titrations and pharmacies

I don't know if where I'm moving has a compounding pharmacy, but there is one where I live now. Has anyone ever asked a compounding pharmacy to make titration solutions for them with any success? Did they cost more?

If not, where would I buy a graduated cylinder except maybe at Science Stores at my university if they even sell them to students/former students.

Forgive me if this info is already here, having trouble searching.

My compounding pharmacy makes my concentrations, but my Pdoc has to call in the script.  For example, I was on 1 mg per day of Ativan (.25 at 4 x a day), so my first cut was .85.  My Pdoc called in a script for 30 days of .85 mg / ml, so I took 1/4 (or .25) ml 4 x a day.  When I moved to a total of .7 per day, I just did the math (and had the pharmacist confirm), and took that amount.  I think it was something like .22 ml, 4 x a day.  Still using the same .85 mg / ml, but down to a total of .55 mg over the day, which works out to .16 ml, 4 x a day.  The pharmacist gave me a stash of 1 ml syringes to use, and they have 100 gradations, so I can get that accurate!

 

Just confirm with the compounding pharmacy what they need from your doc.  And, be aware that it may take a few days to make the compounds, (mine is 72 hours), so between getting the call into my Pdoc, them sending it over, and getting it made, I've tried to call my Pdoc at least a week before I need a refill to give it time.

Can I have the name of your compounding pharmacy. Did you use liquid Ativan? Was it easy to measure cuts?

Was this a difficult taper the way you did it? As you went slowly were you able to fully function?

Concerned,  I use the Cumberland Apothecary in Mechanicsburg, PA.  Not sure if that is convenient for you or not.  Very easy to measure cuts.

 

I've been successful so far.  My last cut hit me a bit hard, but I think I'm stabilized and ready to cut again this week.  Keep in mind how fast and how much you can cut really depend on your body and how long you've been on the medications and at what dosage.  Hop on over to the Ativan support thread for more good info; a lot of us who are tapering directly off ativan (at different rates, dosages, etc) are hanging out there with support. 

Thank you for the name of the pharmacy. I live in new york however they can mail it to me. Did they do the math and help you design a liquid titration program? Is it portable and easy to take with me to work? Are you on 3 or 4 doses a day?

 

I am glad to hear it was not to difficult as I need to function and work while I do this? Also, was it expensive and does insurance cover any of it.

 

Thanks so much for your help.

I'm doing the math along with my Pdoc, and the pharmacist confirms it for me.  The taper plan is a work in progress between me and my PDoc.  It's a refrigerated liquid, so if you are working or travelling you'll need to pack in in something with ice packs. 

 

I'm on 4 doses a day -- 3 doses a day gave me interdose w/d during the day.  I still have interdose w/d in the a.m. as there is a long stretch between my 9 p.m. last dose of the day and my 6 a.m. first dose, but I'm not willing to go to 5 doses.  It all depends on your metabolism.

 

Everyone is different in how much they "function" during a taper and w/d.  There are some on these boards that are working full time, etc.  I have taken off work for several months, but only because I've got other medical issues that we are trying to resolve.

 

You'll have to check with your insurance.  My insurance does cover it, but they apply the highest prescription deductible because it is considered a specialized compound.

I'm on 4 doses a day -- 3 doses a day gave me interdose w/d during the day.  I still have interdose w/d in the a.m. as there is a long stretch between my 9 p.m. last dose of the day and my 6 a.m. first dose, but I'm not willing to go to 5 doses. 

 

Hello Hoosierfans.  I am taking 3 doses of diazepam a day and am considering going to 4 doses a day.

 

I'm interested how you deal with the 9 hour overnight period.  Do you split your daily dose so that you take a bigger dose at 9pm?

 

I was thinking of taking slightly less diazepam in the middle of the day and adding the amount to my bedtime dose.  However I was concerned that this might give a higher peak level of diazepam at night and that this may further mess up my GABA receptors.

 

Have you or anyone else got any thought about what is best to do?

 

-Zoner

"I'm on 4 doses a day -- 3 doses a day gave me interdose w/d during the day.  I still have interdose w/d in the a.m. as there is a long stretch between my 9 p.m. last dose of the day and my 6 a.m. first dose, but I'm not willing to go to 5 doses"

 

 

I find it unusual that you have interdose withdrawal (assuming you are on Valium) that would force you to divide the dose that much.  In fact, what I did while trying to figure out WHEN and how to divide the dose, I personally felt that one evening dose was not helpful.  I was all reved up from the day and it did nothing because I was actually sleeping during the peak effects!  (I normally have no problem falling sleeping however.)

 

So I started to take half the dose when I needed it, a few hours before a stressful part of my day (picking my son up from daycare - called 'mothers little helper' for a reason!) and then continued to taper the evening dose.  That seemed to make sense and it was helpful.  When the evening dose was dropped, I now prefer to take my whole dose first thing with all my medications (I have two meds that must be taken in the morning.)  This works for me.

 

I suggest that you actually consolidate a dose and then take it one hour prior to your most stressful part of the day and then the stress won't build up since the dose will be high enough that it will actually have a noticable effect.  I think that you are not going to benefit more or feel less WD than dividing into 5 doses; I think you will feel more WD symptoms overall and sleep deprived too, which will make it even worse. 

 

You may have to accept that you WILL wake up with WD symptoms and figure out how to tolerate it.  What I do is have a real mothers helper get my son off to daycare and then wake up (emerge from my hiding place -under the covers!) Then I take my medications with breakfast and then relax for an hour before attempting the rest of my day.  This is my coping with morning WD and I haven't taken any Valium for 24 hours by then.

 

Maybe your taper schedule is too fast for you?  You may need to simply start taking smaller cuts or microtaper or hold and let the cuts catch up then reevaluate the pace of your taper and supports to put into place?

 

The pharmacist told me that it is better to take the whole dose (that covers the half life) at once, not spread it around so that you benefit from the peak action.  I was given script to take Clonzepam twice daily, but then I would take 1/2 and then the other half if it didn't work and he said that it would work much better if I took the whole tab and then take the next one 8 to 12 hours later.

 

I had interdose withdrawal from clonazapam and it was distinctly different then what I feel now that I am on Valium.  The interdose withdrawal could be anticipated by the clock and was unrelated to my daily adventures and never random.  The symptoms simply came on because I was only taking 2 doses and the medication only covers 8 to 10 hours, so I learned to prevent one interdose withdrawals by taking a second dose 8 hours later, but could count on waking up with severe interdose withdrawal.  With Valium, it really should cover you all day, but maybe it can be more optomized to your daily struggles?

 

I get mild WD symptoms everyday, all day long.  I wake up with withdrawal symptoms.  I get random or not so random symptoms (triggered by stress) all day long and it is mostly tolerable now that I am using the daily taper method.  I am withdrawing from a benzo... and I accept that sometimes it really sucks!