Valium 5mg titration - dry or liquid micro taper?

Greetings, potatosaur.  I thought you might find the following paper of interest.

Salim M, Eason T, Boyd BJ. Opportunities for milk and milk-related systems as 'new' low-cost excipient drug delivery materials. Adv Drug Deliv Rev. 2022 Apr;183:114139. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0169409X22000291

Abstract: Milk is well recognised as an amazing delivery system for essential lipids, poorly soluble nutrients, sugars, amino acids and delivery of critical biological molecules to sustain the infant and adult alike. It is also a safe and abundant resource with potential to act as a low-cost material for formulation of medicines, especially for paediatric patients and those in low economy settings. However, its use in low cost formulations has never developed beyond preclinical evaluation. Reasons for this are several-fold including variable composition and therefore regulatory challenges, as well as a lack of clear understanding around when milk or milk-related materials like infant formula could best be deployed by linking drug properties with excipient composition attributes, especially when taking digestion into account. This review collects the current understanding around these issues. It is apparent from the evolving understanding that while milk may be a bridge too far for translation as an excipient, infant formula is positioned to play a key role in the future because, as a powder-based excipient, it has the performance benefits of milk powder together with the controlled specifications during manufacture and versatility of application to function as a low cost lipid excipient to enable potential translation for the oral delivery of poorly water soluble drugs for key populations including paediatrics and low economy medicines.

Keywords: Digestion; Formulation; Infant formula; Milk; Poorly water-soluble drug.

Edit: corrected typo to ensure proper username redaction

Thank you, Nogoldchain, for your kind words and your input. I agree with your conclusion regarding the poor solubility of diazepam in water.

 

I have proof-read my previous reply and added further information on whole milk. In particular, to measure it correctly, I have proposed an approximation based on the literature to measure it right out of the fridge instead of waiting for it to settle at room temperature.

 

For those who are interested, I have prepared a spreadsheet to help with micro tapering via dilution of an oral prescription solution with full fat milk. To make your own copy, click on “Share and export” then “Make a copy”. You will then be able to edit your copy.

 

Please read the entire section on milk, the conclusion and the caveat in my previous reply before using the spreadsheet.

 

https://docs.google.com/spreadsheets/d/1LR8pt77N9BCGHJ_rRw5G48aXkN0vaukF9NF_qamxvp8/edit

 

Please fill in the spreadsheet with the following information:

 

- the concentration of your oral prescription solution (e.g. 5 mg / mL)

- the amount of diazepam you want to obtain for your taper

- if you are measuring the milk right out of the fridge instead of letting it settle at room temperature first, either:

  - your room temperature in Celsius degrees as measured with a thermometer. Your room temperature must be at or above 18C.

  - it is strongly suggested that the milk be brought up to between 25 to 40C with a gentle warming method (possibly a cup warmer). In this case, instead of indicating your room temperature, indicate the temperature that you plan to attain — between 25C and 30C to attain sufficient solubility of diazepam in the milk —. Use a food thermometer to monitor milk temperature as it warms up.

Would your work apply to lorazepam as well?  Very sensitive to meds/chemicals and not sure what ingredients to choose for liquid taper.