Why Milk?

  I am curious as to why milk is listed as the vehicle of choice in the titration FAQ.  Any preparation of crushed tablets into a suspension, by a pharamcist, uses a methylcellulose containing mixture.  There are commercially available syrups specifically designed for this purpose, but plain old methylcellulose is a common OTC laxative.

 

  Any preparation of a liquid solution using a raw benzodiazepine, be it oral, injectable or other, uses a 40%+ propylene glycol or a propylene glycol/PEG mixture.  Benzodiazepines are soluble in both these chemicals, and insoluble in water. PEG is also available as a common OTC laxative, and propylene glycol can be obtained, by the gallon, from veterinary suppliers for about $30.

 

  So, why use milk?

 

Thanks.

Hi whacker1,

 

Welcome to BenzoBuddies! In response to your questions, benzos tend to adhere to the fat in milk. As far as using other prepared suspensions, I don't see why you couldn't use them, some may contain sugar? Others may be able to answer that part of the question.

 

T2

Hi,

 

As Theresa explained, the benzo powder seems to have an affinity for the fat in milk - this makes it preferable to water. Additionally, milk is readily available.

 

We will probably look more closely and more 'professional' solutions at some stage, as they do offer some advantages over milk. How expensive are the liquids you have described? This is a significant factor for some people.

    Propylene Glycol runs about $30 a gallon.  PEG 400 goes for about $40 per 500ml.  A commercial syrup like Ora-Plus/Ora-Blen goes for about $25 for 500ml.   

 

    I  have yet to come across any medical literature which uses crushed tablets in propylene glycol or polyethylene glycol.

 

   OTOH  check this article out from the University of Maryland Medical center:

 

"Extemporaneously Prepared A 0.1 mg/mL oral suspension has been made using five 2 mg tablets, purified water USP (10 mL) and methylcellulose 1% (qs ad 100 mL); the expected stability of this preparation is 2 weeks if stored under refrigeration; shake well before use

Nahata MC and Hipple TF, Pediatric Drug Formulations , 2nd ed, Cincinnati, OH: Harvey Whitney Books Co, 1992"

 

 

   umm.edu/altmed/drugs/clonazepam-030200.htm

 

    I'm guessing they're using a suspension because of the binders in the tablets.

   

 

Is methylcellulose a laxative at these kind of volumes? For obvious reasons, members might be reluctant to use too much of it!

Is methylcellulose a laxative at these kind of volumes? For obvious reasons, members might be reluctant to use too much of it!

 

          Not a few cc's of a 1% solution.  It's just a common fiber.

 

http://shopping.yahoo.com/search;_ylc=X3oDMTEwNTByOW5sBF9TAzI3MTYxNDkEc2VjA2ZwLXRhYgRzbGsDc3Bpcml0?p=methylcellulose&fr=yfp-t-131&toggle=1&cop=mss&ei=UTF-8

 

 

I will look at this again later. We use titration to allow for small, but very frequent cuts to the dose. Some people seem to react very poorly to cuts from pill-splitting when they reach lower doses, and our titration method has worked very well for those people. Although I am sure that our method - that allows for reductions as small as 1% of just one of their tablets from their daily dose - is huge overkill for 99% of people, any replacement method would need to offer significant improvement over the relatively large cuts obtained when pill-splitting. Maybe you have missed this point with our titration method? It is less about obtaining a particular concentration/dose, and more about making tiny, but frequent cuts to the dose. It is about cutting out the relatively large drops in dose associated with pill-splitting. We would need to work through some numbers to determin how well this might replace our existing method, or if it is more of an alternative method for different circumstances.

I will look at this again later. We use titration to allow for small, but very frequent cuts to the dose. Some people seem to react very poorly to cuts from pill-splitting when they reach lower doses, and our titration method has worked very well for those people. Although I am sure that our method - that allows for reductions as small as 1% of just one of their tablets from their daily dose - is huge overkill for 99% of people, any replacement method would need to offer significant improvement over the relatively large cuts obtained when pill-splitting. Maybe you have missed this point with our titration method? It is less about obtaining a particular concentration/dose, and more about making tiny, but frequent cuts to the dose. It is about cutting out the relatively large drops in dose associated with pill-splitting. We would need to work through some numbers to determin how well this might replace our existing method, or if it is more of an alternative method for different circumstances.

 

  Titration is a good idea.  I get it.  I just doubt the use of water or milk as the best vehicle for making those tiny cuts.  I'd say the margin of error could be fairly substantial.  Just looking to perfect the idea.

 

I understand your concern, but people tend report good results, even when using water. More care must be taken when using water, and I believe milk delivers more accuracy, but a 'professional' solution would be great. It does, however, bring added complications. Most people titrating are changing dose every 1 or 2, or sometimes, 3 days. It would be relatively easy to make up syrup to a particular concentration, but what about making a new concentration every day or two? Until I run through some real numbers, I cannot be certain of the practicalities of this method delivering a dose that can be finely manipulated from day-to-day. Even if it does not offer the fine manipulation of our present method, we should still explore it. A method that allows people to take the med around with them has definite pluses over our present titration method. Of course, the liquid you mention should be refrigerated, but still, it still offers greater portability. New solutions can always be make up anyway, because for this to work, each solution is unlikely to be used for long (if they are making small and frequent cuts to their dose).