compounded clonazapam don't understand measurements

I'm getting ready to work with a new doctor that's willing to write a compounded clonazepam script. I want to be prepared to ask for what I need.

 

If I were to ask for .1mg/ml will I be able to micro taper .001mg a day? Would a 1 ml syringe work for this? What would be the ml measurement on the syringe?

 

I'm on a twice a day dose. Do they make a vial of the suspension and I have to calculate how much to remove for the am and the pm? 

 

For instance, how do I measure .5mg for the am dose.  What would be the measurement on the vial?

 

I hope this question makes sense.

Lilpea!

Great to hear from you! I'd be happy to help you; I am also using compounded clonazepam to DMT. I am doing a liquid/tablet hybrid, so I minimize both the cost and risk of using a liquid.

 

If you read my tapering notes (in signature) I describe how I taper. I use Jim Hawk's online DMT schedule generator so I can do a percent-based liquid/tablet hybrid DMT. I am using 0.5mg tablets, and a liquid at 0.125mg/ml. A good compounding pharmacy can make you any potency liquid you need. I use 0.125mg/ml because that means 1ml = 1/4 tablet, and 1/4 tablet is the smallest size I can remove from my dose with tablet splitting. I replace this 1/4 tablet with 1ml of my liquid and titrate the liquid at whatever rate I want until it's gone, then replace another 1/4 tablet and repeat. Liquid/tablet hybrid!

 

Yes, a 0.1mg/ml concentration can be tapered by 0.001mg/day if you have a 1ml syringe with 100 gradations. The ones I get from my pharmacist are this accurate, and they are also available on Amazon for a couple bucks each. I think you'd need to stick with 1ml sized syringes to get this degree of accuracy. I also like taking the tiniest dose of liquid possible to minimize solvents or other liquid excipients that I'm eating, so I like a smaller syringe size with a more potent liquid.

 

You mention a suspension, but I think you can do better if your pharmacist is capable. I suggest considering a 30% ethanol to water solution of pure clonazepam; the liquid will be see-through indicating that the clonazepam is totally dissolved. This is what I receive every couple months; it comes in a medicine bottle with a push-in syringe adapter (magic) and a 1ml syringe with 100 gradations. I buy 35ml at a time, and this costs $35 including 2-day shipping from out of state. It's a true solution but I still shake it a little for good luck. Dosing is so easy.

 

I suggest doing a liquid/tablet hybrid. The Jim Hawk generator is explained in detail in my tapering notes in case it's not working for you (there is a recurring glitch), but what it will tell you to do if you choose "Combine with Tablets" is for your 0.5mg dose to just take 0.5mg in tablets. When you want to take 0.499 it will tell you to take 0.375mg in tablets, and the necessary milliliters of your liquid to make up the difference to 0.499mg. The schedule generator does ALL the math for you if you fill it out correctly.

 

If you want to do it old-school and plan a linear taper of 0.001mg/day from one or both of your doses I can help you with that math wise, but I suggest looking at the generator first. It's wonderful.

 

Also, I'm not sure what the vial is you're referring to; do you mean syringe?

If you're in New England or Florida I can recommend a really good compounding pharmacy...

Let us know how we can help! 

Hi slow!

Thanks for writing all that out. You're always so helpful. My benzo brain fails me.  What I comprehend is that your doses are predominantly tablets and the liquid portion you keep to a minimum which is equivalent to reducing 1/4 tab as your titration.

 

I'm sure your way is better but I'm burnt out and don't want to futz with tablets anymore. Also, for my daytime dose, I've been making .485mg of my daytime dose in a vodka water home brew so my body is used to all liquid in the day.  I split a .5mg tablet into .25mg for evening and want to switch to liquid for evening as well.

 

I was hoping to just deal with liquid and discard as I go.

 

I don't think this new doc would write tablets and compounded liquid together for me for the duration of my taper.

 

I would rather have a solution like you get but is that recipe too strong if I take almost .75mg total for the day of it? 

 

Otherwise, it seems from what I've researched that unless you specify, the standard approach is a suspension in OraPlus or something similar.  I wish I could use your pharmacy but I live in CA.

 

Is your solution recipe too strong to take all of my dose?

 

 

 

 

 

By too strong, I'm wondering what 30% ethanol means.  The solution is made up of 30% ethanol?

I understand; thanks for clarifying your situation and preferences lilpea.

 

If you're making your liquid homebrew from tablets, then I don't think your body is "used to all liquid in the day", at least compared to all the other liquids that are available. Not all liquids are created equal IMO, and I think the closest thing to a tablet you're familiar with is a liquid made with those tablets. Liquids made from tablets have the benefit of containing all the excipients and portions of medicine that are common to your tablets. I think the farther afield from these tablets you go in dosage form, the more chance for adverse reactions. This is why I've kept the bulk of my dosage as familiar tablets, and I only use a small amount of liquid substitution for it's accuracy in reductions.

 

The major caveat in my experience with liquid is liquid trials. When we change ingredients, we potentially change our absorption of the medicine and perhaps many other internal reactions. So that's why a liquid/tablet hybrid can really shine, keeping the impact of all these new liquid variables lower while we test the waters.

 

You could do something like a liquid/liquid transitional trial by substituting a portion of your current liquid method with a new liquid and testing for how you respond to the new variables for a period of time like a week or two. If it's all good, then this transition could progress by making one or two more steps to dosing with the new liquid in full. I think it'd be easier to do this liquid trial transition using tablets instead of your vodka-based liquid from tablets, but it's always up to you.

 

Yes the solution I use is 30% ethanol. It's based on this research and the reports of other members making solutions using similar ratios of ethanol to clonazepam. 30% ethanol seems like it can hold slightly more pure clonazepam than 0.125mg/ml or so the data indicates, but I wouldn't push it.

 

Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K. Journal of Chemical and Engineering Data, 2008, Washington D.C.: American Chemical Society, pp. 1107-1109.

https://digital.library.unt.edu/ark:/67531/metadc674044/m2/1/high_res_d/Acree%20Pub-479.pdf

 

If you used a 0.125mg/ml solution of clonazepam in 30% ethanol, a 0.75mg dose would consist of 1.8ml of ethanol. For comparison, there is ~17ml of ethanol in a single shot of 80 proof vodka. I specifically chose this solution to pair nicely with 0.5mg tablets for liquid/tablet; taking 0.75mg in liquid alone would use 6ml of liquid or 180ml per month, which might get pricey. For comparison, I currently use about 10-15ml per month.

 

I'm pretty sure you can buy Ora-Plus at stores or online (I see Ora-Plus, Versa Free, and other suspension vehicles for sale on Amazon) and make your own suspension of tablets this way. The compounding pharmacy can use pure clonazepam, but I think that's just a new variable, not necessarily an improvement over your familiar tablets. Plus there's the significant variable of tolerating the Ora-Plus ingredients. You're already familiar with mixing and measuring liquids, I'm not sure what benefits you'll get from a pharmacy compounded Ora-Plus suspension, but if that's what you're after then I want to support you in figuring out how to use it and trying it.

 

I suggest calling a compounding pharmacy (ideally a few pharmacies) to see what kind of service and options are available before requesting a script; at least out here pharmacies can mail liquid clonazepam so you might be able to find a really good pharmacy at a distance and have them deliver. I found that the less sophisticated pharmacies have only one MAYBE two options, and around here it was just Ora-Plus at a few specific concentrations of clonazepam.

 

Sorry it's so complicated! I hope this is useful for you in considering your liquid options. If you want to talk concentrations and how to dose with a syringe, I'd be happy to help with that.

 

This is a journey...

Everything you've said resonates with me!

 

I'm very concerned about disrupting what my body is acclimated to which is the home-brew with my Accord .5mg tablets. I'm just so burnt out making it and feel it's not accurate at all.  When I count the drops from the oral syringe as I'm eliminating by 1 ml increments, everyday, the drops are a different number of drops.  I wash out the syringe and have even found a tiny long brush to clean out any gunk.  I don't know why the drops fluctuate per 1 ml measurement that I remove.  Would you have any idea?  When I start out with a new syringe, the drops avg 26 drops per 1 ml. The next day it'll be 23, then the next 20, then the next 18.  It plays with my head mentally and I can't deal with the uncertainty anymore.

 

The reason I was switching to this new doctor is that my current psych does not know I've been titrating and can cut me off at any time. He is so not benzo wise and knows nothing about compounding pharmacies or Valium crossover and I'm just so tired trying to figure this out on my own.  He thinks you can just break the pills in halves and be done in a month or two.

 

My conundrum is that he is my tablet provider and I get it for free because I'm on medi-cal.  If I switch to the new doc who is Ashton savvy, writes compounding scripts and does Valium crossovers, she's very expensive. $375 for initial consult, then follow up appts are anywhere from $200-$500 a session. They weren't definitive about where I would fall in that range. I was just going to charge it all.

 

If things don't work out with her I'm left with no prescriber for my tablets.  My current psych is the only one left in this area in the medi-cal that will take me as a benzo patient. I would have severed ties with him and wouldn't be able to get back in.

 

I feel like I'm making a big gamble switching docs and not knowing if anything she prescribes will be received well by my body.

 

I wish you could handle my taper! Your system sounds very methodical and makes sense.  The compounding pharmacy she uses I need to call again but the first time I called them, they didn't sound in the know. I don't know what to do. I'm not doing well and my brain can't seem to make any decisions.  I just go in circles in my head about all the pitfalls. 

 

I understand if you want to throw up your hands and say, you know what, I don't know what to tell you.

One more question. So the pure clonazapam powder in your compounded liquid agrees with you even though you're used to your tablets? Curious to know what brand tablets you're on.

 

Also, when I call around to compounding pharmacies, how do I ask about your formulation in the clearest way possible so they understand what I'm looking for.  Do I say, can you make a 30% ethanol compound with distilled water and pure clonazapam powder? I don't want to use my tablets bc I think the fillers affect the syringe measurements.

Don't worry lilpea; life is complicated. I'm happy to explore this with you. 

 

I'm also on Accord Healthcare tablets. When I made my own 30% ethanol 0.125mg/ml solution/suspension of tablets I felt the same as how I feel on the compounded script. The compounded script might be a little more or less potent, but by keeping my liquid portion small I try to minimize this impact.

 

Based on what you've described, I would not switch doctors in your situation. I suspect that we can help you improve your tapering process as much as any doctor, especially if their tricks are just Ora-Plus and patient-led tapering. If you have cash you don't need, I'm all for exploring support options; I am just cautious because I've spent literally thousands of dollars on experts for both cannabinoids and benzos and come away with nothing special. In the end, I've always had to experiment on myself, and often times doctors have encouraged me to proceed recklessly or against my own judgements, causing disastrous results.

 

From my experiences with many many doctors I have come to the conclusion that there is no one out there who knows me, day-to-day, better than me. Therefore I believe there is likely no one out there who can guide my taper better than me. Often I have wished this was different, but it's almost like wishing someone else would live my life for me. So instead my goal has become to be the very best benzo taperer that I can be, as a service to myself. The lucky thing is I only have ONE patient, just like yourself; I believe you too can become the very best taper guide for yourself, and I'd like to help you get there.

 

I hear that your current prescribing doctor could cut you off or interfere with your taper if they find out, but only if that happened would I be trying to switch doctors. Until that point, I'd put the cash I didn't spend on the private practitioner in a savings account and wait. Maybe I'd spend it on trauma-informed psychotherapy? I'd also be stockpiling my tablets; these seem to last a long time, and the lower we get the longer they'll last.

 

Do you have a good tablet splitter?

I like the aluminum ones on Amazon (I have the EqualSplit brand)

 

Are you doing a daily liquid discard right now?

What are the obstacles you are facing right now in terms of taking reductions?

Sorry, just saw your edited post now; I was chipping away at my earlier reply over the day and didn't refresh the page.

 

Also, when I call around to compounding pharmacies, how do I ask about your formulation in the clearest way possible so they understand what I'm looking for.  Do I say, can you make a 30% ethanol compound with distilled water and pure clonazapam powder? I don't want to use my tablets bc I think the fillers affect the syringe measurements.

 

Fillers should not affect syringe measurements. They're tiny particles. I suggest using an oral syringe and the opening is plenty large enough for any fillers to pass easily, and if you measure your final dilution volume with the tablets already in the measuring vessel, the mg/ml will work out. More on that if you want to discuss making something at home.

 

If you want a compounding pharmacy to make a 0.125mg/ml solution of clonazepam in 30% ethanol, that's all you need to tell them. They will calculate how many milligrams of clonazepam powder to use based on how many milliliters you order. They will likely use 200 proof (100%) ethanol, and dilute it with distilled water to the final volume. 

Wow, you articulate the thoughts that have been swirling in my head and deduce down things so well!  I've been going crazy trying to figure out what to do about changing providers.  The thing is, I just hate making the liquid.  Everyone talks about how easy it is once you get the hang of it, but I find it tedious, draining and nerve wracking.

 

So what I've been doing for my a.m. dose is dissolving a .5mg tab in 1 ml of 80 proof alcohol in a tipped jar, jiggle it a little to start the dissolution. Let it sit for around 20min. Pour 100ml of Crystal Geyser water (in retrospect should've started with distilled water) from a graduated cylinder into the jar with the dissolved slurry. I take the 1 ml syringe and stir in a scissoring motion like 100x then draw up 1ml from the middle and discard. 

 

I've been stuck at only removing 3ml total (1ml=.005mg) from the 100ml solution/suspension for a dose of .485mg and have been holding to be stable for the changeover.  I also had a setback after getting down to .471mg in the a.m. and now I'm hypersensitive to the tiniest cuts.  Even getting from 2ml to 3ml came with acute symptoms. I don't know how my body would react if I reverted back to the tablet and cut out only 1/4 in liquid...

 

Where do you buy the 30% ethanol btw...

 

My 2nd and final dose for the day, I split a .5mg tab in half and weigh it on the cheap crazy making scale for a .25mg dose. Burnt out doing that process too because I don't know if it's ocd but the jumping numbers wear me out and the weights it comes with never weigh what it's supposed to even when I calibrate the scale.

 

I did just order your aluminum pill splitter on Amazon yesterday! That may be a game changer.

 

I'm super grateful for your help and time. I was so excited at the thought of switching to a compounded liquid.  I can't seem to let go of the thought of that luxury. 

 

Could you explain to me just so I can explore compounding pharmacies and what they are capable of around this area - what is the verbage I say to describe the concentration and recipe if I want to dose the way I have been with the liquid. I just want to exhaust that option one more time before resigning myself to having to make the homebrew.  I don't want to chance something like Ora-Plus but pure clonazapam powder with the ethanol sounds like it could be an ok transition.  Or are you thinking it'll cost too much and that maybe your dose is tolerable because it's a small amount?

 

I have enough tablets to stay with the evening dose as is at least for a while. Going in circles again. Ugh what have benzos done to me!

 

Thanks so much for your support!

 

 

 

Just got your updated post so disregard my repeated questions!

Another question. So when you were making the 30% ethanol liquid at home, did you dissolve only 1/4 tab into the ethanol and do a discard method? Do you have the recipe in your hyperlink? I'm too dense to use the Jim Hawk calculator.  How does your DMT work to get to 6% reduction in 14 days. Do you pull out a certain amount with a syringe and consume it from the syringe or do you discard and drink the whole potion? Please excuse me if I am being super dense.

A daily liquid discard is so tedious in my opinion. And on top of that you're dry weight adjusting your split tablets with a cheap milligram scale! Gah! It's my worst nightmare. 100x scissor-motion stirring, jumpy scale numbers... I feel your pain.

 

Thank you for sharing the details of how you've been tapering. This helps me immensely in understanding both why you're struggling to dose every day and why you'd be willing to pay and risk so much just for a compounding script. I think we can go a long way to helping you become a better taper guide for yourself, and first of all it sounds like we need to explore ease of dosing!

 

Let me tell you how I dose. I'm approaching your dosage range; I am holding today at 0.9mg/day (technically the schedule says 0.8996mg...).

 

I currently dose twice a day, 7am and 8pm. At 7am I take 3/4 of a 0.5mg tablet cut by eye using the EqualSplit splitter for 0.375mg of medicine (I usually split a few in advance and leave them in the splitter).

 

Secondly, I consult a printed page of a DMT taper schedule generated by Jim Hawk's online tool and it tells me that to hold at the last dose I took (0.9mg/day) I need to take 0.20ml of my 0.125mg/ml liquid in addition to my 3/4 tablet. I grab a small plastic bag in the fridge containing my medicine bottle and syringe, I shake the bottle gently, I open the bottle, I uncap the syringe, I press the syringe into the syringe adapter in the neck of the bottle, I turn the bottle upside-down, draw a little more than my dose, purge the extra into the bottle until the plunger is at 0.20ml, right the bottle, disconnect the syringe and squirt the liquid into my mouth. I drink a little water. Cap goes back on the bottle, cap on the syringe, both in the little bag, back in the fridge.

 

At 8pm I take a whole 0.5mg tablet.

 

That is my entire dosing routine.

 

If I was on homebrew, I'd need to mix 30ml of liquid clonazepam every month or two which takes about an hour. If I was on liquid from tablets I'd also shake the bottle more vigorously immediately before dosing. Homebrew takes almost the exact same amount of time to use but I'm a little more cautious to check that it has homogenized as much as possible before drawing my dose.

 

I think you are not too dense to use Jim Hawk's taper schedule generator. I wrote an instructional and it is only confusing at first; it's a very powerful tool. This generator is how I get my 6%/14 day taper rate; I don't do an inch of math. I just print and follow the schedule. I reduce my liquid dose every day or else hold, until the liquid dose is eliminated. When I'm ready to cut again, I remove 1/4 tablet from one of my remaining doses, substitute it with 1ml of liquid and begin again.

 

I think many of your questions will be answered by just reading my tapering notes, especially the liquid clonazepam recipe. I make it with 180 proof organic grape alcohol because I'm fancy, but you could use 80 proof vodka or similar and likely get the same results. I'm going to take a look at the recipe right after this and make sure it's clear about how to use 80 proof, since not everyone can find 180.

 

I'm so glad you're going to try the aluminum pill splitter! The video shows how I split.

 

What other steps do you think you could take to make dosing easier?

Let's do this!

Just finished making some small adjustments to the recipe in my tapering notes, for clarity. 

Thanks so much again for taking all this time with helping me. 

 

I think it's my depression or anxiety from this benzo withdrawal but I'm going to have to read and reread. You wrote everything clearly. I just can't seem to synthesize it and take action.  It's the weirdest malady. I can barely open a bill and get it paid.  Everything overwhelms me.  I'm sure it's easy to make.  I just don't have the capacity right now.

 

I've got to think this through some more. I just am not a good learner by reading instructions. Ugggg I may go with the expensive doctor...idk.

 

Sorry. I hope I don't sound ungrateful.   

It's really alright. The forum is a limited means of communication and support. If you need more support and new doctor would do that for you, I completely understand. Do you have a family member or friend who could support you in at least making your dosing routine easier?

 

Think about it. I'll be back on tomorrow. No pressure, no rush.

I'd just like to see you have an easier time of this.

Greetings, lilpea.

 

Regarding your questions about using syringes ...

 

Here’s a tutorial (with pictures) from the The Withdrawal Project that might help:

 

https://withdrawal.theinnercompass.org/taper/using-syringes

 

If you do decide to work with a compounding pharmacist, s/he can help you use a syringe as well as calculate your doses.  (Compounding pharmacists can also provide you with high-quality, properly calibrated oral syringes to use.)

 

Hello, slownsteady.

 

I just read through your recipe for homebrew clonazepam and wonder if you have evidence to support your claim that the liquid is “likely to be shelf-stable for many months”?

 

Although the amount of alcohol in the liquid may indeed reduce instability (degradation) due to microbial activity, liquid medications are subject to multiple other sources of instability (e.g. light, heat, hydrolysis, chemical interaction between ingredients). Evaporation of the alcohol in the liquid over time should also be considered.

Hello, slownsteady.

 

I just read through your recipe for homebrew clonazepam and wonder if you have evidence to support your claim that the liquid is “likely to be shelf-stable for many months”?

 

Although the amount of alcohol in the liquid may indeed reduce instability (degradation) due to microbial activity, liquid medications are subject to multiple other sources of instability (e.g. light, heat, hydrolysis, chemical interaction between ingredients). Evaporation of the alcohol in the liquid over time should also be considered.

 

Hey there Libertas!

 

The full 'claim' that you intended to quote is "This formula seems likely to be shelf-stable for many months." I made that remark largely based on what I was told by my compounding pharmacist; I used the phrase "seems likely" to indicate that this conjecture.

 

A dark, cool environment seems ideal for reducing most if not all the sources of instability that you mention; this is why I prefer to store my medicine in the refrigerator.

 

The only remaining issue that refrigeration leaves is precipitation of the clonazepam due to lower temperatures, but I've found this doesn't occur with a pure clonazepam solution at the same potency and ethanol ratio. I still always treat my liquid made from tablets as a water-based suspension, so this has not been an issue regardless.

 

Thanks for watching out for me! So far so good.

.

Libertas,

I'm not sure how to be more clear with you, but I will try...

 

In the interest of providing members with accurate information, might I encourage you to consider adding the following clarifications to your document?

 

All the accurate information is already there...

This formula seems likely to be shelf-stable for many months, but to err on the side of caution I store my liquid medicine in the fridge.

i.e. my conjecture, and then my personal choice for storage.

 

...the claim about stability was made by one compounding pharmacist in reference to a formulation that uses the pure active drug substance as the drug source. 

I'm not sure how you got to that conclusion, but we were talking about using tablets. Again this was conjecture, i.e. an opinion and not a claim about stability.

https://examples.yourdictionary.com/fact-vs-opinion-simple-examples-show-difference

 

I value your extensive interest in the various opinions and limited research around benzo tapering. I am disappointed that your contribution to this tapering thread has been to nitpick my personal tapering notes, purportedly "in the interested of providing members with accurate information".

 

Maybe you need to re-read the first line on my progress log...

These are just personal and static documents.

 

My personal tapering notes are accurate to my thinking and experiences, and available on the forum as exemplary of what I have done and why.

 

Were I to claim medical facts that cannot be supported by evidence, I would gratefully receive your inquiry and provide further clarifications if possible. Since you are NOT inquiring about facts that I've claimed, I'm left wondering what you are trying to accomplish here.

 

I'm sorry lilpea; I didn't realize Libertas was needing so much help understanding a single sentence in my personal tapering notes. I hope this final clarification has given them sufficient perspective, and I'm still here if you want to explore your tapering options.

Greetings, lilpea.

 

Regarding your questions about using syringes ...

 

Here’s a tutorial (with pictures) from the The Withdrawal Project that might help:

 

https://withdrawal.theinnercompass.org/taper/using-syringes

 

If you do decide to work with a compounding pharmacist, s/he can help you use a syringe as well as calculate your doses.  (Compounding pharmacists can also provide you with high-quality, properly calibrated oral syringes to use.)

 

Thank you for your response Libertas.  I look forward to looking at the hyperlink. 

 

Would you be open to telling me what kind of compounded K you are using?  I'm not sure if you're currently tapering or are already off but since you sound like you have a science background, I was curious to know what kind of compounding is working for you. A suspension? OraPlus? Pure clonazapam powder? Tablets you provide? Also the concentration of your compound and if you're microdosing or doing cut and holds?

It's really alright. The forum is a limited means of communication and support. If you need more support and new doctor would do that for you, I completely understand. Do you have a family member or friend who could support you in at least making your dosing routine easier?

 

Think about it. I'll be back on tomorrow. No pressure, no rush.

I'd just like to see you have an easier time of this.

 

Thank you. I don't think I can teach anyone in my family how to do this at the moment. Always appreciate you