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ADMIN NOTE This topic is a general discussion of how to make a liquid from drugs. 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. For those interested in reviewing pharmacy techniques for making liquid suspensions, see: Pharmlabs Suspensions Suspensions Also see Find tips for tapering your specific drug in this list: Important topics in the Tapering forum Why taper by 10% of my dosage? Using an oral syringe and other tapering techniques Splitting or crushing tablets or pills Using a digital scale to measure doses Making a Celexa solution yourself Questions and answers about liquid medications Haywood, 2013 Liquid dosage forms extemporaneously prepared from commercially available products - considering new evidence on stability. (refers to suspensions made with pharmacy liquids) Liquid medications -- use past expiration? 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. 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: 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.