Using a scale to weigh and measure doses

[SlimDunkin6o4]

@ChessieCat

 

I think that I got to the bottom of this. Apparently, my pills don't weigh the amount that they're listed as on my bottle. Turns out, half of a mini-tablet within my 37.5mg Effexor XR is actually about 10 or 11mg as opposed to 6mg. I even tested out a few of my half mini tablets to be sure, and I got the same reading. The full mini-tablet is about 23mg, so this more or less checks out. Which is to say, I accidentally just about halved my dose for nearly three weeks.

 

Obviously, I'm pretty upset by all of this. I was doing so damn well (relatively speaking...) on the roughly cut up half-mini-tablets, and I've just felt awful since I accidentally halved my dose. The worse anxiety I've felt in months and the recurrence of panic attacks (even as I wake up...), moments of confusion, generally spaced out, and about a week-long migraine. I basically couldn't work for about two days there at one point. Awful, awful stuff.

 

I made the correction on Monday, and I'm on 10mg, twice a day, and I can sort of feel myself slowly getting better. I'm not necessarily qualified to comment confidently on any of this, but my hope is that I'll get back to where I was before this dosage SNAFU, and in about as long as it took me to get to this place, too -- which is to say, three weeks. That's my hope, anyway. I'm curious to get people's thoughts on this though!

 

The lesson here, I suppose, is not to trust the measurements on the pillbox. 

 

My questions about how to precisely measure out doses as I work my way down from 10mg remain, though. My scale just cannot pick up anything lower than 4mg. I went through some of the threads out creating a liquid suspension, but none of them seemed to deal with how precisely to do that with Effexor XR -- unless I missed something, which is totally possible.

[JandD]

I would like to briefly address two things I am still unclear on:
 

1) Tablet weight
We have now started the olanzapine reduction with my wife. Small microptapering steps, with a stabilization phase if needed. For this I have bought two digital scales to eliminate measurement errors as much as possible. Namely, I noticed that in some cases weight deviations can occur at once during the weighing process. For example, the scale shows 0.008 g more than at the beginning of the first measurement.
 

The procedure (may sound time-consuming, but it only takes about 5 minutes): 
- Check if 10 g scaling weight is correct
- Weighing the tablet on both scales
- The results are correct or average with the smallest deviation
- Calculation of individual daily dose: (weight of tablet / total dose)*desired dose = weight to be weighed out 
- Example: 20mg Olanzapine tablet, weight is 0.408 g. Desired dosage = 16.7 mg => 0.408 / 20 = 0.0204 => 0.0204 * 16.7 = 0.341 g
- Check the final weight on both scales
 

What I noticed is that the weight of the tablets varies surprisingly.
In 30 measurements, the lowest was 0.400 g and the highest was 0.434 g. As I said, measured by two independent scales. 

I am honestly surprised. If you assume that regardless of the weight of the active ingredient content is always the same, then this means to me that you always have to take into account the weight of the current day tablet in the method by weighing. A flatly calculated average value for subsequent reductions can lead to reasonably large fluctuations (this is irrelevant for the liquid method), especially if it is accompanied by an additional reduction step. Am I wrong with my thoughts here?!

2) Influence of oxygen on active ingredient content
Currently I am dividing small crumbs with a tablet cutter. I collect these crumbs. I would like to use up these crumbs e.g. every 10 days to leave a new tablet unopened (as backup). 

With this dosing step, there would possibly be some inaccuracies, as described above. Here, a mean value would be applied, which is probably 0.417 g per olanzapine tablet in our example.
 

Is there, however, an additional influence on the active ingredient content due to the oxygen? I think I once read here in the forum that this could be possible with certain tablets. I wonder if this influence could also happen with the liquid method - i.e. someone dissolves a tablet and takes a certain amount every day and during this time the liquid is stored maybe for 7 days in the refrigerator?

[ChessieCat]

13 hours ago, JandD said:

What I noticed is that the weight of the tablets varies surprisingly.
In 30 measurements, the lowest was 0.400 g and the highest was 0.434 g. As I said, measured by two independent scales. 

I am honestly surprised. If you assume that regardless of the weight of the active ingredient content is always the same, then this means to me that you always have to take into account the weight of the current day tablet in the method by weighing. A flatly calculated average value for subsequent reductions can lead to reasonably large fluctuations (this is irrelevant for the liquid method), especially if it is accompanied by an additional reduction step. Am I wrong with my thoughts here?!

 

 

What you do is weight 10 tablets and take an average.

 

Even where tablets are compounded by a pharmacist there is still going to be some variation in the dose of each capsule.

[Carmel5]

I take effexor i used a compounding pharmacy in the past, I am now low enough to count the tiny beads in the capsules.

 

[Wanttofreemyself]

Having trouble weighing doses using a scale. So I want to take 27mg of celexa. But I only have 20mg tablets, how would I weigh it and cut it up?

 

So far I take 2 tablets and weigh them then I take the second tablet and shave it down using a nail file till I get a close dose. I hope this makes sense and I hope I'm doing it right.

[ChessieCat]

@Wanttofreemyself

 

Please weigh 10 tablets and divide the total weight by 10 which will give you and average weight.  Once you have done that please advise the average tablet weight as well as re-stating the dose of the tablets (Celexa 20mg) that you are using so that all the information is in one place which will make it easier for whoever helps you.  Thank you.

 

Please also read the relevant section of this topic that Brassmonkey wrote so you can understand the difference in the terms that are used when discussing weighing tablets and calculating doses:

 

brassmonkeys-tips-and-tricks-for-tapering

 

Edited May 27, 2022 by ChessieCat

[Wanttofreemyself]

Thank you. I weighed my ten 20mg tablets and it was 1.370g. After i divided by 10, it was 0.137mg.

 

I still didn't built up the courage to start taking my pills everyday yet. Still skipping one day.

[Wanttofreemyself]

On 5/26/2022 at 11:14 PM, ChessieCat said:

@Wanttofreemyself

 

Please weigh 10 tablets and divide the total weight by 10 which will give you and average weight.  Once you have done that please advise the average tablet weight as well as re-stating the dose of the tablets (Celexa 20mg) that you are using so that all the information is in one place which will make it easier for whoever helps you.  Thank you.

 

Please also read the relevant section of this topic that Brassmonkey wrote so you can understand the difference in the terms that are used when discussing weighing tablets and calculating doses:

 

brassmonkeys-tips-and-tricks-for-tapering

 

By the way, should I just go with the average weight of the pill or still measure my pill before taking them?

[brassmonkey]

When you first calculate the weight of your dose you would use the average weight of the pills. After that you use the weight of the previous dose to calculate the weight of your new dose. So that actual weight of the pills is only used for the initial calculation and no longer applies. In affect after the initial dose the pills become a "supply pile" of material from which you measure a specific amount.

[Wanttofreemyself]

So for example, my pills individually weigh sometimes 133, 134, 135mg but the average weight of 10 pills is 136. What should I be looking at? Sorry trying to figure it out. 

[YachtRock]

5 minutes ago, Wanttofreemyself said:

So for example, my pills individually weigh sometimes 133, 134, 135mg but the average weight of 10 pills is 136. What should I be looking at? Sorry trying to figure it out. 

 

Don't worry, it is confusing for all of us. So you would use 136mg (or 0.136 grams) as your average "pill weight" (mgpw). If those are 20mg dosage pills ("active ingredient" or "mgai") then every 6.8mg of crushed pill powder (136 divided by 20) contains approximately 1mg of the drug. This is as precise as we can get not knowing the exact mixture of chemical and filler so we approximate. You would then crush a handful of them in a pill grinder and work from that pile of powder. So in order to get 27mg dosage/active ingredient, you would weigh out 184mg (27 times 6.8 = 183.6 rounded up) of the powder. As brassmonkey points out, from here forward the only thing that matters is the 6.8mg = 1mg conversion, the weight of the pills only matter if you change the dosage of the pills you are crushing. Taking this another step further, if and when you decide to drop another 10%, your target active ingredient would be 24.3mgai or 165mg of powder (24.3 times 6.8 = 165.24 rounded down).

 

I hope this helps!

[Wanttofreemyself]

Thank you, that was helpful. I began to take only 13.5mg today. No more skipping days

 

I try to cut the pill close enough to the weight and then file it down a little to get the exact weight. I haven't tried to crush my pills before. Not confident in that. 

 

I hope what I'm doing is okay.

 

[YachtRock]

18 hours ago, Wanttofreemyself said:

Thank you, that was helpful. I began to take only 13.5mg today. No more skipping days

 

I try to cut the pill close enough to the weight and then file it down a little to get the exact weight. I haven't tried to crush my pills before. Not confident in that. 

 

I hope what I'm doing is okay.

 

 

If you find that filing down the pills is too frustrating, this is the pill grinder I use which works well:

https://www.amazon.com/gp/product/B07D3X37L8/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

 

I think taking 13.5mg daily makes the most sense to me, but I would imagine the filing process to get tedious very quickly! Then again so is weighing and filling empty capsules every two weeks  Hang in there, you sound like you are on the right track.

[Wanttofreemyself]

Thank you, 

 

And is it more recommended to take your dose at the exact same time everyday?

[YachtRock]

49 minutes ago, Wanttofreemyself said:

And is it more recommended to take your dose at the exact same time everyday?

 

Absolutely 100% yes

[brassmonkey]

Very nicely explained @YachtRock.

 

As you probably noticed it can be a bit tricky keeping track of what you are talking about when you say xxmg. This might help:

 

Because both weight and strength are measured in milligrams it is easy to confuse them. We add the MGAI and MGPW designations when discussing our doses so we can tell which number we are talking about. We use MGAI when talking about what dose we are taking but use MGPW to weigh out that dose on the scales when dry-cutting. Both of these measurements need to be recorded in your notes.

MGAI Milligrams Active ingredient, this is the strength of the drug in a single dose. It is in your prescription and is listed on the packaging. For example, I was taking 40mg Paxil at the start of my taper. 40 milligrams is the amount of active ingredient in each tablet. As we taper this number decreases with each reduction. The MGAI is also part of the strength designation for liquid preparations. It is listed as a ratio of Mg/mL.

MGPW Milligrams Pill Weight, this is the physical weight of the full tablet or the weight of the powder for a reduced dose as measured on the scales. It is different from the MGAI because each manufacturer adds fillers to make the pills.

The MGAI and the MGPW are proportional to each other. By making a change to one of them the same change is automatically made to the other. If we reduce the weight of the dose (MGPW) that we weigh on the scale by 10% then the strength of the dose (MGAI) is also decreased by 10%.

 

The way you made your calculations is correct. But doing it that direction can make the calculations a bit more difficult. If you come at it the other way round you will get an answer in Strength of Active ingredient per 1mgpw. It makes the calculations a little easier to follow.

 

AIC, Active Ingredient Concentration, is the ratio of Active Ingredient to Pill Weight. It is calculated by dividing the MGAI by the MGPW. This will tell us how much Active Ingredient is in 1milligram of pill/powder.

 

[Wanttofreemyself]

2 hours ago, YachtRock said:

 

Absolutely 100% yes

Thank you. Will be doing that

[Wanttofreemyself]

3 hours ago, YachtRock said:

 

If you find that filing down the pills is too frustrating, this is the pill grinder I use which works well:

https://www.amazon.com/gp/product/B07D3X37L8/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

 

I think taking 13.5mg daily makes the most sense to me, but I would imagine the filing process to get tedious very quickly! Then again so is weighing and filling empty capsules every two weeks  Hang in there, you sound like you are on the right track.

Yeah I don't think I'm ready to crush my pills yet.  Maybe in the future. Seems pretty technical. 

 

Thank you,  trying to hang in there.

[Wanttofreemyself]

I have a bunch of smaller broken pieces of tablets. Can I still use them?

 

Is it alright to throw them together on the scale till I get my accurate weight?

[Wanttofreemyself]

On 6/2/2022 at 7:54 AM, YachtRock said:

 

If you find that filing down the pills is too frustrating, this is the pill grinder I use which works well:

https://www.amazon.com/gp/product/B07D3X37L8/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

 

I think taking 13.5mg daily makes the most sense to me, but I would imagine the filing process to get tedious very quickly! Then again so is weighing and filling empty capsules every two weeks  Hang in there, you sound like you are on the right track.

What empty capsules do you use?

[YachtRock]

5 hours ago, Wanttofreemyself said:

I have a bunch of smaller broken pieces of tablets. Can I still use them?

 

Is it alright to throw them together on the scale till I get my accurate weight?

 

Yes that works fine. I did that when I was tapering Propranolol. Kept breaking them into small chunks of 1-4mg each. The final weight is all that matters.as for the capsules I use, I have the gelatin ones and wish I had bought the vegan capsules but this is what I have:

 

Capsuline Size 0 Empty Gelatin... https://www.amazon.com/dp/B00PYUZ5UQ?ref=ppx_pop_mob_ap_share

[Wanttofreemyself]

Does the original pill weight of the broken tablet pieces matter when putting it on the scale? Because I don't know it. I only know the  average pill weight, 0.136mg.

 

According to my calculations I only need to take about 0.91/0.92mg a day. 

 

For example, Can I throw like 4 broken tablet pieces on the scale if it adds up to 0.91mg and take that dose?

 

I'm unsure if the active ingredient will be the same if the broken tablet piece are from different pills. Will it still be fine? Will I get the same dosage?

[YachtRock]

So you are now taking half of your previous 27mg dose everyday so based on the math we previously discussed 0.092 grams sounds correct. I worry you are mixing up your numbers. The common jewelers scale most of us use measures in GRAMS but up to three decimals. So 0.136g is actually 136mg. When you say 0.92mg you realize on a scale that is actually 0.00092 grams which our scales can NOT measure. So you would add pill fragments until your scale reads 0.092 which is 92 milligrams of pill weight. Since each 20mg pills weighs 136mg the numbers sound correct but he careful of your measurements and decimals places

[Wanttofreemyself]

Yes thank you, sorry about that. 

 

Does it matter if it's 1 or 2 milligrams more or less? Or you have to be precise each time? For example, sometimes the scale can get fidgety and read 91, 92, or 93mg.

[Wanttofreemyself]

18 hours ago, YachtRock said:

 

Yes that works fine. I did that when I was tapering Propranolol. Kept breaking them into small chunks of 1-4mg each. The final weight is all that matters.as for the capsules I use, I have the gelatin ones and wish I had bought the vegan capsules but this is what I have:

 

Capsuline Size 0 Empty Gelatin... https://www.amazon.com/dp/B00PYUZ5UQ?ref=ppx_pop_mob_ap_share

Are the vegan capsules better?

[Wanttofreemyself]

I was talking to the pharmacist earlier and was asking about my leftover pieces of tablets from pill cutting and they don't recommend that I use them even to combine to try get an accurate weight on the scale.

 

Anyone ran into this problem?

[YachtRock]

I am NOT a medical professional or a pharmacist, but I disagree with them. I see no reason why fragments of a pill (cut, shaved, crushed or whatever) would not provide the same amount of drug regardless of the state of the tablet. Maybe it would cause a problem if these fragments or pieces were sitting in a container for a few years, but I personally think you are safe. Curious if anyone else disagrees.

[ChessieCat]

6 hours ago, Wanttofreemyself said:

I was talking to the pharmacist earlier and was asking about my leftover pieces of tablets from pill cutting and they don't recommend that I use them even to combine to try get an accurate weight on the scale.

 

Anyone ran into this problem?

 

Many members here keep the left over bits of their tablets to use.  You just need to ensure that you store them properly and use them within a reasonable time.

 

The majority of pharmacists will (most likely) be following what the drug companies tell them.

 

There are some tablets that members have to be aware of what they do with them.  But the information is contained in Post #1 of the relevant Tips for Tapering topic for that particular drug.

 

myths-about-your-drugs

 

[Wanttofreemyself]

5 minutes ago, ChessieCat said:

Many members here keep the left over bits of their tablets to use.  You just need to ensure that you store them properly and use them within a reasonable time.

 

The majority of pharmacists will (most likely) be following what the drug companies tell them.

 

There are some tablets that members have to be aware of what they do with them.  But the information is contained in Post #1 of the relevant Tips for Tapering topic for that particular drug.

Yeah this young pharmacist looked at me like I was doing or asking something dangerous. They looked confused that was I using a scale and told me to take the whole pill 20mg but I said I only wanted 13.5 mg of it. Then they said try cutting the pill into fourths

[Finnishgirl]

On 9/12/2021 at 7:15 PM, Nomansland said:

Hello everyone,

 

i want to make a post about even distribution in powder/crushed tablets.

 

So, a lot of people asking if mixing powdered tablets will create an uniform distributed powder (active ingredient + fillers).

When we think about about how actual pharmacies compound medications or capsules, it is clear that good mixing creates a evenly distributed powder.

 

Please see these videos from pharmacies, which explain how they compound capsules. They dont use special equipment or expensive machines.

All of them just mix and mix active ingredients and filler until an even, fine powder is formed and fill them in capsules using a target weight (as long as you know you get your specific weight of powder in your capsule, it doesnt matter how to fill them). Thats how every pharmacy will compound capsules in any country.

 

https://www.youtube.com/watch?v=KQ1zEWnyYcw

 

https://www.youtube.com/watch?v=qqwMv0Ly_1c

 

https://www.youtube.com/watch?v=g8JLKzzRjHs

 

In addition, our previously intact tablets were already very fine and even mixed (bulk) powder of active ingredients + fillers before they were pressed in the machine (thats how normal immediat release tablets are made, see this video: https://www.youtube.com/watch?v=ofUIvL397FI). Once powder is mixed together, it will not "spontaneously" unmix by even more gently swirling/mixing.

 

So in my opinion, if you are unsure about distribution using this method, just grind them fine and mix the powder for some time, because thats what pharmacies do

around the world and there should be no problem.

 

Greetings

 

Hey! This is what I have been wondering too. Like, is it okay to just dry cut the tablet with a knife? Is it evenly distributed? Some folks in my own country's tapering group have even asked this from Big Pharma companies that have replied that the active drug might not be evenly distributed unless there is groove (then the amount of drug on both sides is even). On the other hand, I would also think that the processing of the tablets is such that it should be evenly distributed.

[UncleLeroy]

Measuring doses using a digital scale

 

I found all the information to do this from reading this site. (I am helping my husband taper from 5mg olanzapine/zyprexa tablets.) We are ending the 2nd week of the initial taper (10%) to 4.5mg.

 

This is the technique we use:

 

Supply List:

—Gemini 20 digital scale, reads out to .004 grams (4 milligrams).  It comes with metal jewelry bowl, tweezers, calibration weights, and instruction manual on how to calibrate and tare.

—Marble mortar and pestle (I had on hand) to crush pills to the finest powder, even the tougher coating. Using this also automatically mixes/distributes powder and coating very well...it all turns to powder. (Originally tried a store bought manual pill crusher and it was terrible. Also tried two spoons, not great with the tough coating. The heavy weight of the marble pestle is magic).

—Empty capsules size 00 

—2 blue post-it notes, creased to be used as funnels

—1 standard-size, red-colored sheet of paper as a placemat to catch spills. The red contrasts nicely against spilled powder and the paper is easily used as a backup funnel to finish filling capsule.

—A large clip that acts as a stand which clips to a paperclip. (This is my capsule holder set up). The curve of the paperclip 📎 holds my capsule perfectly.

 

1. Turn on the scale, calibrate, and then tare with jewelry bowl on the scale.

2. Weigh all the pills we'll be using for the week individually. (7 for us)***

3. Record each weight, take the average. For us, it is .189 grams (or 189 mgpw) for each 5 mgai- milligrams of active ingredient tablet.  

4. Calculate the reduction. First, find the weight of 1 mgai by dividing by the total weight by 5. We divide by 5 because our prescription is for 5mg(ai) per tablet. (.189/5=.0378). Each milligram of active ingredient (plus filler, but let's not go there or it can get confusing) therefore weighs .0378 grams (or 37.8 mgpw). Since we want to reduce to 4.5 mgai (10% off of 5 mg), I multiply .0378 by 4.5 = .170  grams (170 mgpw). I will use the .170 number as my target weight. So, .170 grams = 4.5 mgai

5. Crush all 7 up ( a few at a time)  in the mortar and pestle to a fine powder, until I have my bulk mix.

6. Pour powder onto creased post-it note and turn on scale again, tare with the bowl on the scale.

7. Gently tap/shake powder into the bowl. I go over the target weight by just a little as the number always drops a little when I close the lid. Wait for the scale to settle. 

8. If I overshoot my target weight, I use the end of a pen cap as my tiny "spoon" to remove some powder until I reach target.

9. Pour the weighed powder from bowl to another creased blue post-it (I like the contrast to see powder). 

10. Funnel weighed powder into empty capsule over placemat. Funneling is just me tapping the powder down the creased paper into the mouth of the capsule. 

11. Secure capsule lid, put in designated weekly dose container.

12. Turn off scale in between weighing so it doesn't automatically turn off during one.

13. Put all supplies back into designated desk drawer and say goodbye for the week.

(***Side note: We started the second week of initial reduction at the tail end of a prescription, meaning I could only weigh a few tablets instead of the 7 until prescription was filled. When I took the average of these, it was considerably higher than the previous average.  Each tablet weighed considerably more than the others.  These were all tablets from the same bottle. I believe moisture played a role, even though we kept tablets in the bottle with silica/absorption packet, as we live in a very humid climate and it's the rainy season. Still, they seemed dry as a bone when crushing them. We decided it was best for us to continue to take a weekly average weight and do calculations of 1 milligram of pill weight each week to maintain consistency of the doses, at least for now).

 

[MarliesDutch]

Hi all, I need advice on scale-problems.

@brassmonkey I guess you’re the expert on this one?

 

(I read the thread and watched the video’s. Flat surface, no air moving, not moving the table etc.)

 

Last weeks I used a Dutch precision scale: Trendfield. I cut tablets Lora ‘till right mg.
Was anoying ‘cause the scale kept doubting between 0,038 and 0,041. And I needed 0,039…. Despite calibrating.

 

So, ordered Gemini-20 on Amazon.

And ordered capsules do make dosing easier (in stead of cutting or fyling to much). Less doubting. 

But this scale also has issues. After calibrating, the weights weigh 9.999 and a moment later 10.002. 
Same happens when weighing capsules; 0,102 (half capsule incl dosage of 0,039). And the next moment 0,099.

And sometimes it weighs 0,099, I scoop something out and it weighs even more?!

 

Checking with the Trendfield scale: that one weighs al + 0,002 it seems.

 

So how can I make precise reductions when all scales are a bit off?

I’m worried I might have to much Lora prior to last weeks (because of the difference in scales).
 

The difference seems so little, but I’m stabilizing/holding right know and as of September 07th, start tapering again with 10% first two months. 
Worried the dosages are off too much.

Don’t know what to do….

 

[brassmonkey]

The Gemini-20 and clones tend to have an error range of 2-3mgpw. Unfortunately, without spending thousands of dollars that's as good as we can get. In general, it is best to weigh once and move on. Reweighing and reweighing the same sample will just lead to frustration.

 

Most of these medications have an AIC (Active Ingredient Concentration) of about 0.008. Meaning that there is 0.8mgai (Milligrams Active Ingredient) for each 1mgpw (Milligrams Pill Weight). So, slight variations are not all that damaging. Also, we are not so worried about dose strength as we are about Blood Plasma Concentration, the amount of medication in the blood stream at any one time. The act of tapering is to lower the maximum BPC slowly over time. The concentration itself will vary from hour to hour, but it is the maximum that we are concerned with. Making those small variations in the dose strength not really count at all.

 

Some people are quite sensitive to their dosing and if they are taking a short half-life benzo it can cause problems. But for most people it isn't a problem.

 

The one way around it is to use a liquid, but that presents its own problems.

[Obstacle1]

@brassmonkey or others..Any idea if the Gemini scales perform much worse in hotter temperatures? I saw you say it has a normal operating temp range going up to 86F but I'm looking to go on holiday soon where I expect temperatures will exceed that. Should I be concerned that the scales won't work as well?

[brassmonkey]

Shouldn't cause any problems. For travel I suggest making up all your doses in advance and just taking the "prepackaged" doses with you. Trying to make up doses while traveling is a real pain.

[Obstacle1]

On 7/30/2023 at 8:36 PM, brassmonkey said:

Shouldn't cause any problems. For travel I suggest making up all your doses in advance and just taking the "prepackaged" doses with you. Trying to make up doses while traveling is a real pain.

Thanks, I haven't tried pre-making any doses to be honest. Is it okay to do that or does exposing ground up powder to the air affect the drug somehow?

 

It would be a lot more convenient to pre make them