HELP - Compound pharmacy not open

Hey guys! I need help quickly.

 

I just switched to a liquid compound Friday. I was doing okay - overly sleepy but adjusting well.

 

I just went to take my midday dose and it’s jellied and ruined. I had it refrigerated like I was instructed to do so I’m not sure what happened.

 

I’m trying to figure out if I should go back to weighing  pills until I can get in touch with the pharmacist Tuesday or if I should try a liquid myself.

 

I tried it a year ago and failed miserably - I felt awful after one dose so maybe pills are best in the meantime?

 

I switched to liquid compound due to inaccurate weighing since pills are SO small and I couldn’t get stabilized.

 

If I were to do my own liquid, can someone help me quickly with the formula?

 

Lorazepam .5mg tablet

I take .06mg 3 times a day

Did you ever work with Bob7 when you were weighing your dose?

After my freak out, the compound is not jelly. It just got too cold and needed to thaw. It looks good now.

 

I will call the pharmacist when they open tomorrow to make sure it’s okay but I’ll continue with it.

 

Thank you so much for responding quickly pamster!

 

I’ve been through so much with forms of Ativan, this scared me.

I had the same thing happen to my compound when it got pushed to the very back of the refrigerator (which is colder and sometimes freezes things).  Your liquid should be ok.  Just be sure to shake it vigorously before you measure your dose.

 

I forgot to add ... if you don’t already have one, you might consider investing in a refrigerator/freezer thermometer so you can monitor the temperature in your refrigerator.  For example: Taylor Classic Refrigerator / Freezer Analog Extra-Large Dial Thermometer.

I wondered if that could be the problem, its like drippings from meat will jell in the fridge but once you take them out they go back to liquid form.  I'm glad you figured it out and that Libertas was able to add her experience.

I had the same thing happen to my compound when it got pushed to the very back of the refrigerator (which is colder and sometimes freezes things).  Your liquid should be ok.  Just be sure to shake it vigorously before you measure your dose.

 

I forgot to add ... if you don’t already have one, you might consider investing in a refrigerator/freezer thermometer so you can monitor the temperature in your refrigerator.  For example: Taylor Classic Refrigerator / Freezer Analog Extra-Large Dial Thermometer.

 

Thank you so much Libertas! The pharmacy is closed and we had an ice storm. I’m new to compound like this (I had a bad experience previously with oil compounds - not stability tested or refrigerated) so I was slightly panicking.

 

I am ordering a refrigerator temperature now. What temp should it be at? I have also turned ours up a tad and moved it away from everything in the door.

I wondered if that could be the problem, its like drippings from meat will jell in the fridge but once you take them out they go back to liquid form.  I'm glad you figured it out and that Libertas was able to add her experience.

 

Yes! I kept saying it was frozen but it was kind of jelly so I thought it was ruined. I was so confused how it froze when there was a little alcohol in it but I think it just got too cold and “froze” together and just needed to thaw.

 

I was so scared because everything is closed and I have a bad experience with compounds (old formula wasn’t soluble or stable so dosing was off). I thought it was ruined!

 

Now we know - hopefully my freak out helps someone else LOL.

You are welcome, HopeForTomorrow.  I keep my refrigerator at around 37 degrees Fahrenheit.

You are welcome, HopeForTomorrow.  I keep my refrigerator at around 37 degrees Fahrenheit.

 

Perfect. I will do that. Thank you again, libertas. You are a gem!

You are welcome, HopeForTomorrow.  I keep my refrigerator at around 37 degrees Fahrenheit.

 

Libertas, after 2 really good days/nights, last night was horrific with withdrawal symptoms so it made me worry about the compound some.

 

Well I shook it last night around 9:30pm and woke up at 6am to take my dose, it’s sold again. I had turned our refrigerator down so it doesn’t make sense?

 

I am hoping our pharmacy opens at 9am but we’re in an ice storm so I’m scared they’re closed today.

 

What should I do? Leave it out again? Go back to pills temporarily even though I had uneven dosing due to pill weight?

I’m sorry you had a difficult night.  I agree you would be wise to get in touch with your compounding pharmacist to let him/her know what you are experiencing with your liquid and ask if this is expected behavior.  I also suggest you ask what ingredients are in the liquid, in what amounts, and if one or more of the ingredients might be a factor.

 

In the meantime, I’d just return to whatever method I was using previously.  I know some members worry a great deal about dosing accuracy.  However, to quote one of our senior moderators who has extensive experience as an analytical chemist plus ‘knows a thing or two’ about pharmaceuticals and pharmacology:

 

“Try to be reasonably accurate, but don't stress over it.  If you're a few percent over on one dose, you'll probably be a few percent under on another dose.  It kind of averages out over time.”

 

Edit: wording

I’m sorry you had a difficult night.  I agree you would be wise to get in touch with your compounding pharmacist to let him/her know what you are experiencing with your liquid and ask if this is expected behavior.  I also suggest you ask what ingredients are in the liquid, in what amounts, and if one or more of the ingredients might be a factor.

 

In the meantime, I’d just return to whatever method I was using previously.  I know some members worry a great deal about dosing accuracy.  However, to quote one of our senior moderators who has extensive experience as an analytical chemist plus ‘knows a thing or two’ about pharmaceuticals and pharmacology:

 

“Try to be reasonably accurate, but don't stress over it.  If you're a few percent over on one dose, you'll probably be a few percent under on another dose.  It kind of averages out over time.”

 

Edit: wording

 

 

Well, I spoke to my pharmacy and found the answer. They added a filler to the lorazepam powder so that they could weigh accurately because they do not have the best scale.

 

To me, once that filler is added, the PCCA formula is messed up - she said that may be why it keeps jellying like that. She couldn’t tell me if what it did messed with the stability or accuracy - she also wouldn’t allow me to bring it back to get another prescription without the doctor okaying it.

 

So I spoke to another pharmacy who has better equipment and all they do is compounding. He said he could help and do the exact formula and solution from PCCA.

 

I have to get a new prescription with my doctor and it won’t be in until Wednesday.

 

I am praying so badly this is the answer. I have been through so much with dosing options and liquid compounds.

Thank you for the update, HopeForTomorrow.  It sounds like the first pharmacy may have been well-intentioned but lacked the necessary equipment and expertise to prepare your compound. 

 

Finding the right compounding pharmacy requires due diligence.  Generally speaking, pharmacies that specialize in compounding are preferable to those that do not.  Other indicators to look for include appropriate accreditation(s) and/or affiliations.  So, tip of the hat for finding a pharmacy that specializes in compounding and is a member of PCCA!

Thank you for the update, HopeForTomorrow.  It sounds like the first pharmacy may have been well-intentioned but lacked the necessary equipment and expertise to prepare your compound. 

 

Finding the right compounding pharmacy requires due diligence.  Generally speaking, pharmacies that specialize in compounding are preferable to those that do not.  Other indicators to look for include appropriate accreditation(s) and/or affiliations.  So, tip of the hat for finding a pharmacy that specializes in compounding and is a member of PCCA!

 

Thank you so much Libertas! I wish the other pharmacy would have been more transparent but I do not think they realized how much it matters with this medication.

 

I am back to weighing pills, unfortunately and will try again with the new compound.

 

Something has got to give!

 

Thank you again 🤍

Thank you for the update, HopeForTomorrow.  It sounds like the first pharmacy may have been well-intentioned but lacked the necessary equipment and expertise to prepare your compound. 

 

Finding the right compounding pharmacy requires due diligence.  Generally speaking, pharmacies that specialize in compounding are preferable to those that do not.  Other indicators to look for include appropriate accreditation(s) and/or affiliations.  So, tip of the hat for finding a pharmacy that specializes in compounding and is a member of PCCA!

 

Hi Libertas!

 

I got my new compound today. It seems correct. I asked the pharmacist if he had any issues with the formula, he said not at all.

 

Here’s my dilemma - I took my first dose (nighttime) and about an hour later started having BAD irritability, physical anxiety - full fledge withdrawal. It’s been about 4 1/2 hours since - insomnia and symptoms are not letting up - they continue to worsen and are pretty awful.

 

Is this normal for the transition? The other compound I felt “drugged” and slept 9 hours so I’m wondering if that one wasn’t mixed well or something.

 

Anyways - is this normal? Should I just ride out the awful symptoms? Starting to feel like I just took a dose of water. Oof, it hurts.

I see in your signature you've tried liquid compounding before but it hasn't worked? It might be that you're sensitive to the liquid because I know you're very sensitive to almost anything?

 

Just shooting in the dark here but if liquid proves not to be working for you, would it be possible for the pharmacy to make you pills? I know there are members who get their pharmacists to compound capsules to help them reduce. Would that be something you might want to consider? Anyway I'm sure Libertas will also have some very good suggestions.

 

I'm sorry it has been such a struggle. And well done to you for sticking it out with everything that's been thrown at you. 

I see in your signature you've tried liquid compounding before but it hasn't worked? It might be that you're sensitive to the liquid because I know you're very sensitive to almost anything?

 

Just shooting in the dark here but if liquid proves not to be working for you, would it be possible for the pharmacy to make you pills? I know there are members who get their pharmacists to compound capsules to help them reduce. Would that be something you might want to consider? Anyway I'm sure Libertas will also have some very good suggestions.

 

I'm sorry it has been such a struggle. And well done to you for sticking it out with everything that's been thrown at you. 

 

I have had issues last year with the liquid compound suspensions. The pharmacy I used last year (and this precious one) did not use PCCA formulas so they weren’t stability tested. I did stabilize on a liquid suspension last year (NOT PCCA) after an updose but each .001mg cut threw me and I later learned I couldn’t necessarily trust a suspension - especially not one that’s not stability tested.

 

I was doing well with the transition of this previous one until it messed up in the refrigerator. I’m now wondering if that one wasn’t mixed well since the pharmacy messed it up too and I had an updose - that’s why the transition was easy - I was more sedated.

 

With this one, it feels like a huge cut. Horrible symptoms already and that worries me. I do not want to updose, get stuck and then have to find yet another method to this.

 

My only hope is that if I do have to updose to stabilize on this one, maybe cuts will be easier/better experience than last year since this is a stability tested PCCA formula.

 

How long do I give it to know if I need to updose, etc?

The way you've explained the situation feeling like an updose and cut seems to make sense, especially if you tolerated the liquid.

 

I have no idea how long you should give it to stabilize before considering an updose. I guess it depends if it's considered a cut or a crossover to liquid or both. Hopefully Libertas would give you some insight. I'm sorry I can't be of more help.

 

Please hang in there and know you're not alone.

Greetings, HopeForTomorrow.

 

Let’s focus on the positive news first.  You now have a professionally formulated and compounded liquid form of your benzodiazepine!  Even better, if it’s the formulation I’ve seen, it is likely a solution (not a suspension).

 

Next, let’s examine the facts.  First, it is not uncommon for members to experience an uptick in symptoms when they make a change in dosage forms — especially if they are also experiencing high anxiety about making the change. Second, if I’m remembering correctly, you have had other issues that might be making you more sensitive to the change.  Third, it’s entirely possible you were taking a higher dose than you thought you were in dry form. Consequently, when you switched to liquid at what you thought was an equivalent dose, you actually made a reduction in dose.

 

Now, let’s discuss options.  One would be to hold at your current dose for another day or so in hope your symptoms begin to stabilize.  Another would be to gradually titrate your dose upwards (e.g. by 2.5% to begin) to see if that helps.

 

Finally, in case you haven’t already discovered it ... for benzodiazepine-specific information and support, you might want to read and/or post to the Tapering off Ativan Support Thread at:

 

http://www.benzobuddies.org/forum/index.php?topic=44903

Greetings, HopeForTomorrow.

 

Let’s focus on the positive news first.  You now have a professionally formulated and compounded liquid form of your benzodiazepine!  Even better, if it’s the formulation I’ve seen, it is likely a solution (not a suspension).

 

Next, let’s examine the facts.  First, it is not uncommon for members to experience an uptick in symptoms when they make a change in dosage forms — especially if they are also experiencing high anxiety about making the change. Second, if I’m remembering correctly, you have had other issues that might be making you more sensitive to the change.  Third, it’s entirely possible you were taking a higher dose than you thought you were in dry form. Consequently, when you switched to liquid at what you thought was an equivalent dose, you actually made a reduction in dose.

 

Now, let’s discuss options.  One would be to hold at your current dose for another day or so in hope your symptoms begin to stabilize.  Another would be to gradually titrate your dose upwards (e.g. by 2.5% to begin) to see if that helps.

 

Finally, in case you haven’t already discovered it ... for benzodiazepine-specific information and support, you might want to read and/or post to the Tapering off Ativan Support Thread at:

 

http://www.benzobuddies.org/forum/index.php?topic=44903

 

Thank you so much Libertas!

 

Can I hold here for a bit and if in the next couple of days it doesn’t improve at all or gets worse, is it safe to do 2.5% increase at that time?

 

I guess it’s easier for me to fight through this if I know stability is around the corner. The symptoms are pretty torturous right now and worse than they’ve been in a long time.

 

Is it normal for the switch to throw me for a huge loop initially (especially with all of the back and forth this week?) This feels so much worse than “normal withdrawal” but then again I was doing dry cuts at 4% and hadn’t made much headway in cutting.

 

Thank you again Libertas! Very familiar with the tapering off Ativan Support Thread and go there often.

You are most welcome, HopeForTomorrow.  I wish I could answer your questions, but there are few absolutes or guarantees regarding benzodiazepine discontinuation.  Each of us is a guinea pig in our own ‘n of 1’ (single subject) experiment. It’s clear you possess both the intelligence and drive to find solutions to whatever issues you may encounter.  I have every confidence you will make the right decisions for you!

 

Edit: wording

How are you doing HopeForTomorrow?

How are you doing HopeForTomorrow?

 

Thank you so much for checking on me Libertas! So kind.

 

I decided to stay at .18mg but it’s been a bizarre ride. After 2 nights of insomnia, I had 2 good(ish) nights. Then 2 nights of insomnia again. Lots of physical symptoms - flu like symptoms where I just have to lay around, eye pain, severe malaise and off and on body/leg aches.

 

It feels VERY up and down - does this sound “normal” for a transition after some up and downs with weighing, etc?

Hello, HopeForTomorrow!  Thank you for checking in — I’ve been thinking about you and hoping you’re ok.

 

Ups and downs are quite common during any taper change ... especially ones that involve a change in dosage form.  I don’t have experience with lorazepam, but with clonazepam, it can take up to 3 days for a change to fully ‘register’ and 10+ days for things to settle back down.  Needless to say, it’s important to refrain from making any additional changes in the taper (e.g. making a dose reduction) until things settle back down.

Hello, HopeForTomorrow!  Thank you for checking in — I’ve been thinking about you and hoping you’re ok.

 

Ups and downs are quite common during any taper change ... especially ones that involve a change in dosage form.  I don’t have experience with lorazepam, but with clonazepam, it can take up to 3 days for a change to fully ‘register’ and 10+ days for things to settle back down.  Needless to say, it’s important to refrain from making any additional changes in the taper (e.g. making a dose reduction) until things settle back down.

 

 

Thank you Libertas! I’m going on day 7 and having pretty horrid symptoms. Weak, can’t hold my eyes open, severe flu like symptoms/malaise but can’t sleep. I was falling asleep/dosing off this evening, took my evening dose and then immediate stimulation, waves of fear, insomnia, some tinnitus. It’s like my body is saying *danger - this is poison*

 

I am trying to hang on but scared liquid is just not metabolizing correctly for me. This is my 5th shot at a liquid - second PCCA stability tested.

 

Has anyone ever dry cut using a pharmaceutical grade scale? I’m willing to pay $600 if it will help me have accurate dosing in pill form and a steady taper.

 

My .5mg pill weighs on average .050grams. I’m at .006grams (.06mg), 3 times a day. Obviously impossible to weight on a cheap scale.

 

I found this one:

Hanchen Digital Analytical Balance, 0.1mg Precise Electronic Scale for Lab/ Pharmacy/ Jewelry Store/ Chemical Plant 0.0001g (120g/0.0001g) https://www.amazon.com/dp/B01MU940MZ/ref=cm_sw_r_cp_api_glt_i_VN002YEAZAFDW6N2NFG2

 

 

My other option if my body continues to reject this liquid is to do Bob’s method. I tried once before - it was fairly easy but I had a pretty immediate reaction to it - shivers and shaking for hours, derealization and waves of doom. I also didn’t love that the pills and the filler were the same color so I was never confident. I’m willing to try again if this is the safest option and I can’t tolerate liquid.

 

My compound pharmacy will not do compound capsules because my dose is so low, it would be too expensive they said.