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Compounded Klonopin updates and questions


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Hi all,

 

It's been a turbulent while, but I do have some updates and would really appreciate your thoughts/ feedback.

 

As I mentioned in the last forum, I had found a good compounding pharmacy and they were willing to work with my husband's psychiatrist to provide the formulation in the article that @slownsteady and so kindly offered. Between vaccines, recovery, second vaccine, recovery from that and moving, we didn't actually start with this until about a week ago.

 

As a note, the powder form was used for the compound, not tablets. So here's what happened:

 

1. The first bottle was a 1mg K to 4 ml liquid solution ratio. So my husband was going to be replacing the .125 mg k tablet with .5 ml of the solution. We picked it up on 8/27 and the "use or discard" date (which I had not noticed when I picked it up) was 9/11/21. So at the time that my husband tried it for a couple of days it was past that day. He felt as though as withdrawal was worse. The pharmacist who is personally overseeing this (can't say enough good things about him) stated that because the formula is not considered one of "proven stability", the system defaults to the 2-week time frame. He believed that the medication should still be ok, but advised that it's best to not take any chances, since my husband is so susceptible to side effects and sensitive to changes.

 

2. The correct ratio should have been 1:20, not 1:4 (as I said the idea is to duplicate the v-microtapering schedule he had created) so after talking to his psychiatrist, the pharmacist produced the new prescription. My husband replaced .125 mg k with 2.5 mg liquid solution. He went to bed okay, but woke up and had severe anxiety and restlessness. Not quite akathisia, thank goodness, but worse than he's felt in months. An additional consideration for last night is that a couple of hours after taking the solution, I but some cbd balm on his back (500 mg strength).

 

I am quite taken aback... he's been traumatized by akathisia and this morning was so alarming to both of us.

 

I'm hoping that you guys may come up with some thoughts on this. Any suggestions are very much welcome.

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Hi feelberlin,

I'm so sorry to hear your husband has been feeling unstable after these two liquid trials.

 

Could you tell us more about the liquid he's currently trialing? Is it a water and ethanol based solution of pure clonazepam (if so, how much ethanol is in the final dilution)? Or is itsomething else?

 

You mention the new liquid is 1:20; does this mean 1mg clonazepam per 20ml of liquid, i.e. 0.05mg/ml?

 

Is your husband still in the middle of a crossover to diazepam, as your signature suggest? If not, would you mind updating us on his dosage?

 

I hope we can help.  :thumbsup:

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Hey slownsteady! :smitten:

 

The prescription is based on the formula in the article. It seems to be 9 parts alcohol, 1 part water and, yes, pure clonazepam. The compounding pharmacist has been communicated with my husband's psychiatrist to get the ratio right and has a pretty good understanding of how sensitive his neurochemistry is.

 

My husband and I have been talking about this for hours on end, especially because, replacing the compound with the pill has helped deal with the excitatory reaction. The pharmacist was dumbfounded and his theory was that either that was a freak occurrence (a "once off"), or that the 1:20 ratio was the issue (too diluted). The thing that does not make sense is that alcohol should have compounded the effect of the klonopin.  :-\ The more likely scenario, based on the crazy reaction is that something made it into the compound that should not have. I am open to all likely theories... I'm coming up empty other than that..

 

Yes the 1:20 is 1 mg Klonopin to 20 ml liquid solution. So this was done so that he could replace the .125 mg tablet with 2.5 ml of the compound. This would correspond with the Ashton schedule for diazepam.

 

Which brings me to your question (and a reminder that I need to update my signature). No we stopped with the crossover. As it turns out the way that klonopin binds to the receptor is tighter than diazepam, so 5 days into switching a dose, the process kicked in bouts of akathisia. It was horrific... and so disheartening to him. Both the K and V groups in the forum helped so much during that time. Some members told me that they had similar trouble with the crossover, with one brave soul managing to cross over and doing well and another saying that direct K taper was a lifesaver.

 

So yeah, the short of it is, no, no longer crossing over. If anything, the idea is to eventually also replace the diazepam with compounded K because coming off 2 different benzos can be more complicated.

 

As ever, grateful for any insight/ ideas.

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Hi feelingberlin,

Thanks for explaining more. It sounds like you're holding mid-crossover and trying to cross back to clonazepam. If your husband is tolerating the diazepam dose he is on, I would be considering holding the diazepam dose, and tapering the clonazepam. I generally suggest tapering the benzo with the shorter half-life first, in this case that would be the clonazepam; tapering the diazepam could be easier at lower doses both with it's longer half-life and with the lower potency tablets commonly available.

 

I'm scratching my head a little about your compounded clonazepam liquid...

 

If you're referring to the article "Ali Shayanfar, Mohammad A. A. Fakhree, William E. Acree , Jr. and Abolghasem Jouyban, Solubility of Lamotrigine, Diazepam, and Clonazepam in Ethanol + Water Mixtures at 298.15 K, J. Chem. Eng. Data, 2009, 54 (3), pp 1107–1109, December 22, 2008", their data indicates that a maximum of 0.08mg/ml of clonazepam was possible to dissolve in a 20% ethanol-to-water solution. I would suggest considering 20% ethanol to dissolve 0.05mg/ml of pure clonazepam.

 

If I understand you correctly, 9 parts alcohol (which I assume is 200 proof or 100% ethanol) to 1 part water is 90% ethanol; this was shown to hold a maximum of 6.18mg of clonazepam per milliliter. In my experience with compounding, this is far more ethanol than is required to dissolve 0.05mg/ml of pure clonazepam.

 

Your husband's reaction surprises me as well, but there must be some truth in it. One consideration is that consuming 2.5ml of 90% ethanol per day is not something I would be comfortable doing while tapering; it's a relatively small amount compared to a shot, but it's 7.5x the maximum amount that I ever consume with my liquid. I wonder if your husband's withdrawal symptom intensity increase was caused by the alcohol having a GABA agonistic effect and then quickly wearing off. I had something similar happen when I took GABA supplements; short term relief and then within hours I had increased withdrawal symptoms.

 

I've dumbfounded my compounding pharmacist before, on two occasions; both times it was just one small variable that threw the whole mixture off for me.

 

Would you consider a 30% ethanol mixture with 0.125mg/ml pure clonazepam? This is closer to the research data in terms of what ethanol is required, while being more concentrated than the 0.05mg/ml solution makes it so your husband can consume even less ethanol with his dose(s). I find this concentration is still plenty easy to titrate daily at my current dosage with a 1ml syringe with 100 gradations.

 

Alternatively, you might want to consider options for making a liquid from familiar tablets. This could be done at-home or with a compounding pharmacy. If the compounding pharmacy can source the same tablet manufacturer as your husband is familiar with, they could make a suspension using one of their stability tested suspension vehicles. You husband could even trial the suspension vehicle independently, while still dosing only on tablets, to make sure it was well tolerated; I suggest doing a trial of the suspension vehicle independently for this reason.

 

Has your husband tried a suspension of clonazepam made using familiar tablets?

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Hey slownsteady,

 

He stopped the transition after the second attempt to replace a dose because it kept causing bouts of akathisia. It was horrible. At this time, by introducing the compound, he was actually first trying to switch his clonazepam with the liquid compound. He has not replaced any of the the diazepam, but was going to once all the clonazepam had been switched.

 

Yes, that is the article. I was going to check with you about the ration, because the amount of alcohol in the compound sounded like a lot, but I was trying to find your post that you were breaking down the calculations. Thank you so much for going over it in the post. Yes, you are correct in your assumptions about the alcohol and he and I have been talking about it quite a bit the last few days. His entire dose translated to clonazepam only would be 1.125 mg, which would then translate to 22.5 mg of the solution daily. That's a lot of alcohol, considering that it too acts on the Gaba..

 

What made us consider the likelihood that there may have been something else present in the compound (human error) is that, there have been times that due to anxiety or a severe panic attack he forgot to take an entire dose. Withdrawal sucks but it does not do... this to him.

 

I can't quite imagine what akathisia feels like... but even what it looks like and he's describing to me is terrifying... I firmly believe that most of you guys, if not all, have been traumatized by this process... it honestly breaks my heart.

 

Back on topic... so the 30% ethanol would be for a 1:1 ratio or would it work for any ratio? I am asking because i will then talk to the pharmacist and the psychiatrist in order to adjust the prescription accordingly. Does that scale as he replaces more medication (meaning will the 30% is sufficient to dissolve 1.125 mg clonazepam) or would the ratio need to be adjusted as the quantity increases?

 

The pharmacist had tried to dissolve the tablets at first and there was so much sediment because of the inactive ingredients... I suppose if worse comes to worse that is an option and I sincerely thank you for it. Would you use 200 proof alcohol? Would I use the calculator you had posted in order to come up with the ml I need for the experiment?

 

He has not had a suspension made from tablets that he's taking. Have you found the sediment caused by the inactive ingredients to present any issue for you?

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If I were in your shoes, I would be cautious about relying on the data from Jouyban et al. to create a clonazepam liquid.  The goal of the study was to generate data to inform a mathematical model for predicting drug solubility — not to inform the development of liquid drug formulations for human consumption or, more importantly, to test those formulations for safety and effectiveness.

 

Your compounding pharmacist might be interested to know about these stability-tested formulations for liquid clonazepam:

 

2.5mg/mL clonazepam oral solution

https://www.iasj.net/iasj?func=fulltext&aId=114176

http://jmracpc.uobaghdad.edu.iq/index.php/IJMRCP/article/view/79/71

 

0.1mg/mL clonazepam oral suspension

https://www.nationwidechildrens.org/-/media/nch/specialties/pharmacy/compounding-formulas/clonazepam-oral.ashx

 

Your compounding pharmacist also might be interested to know about solvents used in two commercially manufactured oral clonazepam solutions.  Roche (the company that developed and patented clonazepam) uses propylene glycol as the primary solvent. UK-based Rosemont Pharmaceuticals uses medium chain triglycerides as the primary solvent along with a tiny amount of 96% ethanol as the co-solvent.

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Hi feelberlin,

Thanks for sharing more about your situation. I agree that 22.5ml of a 90% ethanol solution of pure clonazepam is a LOT of alcohol! That's ~20ml, which is more than a shot of 80 proof vodka; a shot of vodka a day is not something that is recommended for benzo recovery. One advantage of a liquid/tablet hybrid is that my minimizing the use of liquid this solvent portion or whatever other ingredients are in the liquid can also be minimized; this is a huge plus in my experience.

 

I understand you're currently trialing a partial liquid substitute for the clonazepam, but I suggest considering that when you make progress on the clonazepam taper to eliminate the clonazepam entirely before reducing the diazepam. If diazepam is well tolerated, I think it's a superior benzo for stabilizing and tapering.

 

I understand crossing to diazepam was frightening and difficult, but it sounds like your husband has already made the adjustment to the diazepam dose he is on so I suggest if you can to leave it alone until the end. I understand that there's also a bit of a challenge making a longer-to-shorter acting benzo crossover (V -> K); just another reason in my mind to stay the course if you can.

 

All this talk of ratios is a little confusing for me. Do you mind if we consider things in milligrams/milliliter? I think these are the units that pharmacies use, and this is how I am familiar with measuring liquid benzo concentrations.

 

To clarify, the data from the research article by "Jouyban and friends" shows us a maximum amount of moles of pure clonazepam that can be dissolved in ten different ethanol-to-water ratios, given certain conditions like 48 hours of agitation at a fixed temperature (around 77F I think). This is "ballpark" information that I think pharmacies can use to make ethanol and water solutions that will dissolve pure clonazepam, which are easily verifiable because the pure clonazepam can be visibly seen to dissolve and turn transparent.

 

What Jouyban's data shows us is the maximum amount of pure clonazepam that can dissolve at certain concentrations of ethanol. Here is a little chart of the mol/L translated to mg/mL.

 

% Alc.    K (mg/ml)
0        0.03
10       0.04   
20       0.08
30       0.20
40       0.60
50       1.43
60       2.64
70       4.22
80       5.65
90       6.18
100      5.11

 

Since we know the maximum amount that can be dissolved at each ethanol concentration, this means to me that we should be able to dissolve less clonazepam in the same amount of ethanol.

 

For example, I want a liquid that holds 0.125mg/ml of pure clonazepam. I look at the chart above and see that 20% will only dissolve a maximum of 0.08mg/ml, but 30% will dissolve up to 0.2mg/ml. To make my 0.125mg/ml solution of pure clonazepam I asked my pharmacist to use 30% ethanol by volume. The result was a transparent liquid, indicating a true solution of pure clonazepam.

 

But, because the chart shows us the maximum value, I should be able to dissolve amounts less than 0.2mg/ml of pure clonazepam in 30% ethanol; the only downside to going very low in clonazepam at this ethanol concentration is consuming extra ethanol. This is why I suggested for a 0.05mg/ml solution of pure clonazepam to try 20% ethanol, as that was shown to dissolve 0.08mg/ml. I suggest always aiming significantly below Jouyban's results for more reliability.

 

Now when we're talking about dissolving tablets, Jouyban's data does not directly correlate. They were not working with tablets, and not all tablets are created equal, so there's much more guesswork involved. We could guess that being generous with the ethanol concentration as I suggested above would make up some of the difference, and my personal experience trying to dissolve 0.125mg of clonazepam from tablets in 30% ethanol has shown me that this does in fact work for me. But it's not something I can prove and it's not something I would suggest as the first option for someone with the resources and interest in pharmacy compounding.

 

Despite developing a true solution of pure clonazepam with my compounding pharmacist and using it to taper for several months, I did not find it was bioequivalent to my tablets and I was left with a choice: fudge my liquid/tablet hybrid tapering numbers to make a better match or switch back to liquid from tablets. I chose to switch back to liquid from tablets, if only because I thought it would give me a clearer answer as to whether the pure clonazepam was causing my issues. It turned out I was right, as the liquid I made at home from familiar tablets was more symptomatically consistent and easier to taper this past month; this proved that the pure clonazepam was more potent than my tablets, which caused a small updose when I substituted with it and explained why it was harder taper in the later half of my elimination cycle.

 

Which is all to say that I think familiar tablets are special. And one option I suggest considering for your husband is a pharmacy compounded suspension of the same manufacturers tablets. As you probably already know suspensions are not solutions; in a solution the particles of medicine dissolve, but in suspensions they primarily just float around. In a suspension, a deconstructed tablet (ideally finely ground by the pharmacist while incorporating into the suspension vehicle) becomes particles of different tablet ingredients floating in a fluid. A good suspension vehicle is viscous and has a number of other properties that enable the particles to be evenly dispersed so they can be dosed reliably.

 

Compounding pharmacies usually have a variety of options for making suspensions from crushed tablets, and I suggest considering something like this for your husband since you say he is tolerating the tablets well. They biggest issue I've found with commercial suspension vehicles is that they often have lots of ingredients (defoamers, preservatives, etc). This is why I suggested trialing any suspension vehicle they recommend without the drug in it first for a few days to a week to see if they ingredients cause any reaction; only after such a trial would I go ahead with ordering it used to suspend tablets and replace a portion of my daily dosage.

 

Phew. Too much typing!

I hope this helps.  :thumbsup:

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Hello again, feelberlin.

 

Just checking ...

 

Are you in the US?  If so, are you aware that clonazepam is available in 0.125mg and 0.25mg orally disintegrating tablets (ODTs)?  Given your husband’s current dose of 0.875mg, one option to consider would be to use a combination of ODTs and a compounded liquid.

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Since we are talking about compounded K, I would like to jump in and ask a question about the stability-tested compounded clonazepam suspensions not solutions.  I have found a PCCA-certified compounding pharmacist who will make a USP clonazepam suspension at 0.1 mg/ml using the same generic brand of clonazepam tablets I am currently taking.  According to new PCCA (2019) regulations, non-preserved aqueous suspensions (concerns with microbes), have a use-by date of 14 days from the date the suspension was compounded.  This means every 14 days I need to pick up a refill.

 

I will begin by taking 0.25 mg (2.5 ml's) of the compounded suspension using a (1 ml oral syringe with 100 markings) for about 3 weeks to settle in before making any reductions. My question is how did you determine how much to reduce your compounded suspension by (ex. percentage, # of days, etc) , and do you know of a spreadsheet for compounded suspensions? There are plenty of spreadsheets for water titrations involving a "toss", but I have not found anything for compounded suspensions where one is using a syringe to take lesser amounts of the suspension over time.  Thank you in advance.

 

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According to new PCCA (2019) regulations, non-preserved aqueous suspensions (concerns with microbes), have a use-by date of 14 days from the date the suspension was compounded.  This means every 14 days I need to pick up a refill.

 

Hello, Aja56.

 

You might want to double-check with your pharmacist about the 14 day use-by date. It sounds like s/he is referring to the 2019 USP Compounded Nonsterile Preparation (CNSP) standards regarding beyond use dates (BUDs) (see link below).  If so, s/he is correct that the standards specify a BUD of 14 days for non-preserved aqueous compounds. HOWEVER, the standards also state that BUDs can be extended for CNSPs with a USP-NF monograph or stability information (e.g. the clonazepam stability study cited below reported a BUD of 60 days).

 

I suggest you ask the pharmacist to provide you with the specifics of the formulation s/he plans to use.  Is it based on the USP-NF monograph for a 0.1 mg/mL oral clonazepam suspension? What are the ingredients?  Does it have stability information?  If so, can the BUD for your suspension be extended?

 

My question is how did you determine how much to reduce your compounded suspension by (ex. percentage, # of days, etc) , and do you know of a spreadsheet for compounded suspensions?

 

Might I encourage you to start your own thread on the Titration board so members can focus on your particular case?  (Given what you’ve shared in your signature, it sounds like your benzo-wise physician is indeed benzo-wise.)

 

Citations:

Compounding Standards and Beyond-Use Dates (BUDs) (USP <795>, 2019)

https://www.usp.org/sites/default/files/usp/document/our-work/compounding/usp-bud-factsheet.pdf

 

Allen LV Jr., Erickson MA. Stability of acetazolamide, allopurinol, azathioprine, clonazepam, and flucytosine in extemporaneously compounded oral liquids. Am J Health-Syst Pharm. 1996;53(16):pp1944-1949.

https://www.perrigorx.com/pdfs/Sec%20Artem%205.4.pdf

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According to new PCCA (2019) regulations, non-preserved aqueous suspensions (concerns with microbes), have a use-by date of 14 days from the date the suspension was compounded.  This means every 14 days I need to pick up a refill.

 

Hello, Aja56.

 

You might want to double-check with your pharmacist about the 14 day use-by date. It sounds like s/he is referring to the 2019 USP Compounded Nonsterile Preparation (CNSP) standards regarding beyond use dates (BUDs) (see link below).  If so, s/he is correct that the standards specify a BUD of 14 days for non-preserved aqueous compounds. HOWEVER, the standards also state that BUDs can be extended for CNSPs with a USP-NF monograph or stability information (e.g. the clonazepam stability study cited below reported a BUD of 60 days).

 

I suggest you ask the pharmacist to provide you with the specifics of the formulation s/he plans to use.  Is it based on the USP-NF monograph for a 0.1 mg/mL oral clonazepam suspension? What are the ingredients?  Does it have stability information?  If so, can the BUD for your suspension be extended?

 

My question is how did you determine how much to reduce your compounded suspension by (ex. percentage, # of days, etc) , and do you know of a spreadsheet for compounded suspensions?

 

Might I encourage you to start your own thread on the Titration board so members can focus on your particular case?  (Given what you’ve shared in your signature, it sounds like your benzo-wise physician is indeed benzo-wise.)

 

Citations:

Compounding Standards and Beyond-Use Dates (BUDs) (USP <795>, 2019)

https://www.usp.org/sites/default/files/usp/document/our-work/compounding/usp-bud-factsheet.pdf

 

Allen LV Jr., Erickson MA. Stability of acetazolamide, allopurinol, azathioprine, clonazepam, and flucytosine in extemporaneously compounded oral liquids. Am J Health-Syst Pharm. 1996;53(16):pp1944-1949.

https://www.perrigorx.com/pdfs/Sec%20Artem%205.4.pdf

 

Thank you so much Libertas.  I will indeed start a new thread. 

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You are most welcome. Please let us know what you find out about the BUD.  Formulations for clonazepam oral suspensions typically use a commercial suspending vehicle (e.g. OraPlus/Blend); commercial suspending vehicles typically include ingredients to suppress microbial growth.
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  • 3 months later...

Hi all,

 

I will have to update the signature, but for now I wanted to share an update that I hope will be helpful to others as well.

 

My husband has been trying to cross over to liquid klonopin so that he can microtaper. The alcohol+water compound was a complete bust for him, and it took a while to even get started, but it looks like we found something that works. We switched to a propylene glycol formula (thank you for the suggestion @Libertas), which is stable, although it needs to be refrigerated.

 

We successfully made the conversion of .125 ODT to 2.5 ml liquid solution (which would have been the ideal valium ratio in order to make very small cuts). The combination of pure K powder and propylene glycol (and a LOT of peppermint flavoring to make it palatable) has led to a successful switch of 6 out of the 7 OTD tablets. The 6th was switched this Friday. It usually takes a week or two for my husband to be ready to get to the next substitution, but almost there.

 

I'd appreciate your thoughts on something, since we are getting to the point that he can start tapering:

 

1. Would you get rid of the valium before or after the klonopin? Meaning, where would you start the taper? The valium has a long halflife and a lot of metabolites that may help while getting off klonopin, OR it may be easier to get rid of valium since it binds less tightly to the GABA receptors...

 

2. My husband saw a new psychiatrist who said that it is... unwise to start tapering from a place of instability (meaning already in tolerance withdrawal and not particularly functional) and he's setting himself up for failure. He said that he should go up, stabilize and then start decreasing his dose. Any thoughts on that? I don't want to have blinders, and my focus is him coming off, which is what he wants... I just keep thinking about that...

 

3. Has something you have been eating or avoiding helped with your taper? I think protein helps...

 

That's the current update... I meant to update sooner but it's been a ride... Hopefully this report back helps others too. Please let me know if I can answer any questions.

 

Warm regards...

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Thank you for the good news update, feelberlin.  Am I understanding correctly that your husband is now using a compounded clonazepam liquid that includes propylene glycol (in addition to peppermint flavoring :))?

 

In response to your questions ...

 

1) If it were me, I would taper the clonazepam first.

 

2) I agree with your husband’s new psychiatrist that it’s best to get as stable as possible before beginning a taper.

 

3) You will likely get more responses to this question if you post it on our Withdrawal Support board.

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Hi @Libertas!

 

Yes, the current solution is pure Klonopin powder, propylene glycol (and the peppermint flavoring). The propylene glycol is great for dissolving the Klonopin and, because it's a commonly used solvent, it is good for compound stability.

 

1. Thank you for the feedback! When I was reading about the v/k substitution attempts (because the substitution went horrifically for my husband), some members had shared that it was easier/ better when they were on a single benzo (even when that meant sticking to k, because they could not go through with the transition). That's what had us talking about what should be done first. LOGICALLY, valium should help during the taper... but nothing has gone as planned for him...

 

2. My husband is really strongly averse to going up, because he believes that that's "digging the hole deeper", since the objective is to get off of the medication. I get it... I also see your and his psychiatrist's point. I think that part of his strong feelings on this comes from the fact that his neurochemistry is so sensitive... he's on .875 mg (equivalent between the last OTD tablet and the liquid) and the current taper schedule he has devised will take two years assuming all goes well... If he goes up to 3 mg, like his psychiatrist wants him to... I think that the prospect of tapering over a good chunk of a decade is... daunting.

 

I'm not arguing, because I do appreciate your straightforward answer and know that you and most anyone on this board don't offer suggestions lightly. I'm just trying to provide some context for the dilemma.

 

3. Very much appreciate the suggestion! I will try that!

 

:smitten:

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Hello, feelberlin!

 

Thanks ever so for the confirm on the liquid.  Will you do me — actually our community — a favor?  If you have not already done so, ask the compounding pharmacist if s/he would be willing to share exactly what is in the formulation in what amounts/proportions?  It would be an incredible boon to our US members if we could find and share a formulation for a compounded oral clonazepam solution that works given that a commercial solution is not available.

 

I realized I should have asked you for an update on your husband’s current status.  How is he doing?  Are his withdrawal symptoms getting worse, getting better, or staying about the same?  Being stable does not necessarily mean feeling great — it means symptoms are not changing much and the individual feels ‘strong enough’ (physically and mentally) to make a reduction in dose.

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Hello, feelberlin!

 

Thanks ever so for the confirm on the liquid.  Will you do me — actually our community — a favor?  If you have not already done so, ask the compounding pharmacist if s/he would be willing to share exactly what is in the formulation in what amounts/proportions?  It would be an incredible boon to our US members if we could find and share a formulation for a compounded oral clonazepam solution that works given that a commercial solution is not available.

 

 

I'll add my voice to say it would be immensely beneficial to have this information, thank you feelberlin.  :thumbsup:

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Hey Libertas!

 

Absolutely! I'll check with the pharmacist. I'm sure he will share, because we have been working so closely and he's an excellent partner through this. I offered your idea and the link you shared and he figured it out for the 1mg:20 ml ratio that we were going for to simulate the valium benefits in cutting. I'll post it as soon as I have it.

 

Because it is not a tested compound, it will trigger the 14-day disposal warning, but the compound is fine. Although compounding can be done with the tablets, using the pure K powder eliminated the filler and it helps with making sure that each dose is exactly the same.

 

Oh, and flavoring can be anything. He's just partial to peppermint because it helps with his stomach upset.

 

After substituting a dose, he has a bit of a spike in symptoms but that evens out within a week. One good thing that seems to be associated with the compound is that his sleep is better (more days than not). Anxiety is still high, but that goes with tolerance withdrawal. He's angsting about life being wasted in this limbo... I feel him... I try to remind him that impatience can be catastrophic and share the stories I read from you guys and your successes and perseverance. He's worried about brain damage, how to upregulate the gaba receptors and above else- like everyone else here- when life will feel like life rather than survival...

 

It's hard... but he will do it... all of you will as so many of you have.

 

Thank you so much for asking...

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Okay so this is what my pharmacist responded:

 

"We use a small amount of water to wet the clonazepam powder, and the main liquid vehicle is propylene glycol. Flavored with peppermint oil."

 

Not very specific... I will break down the current formula my husband is using.

 

This is for a 1:20 ratio, 14 day supply:

 

14 mg clonazepam (pure powder form)+280 ml propylene glycol+ 5 ml water (+about 40 drops of peppermint flavoring)

 

This creates the equivalent of liquid diazepam, but with the potency of clonazepam, for those who cannot cross over but still want the safety/ convenience of precise cuts.

 

My husband intends to attempt daily microtapers of 0.1 ml (the pharmacist kindly provided us with the syringes to make cuts that small). The thought here is that, if the change is miniscule, the brain may be tricked.

 

My husband's case is so difficult because of his insanely sensitive neurochemistry, but I think that the "recipe" would work for most anyone out there (unless someone is allergic to the solvent? Not that I've heard, because it's the bases for just about any commercial liquid pharmaceutical combo, so I hope it's THAT benign for everyone).

 

Also of note, my pharmacist did attempt the medium chain triglycerides and ethanol option and it was not stable enough for comfort. In his words "propylene glycol worked beautifully".

 

 

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Thank you every so much for obtaining and sharing this information with us, feelberlin!

 

The formulation you’ve described would yield a liquid with a concentration of approximately 0.0035mg of clonazepam per mL (1 divided by 285 or thereabouts depending on the volume of the 40 drops of peppermint flavoring).  0.1mL of the liquid would equate to just 0.00035mg of drug — definitely a very small amount.

 

Your husband is indeed fortunate to have you to support him during this challenging journey.  I wish you both the best hope you will keep us posted as to his progress.

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You are most welcome Libertas and I hope that this helps some of the buddies here.

 

Please let me know if there is anything more that you would like to know and I will check with my pharmacist. If there is a part of the website that I can list the pharmacy info as a resource for people in the DFW area that want to try this, I would would be happy to do that. I have nothing but praise and they carry a bunch of certifications that give me peace of mind.

 

Also a question.

 

My husband is currently taking his medication in 4 doses:

 

8 am: 2.5 ml compounded clonazepam + .125 mg ODT (the last pill to be replaced... next week, probably) + 2.5 mg diazepam

12 pm: 2.5 ml compounded clonazepam + 2.5 mg diazepam

4 pm: 5 ml compounded clonazepam

8 pm: 5ml compounded clonazepam + 2.5 mg diazepam

 

Does it make more sense to consolidate into 3 doses instead?

 

Plasma concentration stability is what led to the 4 doses, because he metabolizes clonazepam very fast, but Ashton had cautioned about revolving your day around meds...

 

Thoughts are very much welcome...

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Hello again, feelberlin.

 

Re: additional questions for your pharmacist ...

 

I’d be interested to know why he elected not to use the other ingredients found in the Iraqi formulation. 

 

Re: sharing contact info for your compounding pharmacist ...

 

We don’t have a specific thread or board for this purpose, but perhaps we should consider this. Let me ask the team about it.

 

Re: consolidating doses ...

 

If your husband is a fast metabolize of clonazepam, I would not consolidate doses.  We have members who dose 4, 5, even 6 times a day; it just becomes part of their daily routine.  No big deal.

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First of all, TERRIBLE typo (corrected in the original post): 14 mg clonazepam (pure powder form)+280 ml propylene glycol+ 5 ml water (+about 40 drops of peppermint flavoring)... Not "1 mg".... Omg...  :-[

 

As to your question, the reason that the pharmacist went with something as simple as possible is because it decreases the likelihood of complications and increases the likelihood of a positive reaction in the case of someone like my husband who has very negative reactions to medication.

 

That was the appeal of the clonazepam+alcohol+water- 3 ingedients, beautifully simple and translucent, so that, when you shake to distribute any sediment, you can observe if it looks right. It just didn't work for him.

 

Honestly I wish milk was a more comfortable option, but the issue I came across in experimenting is the foam when you shake it. Some medication may be there. If you wait, some of the medication may float back to the bottom, which will affect accuracy...

 

The above may sound paranoid and I know that milk has worked for people... having seen him with akathisia though, I'm okay being paranoid if I can help him in some way, and anyone that may benefit.

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Thank you for that correction, feelberlin.  Those numbers sound much more reasonable.  If my math is correct, your husband’s compounded clonazepam solution has a concentration of about 0.049mg/mL (depending on the volume of the peppermint drops).

 

Your husband is not alone in having issues with homebrew liquid made with regular clonazepam tablets, alcohol, and water.  It works for some individuals but not for others.

 

fyi ... The sediment/particles you observed in the homebrew liquid may have included undissolved clonazepam. Per our Titration: FAQs, our current understanding is it is unlikely that 100% of the clonazepam molecules embedded in regular tablets go into solution when a small amount of off-the-shelf alcohol is added to the tablets. It’s entirely possible that some of the molecules do not dissolve or, if they do dissolve initially, some may precipitate back out of solution when additional water is added to the tablet/alcohol slurry. This is why we encourage members to treat such homebrew liquids as suspensions, not solutions (e.g. shake the liquid vigorously before using to maximize homogeneity and measure quickly — water is a very poor suspending vehicle due to its low viscosity).

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