If you're taking two capsules per day, I would try adjusting to purging one, then adjusting to purging the other before beginning any reductions; that's how I'd do it to keep these two unknown reductions at the start of the taper. As a child I remember purging soft-gel vitamin E capsules to put the oil directly on wounds; I remember it being rather easy to do with a sharp knife and they were see-through and we would just keep squeezing the last bit out. Either way, this is all in theory; maybe purging your softgel capsules is impossible or terribly inaccurate; I don't know, but if it's all I had I'd try it. Maybe try an experiment on one if you have any extra. Capsule dissection!

Yes tons of other oils will probably work. Peanut oil, olive oil, etc. My idea was to suspend the medicine; I wouldn't trust it to truly dissolve in the oil, since I don't have any data to know this would work and the capsules have a few little pharmacology tricks in them that I don't suggest trying to replicate.

If there is a dry tablet form of progesterone, yes, that could be a lot easier to taper. If you got a dry capsule or tablet I think you could still suspend it in oil, making a liquid form that's easy to measure and dose. Or you could dry taper it with a scale, if you're more comfortable with that approach. I wasn't able to find a dry form of progesterone on https://dailymed.nlm.nih.gov/dailymed/ but I'm also pretty terrible at searching that site. Everything I saw was in an oil-base.

Let us know what you find. Maybe someone else has ideas?

I'm happy to help.

 

The gelatin is just used to form the shell of the capsule; if you cut it open and purge the capsule contents then you don't have to worry about melting the capsule.

 

If you're taking two capsules per day, I would try adjusting to purging one, then adjusting to purging the other before beginning any reductions; that's how I'd do it to keep these two unknown reductions at the start of the taper. As a child I remember purging soft-gel vitamin E capsules to put the oil directly on wounds; I remember it being rather easy to do with a sharp knife and they were see-through and we would just keep squeezing the last bit out. Either way, this is all in theory; maybe purging your softgel capsules is impossible or terribly inaccurate; I don't know, but if it's all I had I'd try it. Maybe try an experiment on one if you have any extra. Capsule dissection!

 

Yes tons of other oils will probably work. Peanut oil, olive oil, etc. My idea was to suspend the medicine; I wouldn't trust it to truly dissolve in the oil, since I don't have any data to know this would work and the capsules have a few little pharmacology tricks in them that I don't suggest trying to replicate.

 

If there is a dry tablet form of progesterone, yes, that could be a lot easier to taper. If you got a dry capsule or tablet I think you could still suspend it in oil, making a liquid form that's easy to measure and dose. Or you could dry taper it with a scale, if you're more comfortable with that approach. I wasn't able to find a dry form of progesterone on https://dailymed.nlm.nih.gov/dailymed/ but I'm also pretty terrible at searching that site. Everything I saw was in an oil-base.

 

Let us know what you find. Maybe someone else has ideas?

Hi

Thanks for taking the time to send me another reply.

I'm not too comfy with purging the capsules as a lot of the stuff may be inside of them.

Maybe I could cut them into bits, a bit messy though, I would want to take a tiny bit out each day.

Then there is disposal of them as they could pollute the environment.

I don't think you can cut a softgel capsule into usable bits; they're full of a liquid. I suggest doing a little exploration with a sharp knife and one of your capsules. The shell is going to be gelatin and probably a colorant like titanium dioxide; nothing terribly toxic about that from my perspective. If you're concerned about disposing small amounts of hormones left in the capsules, you could take your empty capsules to a local police station; I was told by my pharmacy that at least the stations here in Mass have some kind of prescription disposal service.

Good luck!