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Getting compound custom dosages at compounding pharmacies (US, UK, Canada, and elsewhere)


Altostrata

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I am getting compounded capsules of Seroquel from Johnson Pharmacy in Waltham, MA. They can create sustained-release capsules. They also appear to ship nationwide.

2006-11: rx-ed klonopin for anxiety from life trauma  

2011: accidentally c/t klonopin....lots of healing but reinstated on 20mg valium 8 months later after alchohol use (stay away from booze!)

-tapered valium over the course of a year  2012: hospitalized for 8 weeks after major s/a bc of failed valium taper and put on Seroquel 350mg xr and multiple drug trials w/SSRIs, mood stabilizers, etc. 2013: multiple hospitalizations and failed drug trials

-tapered all other drugs and "stabilized" on Seroquel xr and started tapering 2014: re-hospitalized after failed taper, added amitryptaline

-bounced around on different doses of Seroquel xr, maximum 600mg 

2015: finally found good doctor and therapist, tapered amilitryptaline to zero

=looking to start taper again from 550mg Seroquel xr but rough somatic symptoms, especially at night

-failed reduction of 12.5mg in late August, updosed back to 600mg seroquel xr, intense somatic sx at night

-starting in november, using compounded capsules to drop 3mg every 5-8 days

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  • 4 months later...
  • Moderator Emeritus

Anyone having capsules compounded should get a few quotes - the price range is astonishing!

 

I got quotes recently for 200 and 300 x 1mg capsules of pristiq (with slow-release additive).

Pharmacy 1:  $100 per hundred , so 300 caps.costs $300:00

Pharmacy 2:  $ 55 for 200 caps. , 300 caps. costs $80:00

 

About the "slow-release additive"  (necessary for pristiq and some other meds.):

""We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 
 PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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  • 5 months later...
  • Moderator Emeritus

Put my Pristiq tablets in to be compounded today and I asked the compounding pharmacist about the slow release and he told me it is in the capsule, not added to the ground up tablet.

 

My compounder charges me $75 for 500 capsules based on a bulk order.  I provide my own tablets.  And he uses different coloured capsules for different doses :D

 

If anyone in the Sydney area is interested, please PM me and I can provide the details of this pharmacy.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Chessie, that sounds like a brilliant solution to tapering Pristiq. How long does the prolonged-release additive extend the effect of the drug?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Roy Katz of www.customrx.com can ship to any state in the U.S. with a doctor's prescription. Roy will speak with your doctor to explain how it works. He is an expert in custom compounding Cymbalta and has helped hundreds from the Facebook group " Cymbalta Hurts Worse ". We have used him about 3 years with no complaints. About $60.00 a month. He will provide the paperwork for the patient to file insurance reimbursement if needed.
 


Dec. 29, 2016 -- Update

Update on Roy Katz, customRX. He is no longer practicing.

I am now working with a new compounding pharmacy in called Pharmacy Solutions. www.pharmacysolutionsonline.com - Important to ask for Michelle Wong.

They can fulfill prescriptions in 34 U.S. States. I'm working to get them up to speed on Cymbalta tapering, as well as co-coordinating with the prescribing doctor. There is a learning curve for sure as this drug is like no other for some people.

Edited by scallywag
add update on pharmacy
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BethSimmons, as I asked before, how does Roy Katz compound Cymbalta, other than put the beads into other capsules?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 months later...
  • Moderator Emeritus

I thought I would post this here to help anyone who is trying to calculate their doses for compounding.

 

I will be dropping by less than 10% so I hope to only have to hold for 3 weeks to start but I will have additional 2mg x 42 and 1mg x 21 if I need them.

 

Col 1 = No of days on the dose
Col 2 = dose
Other columns are how many tablets I need of each dose for the no of days

Col 1                2        3            4            5           6          7

No of Days     MG     20mg     10mg      5mg      2mg      1mg
21                   29       21                        21         39          6
21                   27       21                        21         21
21                   25       21                        21
21                   24       21                                     42
28                   23       28                                     28        28
28                   22       28                                     28
28                   21       28                                                 28
28                   20       28                                                    .

21                   19                    21           21         42
21                   18                    21           21                     21
21                   17                    21           TBA
21                   16                    21           TBA
21                   15                    21

Row 1                         196       Later       105       200        83

Row 2                           200                     100       200      100
Row 3                           20mg                   5mg     2mg      1mg

Row 4                           4000                    500      400       100     5000
Row 6                                                                                        50
Row 7                                                                                        50 tabs needed

Rows below the underlining are the start of my next batch of compounded tablets.

Row 1 = total number of capsules needed of that particular dose
Row 2 = rounded to nearest 100 (which is the minimum quantity of a dose)
Row 3 = is just for ease of seeing what quantity I need of each dose for ordering
Row 4 = this is the total of the dose to work out how many 100mg tablets are needed
Row 6 = Row 4 total divided by 100mg tablets
 

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 3 months later...

South African Resources

 

Not much to say about resources in South Africa. They are few and far between.

Needless to say the psychiatrist at Valkenberg Psychiatric Hospital had never heard of slow tapering, Fagron, compounding pharmacies etc.

 

So thanks for the WWW and the other SA.

 

 

Meds Pricing

Our meds pricing is controlled and available online here.

 

 

Compounding Pharmacies

There appear to be two main compounding pharmacies in South Africa:

The Compounding Pharmacy, and Fagron Pharmaceutical Compounding Services.

 

Fagron has a branch in Cape Town, which is why we chose them.

They barely put a markup on making up doses of Risperidone to a 0.1 microgram or 0.0001mg decimal point accuracy.

(although to be honest I didn't try weighing the pills to check, not that I could.)

 

They were extremely professional. More like a laboratory than a pharmacy.

  1. Email them your prescription with the new doses, preferably specified by the prescribing doctor.
  2. They will contact you in 3 days to collect or deliver.
  3. Each taper range is in its own bottle, marked with a very small number: 1, 2, 3, 4, etc
  4. Each dose is in a blue capsule

 

 

Fagron Pharmaceutical Compounding Services

http://www.fagron.co.za/

Fagron Cape Town
+27 (0)21 933 5545
Email: cpt@fagron.co.za


Fax: 086 619 4632
61

Clarendon Street


Parow Valley


Cape Town



Fagron Johannesburg
+27 (0)11 675 5331
Email: jhb@fagron.co.za


Fax: 086 619 4398
55

14th Avenue


Northcliff EXT. 17


Johannesburg



Fagron George
+27 (0)44 873 4158
Email: grg@fagron.co.za


Fax: 086 613 1467


Unit 60
14 CJ Langenhoven Street


George

The Compounding Pharmacy

https://www.compounding.co.za/
2 Eaton Ave
Cnr Bryanston Dr.
Bryanston
Co-ordinates: -26.046316 | 28.021929
Email: pharmacist@compounding.co.za
Email: orders@compounding.co.za
Phone: 011 463 0310
Operating hours: Mon-Fri 8.30am – 5pm  ( closed public holidays)

I am here as a supporter to certain individuals undergoing withdrawal, and to learn from and contribute to the forum where possible.
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  • 2 months later...
On 3/4/2012 at 10:20 AM, Altostrata said:

In the United States, these compounding pharmacies will fill prescriptions by mail:

Hi Alto,

To order these meds, do i need a prescription from my dr ??

Great infomation here, TY

Prestiq 50 mg : 2010 - 2016

Prestig 100 mg: Oct 2016- July 2017

Prestiq 50 mg : July 2017 

Along w/ Adding in....

Effexor 37.5 July 2017 w/Prestiq

Trazodone 1-2 pills 4 sleep

Only took EFFEXOR 8 DAYS, STOPPED

TRAZODONE 4 days, STOPPED

 

TAPERING PRESTIQ ONLY : 50MG

BEGUN JULY 27, 2017 Still doing this to Stabalize At this Dose.

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4 hours ago, Ttgreat54 said:

Hi Alto,

To order these meds, do i need a prescription from my dr ??

Great infomation here, TY

States vary in what they require for pharmacies to fill prescriptions.  Most reputable online pharmacies will require you to have a written prescription.  Contact (call or send a message via the contact us page on a website) several of the pharmacies listed and ask what they need to fill from you in order to ship you the medication your doctor has prescribed.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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18 hours ago, scallywag said:

States vary in what they require for pharmacies to fill prescriptions.  Most reputable online pharmacies will require you to have a written prescription.  Contact (call or send a message via the contact us page on a website) several of the pharmacies listed and ask what they need to fill from you in order to ship you the medication your doctor has prescribed.

Ty Scally,

Yes I did contact them, waiting to here back.

Ty

Prestiq 50 mg : 2010 - 2016

Prestig 100 mg: Oct 2016- July 2017

Prestiq 50 mg : July 2017 

Along w/ Adding in....

Effexor 37.5 July 2017 w/Prestiq

Trazodone 1-2 pills 4 sleep

Only took EFFEXOR 8 DAYS, STOPPED

TRAZODONE 4 days, STOPPED

 

TAPERING PRESTIQ ONLY : 50MG

BEGUN JULY 27, 2017 Still doing this to Stabalize At this Dose.

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  • Altostrata changed the title to Getting custom dosages at compounding pharmacies (US, UK, and elsewhere)
  • 1 month later...
  • Moderator Emeritus
2 hours ago, Oceanrat said:

As I try and navigate a messy situation here. And figure out why my taper has gone so awry, I sent my compounded Zoloft to an independent lab for analysis (I know it’s extreme but when you’re suffering in this manner you go to extremes). I’m not saying all compounding places are this way, but here were my findings. The Zoloft was supposed to be 40mgs. I sent 3 capsules in, the active ingredient in 3 were:

35.1

39.3

42.3

not sure if that’s causing my problems, but wanted to share how far off they’re. Now I guess I attempt to bridge over to full liquid, but feeling , well not so confident . 

 

 

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 1 month later...

I'm having a very hard time finding a compounding pharmacy that will compound Pristiq for me. Most of them just say it's impossible. I called the Peoples RX in Texas and they no longer ship out of state. 

 

Does anyone have a good solution for finding a compounding pharmacy that will do slow release formulations that can either mail to me in Washington OR is actually in Washington State?

 

Thanks

Current: Pristiq 50 mg and Wellbutrin 200mg

dweb-tapering-off-pristiq

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I am tapering by getting my Pristiq compounded.  I've gone 75mg to 4mg using this method.  My Intro topic link is in my signature.

 

To find a compounder:  http://www.pccarx.com/Resources/FindACompounder

 

Also see this topic:  Please see this topic:  Tips for tapering off Pristiq (desvenlafaxine)

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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19 hours ago, ChessieCat said:

I am tapering by getting my Pristiq compounded.  I've gone 75mg to 4mg using this method.  My Intro topic link is in my signature.

 

To find a compounder:  http://www.pccarx.com/Resources/FindACompounder

 

Also see this topic:  Please see this topic:  Tips for tapering off Pristiq (desvenlafaxine)

 

Yeah, I went to PCCAR and looked for compounding pharmacies. Called about 10 or 12 and none would work with Pristiq. I'm learning how lucky you were to find someone local that would do that for you. 

 

I've read all through the Pristiq tapering topic and think I'm just going to have to go the Effexor route. I've created a introduction topic and will update there. 

Current: Pristiq 50 mg and Wellbutrin 200mg

dweb-tapering-off-pristiq

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  • Moderator Emeritus

I have contacted the pccarx because I think it is important for them to know that 1) it is possible to compound Pristiq if they don't already know this, and 2) to advise their members that it is possible

 

I have provided my compounding pharmacist's contact information in the above and following correspondence.

 

I have also contacted these pharmacies:

 

https://paramountpharmacy.com/contact/

 

https://www.keycompounding.com/contact/

 

I will let you know if I get a response from them.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • Moderator Emeritus
On 3/17/2019 at 11:22 AM, ChessieCat said:

I have contacted the pccarx

 

And received the following response:

 

I have not provided Ranel's address because it may change in the future if this person leaves the organisation but this is the one I used and you can send it   Subject:   ATTN:  Clinical Compounding Pharmacist

 

customerserviceexternal AT SYMBOL pccarx DOT com

 

Thanks so much for contacting us regarding this.  There are definitely some options on compounding this product and we are happy to assist a pharmacy with the knowledge on how to do this.  We have many member pharmacies within the state of Washington that are PCCA members and would be able to assist this patient.  Do you know where in Washington State your contact is located?  If you can provide that information I can direct them to a pharmacy that is a PCCA member.  That pharmacy is welcome to contact me through our members only website or by calling customer service and I can assist them with a formulation. 

Thank you and have a wonderful day!

Ranel A. Larsen, Pharm D, RPh | Clinical Compounding Pharmacist

PCCA | 9901 South Wilcrest Dr. | Houston, TX 77099-5132

Ph: 800.331.2498    

Fax: 800.874.5760 | PCD Fax: 713-234-6009

www.pccarx.com

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • Moderator Emeritus

This has been added to Post #1 of this topic:

 

Quote

 

 

MOD NOTE:  If you cannot find a pharmacist who will compound your drug I suggest you contact the main compounding organisation in your country and ask them if your drug can be compounded and if it can, to advise you of a pharmacy who can do the compounding for you.  Or you could ask the compounding pharmacy to contact the compounding organisation.

 

PCCA - Professional Compounding Centers of America (includes:  Bahamas, Canada, US, Singapore, Taiwan, Thailand, Australia, New Zealand, Philippines, Malaysia)

https://www.pccarx.com/Resources/FindACompounder

 

 

 

If anyone knows the name of a compounding organisation in their country please post here and I will add the details.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Added pharmacy.ca in Canada to

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Altostrata changed the title to Getting custom dosages at compounding pharmacies (US, UK, Canada, and elsewhere)
  • 2 months later...

As far as choosing the best Compounding Pharmacy, does PCAB Accreditation really matter?

ANTI-DEPRESSANTS (approximates):

2000--2009/10. Zoloft, mid-high dosage. Alprazolam, as needed, rarely. 

2009/10--2016/17. Cymbalta, 90 mg

Early 2017--Mid-2017. Cymbalta, 60 mg

Mid-2017--Jan 2018. Cymbalta, 30--60 mg, reduced in 30 mg increments w/o physical w/d symptoms, possibly some emotional w/d symptoms. Mar 2018--Early 2019. Back on Cymbalta, fluctuating dosages from 30 to 90mg. Reduced from 60 to 30, then from 30 to 0 again, this time WITH very light physical w/d symptoms. Back to 30mg. Early 2019--April 2019. Cymbalta, 30mg. Down from 30 to 0. Physical w/d symptoms again. Back to 30mg. May 2019. Cymbalta 30 mg. Down to 20 mid-month. Started taking every other day in final week of the month. 

Jun 2019. Cymbalta 10-ish mg. Started “eyeballing” about half of the beads in the capsule. Taking every other day, then at mid-month every 4 days. 

July 2, 2019. Took last dose of “eyeballed” 5-ish mg. July 24, 2019. Took first reinstatement dose of 2mg. Dropped down to 1mg (6 beads) the very next day.

Aug 6, 2019. Up-dose to 1.33 mg. Aug 30, 2019. Up-dose to 1.5 mg. 

SUPPLEMENTS

Vitamin D3 4,000 IU/day

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  • 6 months later...

I luckily found a compound pharmacy to help with tapering mirtazapine. They are located on Long Island, New York. They have two locations, one in Westbury and one in Carle Place. I was able to give them my mirtazapine pills and they compounded them (liquid) while I waited. The cost is $15. They also give you a couple of syringes and will help you with the math. There are two locations, Westbury and Carle Place. I went to the Carle Place one. Their website is www.carmandrugs.com. Marie.

10/13--10/14 Ambien. Started tapering 1/14  Jumped 10/14.  Done.                                                                              

3/14        7.5 Remeron  still taking this.                              

2/14         75 Trazodone   -    Tapered by dry cutting all the way down.

1/16        4 mg Trazodone  -  Jumped. Bad mistake. Got hit with late withdrawal 6 weeks later. Reinstated.

4/16        Reinstated 1 mg, updose to 2 mg Trazodone

2/19        .04 Trazodone. Walked off.  Done.

10/3/19  Started 7.5 Mirtazapine taper cut to .073 gram weight, pill weighs .076

4/5/20    New Mirtazapine Taper - Compound Liquid 7.35 mg April '20, 7.25 mg May, 7.05 mg June, 6.99 mg June, 6.78 mg July, 6.57 mg Aug, Sept 6.35 mg, Sept 6.24 mg, Sept 6.21 mg, Oct 5.99 mg, Oct 5.90 mg, Oct 5.70 mg.

1/11/21 6.05 mg Messed up taper due to syringe change. Must remember the 1 ml syringe contains 1.5mg! 1/16/21 5.99 mg

2/21 5.75 mg, 3/21 5.6 mg, 4/7 5.45, 4/14 5.30, 5/12 5.15, 5/25/21 4.99 mg, 6/29 4.87 mg, 7/14/21 4.74 mg, 8/5 4.62 mg 8/17 4.5 mg, 8/30 4.38 mg,9/16 4.26 mg,10/9 4.14 mg, 10/23 4.05 mg, 11/6 3.96 mg,11/17 3.87mg.***Jan 22 Liquid was changed/couldn't tolerate***Changed back to pills. Feb 22/3.9 mg, 2/17/22 3.8 mg, 3/23 3.7 mg, 4/7 3.6 mg, 5/10 3.5mg,6/10/22 3.4 mg, 7/4 3.3 mg, 7/25 3.2 mg, 8/20/22 3.1 mg, 9/15 3 mg, 10/8/22 2.9 mg., 12/15 2.8 mg, 1/6/23 2.7 mg, 2/16/23 2.6 mg, 3/9 2.5 mg, 4/4 2.4 mg, 4/29/23 2.3 mg, 5/26 2.2 mg, 6/22/23 2.1 mg, 10/14 2 mg, 11/12 1.9 mg, 11/28 1.8 mg ,12/14/23 1.7, 12/31/23 1.6 mg, 1/20 1.5 mg, 2/6/24 1.4 mg, 2/12 updose 1.5 mg, 3/27/24 1.4 mg,5/31/24 l.2 mg. Taking multi-vitamin, vit. D, cholestoff, psyllium husk, and fish oil.

 

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  • 7 months later...
21 minutes ago, ChessieCat said:

getting-custom-dosages-at-compounding-pharmacies-us-uk-canada-and-elsewhere

 

I suggest you also post your question is the above topic.

 

You also ask your compounding pharmacist for assistance.

 

 

I'm working with a compounding pharmacy.    I'm wondering if anyone has had luck getting Kaiser Permanente to write compounding prescriptions for tapering. 

Also, if Kaiser won't do it,  should I ask for a prescription for 20mg so it's easier to weigh?     

Cymbalta/Duloxetine

2012-2014 - Cymbalta/Duloxetine 60mg

2015- Duloxetine compounding pharmacy taper from 60mg at 5mg per month, ~10 months.

March to June 2016 – off Duloxetine. 

June 2016- Tried many different drugs to treat sever anxiety: Paxil, Prozac, Latuda. 
July 2016- Reinstated Duloxetine 60mg.  
8/24/20- Reduced from 60mg to 30mg of Duloxetine.  (I thought I could do this due to my whole food plants only diet and vigorous exercise routine, huge mistake!)

9/6/20 – Reinstated 60mg due to unbearable withdrawal symptoms: non-specific anxiety, anger, agitation, sore eyes, weight loss, headache, trouble staying asleep, and dizziness. 

9/11/20 – I’m feeling much better after reinstating 60mg, but still a little anxious. 

 

I want to do a 10% monthly taper from the last dosage once I stabilize on my initial dose of 60mg

 

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  • ChessieCat changed the title to Getting compound custom dosages at compounding pharmacies (US, UK, Canada, and elsewhere)
On 10/31/2015 at 12:56 AM, peggy said:

 I asked her how can they be sure that the effexor is evenly distributed between the capsules and she said the machine mixes well. 

Hello Everyone,

 

I am currently in Luxembourg and was thrilled to find out last year that I had access to a compounding pharmacy.  It didn't occur to me to check that they were indeed safe and reliable.  After experiencing emotional and behavioural changes which have been really tough, it occurred to me to check exactly how the pharmacy was compounding the drugs.  There are 2 pharmacies in the country which claim to offer compounding, but my interpretation of the process they describe seems to me to be so unlikely to be a reliable method.  I am calling it the "cake mixture" method, as it seems to me to be not much more sophisticated than putting white flour in a bowl, then adding yellow flour, and mixing it multiple times before spooning it out into capsules resulting in equal volumes (hopefully) but of, surely, unequal ratios of white to yellow - in my case, of Zopiclone to excipient.

 

I am housebound, so my father kindly asked the pharmacist to describe each step.  He detailed as follows:

 

1. Equipment. Pharmacy-grade mortar and pestle, scraper, scales, volumetric vertical measuring column, capsule-filling apparatus.
 
2. Calculations. The pharmacist knows the volume of product required to fill precisely 60 capsules. He calculates the milligrams of Zopiclone tablets required to give the dosage of 0.58 mg of active Zopiclone molecules in each capsule.  Note that the 7.5mg tablets contain only a small quantity of active Zopiclone molecules and a larger quantity of excipient (mainly lactose), so he has to calculate the milligrams of tablets accordingly. He then calculates how many milligrams of lactose he will have to add to the crushed Zopiclone tablets to give the precise quantity to fill 60 capsules. 
 
3. Process. He uses a mortar and pestle to crush the Zopiclone tablets into powder, and mixes this powder with the lactose powder that he adds. This mixing process is laborious, and typically he will make three or four "rounds" of mixing to ensure even dispersion of the Zopiclone powder with the lactose excipient.  He then puts the total powder into the volumetric measuring column to ensure that it is precisely correct.  He then prepares the 60 empty capsules by placing them in the capsule-filling apparatus - essentially a series of flat tray-like panels one of which is perforated with holes with exactly the diameter of the capsules.  He inserts the 60 capsules which fit exactly into the holes, with their tops flush with the panel.  He then pours the powder on to the panel, and spreads it out so as to fill each capsule with the precise quantity desired, so there is no residue left on the panel - each capsule is full and flush with the level of the panel.  Finally another part of the apparatus is lowered on to the capsules, and inserts the top of the capsules to seal them.
 
4. Questions. (a) How does the pharmacist ensure homogeneity of product? He told me that the mortar and pestle process is time-honoured and works to a high degree of precision, particularly as the mixing process is repeated several times. The pharmacist does regular checks that the process ensures homogeneity, particularly with interns and new or younger staff: these checks are done by carrying out the process with a coloured excipient and a white powder to examine the consistency of samples of the mix and of any residues. The pharmacist had no doubt that the process is completely reliable. (b) How does he ensure that each capsule is filled with the same correct amount?  This is achieved by the process of filling each capsule precisely up to its rim, as described above.
 
5. Conclusion. This is, clearly, a manual process - it is not performed by a robot. This means that one has to trust the professionalism and experience of the pharmacist to carry out the production with total reliability and precision.
 
*
I'm sorry this is lengthy for everyone who is familiar with this.  I need to understand it properly to know what my options are.  I would be so grateful if someone could confirm whether I am correct and that the above method is simply not reliable.  To me, it seems so likely that I could be taking 0.23mg of Zopiclone one night, 0.67mg the next night, 0.09mg the next night, etc.  As I have had such severe problems, with a lot of other difficulties in my life, I need to ascertain if this could be part of the problem.  I need to arrange my next prescription soon.  It would be extremely helpful to know whether I can trust this method or whether actually, machines are needed to work with the tiny amounts of drugs we are dealing with.  If this is the case, I will have to find alternative ways to complete this taper, and indeed address the further 3 that lie ahead.
 
Thanking you all very much in advance.  My very best to everyone, particularly anyone who is fighting just to keep going, as I am.
 
Harriet8

1997   1st psychiatric appt: began medications (no record);   2002   Efexor XL, Xanax, Risperdal, Stilnoct; 2003  Efexor, Xanax, Stilnoct, Serlain;   2004   many medications (no record), but including Lithium, Diazepam, Lorazepam;   2005  Clomipramine; Imipramine; (8 sessions of Electroconvulsive Therapy, ECT);   Sept 2005 Citalopram, Quetiapine 800mg, L-Tryptophan;   2006 - 2009 Reduced L-Tryptophan and Quetiapine, finished Quetiapine Nov 2009;  Jan 2010  Began reducing Citalopram   >>>STARTED NOTICING SOMATIC SYMPTOMS (described above)>>>   2012   Citalopram, Diazepam, Zolpidem, Promethazine, Risperidone, Mirtazepine, Trazadone, Buspirone, L-Tryptophan, Chlorpromazine, Alprazolam   Sept 2012medications changed to Citalopram, Quetiapine, Diazepam, L-Tryptophan;   2015 - 2017: reduced meds until just Citalopram 60mg;   2017  1 May   Citalopram, 50mg   25 May Citalopram, 40mg   Dec 2017 - Apr 2018: Citalopram, 35mg > 30 mg >   25 mg > 20mg;   2018   1 May Citalopram 30mg,   21 May 35mg   Jun Diazepam, 2mg, increased to 6mg (3 x 2mg to assist eating)   Aug Zolpidem for 10 days   Sept Zopiclone 3.75mg;   (Nov: inpatient admission):  Dec Pregabalin 100mg added, Diazepam increased to 8mg, Citalopram increased to 40mg;   2019  Jan Citalopram 40mg, Diazepam 8mg, Pregabalin 100mg, Zopiclone 3.75mg (now reducing Zopiclone: 2.81mg on 2 May, 1.88mg on 16 May)

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Do a search for making compound capsules on Youtube for videos.

 

 

 

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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I asked the other mods of their thoughts on how accurate compounding methods are and BrassMonkey responded with the following:

 

Quote

 

 

You are never going to get the exact same dose from capsule to capsule using any method. Even the Big Pharma manufacturers can't do it. Using the method listed above is about as good as you're going to get. There are mixing standards that have been developed and tested over the centuries to get as close to a homogeneous mixture as possible, and they are very accurate.

 

The only place I see an error sneaking in is during the capsule filling process. It is, however, the industry standard  and will yield capsules that are with in a few milligrams pill weight of each other. When you extrapolate this to the milligrams active ingredient in the capsule the difference in actual dose strength is minimal. Well within the international standard of 3%. Yes, that means that you could, in theory, get a 6% variation from day to day, but the likely hood of that more than once is very small.

 

A minute daily variation in dose strength should make no difference in a taper. You have to take into account half lives, blood serum concentrations, daily metabolism, bio availability, in addition to dose variation. So even if the capsules were exactly the same you would still be getting a different dose every day. All we can hope to do is to keep the daily doses as consistent as possible and cope with it as best as we can. The system isn't perfect, but it is pretty darn close, and it is all we have to work with anyway.

 

 

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Thank you, ChessieCat and BrassMonkey.  Looking at videos and they do seem to be similar to what my pharmacist here is doing.  It surprises me, as it does not seem reliable enough.  My sister is a chemist and thought it was most definitely not adequate.  Her explanation was difficult to understand.  I will return to it.  But if there is no access to anything else, I can only work with what is available and possible in my situation.  I am very grateful for your help and so promptly.  Thank you.

1997   1st psychiatric appt: began medications (no record);   2002   Efexor XL, Xanax, Risperdal, Stilnoct; 2003  Efexor, Xanax, Stilnoct, Serlain;   2004   many medications (no record), but including Lithium, Diazepam, Lorazepam;   2005  Clomipramine; Imipramine; (8 sessions of Electroconvulsive Therapy, ECT);   Sept 2005 Citalopram, Quetiapine 800mg, L-Tryptophan;   2006 - 2009 Reduced L-Tryptophan and Quetiapine, finished Quetiapine Nov 2009;  Jan 2010  Began reducing Citalopram   >>>STARTED NOTICING SOMATIC SYMPTOMS (described above)>>>   2012   Citalopram, Diazepam, Zolpidem, Promethazine, Risperidone, Mirtazepine, Trazadone, Buspirone, L-Tryptophan, Chlorpromazine, Alprazolam   Sept 2012medications changed to Citalopram, Quetiapine, Diazepam, L-Tryptophan;   2015 - 2017: reduced meds until just Citalopram 60mg;   2017  1 May   Citalopram, 50mg   25 May Citalopram, 40mg   Dec 2017 - Apr 2018: Citalopram, 35mg > 30 mg >   25 mg > 20mg;   2018   1 May Citalopram 30mg,   21 May 35mg   Jun Diazepam, 2mg, increased to 6mg (3 x 2mg to assist eating)   Aug Zolpidem for 10 days   Sept Zopiclone 3.75mg;   (Nov: inpatient admission):  Dec Pregabalin 100mg added, Diazepam increased to 8mg, Citalopram increased to 40mg;   2019  Jan Citalopram 40mg, Diazepam 8mg, Pregabalin 100mg, Zopiclone 3.75mg (now reducing Zopiclone: 2.81mg on 2 May, 1.88mg on 16 May)

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I've been using compounded Pristiq for all of my taper without any major issues.  And as BrassMonkey states, there can be variations in our metabolism anyway.

 

The alternative method of DIY by grinding tablets and weighing out the powder has similar accuracy issues.

 

The most accurate method is creating a liquid/solution/suspension but that is not possible with some drugs.

 

The way I see it is that we have to do the best that we can.  I think that the alternative of making bigger reductions or jumping off at a higher dose is more risky than the tiny variations that might occur with compounding.

 

Something that you may not have considered is that Zopiclone has a short half life, so if you are taking at night to aid sleep, so only once a day, then you are already having inconsistent dosing, ie the level in your body goes up and down during a 24 hour period every day.

 

I don't think you need to be concerned about the compounding.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 2 weeks later...
  • Moderator Emeritus

 

AUSTRALIA - Online compounding chemist

 

On 11/12/2015 at 2:19 AM, JanCarol said:

Ian Owles

Australia Online Compounding Chemist

http://www.australiancompoundingchemist.com.au

10 Kosciusko Crescent

Southport, QLD 4215

07 3040 1960

0422 64 3378

 

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 3 weeks later...
  • Moderator Emeritus
17 hours ago, freeaway said:

Hey everyone! I actually found a compounding company that is able to do any form of dosage for Pristiq with extended formula!

I just spoke to them and they can alter it with extended release with any dosage! So they can literally make it into micro dosages!

 

Please share if anyone needs this type of service!

 

https://valorcompounding.com/

 

The girl I spoke to was name Lauren, she was very nice and helpful.

 

 

Please note this compounder that Freeaway found (Freeaway lives in New York). 

 

 

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  • 9 months later...

question about compounding Zoloft

 

Hi, I have a question in case someone knows, when a medication is compounded (in capsule form, crushed and then encapsules) would this affect the efficacy of the drug? would crushing it make the person absorb it more quickly than intended?

•august 2016- feb 2019: on and off SSRIs (fluoxetine and agomelatine) also unknown drug and clonazepam for a short amount of time 

_________________________________________________________

•January 25 2020: 50mg of setraline and clonazepam 1mg 

•March 2020: increase to 100mg of setraline

•May 2020:  stopped setraline, fast tapper 3 weeks. stopped clonazepam, according to how my psychiatrists told me. 

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4 hours ago, Istm said:

question about compounding Zoloft

 

Hi, I have a question in case someone knows, when a medication is compounded (in capsule form, crushed and then encapsules) would this affect the efficacy of the drug? would crushing it make the person absorb it more quickly than intended?

 

This is a question you could ask the compounder.  However I do NOT think that it would cause any issues.  I think we have members here who crush their tablets and weigh their dose.  I know that BrassMonkey did this for his successful taper off Paxil.  It might take a little while for your body to adjust to the new form of the drug because it will be entering your body in a different way.  It is better to only make one change at a time, so when you change to the capsules you would NOT make a reduction.  When changing form of drug it is suggested that you do a cross over (if possible) to make it gentler on your system:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

You can make your own liquid Zoloft.  You could find other members taking Zoloft to see how they are tapering.

 

tips-for-tapering-zoloft-sertraline

 

how-to-make-a-liquid-from-tablets-or-capsules

 

I have been getting my Pristiq tablets compounded for the majority of my taper.  The compounder added slow release formula to the powder.  Once I got to a very low dose I have been using the contents of the capsules to make a liquid.  I have had no issues doing either of these things.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • 1 month later...
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This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 4 months later...

I just called a couple of local compounding pharmacies and found that it's doable as long as I have my doctor's prescription (which may need to include a tapering schedule), but that if I wanted to get a liquid formulation to replace tablets, the shelf life is no more than 14 days. And, as other people have mentioned, it would be expensive; that's $60 a month just in compounding fees.

TreeFrog          Key:   v = decrease; ^ = increase

2008: started citalopram

2019-2020:  trazodone: Sept 16-July 31

2021:  Nov 6 v cit 15mg; Nov 12 v cit 10mg; Nov 24 switched to duloxetine 30mg; Dec 8 ^ dulox 60mg

2022:  Jan 16 v dulox 30mg; Jan 31 skipped dulox doses; Feb 11 stopped dulox; Mar 20 reinstated dulox 1.9mg; Mar 26 v dulox 1.15mg; Mar 28 started traz 25mg; Mar 29 stopped dulox, started cit 5mg; Mar 31 ^ traz 37.5mg; Apr 3 ^ traz 50mg; Apr 6 ^ cit 10mg; Apr 13 ^ cit 15mg; Apr 15 v traz 37.5mg; Apr 20 v traz 25mg; Apr 23 v traz 12.5mg; Apr 29 ^ traz 18.5mg; Jun 23 v traz 16.5mg; Jul 1 ^ traz 18.5mg; Nov 3 v traz 17.5mg; Dec 20 v traz 15.75mg

2023: Jan 12 v 14mg traz; Jan 28 v 12.5mg traz

2024: May 2 v 10mg traz

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  • 7 months later...

Compounding Pharmacy Error

 

You are not going to believe this ****. Or maybe you will, but I’m still shocked!

 

So yesterday I picked up another 30 day script for 13.5mg lexapro since I’m about to run out. I noticed that the pill size was back to what it had been originally before last month, which was the only month it was a good bit smaller. Picture attached. 
 

When I got home I called the pharmacist about it and he explained some generics use different fillers and that the dose of the drug should still be the same despite using different generics (which actually started the month before and I was fine). I can say with 100% certainty now that the previous month‘s dose was not 13.5mg. After having brain zaps every single day for the last several weeks (and a slew of other symptoms including invasive suicidal thoughts) they have finally completely dissipated after I took the first of the new batch of pills this morning. 
 

I still have two of the previous months pills and want to see if there’s a way I can prove they gave me the wrong dose through a lab test. I have never been a litigiousperson but in this case I feel they should be held accountable. 
 

What do you think about this? I suffered through my wedding, starting a new job, sleepless nights and suicidal thoughts all because they made a careless error. I am really just happy that I am already feeling better but feel it’s irresponsible to just let it go.  Thanks again for all your help!

 

Edited by ChessieCat
Resized font

2005-2008 Paxil (anxiety)

2008-2011 Lexapro

2011-2016 Pristiq 50mg

2016-2018 Effexor 75mg

2018-2020 Lexapro 20mg

2020-2022 Lexapro 20mg and Wellbutrin 150mg

6/2022 Stopped Wellbutrin CT

7/15/22 Began tapering at 15mg lexapro at 10%

11/15/22 Lexapro 13.5mg

12/15/22 Lexapro 12.15

2/15/22 Lexapro 12.15..holding

 

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097BBF6F-1385-4967-93A1-524AA3D550BD.jpeg

2005-2008 Paxil (anxiety)

2008-2011 Lexapro

2011-2016 Pristiq 50mg

2016-2018 Effexor 75mg

2018-2020 Lexapro 20mg

2020-2022 Lexapro 20mg and Wellbutrin 150mg

6/2022 Stopped Wellbutrin CT

7/15/22 Began tapering at 15mg lexapro at 10%

11/15/22 Lexapro 13.5mg

12/15/22 Lexapro 12.15

2/15/22 Lexapro 12.15..holding

 

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24 minutes ago, Grind80 said:

Compounding Pharmacy Error

 

@brassmonkey Do you have any thoughts about this?  Thanks.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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