How to make a liquid from tablets or capsules

[ChessieCat]

I've responded in your Intro topic.

[brassmonkey]

It is all due to mathematical semantics and the definition of percent in relation to setting up a formula.

 

Multiplying by 0.10 will give an answer that is 10% of the original number. 10 X 0.10 = 1

 

To find the number that is 10% less that the original you have to subtract the answer from the original number 10 - 1 = 9.  This is the step you left out of your calculation.

 

Doing the calculations this way can end up being confusing especially if you are working with numbers other than 10, and the formula needs to be reworked each time you do a new reduction. In the long run it is easier to do the subtraction first and then multiply to get the answer.  Doing this we can establish standard formulas that will work for everyone.

 

If we want to do a 10% reduction we start by subtracting 0.10 from 1.  1 - 0.10 = 0.90 which tell us we want 0.90 of or 90% of our original number. Because of the rules of arithmetic, multiplying  any number by 0.90 will give a 90% reduction of that number. So for our purposes any dose weight or the dose strength multiplied by 0.90 will give the weight or strength required for a 10% reduction.

 

The same thing works for a 5% reduction. 1 - 0.05 = 0.95. Which you use the same way as above to calculate the new dose.  If you wanted to do a 2.5% reduction you would multiply by 0.975, or if you wanted to do a 7.5% reduction you would multiply by 0.925. Those are the percentages for a standard Brassmonkey Slide.

 

CC responded in your intro topic while I was writing this up, so between the two of us I hope you now understand things better.

[Janece]

1 hour ago, brassmonkey said:

It is all due to mathematical semantics and the definition of percent in relation to setting up a formula.

 

Multiplying by 0.10 will give an answer that is 10% of the original number. 10 X 0.10 = 1

 

To find the number that is 10% less that the original you have to subtract the answer from the original number 10 - 1 = 9.  This is the step you left out of your calculation.

 

Doing the calculations this way can end up being confusing especially if you are working with numbers other than 10, and the formula needs to be reworked each time you do a new reduction. In the long run it is easier to do the subtraction first and then multiply to get the answer.  Doing this we can establish standard formulas that will work for everyone.

 

If we want to do a 10% reduction we start by subtracting 0.10 from 1.  1 - 0.10 = 0.90 which tell us we want 0.90 of or 90% of our original number. Because of the rules of arithmetic, multiplying  any number by 0.90 will give a 90% reduction of that number. So for our purposes any dose weight or the dose strength multiplied by 0.90 will give the weight or strength required for a 10% reduction.

 

The same thing works for a 5% reduction. 1 - 0.05 = 0.95. Which you use the same way as above to calculate the new dose.  If you wanted to do a 2.5% reduction you would multiply by 0.975, or if you wanted to do a 7.5% reduction you would multiply by 0.925. Those are the percentages for a standard Brassmonkey Slide.

 

CC responded in your intro topic while I was writing this up, so between the two of us I hope you now understand things better.

Once you make the suspension is it safe to leave it on the refrigerator , like if I take my meds in the morning ... will it weaken the medication if i make it at night before bed , and take it first thing in the morning?

[ChessieCat]

SA generally suggests keeping the liquid covered in the refrigerator.  It may be better to keep it in a dark container.  I don't bother because there is only me using the fridge and it doesn't get opened that much.  SA's suggested keeping time is 3-4 days.  I keep mine for longer but it is hard to tell if there is any issue because at this time I am only taking a very small part of my dose in liquid.  Once I get to taking all liquid I will probably reduce the length of time that I keep the liquid.

 

Remember to stir well before using.  I use a mini whisk but I have to make sure that I don't stir it too much because it adds bubbles, which are probably from the slow release formula that is added to the compounded capsules.

 

If you container has a tight lid you might be able to shake it.

[hayduke]

1 hour ago, ChessieCat said:

SA generally suggests keeping the liquid covered in the refrigerator.  It may be better to keep it in a dark container.  I don't bother because there is only me using the fridge and it doesn't get opened that much.  SA's suggested keeping time is 3-4 days.  I keep mine for longer but it is hard to tell if there is any issue because at this time I am only taking a very small part of my dose in liquid.  Once I get to taking all liquid I will probably reduce the length of time that I keep the liquid.

 

Remember to stir well before using.  I use a mini whisk but I have to make sure that I don't stir it too much because it adds bubbles, which are probably from the slow release formula that is added to the compounded capsules.

 

If you container has a tight lid you might be able to shake it.

 

Similar here.  I use an old hydrogen peroxide bottle from the chemist's which has a tight lid and brown glass.  I'm getting 5-6 days out of a tablet right now.  (0.39/2.5)  It seems to keep well enough.  The fridge isn't used that much and it's cheap but a late model well regarded for holding its temperature, food lasts a lot longer than the old one did.  I'm not sure how far past 7 days you can sensibly go, and it'll be different for each tab/drug/mfr etc.

 

As always, go by feel

[bubbles]

3 hours ago, ChessieCat said:

If you container has a tight lid you might be able to shake it.

 

I bought some amber bottles intended for, I think, essential oils. I popped out the glass dropper as it isn't useful for me and just use the lid with the bottle. I shake it vigorously when first making up a batch and then let it sit for a day before use. I shake a bit more gently in use to try to avoid too many bubbles. Not sure if that's right or not but it doesn't seem to be doing me any harm.

 

 

 

[ChessieCat]

TIP:  If using a large quantity of water (eg 1 litre) to make your liquid, after dissolving. mix the liquid and pour some of it into a smaller container instead of having to extract dose from the large quantity.

 

And if you know that you are not going to be using all of the liquid then you do not even need to keep the whole lot you could take out enough (plus extra for "just in case") and throw out the rest.

 

I would also suggest that you do not use a container (eg jug) that you might use for cold water just in case you forget about it and end up drinking it.  Or at least if you do, mark it in some way, eg tie a piece of string around the handle (with a double knot so that it does not come off easily), so that it will remind you that it is not pure water.

 

For my next reduction I will be dissolving a 2mg compounded capsule in 1 litre of water so that I can measure the dose I need more accurately.  This morning I realised that I would have to use a larger container than what I am currently using (400mL of water, and previously only using 200mL) and was thinking that it would be difficult to measure out a dose from a larger container.  Then I had a 💡 moment.

[Tom2020]

On 3/1/2021 at 1:28 AM, ChessieCat said:

TIP:  ... was thinking that it would be difficult to measure out a dose from a larger container.  Then I had a 💡 moment.

Can you explain please why it would be harder to measure from a larger container?

[ChessieCat]

The 1 litre jug I am using is at about 25.5cms/10" tall and about 13cm/5" in diameter.  The syringe is about 7.5cms/3" long.  As I use the liquid the level is going to get lower so it will be further down in the jug and I will not be able to put 2 hands in to hold the syringe with one hand and pull up the plunger with the other.

[Tom2020]

Thanks ChessieCat. I couldn't picture it before but that makes sense.

[Yesyes123]

On 5/20/2019 at 2:26 PM, Lakelander82 said:

Realistically though, measuring out  such minuscule doses accurately, especially using your own homemade suspension is next to near impossible. Even if you carry out everything the same every time, you could be getting 12mg one day, 8mg the next, 14mg the next day, 5 mg the day after that. Your dose could be all over the place each day. When I got down to 12mg (theoretically) it looked like I was taking water with a few granules of powder in it, there could have been 2mgs in it for all i know. Everything is just guess work. 

 

If the drug is soluble in water and is well dispersed after a thorough shake, you would be measuring it out with a syringe and getting an exact dose, wouldn't you?

[brassmonkey]

@Yesyes123-- that is correct. Many of these drugs are freely soluble in water, so when mixed with water the Active Ingredient moves from the pill to the water and is evenly distributed. Each drug has a different solubility rate, but in general if you use 1mL of water for every 1mg of pill strength you get a 1:1 solution that is quite easy to work with. 

 

For a medication with a good solubility rate there will be some sediment left floating in the liquid and settling to the bottom of the bottle. For these drugs this sediment can be ignored.

 

Some of the drugs are less soluble in water and the Active Ingredient stays in the powder. For these drugs we have to do what is called a Suspension. The ground up powder is left hanging or suspended in the liquid when the dose is measured. This required a good shake to make sure it is evenly distributed in the liquid. It is best to use a "suspension medium" instead of water. A suspension medium is thicker than water and keeps the powder from settling out.

 

Either way making and using a homemade liquid can be a very accurate method for measuring ones dose. It is a little more complicated to work with but overall it is more accurate and much more flexible than the dry cutting methods.

[Tom2020]

On 3/8/2021 at 1:32 PM, brassmonkey said:

Either way making and using a homemade liquid can be a very accurate method for measuring ones dose. It is a little more complicated to work with but overall it is more accurate and much more flexible than the dry cutting methods.

I was just about to ask if there was a consensus on liquid vs. weighing.  The other relevant thing I read was Rhiannon: "Personally this [liquid titration] 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." (in the first post in this thread).

 

If that is the consensus, would it be worth adding something be added to the introduction of these threads to help people decide? Are there any exceptions? Counting beads seems accurate but I don't know how convenient it is.

 

 

 

[brassmonkey]

Thanks Tom2020, the suggestion will be added to the list. We have a lot of projects in the works to help clarify and make things more user friendly, this will make a good addition. 

[Nomansland]

Hello everyone,

 

i want to add a suggestion here.

 

lately i thought about how to increase the accuracy of liquid tapering for those who taper with water.

We know its important to be as accurat as possible when we measure our dose.

 

So the error when we have to measure exact 1ml of a volume or 1mg in weight can be a thing, depending on measuring mistakes,

such as not hitting the line correctly on syringes/pipettes every time or using slighty more or less water.

 

BUT when we use a reliable scale to measure out our liquid dose, we can be even more precise.

For water 1 ml equals 1 g and 1g can be easily measured accuratly on a reliable scale.

 

For example, if we have an evenly distributed suspension/solution where 1 ml is 0.1 mg of active ingredient, you just

have to weigh out 1g for 0.1mg active ingredient. Tiny weight differences on most scales like 5 mg or even 10 mg

would only mean an error of 0.5 % ( = 0.0005 mg active ingredient) or 1 % ( = 0.001 mg active ingredient). 

 

This is far less than any error you could get with measuring mistakes on a syringe and in my opinion a good, cheap 0.01 g scale would

be enough. Of course a 0.001g scale is even better, but the ones with a maximum weight up to 100 g or 300 g (= 100 ml to 300 ml) are expensive, so a 0.01g scale would be fine for liquid tapering. Just make sure to add the weight of your measuring cup/glas in the maximum scale weight.

 

Greetings

 

Nomansland

[ChessieCat]

@Nomansland

 

That might be a good option for some people. 

 

However to get better accuracy without weighing the liquid it is easy enough to dilute your dose with more water.  The more diluted you make your liquid the more accurate a dose you can measure.

 

When I am due to make a reduction I work out how I am going to get my dose using the 1mL, 3mL, 5mL and 10mL syringes I have.  So far I have made three different dilutions.  2mg Pristiq in 200mL, 400mL and 1 litre.  Doing it this way I do not have to measure anything less than 1mL.

 

For my current reduction I am using 1 litre and take 39mL, measured by 3 x 10mL plus 9mL, measured using the 10mL syringe, but I could use 3 x 3mL.

[Nomansland]

Hello @ChessieCat,

 

thank you for your answer.

 

Of course, using more water for a (good distributed) suspension will make the error much smaller.

 

I want to point out, that measuring (for example) your 39ml of liquid in weight by scale would be 39g.

Both methods should work fine, but weighting 39ml (=39g) on a reliable scale is even more accurat than

using 2 different syringes multiple times to get to 39ml. The error of the scale weight variation would be

much smaller than the possible measuring error by using syringes multiple times, "dead space" problems etc.

 

Even quite accurat weighting in 0.1 ml steps like 39,5 ml (= 39,5 g) would be an option for some people, for example.

 

Again, i think both methods are fine. But weighting the liquid should be (in my opinion) even more accurat and

faster/easier (because you dont need to use and measure with different syringes).

 

Greetings

 

Nomansland

[hayduke]

@Nomansland Syringes give reasonable accuracy, but you can do better with a pipette.

 

Recently stumbling across cheap 5ml adjustable volume micro pipettes on flea bay is the most accurate way I've found to titrate dosage.  Reduces the chance of errors at the end of a long day, and makes the whole thing quick and easy instead of a song-and-dance with all the setting up, squinting, and putting away lots of paraphernalia when you just wanna flop into bed.

 

 

If weighing the suspension works for you, go for it.

 

Realistically, repeatable consistency of the dosages is more important than an absolute specific volume, even though that's obviously still nice to have.

[Nomansland]

Hello @hayduke,

 

because of your post, found it a few months ago, i remembered using pipettes in a lab and already got a nice set of some glas measuring lab pipettes from ebay. Thank you for that.

 

They are not automatic micropipettes like you mentioned because my suspension will use more liquid, but i agree with you that these are more precise and easy to use.

 

Just want to share my thoughts and opinion about weighting liquid and why its more accurat (and could provide more repeatable dosing). Hope it will help someone.

 

As we know, in the end everyone has to make their own decisions.

 

Greetings

 

Nomansland

[ChessieCat]

2 hours ago, Nomansland said:

As we know, in the end everyone has to make their own decisions.

 

And it's really good for members to put forward their ideas because it gives other members various ways to consider.

 

Thankfully I do not seem to be too sensitive to a slight variation in dosing, if it is occurring.  I've noticed that there are sometimes air bubbles that I cannot shift so I just do my best with what I've got. 

 

For this reduction I am measuring 2 syringes and adding them to a medicine cup and then drinking that and then repeating with 1mL less.  There have been a few times when I have splashed a bit over the side when emptying the syringe.  I've decided that I'm not going to stress about it.

 

However for members who are making a strong solution with a strong drug, and therefore measuring tiny amount/s then the more accurate they can be the better, especially if they are sensitive to dose variations.

[ChessieCat]

Just wondering whether others think that this might work okay:

 

I am have difficulties getting rid of air bubbles.  I am wondering if it might work to fill the syringe with plain water and expel the air bubbles and then empty the syringe before drawing up the dose.  As long as everything is done the same way for the duration of the time you are taking that particular dose it should not cause any issues.

[ChessieCat]

20 hours ago, ChessieCat said:

I am wondering if it might work to fill the syringe with plain water and expel the air bubbles and then empty the syringe before drawing up the dose. 

 

I tried this last night and I didn't end up with the large bubble/s that I usually do.

[bubbles]

I tend to draw the med up once and expel it, and then go again. Definitely fewer bubbles second time.

[hayduke]

2 hours ago, bubbles said:

I tend to draw the med up once and expel it, and then go again. Definitely fewer bubbles second time.

 

I'm in the habit of doing this a few times just to mix up the suspension better

[ChessieCat]

10 hours ago, bubbles said:

I tend to draw the med up once and expel it, and then go again. Definitely fewer bubbles second time.

 

Yes, that might be a better way.  Thanks.

[Dee12h]

I made my lexapro suspension today. 10ml of saline solution & 1 pill (10mg). I went back an hour or so later, and there is a lot of white stuff floating around in the liquid. I assume it’s filler, bc the powder pretty much dissolved, & it’s a different color white from the powder. If it really only lasts 2-3 days, & I’m using less than 1mg per day, I’m going to be wasting a lot! Anyone experienced it lasting longer? Tia!

[Aleena]

It lasts for a whole week in refrigerator. I am using home made liquid for tapering. It's good to go for a week. 

[BigSun]

Hi Dee,

 

I tried the same thing, and couldn't really tell what the white stuff floating was.  Did it include the active ingredient or was it just filler?  I think that is an important question, to know whether the active ingredient is truly distributed evenly in the solution.  This says that Lexapro dissolves in saline solution, but I tried it with that too, and got the same floating white stuff effect.

 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/21323se1-003,se8-007,21365se8-001,se1-004_lexapro_lbl.pdf

[Dee12h]

3 hours ago, BigSun said:

Hi Dee,

 

I tried the same thing, and couldn't really tell what the white stuff floating was.  Did it include the active ingredient or was it just filler?  I think that is an important question, to know whether the active ingredient is truly distributed evenly in the solution.  This says that Lexapro dissolves in saline solution, but I tried it with that too, and got the same floating white stuff effect.

 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/21323se1-003,se8-007,21365se8-001,se1-004_lexapro_lbl.pdf

After I checked it overnight, the whole thing was dissolved. It’s the generic escitalopram. 

[BigSun]

Wow, that is interesting.  I left it soaking overnight too, and it still had the white stuff.   I think I did have the brand name one though.

[brassmonkey]

The floating white stuff is filler. If you let the pill soak over night all of the active ingredient will dissolve in the water leaving none in the filler. Different manufacturers will use different fillers so some will also dissolve along with the active ingredient, but most will leave a white or colored sediment of some sort.

 

Because the the nature of dissolving something in a liquid it will automatically provide an even distribution throughout the liquid. Lexapro is considered sparingly soluble in water, so if you are trying to dissolve a large amount of lexapro in a small bit of water, you will have problems. As mentioned earlier in this thread using isotonic saline (salt water) works much better.

[SkyBlue]

On 4/9/2021 at 5:30 PM, ChessieCat said:

 

I tried this last night and I didn't end up with the large bubble/s that I usually do.

Nice problem solving, Chessie!

[JustBella]

Considering trying lamotrigine @.5 to try to stabilize my w/d symptoms, but mot sure how I would get such a small dose and how I would untilmately taper off.

It appears there are 2 mg chewables, but not sure I could get those.  
if I could, could those be dissolved in water?  
 

 

 

[Cruizer]

@ChessieCat Hi Chessie, just wondering as we are both in Australia, where you may have purchased your syringes and other utensils needed to make an accurate liquid solution? Also, do you use alcohol when dissolving the tablet or any thing else other than normal tap water? Brass suggested 1ml of Vodka but it seems people on here don't really do that. 

[hayduke]

Hey @Cruizer

 

I just use tap water filtered through a brita style jug.

 

Can't speak for ChessieCat, but syringes should be cheap and easy to find at most chemists.  (Proper ones, not so much the franchised american-style crap where they group their stuff on the shelves by brand not product type...don't get me started)

 

I went to three local ones when I was setting up, all had 10-20 ml ones and a third was reliable for 60ml.

 

When I went to pipettes, plenty online:

 

25 ml serological pipette

10 ml pipette

Pipette pumps

 

Adjustable volume pipette (these are the best thing I've found, especially for the tail end of the taper)

 

And your syringes too 60ml syringe

[badmeditator]

I had great luck grinding lurasidone (Latuda) 20 mg tablets into a powder with a granite mortar and pestle I found in the kitchen.  It grinds into a powder really nicely.

 

I was able to measure out the 77 mg pill weight (18.76 mg of active ingredient) I wanted on my A&D FX-120i milligram scale very readily using a small paint brush to sweep small amounts into a stainless steel cup.  I just dumped the measured powder into a cup of tea, mixed it up, and drank it.  There was nothing left in the cup at all when I was done.

 

At what pill weight should I think about making an Ora-Plus suspension instead of just measuring it out on my milligram scale?  I will be going down to 1.44 mg of pill weight at the endpoint in mid-2023.

 

Ora-plus is super expensive from amazon.ca, about $50 for half a litre!