How to make a liquid from tablets or capsules

[Rhiannon]

ADMIN NOTE For tips for tapering your drug , find the link in this list  Important topics in the Tapering forum and FAQ

 

You cannot make a liquid from extended-release drugs, such as bupropion SR or XL, or drugs with a protective coating, such as Cymbalta (the type of Effexor XR that comes in a capsule filled with tiny beads is an exception). Many extended-release tablets are held together by a glue to retard their absorption. Mixed with water or other liquids, these tablets become a soggy glob.

 

Otherwise, given variable solubility of drugs, what you're usually doing when you mix a tablet or content capsules with water is creating a suspension, rather than a solution.

 

High solubility is not a requirement for a suspension. Substances that dissolve in solutions will be more reliably distributed evenly throughout the solution, but we have to work with what we've got. A suspension does not require solubility. It's a bunch of particles hanging in a liquid, hopefully fairly evenly distributed. There may be flakes or particles visible in the suspension, some sinking to the bottom of the vessel. We recommend gently shaking or stirring before drawing out a dose from a homemade suspension (avoid creating a froth, because bubbles can throw your dose measurement off), to make sure the active ingredient (the drug) is distributed throughout the liquid.

 

We have many people tapering successfully with homemade suspensions, as well as compounded suspensions and solutions. Also see

 

Pharmacy liquids to make suspensions

 

Questions and answers about liquid medications

Compounding pharmacies (US, UK, and elsewhere)

 

Described below, making a liquid from Celexa tablets is only one example of how to do it. Information provided here for Celexa is relevant to making liquids from tablets of other drugs. 

 

To skip the discussion about make a liquid with Celexa tablets specifically, jump to  "How To Make Liquid from Tablets or Capsules"  for more general information about making homemade liquids from many drugs.

 

Also see @Faure's method for making a liquid described here.

 

Also see music321's post about serial dilution of liquids

 

PS Originally, Rhiannon was using a small amount of ethanol to dissolve her Celexa. She later changed her method and was successfully dissolving her tablet in water only.  Her topic, Making a Celexa Solution Yourself,  has been merged into this topic; the early posts about Celexa have a note added at the top of the posts.

 

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Making a Celexa solution yourself

 

A couple of folks asked me to post here about how I dissolve my Celexa and liquid taper it that way.

 

I use a shot glass and dissolve the tablet in a small amount of water (enough to cover it) and a couple of mLs of ethanol (very pure drinking alcohol, I use "Everclear" type, available at the liquor store.) The tablet doesn't dissolve quickly, so I usually leave it there and come back in about twenty minutes.

 

NB:  Rhiannon changed her method of dissolving citalopram.  She stopped using ethanol.  See below quote.

 

On 11/29/2011 at 8:40 PM, Rhiannon said:

 

Just wanted to add that I've changed my method, it's even simpler now.

 

I just dissolve the tablet in 20 mL of water directly. It does take some time to dissolve. [The tablet doesn't dissolve quickly, so I usually leave it there and come back in about twenty minutes.] Then I stir it up well and pipette out my dose for the day. Since I'm taking 10 mg in 20 mL, my dose is, right now, 8 mL of water, for 4 mg of Celexa. It seems to be working.

 

 

I stir it with the pipette to get the drug to dissolve into the ethanol (citalopram is soluble in ethanol). I don't know how well it actually dissolves but as long as it's mixed well it doesn't really matter.

 

Then I add enough water to bring it up to 20 mL total. I mix it well and then draw up my dose for the day, and then pipette it straight into my mouth followed by a pipette full of water (both to rinse the pipette and to dilute the "shot"!)

 

My current dose is 5.25 mg of citalopram, so given the dilution I'm using (10 mg in 20 mL) I measure 10.5 mL as my daily dose.

 

All of this could be adapted easily to using syringes for measurement instead of a pipette. (And if you are more delicate than me you could measure it into a spoon or cup rather than squirting it straight into your mouth.)

 

But using pipettes is really easy too, very simple to learn and do.

 

I'll be seeing my doctor again some time this summer and like I said elsewhere, I may see about getting the citalopram liquid already made up, but it's a $15 copay and the pills are only $5. And I'm already dissolving and pipetting my other meds anyway so it's not really any particular hassle to do it this way with the citalopram.

 

Personally this is the method I would use to taper any med. I've done the dry cutting method using a scale, and I find liquid titration easier to control. I can get my cuts as small as I want by adjusting the dilution.

 

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Making  Suspensions

 

 

Some of the medications we use are insoluble in water. Even with a lot of time and shaking they will not dissolve.  What happens is that the powder from a crushed tablet will get mixed with and float around in the water. This is called a suspension. It is a very temporary thing as the powder will precipitate out quickly and not be evenly distributed in the liquid. Medications that have a Dose Strength that is higher than their Solubility Rate will not fully dissolve fully and need to be used to create a suspension.

 

The precipitation of the material can be worked around by stirring the liquid just before measuring the dose and trying to mix the liquid while the dose is being removed.  It is not a good idea to shake the liquid because this will introduce many small bubbles that can throw off the accuracy of the dose. Many people have good success using this method, but it can lead to inaccurate dosing.

 

If you have a 10mL syringe and want to use the larger tablets it is possible to mix a suspension right in the syringe. Draw water into the syringe to the 10mL mark. Place the cap on the tip so it won't leak and carefully pull the plunger all the way out of the syringe.  Drop in the tablet and gently insert the plunger just enough so it doesn’t leak.  Don’t worry about trapping some air in the syringe. Let it sit for an hour or so until the tablet crumbles, shaking it occasionally. When you are ready to take the dose, shake it up good, remove the cap and hold the syringe so the tip is up and carefully squeeze out the air bubbles.  Shake it up again and for a full dose you would take the entire contents. When you start to taper you would squeeze out a set amount of liquid before taking the rest.

 

The dilution ratio of the liquid is not important because you will determine each reduction by the marks on the syringe. As the taper progresses more and more liquid will be discarded. When a large portion of the dose is being discarded it is possible for some ADs to save that liquid for two or three days and use it to make up a “free dose”.

 

By using this method there is no need to worry about the powder settling out. Another possibility is to use a suspension liquid that is thicker than water to hold the powder in place for a longer time.

 

Suspension Media

Because it is so thin, water is not always the best media for making a suspension. Even though it is quite fine in texture the powder made by crushing the tablets is still heavier than water and can settle out quite quickly. A better way is to use a thicker base material.

 

There are several commercially made “Suspension Medias” available online or through your pharmacist. Ora-plus and Ora-sweet are two of the most common, but a quick online search will bring up other alternatives. There are some ways to make your own which can work quite well also.

 

Believe or of not there are some people who have trouble drinking water because it is too “wet”. There is a product available at many drug stores or chemists referred to as “thick water”. It is thick enough to hold the powder in suspension quite well.

Making a homemade suspension media can work well too. A common one is to use maple syrup; you could also use corn syrup or other cooking syrups. There are quite a few recipes available online using a variety of materials. All these media would be used in the same manner as water following the directions given in other parts of this article.

 

Using fruit juice is also popular as a suspension media. Some juices are much thicker than water and suspend the powder quite will. They also taste much better. Because they contain fruit pulp it is hard to see if the powder is well mixed in. However, DO NOT USE GRAPEFRUIT JUICE, it reacts badly with many medications and can create a liquid that is dangerous to drink.

It can seem that making a liquid from tablets borders on getting a degree on chemistry. But by following the process step by step it is pretty straight forward, and these techniques are being used by many people to facilitate their tapers.

 

Edited May 4, 2023 by Altostrata
updated

[Rhiannon]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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Just wanted to add that I've changed my method, it's even simpler now.

 

I just dissolve the tablet in 20 mL of water directly. It does take some time to dissolve. Then I stir it up well and pipette out my dose for the day. Since I'm taking 10 mg in 20 mL, my dose is, right now, 8 mL of water, for 4 mg of Celexa. It seems to be working.

 

You could do the same thing with a syringe.

 

Really, a pipette is just a bigger syringe; a tube with lines to mark quantity, designed for sucking up and then dispensing measured amounts of liquids. Since it's bigger and actually designed for the purpose, a pipette does allow more precise measurements. But it's really the same procedure.

 

 

Edited February 13, 2019 by ChessieCat
bolded

[Altostrata]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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Rhi, do you know how long the Celexa solution will keep in the fridge?

 

Edited February 13, 2019 by ChessieCat

[Rhiannon]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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No, I don't. I usually take all my doses of everything within 24 to 36 hours after mixing them up. So far I haven't had any noticeable problems within that time frame.

 

I just recently (when I got to 4 mg) started splitting up my Celexa dose into two doses daily, but before that I was taking it all as soon as I mixed it up.

 

There's been some discussion on Benzo Buddies about how to compound your own meds using Ora-Plus, which is what pharmacies use. I haven't tried it. But I think when people do that, they keep it longer.

 

Edited February 13, 2019 by ChessieCat

[Mar2a]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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On 11/30/2011 at 7:40 AM, 'Rhi' said:

Just wanted to add that I've changed my method, it's even simpler now.

 

I just dissolve the tablet in 20 mL of water directly. It does take some time to dissolve. Then I stir it up well and pipette out my dose for the day. Since I'm taking 10 mg in 20 mL, my dose is, right now, 8 mL of water, for 4 mg of Celexa. It seems to be working.

 

Thanks so much for posting! I just tried this myself.

 

I just put a 40 mg tablet in a container and added water to 10 ml (that was the maximum it would hold). I stirred it up well and poured it into a small bottle. Then I added 10 ml more of water to the container, swished it around, and poured that, too, in the bottle.

 

So now what I have is 40 mg of citalopram (Celexa) dissolved in 20 ml of water. This means that there is 2 mg of citalopram in every 1 ml of liquid. So, if I need to take 6 mg of the drug, I take 3 ml of liquid. (Could someone please check my calculations? Memory and math problems figure largely in my decision to stop citalopram.) I capped the bottle tightly and put it in the refrigerator. I plan to shake it well before each use.

 

So where did I get the equipment?

 

Container - cough syrup measuring cap. They used to always be marked off in teaspoons and tablespoons, but now a lot of them have ml markings, at least on one side.

Bottle - had a leftover brown bottle from some herbal tincture. It had a dropper, but it wasn't filling properly.

Oral syringe - I think you can buy these at drug stores (look for the pill planners), but I had an unused 3 ml syringe from cat medications. (I also have a 1 ml one, which will come in very handy when I step down some more.)

 

Edited February 13, 2019 by ChessieCat

[Altostrata]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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Mar, your math looks correct to me.

 

You have a solution of 2mg Celexa in 1ml water. To take 6mg Celexa, take 3ml of the solution.

 

Thanks for the additional tips!

 

Edited February 13, 2019 by ChessieCat

[Rhiannon]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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Mar2, sounds good.

 

When you get to smaller doses you might find you want to cut by smaller increments at a time. When that time comes, there are a couple of ways to do that. The simplest one would be to keep doing what you're doing now only use a lower dose pill. So for example if you did exactly what you're doing now but you were dissolving 20 mg instead of 40 mg you would have 1 mg per mL. And when you get to 10 mg you can do what you're doing and end up with 0.5 mg per mL. That will allow you to cut by smaller increments.

 

You can also dissolve the pill in more water, which would effectively do the same thing. And you could do that any time, without having to wait until you're down to smaller dose pills. For example right now if you wanted to go to 1 mg per 1 mL you could just add two more of those capfuls (20 mL) more) to your solution so you would have a total of 40 mL.

 

Hope that makes sense. Not really so much saying you need to do this or anything, but I think other people who read this might want to know.

 

Keep us posted on how this works for you. I like it that you've improvised with readily available equipment. I'm a science nerd myself and work in a lab so I'm really comfortable with graduated cylinders and pipettes, but I think they can be kind of awkward for people who haven't really ever played with them much.

 

Edited February 13, 2019 by ChessieCat

[Mar2a]

Silver Star, thanks for the feedback and tips. I'll keep them in mind for my next step down.

 

As for an update: I saw my doctor and she said that the small decrease in dosage that I did should have had no effect, that the amount was biologically insignificant (I might be misquoting on that). I've been going to her a long time and she and I openly discuss our differences of opinions and work something out. She said that I could have gone from 40 right to 30, though she did agree there might be physical symptoms, but that I could ride them out because they'd last only 3-5 days.

 

So, what I'm doing now is taking 1/2 of my 40 mg (that gives me 20) and a 10mg pill (whhc she prescribed precisely for this), for a total of 30. I'll try that for a while, and continue stepping down slowly, though I might be go a little quicker than before, knowing that the physical effects from each step-down could be short-lived. I can always step back up if it isn't working out.

 

I've been trying to walk every day at lunch, which gives me the double boost of sunshine and exercise, which seems to be helping keep the emotional part easy.

 

Thanks again, everyone, for your help with this,

 

Mar2a

 

Edited February 13, 2019 by ChessieCat

[Altostrata]

With all due respect to your doctor, Mar, that is exactly how people get severe withdrawal syndrome.

 

While many people can quickly withdraw from these drugs, doctors are misinformed about how difficult it may be for some people to taper these medications. Doctors usually advise tapers that are too fast and overlook signs of severe withdrawal.

 

They also believe that withdrawal symptoms are always mild and last only a few days. If you look around this site -- or the Web in general -- you will find many, many, many reports from patients that this is untrue.

 

Withdrawal symptoms are signs that your nervous system is under stress. Don't put your nervous system through ANY withdrawal symptoms if you can help it.

 

If you have ever experienced withdrawal symptoms, you are at risk for severe withdrawal. Tapering gradually reduces that risk. Small decreases are not biologically insignificant, they are gradual.

 

You may be among those who can taper quickly, but if you get ANY withdrawal symptoms following your doctor's advice, please taper more slowly. Listen to your body.

[Rhiannon]

"As for an update: I saw my doctor and she said that the small decrease in dosage that I did should have had no effect, that the amount was biologically insignificant (I might be misquoting on that). I've been going to her a long time and she and I openly discuss our differences of opinions and work something out. "

 

Ditto due respect, et cetera, but basically this is what doctors have been taught at school. The most-used psychopharmacology textbook in medical schools has as major contributors several psychiatrists who are paid six figures a year by pharmaceutical companies to "teach" doctors about their drugs. (Sorry--sounds Machiavellian, but it's true--doctors actually get most of their education about these meds from "authorities" well-paid by the companies who make them.)

 

The fact is that there are NO STUDIES of these drugs at small "insignificant" doses. And NO studies of their use over the long term. A long study is about three months, and the doses used in initial studies are picked sort of arbitrarily based on what seemed to affect the experimental animals (usually rats) without visibly harming them.

 

There is, however, evidence that over time the brain does change itself in response to the use of the drugs.

 

Which means that when you do studies on people who haven't been on the drugs already, the results of those studies can't really be applied to people who've been on them for a long while (who now have a chemically different brain).

 

So in actuality there's no actual scientific, medical information about what size dose, or cut, will affect someone who has been taking a med for more than a few months.

 

In real life, MANY people find that "biologically insignificant" doses of drugs have a great deal of effect, PARTICULARLY when you try to get off of them.

 

The best authority in the case of med withdrawal is your own body. I always say, start conservatively, make a small cut, and see how your body responds. Wait a long time so there's time for the lag effect to play out. If after three weeks you've felt no effect at all, make a slightly larger cut, then wait at least a month to make sure there's not going to be a cumulative effect. Continue to experiment conservatively until you know how your own body--your own biology--is going to react.

 

In other words, figure out for YOURSELF what is "biologically significant" for YOU.

[Altostrata]

That term "biologically insignificant" used by a doctor is just plain wrong. Minute amounts of chemicals in our drinking water, for example, are not biologically insignificant -- it's a concern all over the world.

 

Psychiatric drugs are probably dosed at far higher amounts than they need to be to affect the nervous system. Drug dosages are determined by pharmaceutical companies during clinical trials in an arbitrary fashion among small numbers of subjects who may not be representative of the population who will eventually take the drug.

 

If you can feel it, it's not "biologically insignificant." What a doctor is saying with this term is that any withdrawal symptoms you feel are in your imagination. This is belittling and bad medicine.

[Altostrata]

ADMIN NOTE This topic is a general discussion of how to make a liquid from drugs.

 

Find tips for tapering your specific drug in this list: Important topics in the Tapering forum

 

Also see

Questions and answers about liquid medications
Liquid medications -- use past expiration?
Using an oral syringe and other tapering techniques

Splitting or crushing tablets or pills
Using a digital scale to measure doses

 

Pharmacy techniques for making liquid suspensions, see:

Haywood, 2013 Liquid dosage forms extemporaneously prepared from commercially available products - considering new evidence on stability. (refers to suspensions made with pharmacy liquids)

Pharmlabs Suspensions  (external site)

Suspensions (external site)

For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic. Do not put those questions in this topic, because such detailed discussion will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 

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A liquid preparation of an antidepressant or other psychiatric drug makes controlled tapering much easier. Taking part of your dosage in tablet form and part in liquid form makes the transition from tablet to liquid go smoothly.
 
Some psychiatric drugs are available from the pharmacy as a liquid, many are not. Compounding pharmacies can make liquids from many medications. A prescription is required for both types of liquid.
 
(Some medications, however, cannot be made into a liquid. Extended-release drugs such as Effexor XR, Cymbalta, and Pristiq are protected by a coating that cannot be broken. To find tips for tapering your particular drug, see Important topics in the Tapering forum and FAQ .)

If a compounding pharmacy is not an option, many people make liquid preparations themselves.
 
(This list from a UK medical group confirms that many drugs can be made into liquids: http://stockportccg.org/wp-content/uploads/2012/01/34838_Med_Admin_Dysphagia.pdf )

Note: Most do-it-yourself liquids are suspensions -- particles of the drug float around in the liquid, and the mixture needs to be shaken for relatively equal distribution of the particles.

 

When and how to substitute a liquid for a tablet

A liquid form of a drug will get into your system faster than a tablet. Some people can feel this difference.

 

The easiest way to substitute a liquid for a tablet is to ease into it -- take part of your dose in tablet form and part in liquid. After you get used to this for 4 days or more, substitute the liquid for the rest of the dose.

 

While you're making the substitution, do not make a decrease in your total daily dose. You need to see how you do with the substitution of the liquid before you continue to taper. If, over 4 days or more, the liquid dose seems too strong for you, you may want to reduce it slightly and continue your taper after you stabilize.
 

If it's more convenient for you, it's fine to continue to take part of your dose in tablet form and part in liquid form.

How to make a medication in tablet or capsule form into a liquid
As an overview, here is a video about making a liquid from a naltrexone tablet. Naltrexone is not a psychiatric drug, but the principles are the same:

 

 

 

 
(Refrigeration of the batch is not necessary while the tablets dissolve. Refrigerate the liquid afterwards, though.)
 
Below are general instructions for making your own liquid with water or pharmacy liquid.
 
Basically, you need
- the drug, as a tablet or powder from a capsule
- water or Pharmacy liquids to make suspensions
- a way to measure the amount of water or pharmacy liquid (oral syringe, pipette, measured container or graduated cylinder; a graduated cylinder is probably easiest)
- a clean container with a cap in which to keep your liquid

Try to be very consistent with your method every time you make a batch of liquid -- do everything in the same order, with the same equipment.

 

Don't worry about "compounding losses", the amount of powder that sticks to implements.
 
Assemble your equipment
1. Obtain a way to measure the water or pharmacy liquid

• A 10cc (10mL) or 20cc (20mL) oral syringe (as seen in the video) OR
• A 100cc (100mL) medicine bottle from the pharmacy. These usually have markings showing 100cc or mL (ask for the cap with the hole in it, so you can fit the oral syringe in it to draw from the bottle). There should be no charge or a very small charge. OR
• A graduated cylinder marked with ccs or mLs. Graduated cylinders are more exact than oral syringes or medicine bottles and best for large volumes of liquid)

2. A small clean transparent wide-mouthed jar with a water-tight top or an empty tinted plastic medicine container with a top.
 
3. If your medication is in tablet form, a pill cutter or crusher. (This is optional. You can cut a tablet with a knife and crush it, if necessary, with the back of a spoon.)
 
4. Depending on how much medication you wish to take, a .5mL, 1mL, 5mL, or 10mL oral syringe to take a measured amount of the drug.

How to mix the liquid
 
1. Prepare the drug.
 

On 4/13/2014 at 10:19 AM, Rhi said:

....
If you want to make your own liquid you may not need to crush the pill. I don't recommend it, because small amounts are lost as powder. First just try putting it in water and see if the pill dissolves on its own. It may take a little while, my one that's coated takes about ten minutes. If it doesn't dissolve in water then try to crush it directly in the container that you're going to be adding water to, so powder won't be lost.
....

 
Alternatively, if your medication is in tablet form, you can

• cut the tablet up into rough quarters with a pill cutter or knife
• crush the tablet into powder using a pill crusher or mortar and pestle
• cut it up and carefully crush it with the back of a spoon on a piece of waxed paper

If your medication is a powder in a capsule, carefully open the capsule above the container and pour the contents into the bottom of the container.

To open a capsule, grasp each end in your fingers and gently twist. The capsule should come apart in the middle. Do this over the open container, to catch the powder in the container.
 
2. Measure the water (or pharmacy liquid)

• With an oral syringe: Draw room temperature (not hot, not cold) water into an oral syringe and convey it to the container. A 10mL (10cc) or 20mL (20cc) oral syringe is handy for this purpose.[br][br][br]
  
  For example, if you wish to make 30mL of a solution, fill the 10mL syringe 3 times with clean water and inject it into your container.
• With a graduated cylinder: For example, if you wish to make 30mL of a solution, fill the graduated cylinder to the 30mL mark and pour it into the container.
• With a 100cc (100mL) medicine bottle: Fill carefully to the 100cc or 100mL line. You'll have to bring the bottle up to your eye level to do this. Please note the measurements on these bottles are less exact than the graduated cylinder.

To mix, put the cap on the container, tightly, and shake it gently. You will be able to see particles swirling around in the water (some of the filler used in tablets and capsules is insoluble).
 
Wait until the tablet chunks are dissolved before taking a dose.
 
How much liquid should I use to make my suspension?
The only tricky thing about making a solution is creating and remembering the concentration: the ratio of drug to liquid.

The easiest concentration is 1:1 or 1mg medication in 1mL solution. Examples:

• If you want to take 18mg Prozac, for example, you can mix 20mg with 20mL water and take 18mL, which contains 18mg Prozac.
• You could put a 10mg Paxil tablet in 10mL water for a 1:1 dilution. There would be 1mg in 1mL and 0.1mg in 0.1mL. The 1:1 dilution would require a small 1mL oral syringe. To reduce 10% from 1.1mg, you would take 1mL. Another 10% reduction would be 0.9mL.
• You may find a 1:1 dilution to be a little thick or grainy. For convenience, you may wish to make a higher dilution of a 10mg tablet in 20mg water for a 1:2 ratio. There would be 1mg in 2mL and 0.1mg in 0.2mL. If you made this liquid, your dose would be 2.2mL (1.1mg). To reduce by 10%, you would take 2mL (1mg).

For doses of hundreds of milligrams, you may want to make a higher concentration. Examples:

• To taper from 100mg Lyrica to 90mg, you can mix 100mg Lyrica in 50mL water, making a 2:1 concentration, each 1mL containing 2mg Lyrica.
• Or, you can mix 100mg Lyrica in 25mL water, making a 4:1 concentration, each 1mL containing 4mg Lyrica.

Keep a note of the concentration! Be sure make a note of your recipe ("100mg Lyrica in 50mL water") and dosage instructions to yourself: "Take 45mL for 90mg Lyrica."
 
What if my medication is "insoluble" in water?
About solubility or insolubility, our esteemed member Rhi, who has lab experience, has made many, many homemade liquids:

 

On 2/27/2013 at 9:30 AM, Rhiannon said:

.... I just wanted to toss in my usual bit on the subject of making preparations for liquid tapering, which is: I personally don't worry about solubility.
 
None of the meds I'm tapering are actually soluble in water. But the pills dissolve into small enough particles that I can stir them up and keep them suspended in water while I measure them out, and that seems to work for me. I stir well before I measure, I stir a little while pipetting them up; I dissolve the pills in glass and pipette out of glass so that I can see visually how evenly everything is suspended, and that's good enough for me.
 
I use water as a medium because I like it that I can easily see for myself how evenly the little particles are suspended or if they seem to be settling out. Also because it's handy and cheap and I don't have to carry it with me if I travel.
 
Mostly I would just say, I don't think it really matters if the medication is soluble in whatever vehicle you're using, as long as it can be evenly distributed. What really matters is that it be evenly distributed and that your method be repeatable and consistent.

 
Measure your dose and take it
With a liquid, you use an oral syringe to take the dosage you wish.

• Get your oral syringe ready.
• Put the cap on the container and shake it gently. (You may see particles swirling around, this is normal.)
• Using the oral syringe, draw from the middle of the liquid, not from the top -- there may be less drug there, it sinks to the bottom.
• If your bottle cap has a hole in the top, draw the liquid from the bottle by following these instructions.
• If this is still confusing, ask your pharmacist to show you how to use an oral syringe

Ex: If your liquid is a 1:1 concentration, containing 1mg in 1mL, and you want to take .5mg, you would take .5mL of the liquid. You can adjust the amount you take as you continue your taper. See Using an oral syringe and other tapering techniques

Also see http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__50942
 
Refrigerate homemade liquids
Most homemade solutions may keep for at least a few days, refrigerated. Drugs tend to be degraded by heat and light, which is why pharmacy containers are tinted.
 
Refrigeration delays the growth of bacteria and mold in your homemade liquid, which was not made under sterile conditions.
 
To find tips for your particular drug
See Important topics in the Tapering forum and FAQ . (You can also Google your "medication soluble stability" to see how long yours will keep.)
 
For more information, consult a pharmacist.

 

 

Edited April 11, 2019 by Altostrata
updated

[Skyler]

Where do I buy these syringes. I see some on amazon. They don't say graduated though.

 

I'll PM you with local info. Most syringes are graduated, so you usually don't see this in the description. Those from compounding pharmacies are best as they are made for repeat dosing and the print does not smudge.

[Shanti]

If only I'd had this information 10 years ago (sigh).

 

I know right. I feel for the people that had no help and information like this. Do you know if an oral dropper is as accurate as an oral syringe?

 

[Rhiannon]

A dropper is not likely to be as accurate as a syringe.

 

However, if it's all you can get, it's better than nothing.

 

If you're using a fairly concentrated liquid, accuracy is more important. If you're using a really dilute solution you can get away with less accurate measuring apparatus.

 

Also, Alto wanted me to mention something about the use of graduated cylinders.

 

I use graduated cylinders and pipettes for my own taper and measuring. (Pipettes are basically equivalent to syringes--just bigger.)

 

If the biggest syringe or pipette you have is 10 mL, and you want to measure out more than about 40 mL of water, it's better to use a graduated cylinder. (Otherwise you can do four or fewer pulls on the syringe)..

 

If you Google "graduated cylinder" or look on Amazon, you can see what a graduated cylinder looks like. It's tall and cylindrical with small markings all along its length for measuring. You may want to Google "beaker" too so you can see the difference and not get them confused.

 

Graduated cylinders are easily available via Amazon or other websites.

 

And before you use the cylinder, if you haven't used one before, read this: http://chemistry.about.com/od/chemistrylabexperiments/qt/meniscus.htm

 

To repeat, if you need to measure out more than about 40 mL and you don't have a syringe that large, you'll get the most consistent results using a graduated cylinder. (If you do more than about four pulls with your syringe, you're going to be introducing a lot of random error into your total measurement, enough that it could affect your dosing.)

[Shanti]

Thanks Rhi, again

 

I was wondering why the graduated cylinder was more precise in measuring than a regular measuring cup. That article helped, as it does stand to reason now that the wider the cup, the more accuracy is lost due to the "meniscus" issue. Good information. I went ahead and accepted the graduated cylinder I bought at Amazon. I got a plastic one and it was only about $7.

 

I need the syringe for pulling out my reduction amount. After my failed attempts at sloppy tapers with the Xanax, I want to be precise and get it right now.

[Aria]

I was on a powered capsule benzo and it tended to dump too quickly for me to get an adequate removal. I went to see a compounding pharmacist who made up a suspension agent to mix my capsule with. I shook the powder and agent together in a closed jar. The powder was distributed more equally and stayed suspended in the mixture. I got a much more accurate removal each time. I was able to keep the mixed portion in the refrigerator to reuse for 4-5 days. The suspension agent was about $ 10.00 (about one pint) which I was able to use in new mixtures over a few weeks.

 

I measured the amount of suspension agent I needed for calculated titration into the calibrated tubes. It was like being a chemist but it worked for me.

[Altostrata]

Thanks for that excellent suggestion, Aria -- rather than water, get a liquid from a compounding pharmacy to mix with your medication.

[Rhiannon]

Precision Versus Accuracy:

 

When tapering, precision is more important than accuracy.

 

For this sentence to make sense you need to know the difference between "precision" and "accuracy." It's not a distinction commonly made in everyday speech.

 

Accuracy is how correct a measurement is. If you measure using a certain container or syringe, is the amount you measure really correct? You could have a container that's off, that says it holds 10 mL when it really only holds 9.5 mL, or says it holds 2 cups when if carefully checked it actually holds two and an eighth cups. If you measured using those, your amounts would not be accurate.

 

Precision is how close and how repeatable a measurement is. If you have a measuring device that says it measures 1.5 mL but when you use it you actually get 1.4 mL, it's not accurate, but it can still be precise. If when you use it five times you get, say, 1.41 mL, 1.4 mL, 1.415 mL, 1.39 mL, and 1.385 mL, that's pretty precise, even though it's not accurate. But if you get, say, 1.7 mL, 1.2 mL, 1.85 mL, 1.6 mL, and 1.1 mL, it's not only not accurate, it's also not precise.

 

This is the concept that's tricky. When I learned it there was a picture of a dartboard. Unfortunately I don't have that picture, so I'll describe it and hope that works.

 

Imagine a dartboard. It has the usual round target shape with the central circle that you're shooting for. Now imagine that someone has thrown five darts at it.

 

Case 1: The five darts are all in a tight cluster the middle at the target. That's accurate and precise.

 

Case 2: The five darts are kind of in a circle around the center of the target. That's accurate, but not precise.

 

Case 3: The five darts are all in a tight cluster but on some other part of the board, not at the center of the target. That's precise, but not accurate.

 

Case 4: The five darts are all over the place. That's neither precise nor accurate.

 

So how does this apply to tapering? Well, in tapering, what really matters is how closely you can control changes in your dose. It doesn't really matter so much if you're measuring exactly 1.5 mL, but whatever you ARE measuring it needs to be pretty much the same each time, not all over the place so you're getting really different doses each time.

 

So, for example, I don't think syringes are as accurate as pipettes, but I think they're just as precise, so for tapering purposes they're just fine.

 

A cooking measuring cup isn't as accurate as labware, and unfortunately it's not very precise either; 2 mL more or less isn't going to make much difference in a recipe, so you don't need to use graduated cylinders to make a pie.

 

An eyedropper or medicine dropper is probably fairly accurate, give or take, but it's not precise--very difficult to control the measurement so that it's really the same amount each time.

 

A plastic graduated cylinder that was made in China for science fair experiments is probably not going to be as accurate as quality labware, but as long as you use it the same way every time (measure with the meniscus in the same place every time) it's going to be just as precise.

 

The important thing with tapering is that the measurements need to be consistent and repeatable and done the same way every time, so you don't get big variations in dosage, and they need to be done using equipment that's designed to be precise.

 

Hope this makes sense! If it doesn't, don't worry about it. You'll be fine regardless. But I thought I'd explain it for people who are doing their own liquid tapers and might find these concepts helpful to play with.

[Altostrata]

Very good point, Rhi. Consistency in measurement, which often means using the same devices the same way each time you measure, is the key.

[primrose]

Hi

 

Please may I ask a question?

Use the oral syringe to measure room temperature (not hot, not cold) water and convey it to the container. A 10mL (10cc) oral syringe is handy for this purpose.

Why does the water have to be room temp?

 

Thanks

[Altostrata]

Because the powder may not dissolve in cold water, and hot water might damage the chemicals.

[areyouthere]

Another way to look at it. It is ok if the measuring instrument that you are using is " precisely inaccurate " . IOW , as long as it is measuring "consistently wrong" you can be confident that you are taking the same dose. Precisely inaccurate is a much, much better way to understand the concept but consistently wrong may make more sense until you can wrap your head around what Rhi so eloquently explains.

 

I think the key here is that we all want to make sure that we are reducing our dose by as close to exactly the same amount each day so that we can eliminate second guessing like " I wonder if I have this symptom because I took a slightly different dose yesterday or the day before or the day before that " .

 

 

Consistency in measurement, which often means using the same devices the same way each time you measure, is the key.

 

Exactly. Or I should say. Precisely

[Altostrata]

For an example of making your own liquid, see http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/page__view__findpost__p__38643

[ChanceLucky]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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Have you asked your doctor if this solution will work just as effectively as the actual pill would? I'm thinking about doing this too.

 

Edited February 13, 2019 by ChessieCat

[Altostrata]

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ORIGINAL TOPIC:  Making a Celexa Solution Yourself

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On 12/21/2012 at 3:24 AM, ChanceLucky said:

 

Have you asked your doctor if this solution will work just as effectively as the actual pill would? I'm thinking about doing this too.

 

 

 

Rhi's been doing this for ages and has a lab background, I'd trust her on this.

 

Edited February 13, 2019 by ChessieCat

[ladybug]

What about the colored coating of the pills? Would you just mix this in the water as well?

[Altostrata]

What drug are you referring to? Does it have a hard coating?

[ladybug]

What drug are you referring to? Does it have a hard coating?

I'm referring to brand name Paxil, which all have a soft colored coating.

[Altostrata]

I would crush it, dissolve it well, and make sure to shake the suspension before drawing out a dose.

 

Paxil is available in a liquid, which would be preferable.

[ladybug]

I would crush it, dissolve it well, and make sure to shake the suspension before drawing out a dose.Paxil is available in a liquid, which would be preferable.

I know, but it's insanely expensive if you are uninsured. Like $250 a bottle or something. I'm also scared of the switch, since some people do not tolerate the liquid Paxil well. I can't even tolerate generic Paxil so I always figured I would be one of those unlucky ones who wouldn't be able to tolerate the liquid Paxil. I'm just scared that my shaving and weighing is not giving me an accurate dose, and at these low doses that's so important.

[mammaP]

I have been experimenting today with effexor beads (brand rodomel). I dropped from 

4 beads to 3 on 2nd November, a reduction of 25% because there was no choice. The 

capsules are slow release and contain 400 beads. Who would think that just 1 bead

could lead to withdrawal symptoms? All was fine for around 4 weeks then the dreaded 

insomnia came. 

I decided to try and dissolve the beads for the rest of my  taper.

 

After 5 hours sitting in water they were still whole and floating on water.

 I took a fresh one and crushed it in a pill crusher then added a teaspoon of water.

The shell did not dissolve but went clear and floated on top of the water.

The powder seemed to settle on the bottom so I picked off the shell with tweezers.

I swirled the liquid around but couldn't see the powder in the liquid so I assume it dissolved

 I will be trying this when it's time for my next drop, 

Watch this space! 

Edited January 9, 2014 by mammaP
Corrections

[Nikki]

The easiest concentration is 1:1 or 1mg medication in 1mL solution. If you want to take 18mg Prozac, for example, you can mix 20mg with 20mL water and take 18mL, which contains 18mg Prozac

 

Alto if I am taking 50mgs. Serzone what size syringe should I get and does this mean I would fill a syringe with 50mgs. or 50mL of water - crush a 50mg. tablet - mix and then withdraw 40mgs. to drop one mg.?

 

This stuff confuses the daylights out of me

[Altostrata]

Nikki, you explained it yourself.

 

If you make a 1:1 solution of 50mg in 50mL, you would take 45mL to accomplish a decrease of 5mg (10%).

 

It might be handier to make a solution of 50mg in 10mL (5:1). To decrease by 10%, or , you'd take 9mL.

 

Either way, it might be easiest to remove the decrement and throw it away, then drink the rest.

 

Please ask a pharmacist to help you decide on what oral syringe to use.

[Nikki]

thank you....yes I did answer it myself but I made a typo meant to type 49 instead of 40...

[moodyblues78]

It seems to the rule that you should not store your DIY liquid for more than 3-4 days.

 

Doesn`t that prove the fact that the liquid is losing it`s medical effect very fast? So even if make only 3 days worth of medicine, every dose is less effective that previous?

 

I`m noticing a pattern that I feel better when I take my 1st dose. Days 2 and 3 are downhill and things get a little better when I make a new patch. I can not be sure about this yet but I`m very scared to experiment any further.