Daffy: making a liquid taper from a capsule

[Daffy]

I was wondering how to make a liquid solution to taper my last 10mg of Nortriptyline. ....is it accurate to mix it with water?

[Carmie]

Hi Daffy, 

 

Welcome to SA. I’m actually water titrating myself. I just crush my tablet with a mortar and pestle. My tablet is 25mg and I add 20ml of water, which makes every ml 1.25mg. Your calculations will be different, off course. 

 

There are threads under the tapering section that show how to water titrate. Could you please fill in a drug signature too. Someone will send you the links to these. I’m not computer savvy. 

 

I’ve been water titrating for years now, it’s quite easy to do, and makes it possible to taper the tinier doses. 

 

It would be a a good idea to crosstaper to the liquid though. Crosstapers usually look like this:

 

3/4 of old formula.                    1/4 of the liquid. 

 

1/2 old formula.                          1/2 of the liquid. 

 

3/4 of old formula.                      1/4 of the liquid.

 

Then all liquid. 

 

You stay at each stage for 3 to 7 days. I once changed formulas without a crossover and went into 3 months of waves. I went from water titrating my tablet to water titrating a compounded capsule without a crossover, and I really payed for it. I knew nothing about crossovers then.

 

I decided to go back to water titrating the original tablet, but this time with a crossover, and it was smooth sailing.

 

When you eventually taper, please taper no more than 10% a month. 

 

Wishing you all the best with your tapering 💚

 

Edited April 3, 2019 by Carmie
Addition

[Daffy]

Thank-you for your reply, Carmie. I really appreciate it!  Sorry, but I don’t understand how to do a crossover at all. How would I be accurate in taking part of the capsule and part liquid. Do you mean emptying part of the capsule into water and taking that with the rest of the powder in the capsule?

[Daffy]

Could someone please send a link for my drug signature?

[Carmie]

Hi Daffy, 

 

Crosstapering certainly takes some calculating. If you decided to crosstaper you would actually have to use a scale to measure your old formula. This would be the formula: 

 

Old Formulation:                               New Formulation:

 

7.5mg of the capsule.                      2.5mg of the liquid. 

 

5mg of the capsule.                          5mg of the liquid. 

 

2.5mg of the capsule.                       7.5mg of the liquid. 

 

Then all liquid. Do each phase for 3 to 7 days, or longer, as I already mentioned.

 

You would be doing two different formulations. 

 

You can make up the liquid formula with a capsule, and you can keep any left over in the fridge if you want to. I always throw away what’s left and start afresh the next day. 

 

If you add 10ml of water to a 10mg capsule that would make every ml 1mg. Alternately, you could add 20ml of water, and that would make every ml 0.5mg. 

 

With your old formulation, you just have to weigh the capsule. 

 

If you want to fill out your signature, just go to the Read This First Section and go to the thread Please Put Your Withdrawal History In Your Signature. There’s a link in there. Thank you. 

 

Take care, sending hugs🤗

 

Edited April 4, 2019 by Carmie
Addition

[Daffy]

Ok, thanks Carmie! What kind of scale would that be?

 

[Carmie]

6 minutes ago, Daffy said:

Ok, thanks Carmie! What kind of scale would that be?

 

 

I haven’t used scales myself Daffy, but the Gemini - 20 portable scale seems to be popular. There’s a thread on the first page of the tapering section looking at scales, and how to use them.

 

Take care💚

[Daffy]

If you didn’t use at scale to measure the mg for crossover how did you get the right dose then? Did you make a generalized guess, Carmie?

[Carmie]

1 hour ago, Daffy said:

If you didn’t use at scale to measure the mg for crossover how did you get the right dose then? Did you make a generalized guess, Carmie?

 

Hi again Daffy, 

 

When I did the crossover last year I was already water titrating the capsules, so all I did was water titrate the tablet also. There was no need for scales. I just made two different liquid formulas. I crushed a whole tablet into each of the different water titrations, and added 20ml of water to each one, and measured the dosages from there. My body was already used to liquid formulas. I’ve been water titrating for years. 

 

I don’t remember exactly what I did years ago when I changed from my tablet to water titrating. I didn’t know about crossovers. I haven’t kept notes that far back. I do remember I was cutting my tablet with a pill cutter, and at one stage I was using part tablet and part water titrating. I don’t remember the doses or anything. 

 

Sendng hugs🤗

[Altostrata]

Welcome, Daffy.

 

Here are our Tips for tapering off nortriptyline 

 

How to make a liquid from tablets or capsules explains how to make the liquid. You can ask specific questions about making a liquid in that topic.

 

What method did you use to taper nortriptyline so far? Have you gotten any withdrawal symptoms?

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Daffy]

I had my med compounded into 1 mg capsules and was taking these with the 10 mg regular capsule that it comes in. Now my dose is getting lower and I will have to switch to liquid so I was thinking of making my own. I have never tapered more than 10% and want to continue this way. I have been on the 10 mg for a few years now and was thinking of starting to taper the remainder. 

I have had anxiety and insomnia when tapering that is why I stopped.

Thank-you for the information. I will look into this.

[Altostrata]

Well done, getting the 1mg compounded capsules. How is your withdrawal insomnia now?

 

If the insomnia is better, you may want to start crossing over to liquid. First read

 

Tips for tapering off nortriptyline 

 

How to make a liquid from tablets or capsules e

 

You can make a liquid from a 10mg nortriptyline capsule with 10mL water, giving you 1mg nortriptyline in 1mL.

 

Then, you can take 9 1mg capsules with 1mL liquid for your daily dose of 10mg. Do this for 3 days to make sure it's okay.

 

Then take 8 1mg capsules with 2mL liquid, totaling 10mg/day, for 3 days. And so on until you get to 6mg in capsules and 4mg in liquid.

 

If everything is okay, you can taper by 10% by removing one 1mg capsule from your daily dosage, to yield a daily 9mg (5mg in capsules, 4mg in liquid).

 

From then on,  taper the liquid part of your dose until you get down to 5mg, then start converting your remaining dose to liquid with the crossover method above.

 

 

[Daffy]

Thank-you, Altostrata. The issue is, though, is that I don’thave the 1 mg capsules anymore and they are quite expensive to compound. I have been on the 10 mg capsule for 2 yrs now. I guess if I was going to do the crossover with the 10 mg I would have to buy a scale wouldn’t I.

 

[Altostrata]

If you want to get a fairly precise measure of the powder, yes.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Daffy]

Do you put the measured powder in the capsule after? If so, how do you prevent from losing some of it in the process?

[Daffy]

I finally have my scale. I am wondering how to weigh 75% of my powder from the capsule so I can mix 25% with water to do the cross over. I also bought some large gelatin capsules. The scale came with some little dishes. Thank- you.

I recently added my signature.

 

[ChessieCat]

using-a-digital-scale-to-measure-doses

 

[Daffy]

I have talked to my compounding pharmacist and they told me that I shouldn’t be mixing Nortriptyline with water as it could affect the drug and prove to not be accurate. I am hearing so much  conflicting information.

 

[Altostrata]

Many pharmacists are horrified at the idea of patients manipulating their drugs and will try to scare them away from doing this. Perhaps this compounding pharmacist can make a liquid for you?

 

Mixing the tablet or capsule contents with water is safe, the prescription oral solution contains water.

 

https://www.drugs.com/pro/nortriptyline-oral-solution.html
 

Quote

 

The oral solution contains nortriptyline hydrochloride equivalent to 10 mg/5 mL (38.0 μmol) of the base and 4% alcohol. It also contains cherry flavor, citric acid anhydrous, purified water, sodium benzoate, and sorbitol.

 

 

 

[Daffy]

I would rather just mix it with water myself but I just needed a little reassurance that it is safe after discussing this with some compounder in my area. Just feeling anxious.

[ChessieCat]

It's important to make sure that you do everything the same way each time.  Always use the same equipment and same method to measure everything.  Even use the same area on the bench or table to measure the liquid because different areas can have a different slope.

 

It might also be helpful to write down your "recipe" (equipment, quantities, method) so that if you have a brain freeze, which even "regular" people have sometimes (when I'm showering I sometimes can't remember if I've washed my legs!), you will have the recipe to at.

 

You could always do some practice measuring without using the tablets just so that you get to feel comfortable doing it before the real thing.

[Altostrata]

22 hours ago, Altostrata said:

"The oral solution contains nortriptyline hydrochloride equivalent to 10 mg/5 mL (38.0 μmol) of the base and 4% alcohol. It also contains cherry flavor, citric acid anhydrous, purified water, sodium benzoate, and sorbitol."

  

 

The prescription liquid consists of the drug plus water, a little alcohol, a bunch of flavorings, and a preservative. There's no magic in it.

 

We recommend you keep a do-it-yourself liquid in a tinted container in the refrigerator and mix up a new batch every 4 days or so.

[Daffy]

Thank-you. This helps.

 

[Daffy]

I got a bit scared after talking with several compounders. 

[Daffy]

I have had 2 nights of crossing over to a water titration and haven’t changed my dosage yet and am having dizziness and some sleep difficulty. Didn’t think it would have that effect. Do you think that this will settle in time?

 

[ChessieCat]

On 4/4/2019 at 12:32 PM, Carmie said:

Old Formulation:                               New Formulation:

 

7.5mg of the capsule.                      2.5mg of the liquid. 

 

5mg of the capsule.                          5mg of the liquid. 

 

2.5mg of the capsule.                       7.5mg of the liquid. 

 

Then all liquid. Do each phase for 3 to 7 days, or longer, as I already mentioned.

 

Q:  Are you doing this?

 

If you are, then you would stay on the current combination until things settle down.

 

If not, it may take some time for things to settle.  It's better to wait until you are stable before making a reduction.

[Daffy]

Yes, I am-that is why I am surprised I am having symptoms. I have a scale and am putting 75% back in a large no.OO capsule and mixing 25% with filtered water. I will continue with this a few more days.

[ChessieCat]

Glad to hear that you are transitioning with a cross over.  Really good that you didn't just go from tablet to liquid 😊

 

It would be better to stay at this combination until you do feel stable.  It might take a week or more.

[Daffy]

I have been trying to get off Nortriptyline for 5 yrs now. I had a long break from tapering and stayed at 10 mg for over 2 yrs and felt OK. I wanted to get off it totally but I was wondering if it is ever recommended to stay on a low dose indefinitely or would you eventually go into tolerance withdrawal?

[Daffy]

Yes, I only heard about a crossover from this website and am very grateful for that.