Esri: I am new here, this is my story...

[Esri]

Hi everyone my name Esri and I live in South Africa. Grateful to be here.

 

My sister is critically ill from her medication. I will start from the beginning. Also bare in mind that I have only recently discovered the online community therefore my observations are partly based on what I've been able to figure out so far. I have a lot to learn. My entire life is committed to this - it has to be - due to the desperately critical and worsening condition my sister is in. My sister only finds relief each day after the tranquilizing effect of her anti-psychotic medication start working in the evening. Shortly afterward she falls asleep.

 

My sister has been on her medication for 17 years. From the start, she has experienced akathisia. Her episodes varied in degree and duration. Over the years, during serious akathisia episodes, she has been admitted into the state psychiatric ward numerous times for many weeks. I figure they identified tardive dyskinesia and extra pyramidal symptoms. In ignorance, we never asked too many questions, believing the good doctors knew what they were doing. Boy, we're we wrong - in a recent discussion I had with the head of psychiatry, the term akathisia was foreign to him.

 

Five years ago, my sister started feeling unwell for periods during the day, and gradually, larger portions of each day became awful. Today, she feels so unwell that she's unable to get out of bed. Rolling all day to find relief from akathesia.

 

The first urgent challenge I face is the following. About three and a half years ago, my sister was given Oxazepam to help with her severe episodes of akathisia, which would help her recover quickly. But was meant only for emergency use. We we're never informed about the dangers of Benzodiazepine, so inevitably my sister developed dependency and used 10 mg once a day for a the majority of the past three years and a half years. Not good!

 

My sister currently take Oxazepam 10 mg twice a day which is still bad because of Oxazepam's short half life (only came to knowledge of very recently). I plan to administer a 7 mg solution of Oxazepam three times daily and gradually, according to the Ashton Manual guidelines, transition her onto Diazepam (👉🏻 Some advice here will be appreciated regarding changing Oxazepam 10 mg twice daily to 7 mg three times daily). 

 

I only realise now that Interdose withdrawal has been a major contributing factor to my sister's suffering for the past three and a half years. However, the noticeable downward trajectory of feeling really unwell started five years ago (apart from the akathesia which has been consistent for 17 years). The hospitals only answer in the distant past (+-4 years ago) has been to rapidly increase the Venlaflaxine XR and Clozapine dosages by a lot for a couple of months, and lowering the dosages after a period again.

 

The second urgent challenge I face is to help my sister recover from the worsening ill condition she's in. Our state hospital wants to change the SNRI to Imipramine and Lamictal, which I am not even considering, but as a result, they are unaware of my sister's poor condition. Any open discussion with them leads nowhere, for all the reasons related to the many failures of the psychiatric medical industry.

 

About eight months ago (January) the hospital changed my sister's Venlaflaxine XR 225mg to Fluoxetine 20mg abruptly because they had a supply problem. After a month we asked to change back to Venlaflaxine XR. At first she was only given Venlaflaxine 75 mg, for a month, to adjust back. The second month she was given 150 mg, but because she seemed okay on 75 mg and knowing we want to start tapering I kept her on Venlaflaxine XR 75 mg to see how it goes. All seemed okay to me apart from feeling unwell like usual. But I can not sure how she managed staying on Velaflaxine 75 mg ever since.

 

Two months later (March) my sister abruptly stopped taking Oxazepam, for a couple of days, and all hell broke loose. Since then I've had to increase the Oxazepam to 20 mg (twice daily 10 mg). Three weeks ago I learned about the 'half life' concept and the very short half life Oxazepam has.

 

I'm way in over my head, so I've begun looking for a Psychiatrist who will listen to me. Someone willing to acknowledge that tapering is the path, we must follow on. Unfortunately it's not likely that I'll be successful. None the less, by reading the section "Complexities of adverse drug reactions and polypharmacy"

 @Altostrata wrote in her paper, I can see all the mistakes I made. Therefore I only need to find a Psychiatrist willing to listen.

Polypharmacy and interdose withdrawal has to be addressed. My sister must first heal before we can begin to think about tapering.

 

My sister has been consistently using the same dosages of medication for about 5 months to date. I realise now that the change up with the SNRI that took place 8 months ago and the insanity of stopping Oxazepam abruptly 5 months ago for a couple of days must have had a detrimental effect, compounding my sister's painful suffering of more than 5 year's already.

(👉🏻 Any advice here will be appreciated).

 

The 17 years of treatment my sister received from our state hospital was a complete failure. I'm deeply ashamed for not seeking answers sooner.
 

@brassmonkey will you please advise if my titration calculations down below is correct.

 

Bare in mind, I'm just assuming alcohol (ethanol) will also work to dissolve Oxazepam. Because ethanol dissolves, if I'm not mistaken, all the Benzodiazepines you used in your titration wright up post (I can't find information on Oxazepam's solubility).

 

Someone recently sent me the following-

###########

Oxazepam: Creamy white to pale yellow powder. Is practically odorless. Slightly soluble in alcohol and in chloroform; slightly soluble in ether; practically insoluble in water.

PS. Please be aware that pharmaceutical scientists ensure that sink conditions are met when experimental solubilities are used in the development of liquid formulations (i.e. the experimental solubility is decreased by a factor of at least 3-4 or even 10+)

###########

 

MY CALCULATION:

 

0.25 ml 90 Proof vodka will dissolve 1 mg Diazepam

 

0.5 ml 80 Proof vodka will the certainly dissolve 1 mg Oxazepam

 

Then, to get to a 1 : 1 solution or-

 

20 mg Oxazepam : 20 mL

 

I have to-

 

0.5 ml (80 Proof vodka) x 20 = 10 ml (80 Proof vodka) will dissolve 20 mg Oxazepam

 

10 ml 80 Proof vodka + 10 ml water = 20 ml

 

Therefore-

 

20 mg Oxazepam : 20 mL Solution 

 

I believe my calculations are correct. That's to say only if 1 mg Oxazepam dissolves in 0.5 mg 80Proof vodka. Please advise.

 

Thank you.

Edited September 15 by Emonda
Name to title

[LotusRising]

@Esri

 

Hello and welcome to SA,

 

On 9/15/2024 at 2:07 PM, Esri said:

I plan to administer a 7 mg solution of Oxazepam three times daily and gradually, according to the Ashton Manual guidelines, transition her onto Diazepam (👉🏻 Some advice here will be appreciated regarding changing Oxazepam 10 mg twice daily to 7 mg three times daily). 

It is not necessary to switch to diazepam if she's stable on oxazepam three times daily, unless interdose withrawal is a problem. Crossing over takes time and not everyone will tolerate, or feel well if switched. It's also worth noting that some will still find Ashton's taper rate too quick, so just something to be mindful of. 

 

Have you looked into compounding? If not, I will leave it to @brassmonkey to address the solubility and titration calculations. 

[brassmonkey]

Your calculations look fine.

[Esri]

Thank you.