Questions and answers about liquid medications, use by date, expiry

[Altostrata]

Daniel, I'm confused. According to Tips for tapering off Abilify (aripiprazole), it comes in this dosages:

 

- Tablets 2 mg
- Tablets 5 mg
- Tablets 10 mg*
- Tablets 15 mg*
- Tablets 20 mg
- Tablets 30 mg
- Abilify solution, oral 1 mg/mL 150-mL bottle NDC 59148-013-15
*also available in DISCMELT® Orally Disintegrating Tablets

 

How are you getting the other sizes in the tablets?

 

People can take part of their doses in liquid form and part in tablets. Some people are sensitive to the differences between liquid and tablets; others are not. If you are a person who is sensitive to the differences, you may not wish to change forms of dosage often.

[daniel0708]

Hi Alto,

 

I have a prescription for 3.75mg tablets from my psychiatrist, who is away on leave. These are 1/8 of 30 mg tablets (he wants me to take half the tablet. I've been forced to get off the drug by stealth because he won't allow me to do it.) Then, I went and saw a primary care doctor who agreed to help me come off the drug. He wrote me a prescription over two weeks ago for 5mg tablets, which I cut into halfs, quarters, and eighths. Finally, on Friday he wrote me a prescription for liquid Abilify (150ml). The bottom line is I have a lot of Abilify, both in tablet form and liquid. I want to use the tablets as well in my weaning process since I paid quite a lot of money for them. I just didn't know if taking tablets for two weeks, then liquid for two weeks, and then switching again, is throwing my body for a loop. I hope I am not sensitive to the difference.

 

I am not planning on "playing" both doctors. I plan to terminate my relationship to the psychiatrist when he comes back from paternity leave in late May. I also will stop seeing the primary care doctor when the taper of Abilify is complete. The nature of the game, as you know, is sometimes you have to sneak around in order to become drug free. It sucks, but it is what it is. At least I am under medical supervision with the primary care doctor.

[Altostrata]

Did you get the 3.75mg made by a compounding pharmacy?

 

You can combine tablets and liquid. If I were you, I'd use the liquid to supplement for intermediary dosages. You don't have to decrease by .75mg or 0.5mg, which are more than 10% of your dosage at every step of the process you've outlined, which by our standards is too fast:

 

Abilify 3.75mg (tablets) to 3mg (liquid) to 2.5mg (tablets) to 2mg (liquid) to 1.5mg (liquid) to 1.25mg (tablets) to 1mg (liquid) to 0.625mg (tablets) to 0.5mg (liquid) to 0.4mg (liquid) to 0.3mg (liquid) to 0.2mg (liquid) to 0.1mg (liquid)

 

 

Again, there's no way to predict how you will react to alternating the tablet and liquid forms.

[Jlynn]

I have a question and I am unable to find it in my search. If this is already a topic being discussed will someone please post the link for me!

 

I am wondering about using a combination of paroxitine tablets at 5-10 mg and the rest of the tapered dose in liquid. I.e. 10 mg tablet and 2 ml of liquid for 14 mg. is this safe or not recommended? For me the pills are much cheaper than the liquid so I didn't know if using both is an option?

 

Thanks for any information!

[Altostrata]

Yes, you can use a combination of tablets or capsules and liquid.

 

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

If your doctor prescribes the liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

[Jlynn]

Thank you Alto! I was concerned the metabolism might be to different and cause problems. Does it matter that my pills are generic paroxitine and the liquid is name brand Paxil? My pharmacy said they didn't see an option for generic liquid.

[Altostrata]

The liquid is absorbed faster.

 

Generic and brand-name paroxetine shouldn't be a problem.

 

Taking part in tablet and part in liquid is probably the easiest way to convert to liquid, which you'll want to do at the end.

[finding123]

Hi there,

 

I am currently tapering off Prozac liquid and I am down to 0.9ml a day. My doctor has pointed out to me today that the bottle of medicine expires after one month of opening it. Each bottle is 70ml, so if I open a new bottle every month I would be wasting a lot. I wondered what everybody else does? Is it considered unsafe / unwise to take the medicine more than one month after opening it? 

 

Thank you.

[Altostrata]

If you use it past expiration, it may or may not be a consistent strength. Generally, it's a good idea not to use a liquid past its expiration date.

 

To reduce expense, you can make your own Prozac liquid, read this topic from the beginning Tips for tapering off Prozac (fluoxetine)

[clarabella79]

Hi finding123,

 

I'm currently using a combination of 5mg tablet + a very small quantity of Paroxetine liquid(currently 1.2ml daily) to taper and I haven't been throwing the bottle of liquid away after the 1 month mark. I mentioned the 1 month expiration warning on the bottle to one of the GPs at my practice and he said it can - as Alto said - start to degrade and lose some of its potency after it's been open a while. From personal experience, I've found it's ok for about 7 weeks. After that, I can tell it isn't working as effectively and I start my next bottle. I guess cost isn't as much of an issue for us here in the UK (I notice you're from Liverpool), as we only have to pay £8.20 (around $13 USD) for a bottle of liquid. It's still useful to know that you can make a liquid from tablets, though, if you happen to run out and can't get to the docs.

 

Well done on getting to such a low dose of Prozac, by the way

[Colonial]

Hi, I'm reading Clarabellas post from July, saying her liquid paxil expires in a month from "opening"?

 

When I get my liquid from the pharmacy, it has the general use by one year on the label, and when I asked what the manufacturer expiration is, they said it was almost 2 full years from the date I received it.

 

I noticed she is from England, is their formulations different?

 

I'm currently using a bottle I got about 6 months ago, but says is still good for another 5 months/

 

Thanks!

[Skyler]

Hi, I'm reading Clarabellas post from July, saying her liquid paxil expires in a month from "opening"?

 

When I get my liquid from the pharmacy, it has the general use by one year on the label, and when I asked what the manufacturer expiration is, they said it was almost 2 full years from the date I received it.

 

I noticed she is from England, is their formulations different?

 

I'm currently using a bottle I got about 6 months ago, but says is still good for another 5 months/

 

Thanks!

 

colonial.. you already have a liquid suspension?  I put the link thru with the idea you needed to make your own.. which many folks here do.  But you already have some on hand?

[Colonial]

my paxil is liquid, yes.

 

but my xanax are the scored pills

 

I was just wondering why Her liquid paxil says 1 month but the date on mine is a year, dont want to be using it if that's an issue.

[Skyler]

ohhh... I see.    

[Altostrata]

Different formulations. Please go by the labeling on your bottle. If you have questions, ask your pharmacist.

[scottly9999]

Hello Fellow Survivors!

 

Just a question thats been running through my head.

While tapering down on Lexapro - and finally convincing chemists here in Australia if liquid Lexapro IS available (yes it is) - although it seems most chemists are reluctant to give you the 10mg/ml bottle, and really push towards the 20mg/ml concentration (I believe it's the PBS pricing or something that does it).

 

I've noticed that I always seem to run into withdrawal symptoms and more problems towards the end of a bottle.

Now as I'm taking only about 2mg or even 1.8mg or 1.5mg, the bottle lasts me a long time.

I opened my current bottle at the beginning of January this year, and it's now mid April.

I'm still on the same bottle, albeit not much left.

I've had horrible withdrawal symptoms lately.

The bottle says discard after 3 months.

Now most medicine has a use-by date, but I was wondering if anybody has had experience of liquid Lexapro (or any other SSRI for that matter) that might lose it's potency over time??

It almost feels that way to me.

[mammaP]

As I understand it the bottle starts to lose potency once opened. Do you keep it in the fridge where it is cool and dark? I'm sure I read that medicines which  are exposed to light deteriorate faster which is why they are usually in brown bottles. 

[Hibari]

Hello Fellow Survivors!

 

Just a question thats been running through my head.

While tapering down on Lexapro - and finally convincing chemists here in Australia if liquid Lexapro IS available (yes it is) - although it seems most chemists are reluctant to give you the 10mg/ml bottle, and really push towards the 20mg/ml concentration (I believe it's the PBS pricing or something that does it).

 

I've noticed that I always seem to run into withdrawal symptoms and more problems towards the end of a bottle.

Now as I'm taking only about 2mg or even 1.8mg or 1.5mg, the bottle lasts me a long time.

I opened my current bottle at the beginning of January this year, and it's now mid April.

I'm still on the same bottle, albeit not much left.

I've had horrible withdrawal symptoms lately.

The bottle says discard after 3 months.

Now most medicine has a use-by date, but I was wondering if anybody has had experience of liquid Lexapro (or any other SSRI for that matter) that might lose it's potency over time??

It almost feels that way to me.

I'm so glad you mentioned this.  Since my cuts are getting smaller, my bottle is lasting longer as well.  I too have felt that my wd is a bit more intense even though I haven't made a cut since mid March and I have been feeling pretty stable. 

[scottly9999]

Hi Guys

 

It's an interesting topic for sure.

The bottle is a brown glass bottle, I just keep it in the cupboard, so it's dark all the time, except for the morning when I take it out - and a reminder that I'm STILL taking this "poison"!!!

I'm about to get a repeat - annoyingly the GP's won't give me a script for a repeat, just the one bottle... and I have to explain it each time to a perplexed GP as to what and why.

Man the drug companies have done a great job of NOT informing the doctors as to what this stuff CAN do to people.

I have met 1 GP over the years who WAS supportive of a slow taper, and was quite serious about it.  He seems to have since retired.

 

I've met a few people who have either stopped cold turkey, or 2.5mg every few weeks, and has a few brain zaps, but after that, they were fine.

WOW.

 

I'll report how I feel once I get a new bottle.

I'm HOPING to get a 10mg/ml bottle - as more accurate - and has the nozzle for an oral syringe.

And if the chemist doesn't have that exact bottle, they say they need to speak to the GP to get permission to give me the 20mg/ml

<sigh>
The GP has no idea in the first place.

[mammaP]

Hope you can get what you need, GP's rarely have a clue! If it's losing potency can you get a script when it SHOULD run out if taking the recommended dose? Not sure if it would be possible or affordable but it shouldn't lose potency. We can be quite creative with tapers and dealing with GP's !

[scottly9999]

Hi MammaP

I'm not really taking the recommended dose, I'm taking what "I" need to take for my taper.

I'm taking about 0.075 of 1ml

Thats such a small amount - Lexapro is quite concentrated too.

My bottle lasts about 4 months.

It says to discard after 3  months after opening.

I've noticed with the 4 or 5 bottles I've been through that I seem to get WD quite badly at the end of a bottle, regardless of where I'm at in my schedule.

 

My current battle with WD has been the most crushing wave of depression I've ever known, lasted about 1.5 weeks.  Came on quite suddenly, and left even quicker.

Horrible horrible horrible.  Worst wave I've ever had.

 

So I'm really asking, have I been through almost a COLD TURKEY WD as if the active part of the medication has expired, did I put myself though CT and have almost got off the drug without realizing?

Coming out other side of the wave, I feel much clearer in my head than I have in a long time, and feel less medicated too.

Just asking if anybody else has had similar experiences to this with liquid SSRI's?

[Altostrata]

Discard 3 months after opening, and save yourself the confusion.

[mammaP]

Sorry to confuse you Scottly, I meant to discard the bottle after you would have finished IF you were taking the recommended dose. That will mean that you are discarding most of it at lower doses. I am good at confusing people    ! 

[scottly9999]

Ok

Update.

I picked up my script last night - and was told AGAIN they don't make the 10mg/ml bottle anymore - I had one last year sometime.

THis may be true, but I was told by another chemist that it's on the PBS here in Australia, and would cost a LOT more.

So still not a straight answer.

The chemist's website blatantly advertised the 10mg/ml bottle, not even mentioning the 20mg one.

<sigh>

oh well.

Saturday 16th marked the end of a horrific wave for me - crippling depression that lasted about 2 weeks, came out of nowhere and left just as quickly.

I had been suffering from very low motivation levels leading upto it, and all sorts... which is what led me to question if the liquid was "off".

 

On SUnday I felt good, like really clear in the head, and connected to surroundings.

EVen in my windows of relief over the last 18 months, I've not had this feeling.

I felt pretty much like I did pre-meds.

I started to think - have to effectively tapered off using "stale" liquid???

 

On Sunday - as part of testing this, I skipped a dose.

and Monday and Tuesday took only 1mg.

I was on 1.5mg of Lexapro (quite a strong SSRI).

This 1mg came from the "expired" bottle.

As of Tuesday night and this morning, I noticed that I was ALSMOST having brain zaps - could feel the tiny pulses, and started moving my eyes to see if they would develop into brain zaps (seems to be connected to eye movement)... but didn't happen properly.

ALso had a few hot flashes 0 liek really hot.  Had to take my shoes off at work yesterday - felt like my feet were on fire.

My mood has been fine - nice and stable.

 

I've taken those 2 symptoms that my drop from 1.5mg to 1mg on "expired" liquid was probably too big of a drop, and that the liquid was probably still active.

 

I've taken 1.2mg of my fresh bottle today.  That was 1 hour ago, no real changes yet.

 

Interesting though.

[scottly9999]

Small update

Ok - 2 days now of 1.2mg of Lexapro from a fresh bottle

And I'm positive I can "feel" its affects - albeit slightly, but none-the-less there.  Slightly less aware of surroundings, little slower thinking.

 

I really do think that I was effectively taking almost no Lexapro on the expired bottle.

[scottly9999]

Another update.

It's been 1 week since starting the fresh bottle.

I can report that I'm feeling more the slightly disconnected, MEH feeling of being on Lexapro - that was slowly fading for me on the older bottle.

I've also gone to 1mg, and feeling a few WD effects.

MOstly muscle aches and body pain - quite strong.

Also fatigue - feeling very rundown.

So currently feeling both WD and SSRI effect - not great.

 

I can cope, just.

[Hibari]

I too have a liquid suspension of one of my medications and as I wrote above, I too feel that my newer bottle is always a stronger than the tail end of my old bottle.

 

I also relate to the run down feeling.  I just made a small cut on one of my medications and I feel exhausted.  I say to you what I am saying to myself, this will pass and it's a time to very nice to ourselves.  It's a weird feeling to be in the not so great but not crisis state of wd. 

 

You've  come a long way and should be proud of what you have accomplished so far.

[scottly9999]

Hi Hibari

 

Yep - I'm telling myself, remember my windows - i'll get there again, and eventually always be in a window!

But wow - this experiment gave me some answers.

 

THe liquid doesn't seem to expire, BUT it did lose some action.

I felt LESS medicated on it, like the world felt less NUMBED out.

Now I'm on a fresh bottle, I've got both withdrawal flu-like symptoms FULL BLOWN, as well as the heavily medicated feeling.

 

Which leads me to another question...

When can I expect to feel "normal" again?

DOes that only come back after months of not having any SSRI in my system?

Or am I supposed to feel it in my windows?

My windows are really just mostly "no withdrawal effects", as oppossed to "feel normal".

 

Can anybody relate to that?

[geminigirl]

QUESTION:

 

I use a glass jar with a lid on it when I put 20 ml of water and then my 20 mg of celexa in.

 

The problem is, once the tablet is dissolved and I shake the jar to even disperse the drug, when I then quickly open the lid to draw out my dose fo the day with my oral syringe, there is liquid that comes out when I take off the lid. I am assuming it's okay because I shook the liquid, but still, I am worried that this will make my dose uneven.

 

I take 2 mg 5 times a day (to decrease akathesia as akathesia gets intolerable if I take a higher dose at once).

 

But ya, is this okay that some liquid comes out when I open the glass jar? I usualyl shake it pretty hard, like in an up and down motion as some of the celexa can settle to the bottle so I think mixing it up and down several times is important.

 

Does anybody have another idea of where to get a good glass jar so tha when I open the lid after shaking it, some of the liquid won't come out?

 

Maybe a glass jar with a plug rather than a lid? I just don't know where to buy those.

 

[SquirrellyGirl]

Hi geminigirl, 

 

This is not a problem if you shook well before opening your jar.  The only problem would be if you were mixing two doses, withdrew one dose but the lost liquid made the second dose less than it should be.  I wouldn't worry about this.

 

I like using these tubes from Amazon to mix my doses:  https://www.amazon.com/Karter-Scientific-Centrifuge-30x115mm-Conical/dp/B005Z4S3ZU/ref=sr_1_1?ie=UTF8&qid=1466361779&sr=8-1&keywords=50+ml+conical+tubes

 

Sure, 50 is way more than you need, but they seal nicely and very little liquid stays in the lid when you open it.  The white markings wear off eventually, so then you toss it and use a fresh one.  You can get them in 15 ml size as well.  https://www.amazon.com/United-Scientific-D1003-Polypropylene-Graduations/dp/B00ES3TIRG/ref=sr_1_1?ie=UTF8&qid=1466361862&sr=8-1&keywords=15+ml+conical+tubes

 

SG

[geminigirl]

Ok thanks.

 

Is there any place I can get 30 ml ones?

[SquirrellyGirl]

No, 50 ml is it, but that would work.  You can wrap the tube with tin foil to block light.

 

SG

[Lakelander82]

Why the need for a glass jar? I grind the tablet in a mortar and pestle then add a known quantity of water via a syringe, give it a good stir and then withdraw my suspension directly from the mortar via the syringe.

[Riffick]

Ok thanks.

 

Is there any place I can get 30 ml ones?

 

The tubes are sometimes known as "specimen tubes" or "sample tubes" and are available in 30ml.  

I'm in the UK so my suppliers will be different to yours but Amazon or eBay should have them.

[Happy2Heal]

if there's anyone good with math who understands the whole "diluting a liquid with more liquid" and using a graduated cylinder to do what I think is called liquid titration, can you please PM me?

thanks

 

all the "maths" hurts my head, hahaha

 

I am taking 0.16mgs of liquid lexapro, which is also 0.16mls (its' a 1:1 solution)

i want to get the dosing more accurate, since the measurements are so small now.

I THINK I need to mix some of the liquid I have with water, and then take some out and throw it away and then drink the rest, at least that's the way I understand it

but I have NO clue how to do the math for this.

[scallywag]

H2H, it's better to answer your questions in the topic so that the information is available for all members and viewers of the site.

 

The easiest way to dilute a solution is to use a 10x or 100x amount of water. The thing we need to keep in mind is that a home-made solution has a much shorter shelf life than a commercially prepared one, probably 5-6 days to be safe.

 

If you were making a solution from your current liquid (1 ml lex liquid = 1 mg lexapro) for a single dose, I would draw 0.16 ml of liquid into a syringe and then pull water into the syringe to the 1.6 ml line. You'd have a 10 ml solution = 1 ml lexapro, where 1.6 ml = 0.16 mg lexapro.

 

To make multiple doses at once, let's use 5. 

lexapro liquid: 5 x 0.16 ml = 0.8 ml

water to make 8 ml = 7.2 ml

Mix those two amounts together and you'll have a liquid that has 5 doses of 1.6 ml = 0.16 mg lexapro.