Oceanrat: tapering Zoloft

[Oceanrat]

Hhmmm, not sure, it’s all generic Zoloft, I asked him if it’s the same, all he really had to offer me was “we all use the same sertraline powder” I kept pressing him for more info, without sounding totally nuts, but that all I got. When you’re in my kinda distress, I can come off pretty paranoid now. Lots changed for me in a very short 3 years now, to go back to acute is tough to swallow. I went over his whole percedure, the weighing, the Zoloft, the filler, seems to be a lot of grey area with compounding pharmacy and the variance etc. who knows, I’ve literally shattered my life by accident in this process. 

[Oceanrat]

Attempting to try and describe this kind of akathesia, with all the other symptoms, feels impossible. Friends and family have kinda given up and think I’m somehow choosing this. It’s all very rough

[apace41]

2 minutes ago, Oceanrat said:

I’ve literally shattered my life by accident in this process. 

 

One of the interesting studies I've read involves the use of "dramatic words" in ones self-talk and the strong adverse effect that has on mood and anxiety.  I know because I tend to be the same way.  It is a form of catastrophizing.  OR, I'm not for a minute suggesting your pain and suffering are not real and intense -- I'm confident they are -- but I am suggesting that if you can start to replace "shattered" with "temporarily damaged" I think you might see some real benefit to your CNS and ability to stabilize.

 

Just a suggestion.  Try it for a few days and see if it helps.

 

Best,

 

Andy

[Oceanrat]

You are completely correct Apace! I will take this advice and definitely work on my inner and outer dialogue! I do find this situation challenging. But you are very correct, it doesn’t benefit my situation 

[Andie]

If you can’t get the information you need from your current compounder, there will be other ones out there who can help and give you the info/support you need. 

 

I also sounded very very paranoid in asking these questions of my Pharmacist!!

 

[Oceanrat]

Looking for some input... it’s hard to pinpoint exactly exactly what’s happening, cuz all the mistakes, damage etc etc. but since switching from Zoloft pill to compounding over 10 months ago, it’s been a real disaster. I have no stability, I’ve spent endless hours talking to the pharmacy, with no great answers. Sometimes they compound by shaving pills, sometimes they use straight sertraline powder, mixed with microcrystalline. I’ve only dropped from 60mg to 40mg in almost a year, never stabilized etc. I’m wondering if switching to liquid Zoloft could help me control the human error or my reactions to the compounding situation??? Any thoughts on liquid? Bioavailability? Do I have to bridge? Any input would be appreciated. Sorry, I’m always hoping to deliver great news, it’s just not my situation. Psych doc is clueless, so is everyone else. I appreciate the help!

[Oceanrat]

Also does anyone have a compounding pharmacy, they really trust? I’m in California 

[ChessieCat]

When changing from one form of a drug to another we suggest doing a cross over.  Each combination for 3 to 7 days:  3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4

 

Zoloft tablets can easily be made into a liquid with water.  You will need a graduated cylinder and a suitable syringe. 

 

Where to get oral syringes

 

using-an-oral-syringe-and-other-tapering-techniques

 

how-to-make-a-liquid-from-tablets-or-capsules

 

getting-custom-dosages-at-compounding-pharmacies-us-uk-and-elsewhere

 

California members, please check in here

 

You would dissolve the xxmg tablet in equal xxmL of water.  That give you a 1mg : 1mL ratio.  The left over liquid can be kept covered in the fridge.

 

Ensure you do everything the same way each time using the same equipment and the same place to measure the liquid.

[Oceanrat]

Thx cheesie, I don’t need to make the pills into liquid, Zoloft already comes in liquid form. If just be switching from the compounding pharmacy to liquid, cuz it’s been a horrendous experience. Main reason I want to switch, is to eliminate compounding issues possibly. For some reason my reaction has been very unpleasant since I started the compounding route

[RachelSusan]

I am on liquid zoloft. The first few weeks it was difficult because I just went straight from hard pill to the liquid. I should have used ChessieCat's suggested way of transitioning, but I was foolish.  After I got over that little hurdle it was great. I am currently still on the liquid, prescribed liquid not homemade, and for me it is a perfect fit.  I don't have to wonder who is compounding that day and if they used the same process as the previous time. I might also suggest that if you don't transition to liquid you change compounding pharmacies.  If you just don't feel comfortable with them that says it all. I am sorry you are suffering so.  Zoloft is a nasty drug.  I hope for better days for you as soon as possible.

Warm wishes,

Rachel

[Oceanrat]

Thank you Rachel for the response!!! Yeah, I’ve just been stuck for so dang long, I’m fearful of making another transition, but it’s been a disaster since I started compounding 😪so I’m inclined to transition to liquid, so I have control. I’m just trying to get advice here. If I would have listened to everyone here in 2015, I’d most likely be better by now🤦🏻‍♂️

[RachelSusan]

Well then Oceanrat you and I are in the same boat, so to speak.  If I had listened I would be off the medication by now, with a lot less pain in my past.  But we understand now, so we only need to focus on what we do in the future, of course using all we have learned here.  You will get there.

[Oceanrat]

Anymore suggestions on liquid approach??

[RachelSusan]

On 1/17/2019 at 2:23 PM, ChessieCat said:

When changing from one form of a drug to another we suggest doing a cross over.  Each combination for 3 to 7 days:  3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4

This was ChessieCat's suggestion in an earlier post.  Start with 3/4 hard pill and 1/4 liquid.  I would hold a week and then move on to the next stage.  See above, the next stage would be 1/2 and 1/2 and so on until you are at 100% liquid, the same amount of equivalent drug as when you were on your hard pill. So it looks to me as if you are on 40mg of Zoloft.Then stay on same liquid dosage until you are very very stable.  Then you can discuss tapering with ChessieCat. The above is what I wish I had done when I went on the liquid.

[Oceanrat]

Thank you. I’m having the 40mg compounded at the moment, in capsules. So I’m gonna have to figure out how to get the crossover correct, get my doc on board, then have the compounding pharmacy make all these odd amounts in different doses, until I’m crossed over. This is gonna be difficult, but i need to figure it out. Sorry my brain isn’t working great.,I appreciate the response very much!! 

[Oceanrat]

Any other suggestions about the liquid Zoloft? What brand are people using and maybe some crossover success? Sorry to be annoying, just super nervous 

[Surfchick]

On 1/17/2019 at 1:10 PM, Oceanrat said:

Also does anyone have a compounding pharmacy, they really trust? I’m in California 

@Oceanrat why are you compounding sertraline? there is liquid form of sertraline 20mg/mL

 

[Oceanrat]

I guess it’s a long story, but my doc didn’t want me going from pill to liquid, he said it’s not readily available, sometimes insurance won’t cover etc. so we chose compounding, it’s been a disaster for me. So now I’ve got him on board with going liquid. So im trying to gather as much info as I can, so that my crossover is successful 

[Surfchick]

@Oceanrat this is what i did..

 

i was on 50 mg zoloft. 

i did 37.5 mg (split 25mg pills up [one 25mg and 1/2 25mg] and 12.5mg liquid (liquid comes 20mg per cc- get a 1 cc syringe on amazon) 

i did this for 7 days before making any drops.

i kept the pills as a baseline and titrated the liquid only. I did about 2-3% drops..

so...

week 1= 37.5 tab + 11.25liq

week 2= 37.5 tab + 9.5 liq

week 3= 37.5 tab + 8.5 liq

etc etc...

until i reached 0 liquid, then started all over again just recently..step 2--->

 

week 1= 25mg tab + 12.5 mg liquid

i am currently decreasing the liquid on this step...

[Oceanrat]

1 hour ago, Surfchick said:

@Oceanrat this is what i did..

 

i was on 50 mg zoloft. 

i did 37.5 mg (split 25mg pills up [one 25mg and 1/2 25mg] and 12.5mg liquid (liquid comes 20mg per cc- get a 1 cc syringe on amazon) 

i did this for 7 days before making any drops.

i kept the pills as a baseline and titrated the liquid only. I did about 2-3% drops..

so...

week 1= 37.5 tab + 11.25liq

week 2= 37.5 tab + 9.5 liq

week 3= 37.5 tab + 8.5 liq

etc etc...

until i reached 0 liquid, then started all over again just recently..step 2--->

 

week 1= 25mg tab + 12.5 mg liquid

i am currently decreasing the liquid on this step...

Thank you for the help!!!! Do you know what brand of liquid Zoloft? My pharmacy was only able to locate some small ML bottles. Thank you 🙏🏻 

[Altostrata]

What does ML mean?

 

People either get brand-name Zoloft liquid or generic sertraline liquid. There are a few generic manufacturers; your pharmacy may change suppliers. You might find it difficult to get a specific generic brand.

 

Besides, the liquid affects each person differently, what's important is that you accommodate to what you get. Many people have no problems with the generic brands.

[Surfchick]

@Oceanrat you are in california right? i had issues with CVS...go to Rite Aid, they have liquid sertraline. its gonna be more expensive than pills, my pills were 5$ per month, the liquid 15$ per month, just fyi..

[Oceanrat]

Yes California. @Altostrata ML-Milliliter, I’m nervous to make another switch, but hoping it’s better in the long run, to taper 

[Altostrata]

All of the liquids are measured in milliliters.

[Oceanrat]

As I try and navigate a messy situation here. And figure out why my taper has gone so awry, I sent my compounded Zoloft to an independent lab for analysis (I know it’s extreme but when you’re suffering in this manner you go to extremes). I’m not saying all compounding places are this way, but here were my findings. The Zoloft was supposed to be 40mgs. I sent 3 capsules in, the active ingredient in 3 were:

35.1

39.3

42.3

not sure if that’s causing my problems, but wanted to share how far off they’re. Now I guess I attempt to bridge over to full liquid, but feeling , well not so confident . 

[Oceanrat]

Sorry to be annoying but my options I think at this point are:

1)go from this compounding situation to all liquid

2) Go to 25mg manufacturers pill form and the rest liquid to make up to 40mg

im up for all input and suggestions, dealing with a real messed up central nervous system and trying to come up with best options. Thank you all for your help!!

[Surfchick]

36 minutes ago, Oceanrat said:

Sorry to be annoying but my options I think at this point are:

1)go from this compounding situation to all liquid

2) Go to 25mg manufacturers pill form and the rest liquid to make up to 40mg

im up for all input and suggestions, dealing with a real messed up central nervous system and trying to come up with best options. Thank you all for your help!!

YEP! i would def not use compounding, no need...its easy to get Rx  liquid and 25mg tabs,  then titrate liquid down from there...

[ChessieCat]

2 hours ago, Oceanrat said:

I sent my compounded Zoloft to an independent lab for analysis (I know it’s extreme but when you’re suffering in this manner you go to extremes). I’m not saying all compounding places are this way, but here were my findings. The Zoloft was supposed to be 40mgs. I sent 3 capsules in, the active ingredient in 3 were:

35.1

39.3

42.3

 

I'm really glad that you got the analysis done.  It's a real eye opener.

 

If the capsules were supposed to be 40mg, then the 35.1mg dose is 12.25% less.

 

And theoretically you could be alternating between 42.3mg and 35.1mg which is a 17% difference.  Ouch.

 

Another member starting having issues after they changed to compounded and felt that there was something amiss with their doses.

 

I've found these:

 

https://www.pharmacytimes.com/publications/issue/2006/2006-11/2006-11-6068

 

"For example, if a commercial product can contain 90.0% to 110.0% active drug, and compounding pharmacists are allowed a 90.0% to 110.0% variation resulting from weighing, manipulations, etc, then the overall variations that may theoretically occur are 81% (0.90 x 0.90 = 0.81) and 121% (1.10 x 1.10 = 1.21). "

 

https://pharmlabs.unc.edu/labs/measurements/weigh.htm

"Weighing

It is generally agreed that pharmaceutical products should be prepared with a low percentage of error. The official compendia allow a tolerance of ± 5% for most formulas, although greater accuracy may be required for very potent drugs with greater toxicity potential. This same degree of accuracy is expected in all extemporaneously compounded products."

 

2 hours ago, Oceanrat said:

not sure if that’s causing my problems

 

Could well be.

 

2 hours ago, Oceanrat said:

2) Go to 25mg manufacturers pill form and the rest liquid to make up to 40mg

 

That would probably be a more "equal" version of what you are currently taking.  At least you will know that you are getting the correct dosage.  It may be a bit rough for a couple of weeks but possibly no worse than what you've been going through with inaccurate dosing.

 

Edited January 30, 2019 by ChessieCat

[ChessieCat]

5 minutes ago, ChessieCat said:

Another member starting having issues after they changed to compounded and felt that there was something amiss with their doses.

 

It might have been you!

[Oceanrat]

Thank you guys so much! How would I cross over? Because I’d now be crossing to, two different, “new” deliveries. From whatever they’re using in the compounding, to new pill +Liquid, this seems like the best combo but my concern is introducing two new combos on an already sensitive cns. Hope I’m making sense? I truly appreciate the feedback!!!

[Oceanrat]

those compounding variances are a real problem correct?  Making sure I’m not being overly upset 😡 

[ChessieCat]

It might be better to change over to tablet first and then after a few weeks reduce the tablet gradually and introduce the liquid.

 

If it was me I'd just go straight over to tablet, mainly because of the possibility of a large variation from day to day with the capsule doses.  It's six of one, half a dozen of the other really.  At least with the tablet you will know you are getting a reasonably accurate dose.  And it's going from capsule to tablet which are closer in "likeness" than going from capsule to liquid or tablet to liquid.

 

The fact is you don't know what dose you are getting with the capsules.  Weighing up the pros and cons, I think going straight to tablet would be the best option.  The sooner you start getting a consist dose the better.

[Oceanrat]

@ChessieCat I agree and understand, but my issue is I take 40mg , the smallest dose of Zoloft in pill form is 25mg, how do I get to 40mg in pill form?? That’s why I was thinking 25mg pill and making the rest up in liquid, to get to 40 mg. Make sense?

[ChessieCat]

Oops, I didn't think of that.  Of course that is why you were compounding.

 

Can you split a tablet in half?  That would give you 37.5mg and then top that up with 2.5mg liquid.

 

I realise that halving the tablet will not be totally accurate, but you've been taking varying doses anyway.  It's a means to an end.

[RachelSusan]

Hi Oceanrat, Your current pill or tablet or whatever form it comes in is 40mg, but that is only because you had it specially compounded, is that right?  So if you were to do anything with that current pill it would be inaccurate because of the compounding procedure, is that correct? If I read your post correctly you are proposing to use a non compounded pill that you get directly from the regular pharmacy which is 25mg. I think in the United States our choices are 25mg, 50mg and 100mg, so perhaps given your choices your suggestion may be the most logical way to go. Whatever way you decide to go I think it would be beneficial just because you will start to get a stable and consistent dose. Due to the change you may possibly have a few weeks that are a little problematic (we don't know for sure)  but you have been so up and down anyway this will hopefully give you some improvement once the initial transition takes place and then you body settles down. It is a most difficult situation you are in but I do believe you will get it worked out. Good luck and please keep us posted as we all care about how you are feeling.

[Oceanrat]

@RachelSusan 

 

Correct, my 40mg Zoloft capsule is from compounding pharmacy. Yes my current compounding pill weight is very inaccurate.

 

Like I was saying, switching to pill form or liquid or a combo are my options. My goal is to get on a accurate, stable dose and minimize the suffering, and minimize a transition “speed bump”. My system is extremely taxed, so I’m just nervous to make the wrong switch. But I’ve gotta for sure ditch the compounding pharmacy idea. The question I guess I’m struggling with, is transition to ALL liquid? Or transition to pill+liquid? Or just pill? What a journey. Thank you so much for the support and suggestions!!!!