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Altostrata

Getting custom dosages at compounding pharmacies (US, UK, Canada, and elsewhere)

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Altostrata

MOD NOTE:  If you cannot find a pharmacist who will compound your drug I suggest you contact the main compounding association in your country and ask them if your drug can be compounded and if it can, to advise you of a pharmacy who can do the compounding for you.  Or you could ask the compounding pharmacy to contact the compounding association.

 

PCCA - Professional Compounding Centers of America (includes:  Bahamas, Canada, US, Singapore, Taiwan, Thailand, Australia, New Zealand, Philippines, Malaysia)

 

Association of Compounding Pharmacists of Canada

 

Association of Compounding Pharmacists of South Africa

__________________________________________________________

 

If you wish to have a compounding pharmacy make liquid medications for you (or make capsules in custom dosages), you will need a prescription from a physician. Any MD can write this prescription, it doesn't have to be a psychiatrist.
 
Make your request for a compounded prescription calmly, politely, firmly, and, if necessary, repeatedly.
 

Instruction for doctors: How to write a prescription for a compounded drug

Write the prescription following this format:

 

Quote
Compounded Medication
Generic Name of Active Ingredient(s) / Strength or Dose (i.e., mg or %)
Dosage Form (i.e., Liquid, Capsules, Suppository, Transdermal Gel, Troche)
Quantity
Directions for Use

 

 

The doctors should be sure to write "Compounded Medication" at the top of the prescription form.

Typically, for a compounded liquid, the prescription may read something like "compounded liquid, 90mg Effexor in 90mL, concentration 1mg:1mL, take 3mg per day" (a 30 day supply).

 

With a 1mg to 1 mL concentration, for example, you can reduce from 10mg to 9mg by taking 9mL of the liquid.
 
Generally, for insurance coverage, the prescription should specify a daily dose that is not available in tablets or capsules, or your insurance will insist you use the tablets or capsules instead.
 
You may be able to find recipes for compounded liquids by using search at http://www.pharmacytimes.com
 
Cost of compounded drugs
Because of the additional labor by a pharmacist, compounded drugs are generally more expensive than ordinary prescriptions.
 
In the US, the retail cost of a compounded liquid drug can be around $70. But charges may vary widely; it may be productive to compare prices from various pharmacies.
 
Some health insurance plans cover compounded drugs and some do not. (US Medicare does cover compounding of drugs on the plan's formulary. Not all pharmacies will accept Medicare for compounded drugs, reimbursement is very low.)
 
You will need to contact the compounding pharmacy for an estimate and your health insurance plan to find out coverage of a compounded drug. Some plans may require "medical necessity" paperwork from the doctor before they will pay for a compounded drug.
 
Get an oral syringe to take a compounded liquid
With a liquid, you use an oral syringe to measure your dosage. Ex: If your liquid contains 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.

 

Because the amounts of liquid drawn in tapering tend to be small, useful sizes of oral syringes are 2mL, 1mL, 0.5mL. A 5mL syringe generally does not have ticks at small enough intervals. See Using an oral syringe and other tapering techniques

Some compounding pharmacies in the UK
According to Dr. David Healy, these pharmacies in the UK can supply liquid formulations of many antidepressants and other drugs:

Rosemont Pharmaceuticals (Tel 0113 244 1999)
These prepare large batches (so may be cheaper) for:
Amitriptyline 10mg/5ml, 25mg/5ml, 50mg/5ml
Lofepramine 70mg/5ml
Mirtazapine 15mg/1ml
Venlafaxine 75mg/5ml
Sertraline 50mg/5ml
Dosulepin 25mg/5ml, 75mg/5ml
 
Contact to find out if they compound your drug.

Cardinal Health, Martindale (Tel 0800 137 627)
This manufacturer will usually prepare what you ask for, so if the antidepressant isn't in the above list [for Rosemont] opt for this.

Large chain pharmacies like Boots or Rowlands may have their own external supplier who they may prefer to use as they have a contract with them.


pharmacy.ca in Canada

This is a company in Canada that not only will compound psychiatric drugs to custom dosages but has done its own research and designed its own tapering calculator (current a linear 10% per step taper, where the amount of taper stays the same, while we recommend a more gradual 10% parabolic step taper, where the amount of taper keeps getting smaller).
 
See below for more information about compounding pharmacies in your area.

 

Edited by Altostrata
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

In the United States, these compounding pharmacies will fill prescriptions by mail:

Edited by Altostrata
updated list

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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alexjuice

I've talked with the pharmacists at People's Pharmacy in Austin, TX who told me they can send compounded medications by mail generally. Occasionally, he said, a state may have regulations that restricted it. He also said controlled substances were not eligible.

 

Otherwise he said it presents no problem with proper Rx.

 

http://www.peoplesrx.com

 

Alex


"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Altostrata

Not every locality has a compounding pharmacy. Here are directories to find them:

 

International Academy of Compounding Pharmacists (IACP)

 

offers list of participating pharmacies

 

Write iacpinfo@iacprx.org or call the referral hotline at 1-800-927-4227

 

Pharmacy Compounding Accreditation Board (United States)

http://www.pcab.info/find-a-pharmacy.shtml

Edited by Altostrata
updated information

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

A Facebook correspondent recommends this compounding pharmacy in New Zealand http://www.pharmaceutical.co.nz/Home_Page.php


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Meimeiquest

I am using a local (not mail order) compounding pharmacy in the greater Nashville area:

 

AllenHill Pharmacy

4096 Carothers Parkway #4

Franklin, TN 37067

615-790-3885


1st round Prozac 1989/90, clear depression symptoms. 2nd round Prozac started 1999 when admitted to dr. I was tired. Prozac pooped out, switch to Cymbalta 3/2006. Diagnosed with bipolar disorder due to mania 6/2006--then I was taken abruptly off Cymbalta and didn't know I had SSRI withdrawal. Lots of meds for my intractable "bipolar" symptoms.

Zyprexa started about 9/06, mostly 5mg. Tapered 4/12 through12/29/12

Wellbutrin. XL 300 mg started 1/07, tapered 1/18/13 through 7/8/13

Oxazepam mostly continuously since 6/06, 30mg since 12/12, tapered 1.17.14 through 8.26.15

11/06 Lithium 600mg twice daily, 2.2.14 400mg TID DIY liquid, 2.12.14 1150mg, 3.2.14 1100mg, 3.18.14 1075mg, 4/14 updose to 1100mg, 6.1.14 900 mg capsules 7.8.14 810mg, 8.17.14 725mg, 8.24.24 700mg...10.22.14 487.5mg, 3.9.15 475mg, 4.1.15 462.5mg 4.21.15 450mg 8.11.15 375mg, 11.28.15 362.5mg, back to 375mg four days later, 3.4.16 updose to 475 (too much going on to risk trouble)

9/4/13 Toprol-XL 25mg daily for sudden hypertension, tapered 11.12.13 through 5.3.14, last 10 days or so switched to atenolol

7.4.14 Started Walsh Protocol

56 years old

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Francis

Ive had multiple doctors send prescriptions to Johnson Compounding in Waltham, MA and the compounded medication/vitamin/amino mix/B12 shots have been sent to me. They have been great at negotiating with my insurance company.


2003-2010 up and down 10-40mg celexa for anxiety
2/2011 10mg
8/2011 5mg for 3 wks, then stopped completely.
middle of night waking after apx 1-2 hours of sleep (nightly), panic/jitteriness after waking
11/11 back on 30mg celexa, ambien/many supplements-insomnia/panic.
2/12 30mg celexa, many supplements (Magnesium eliminated morning tight chest/jitteriness). Off ambien!
7/12 20mg
8/12 15 mg(sleep improving,mood pos)
12/12 2.3 mg got liquid celexa!
1/13 2.1 mg
3/13 1.2 mg
4/13 down to .6 too quickly- cortisol spikes, middle of night waking, night sweats...
4/13 held at .6 for 3 weeks so far. Off most supplements as well. Withdrawal depression almost gone!

7/13 OFF OF CELEXA!!!

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bubble

I went to the site International Academy of Compounding Pharmacists (IACP) which is really good

 

Unfortunately when it comes to Europe, according to their locator there are compound pharmacies only in Germany, Span, Turkey and UK (identified 1 per country...)

 

But since the EU has a common market, I guess it should be possible to order products within the EU from anywhere in the EU so I will explore those options...


Current: Xanax 0.26 (down from 2 mg in 2013), Lexapro 2.85 mg (down from 5 mg 2013)

Amitriptyline (tricyclic AD) and clonazepam for 3 months to treat headache in 1996 
1999. - present Xanax prn up to 3 mg.
2000-2005 Prozac CT twice, 2005-2010 Zoloft CT 3 times, 2010-2013 Escitalopram 10 mg
went from 2.5 to zero on 7 Aug 2013, bad crash 40 days after
reinstated to 5 mg Escitalopram 4Oct 2013 and holding liquid Xanax every 5 hours
28 Jan 2014 Xanax 1.9, 18 Apr  2015 1 mg,  25 June 2015 Lex 4.8, 6 Aug Lexapro 4.6, 1 Jan 2016 0.64  Xanax     9 month hold

24 Sept 2016 4.5 Lex, 17 Oct 4.4 Lex (Nov 0.63 Xanax, Dec 0.625 Xanax), 1 Jan 2017 4.3 Lex, 24 Jan 4.2, 5 Feb 4.1, 24 Mar 4 mg, 10 Apr 3.9 mg, May 3.85, June 3.8, July 3.75, 22 July 3.7, 15 Aug 3.65, 17 Sept 3.6, 1 Jan 2018 3.55, 19 Jan 3.5, 16 Mar 3.4, 14 Apr 3.3, 23 May 3.2, 16 June 3.15, 15 Jul 3.1, 31 Jul 3, 21 Aug 2.9 26 Sept 2.85, 14 Nov Xan 0.61, 1 Dec 0.59, 19 Dec 0.58, 4 Jan 0.565, 6 Feb 0.55, 20 Feb 0.535, 1 Mar 0.505, 10 Mar 0.475, 14 Mar 0.45, 4 Apr 0.415, 13 Apr 0.37, 21 Apr 0.33, 29 Apr 0.29, 10 May 0.27, 17 May 0.25, 28 May 0.22, 19 June 0.22, 21 Jun updose to 0.24, 24 Jun updose to 0.26

Supplements: Omega 3 + Vit E, Vit C, D, magnesium, Taurine, probiotic 

I'm not a medical professional. Any advice I give is based on my own experience and reading. 

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klachance

Hi,

 

 

 

I am new to this forum and new to all of this! I have a son with autism who was put on Risperdal against my better judgement two years ago this past September. He has been having side effects ( I was told it might just make him gain weight) so I have been slowly (and I do mean SLOWLY) tapering him off. He is now down to just .5 mgs. a day in divided doses. I have read some ot the other posts but I haven't noticed if anyone uses a compounding pharmacist. I could not figure out a way to reduce his dose (the 10%) way, and when I tried liquid he wouldn't drink it (no surprise for a fellow with autism), and so I was putting it into vegetarian capsules. That just got too complicated, and breaking the pills was a mess and completely inaccurate. It has been going much better this way, but because the doses are so small (0.05 a capsule) he still takes 10 capsules a day. He doesn't care though, as long as he doesn't have to drink it. Only today did I realize that he should be taking 10% of his current dose, not his original dose. This is without a doubt the most anxiety filled thing I have ever had to do because he cannot tell me how he is feeling, I have to judge his moods and decide if he is having a bad day, or if he is reacting to the reduction in medication. Has anyone else used a method like this, and does anybody else have autism or a child with autism? My son is 19 years old. Thanks, Kim

 

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Altostrata

Yes, you should be able to have these capsules compounded with a prescription from a doctor.

 

See Association of Compounding Pharmacists of Canada http://www.acpcrx.org/

 

This technique is not specific to autism.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

Also see Association of Compounding Pharmacists of Canada http://www.acpcrx.org/


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Sweetcreature

Well I am just off the phone to Cardinal Health, Martindale to see if they stock seroxat and was met with the most unhelpful response I have ever encountered.  I think I interruppted their xmas party.......  

 

Lady: 'We cant talk to individuals...' 'You need to go to a pharamcist' 'You need to go to your doctor...we cant advice you....we don't speak to the public....

 

Me:  (seeking advice/info and simply trying to do some homework on the subject) 'Okay well, when you get instructions from my pharmacist are you able to make the doseage up in the amounts he requests...(explained the whole saga about coming off and trying to reduce in minute amounts)

 

Her: 'We can try...but we cant talk to you...you'd have to go to a pharmacist'

 

Me; 'Any particular pharmacist??  I don't think my local village pharmacy is quite used to doing this and my doctor I'm not so sure either....any one that you recommend at all?

 

Her: ' We cant advice....you'd have to go to a.........

 

Me: 'Yes yes...I would have to go to a pharmacist...I heard you the first time - you've been extremely UNhelpful

 

Good ole British customer services!!!

 

Best this is one taken off the list as they were about as useful as a chocolate fireguard......

 

the people at Rosemont were lovely but unfortunately don't seroxat..........

 

 


May 2001 - age 24 given 20 mg seroxat. Tried to reduce myself after a year. Told by GP to take on alternate days and I would be fine. FAIL. Assumed 'wrong time' due to university stress and that my 'depression' must be worse than I thought.

Increased dose to 30 mg December 2002. Tried the same technique as before to reduce- made it down to a quarter tablet but couldn't stand symptoms, had a sneaking suspicion that it was due to tablets but never considered dependency - 'depression is a diseased brain after all' (is what I was told)

 

Continued until October 2010 - tried to CT and managed to last five months - assumed the depression was really bad but had no understanding of the reason for awful anxiety. Ran back to GP started Prozac- went crazy thought I was going to die. Stopped Prozac after two weeks.

April 2010 Started sertraline. Stablished but felt numbed.

September 2010 Asked for seroxat again. Upped my dose to 30 after three weeks. Felt hyper, caffeinated, but functional. Glad to be over what I thought was 'depression'..

Realised it is the meds, want to be free at last - July 2012 started 10% taper from original dose and took supplements. Took suppliments sporadically and despite the temptation the taper, wanted it 'over with'. Taper took exactly six months and 10 days.

Reductions were as follows:
First 2 weeks- 27 mg
Next 2- 24mg
Next 2- 21 mg
Next 2- 18mg
Next 2 15 mg
Next 2 12 mg (held for four weeks due to house move from London back to Ireland)
Next 2 weeks- 9 mg
Next 2 weeks- 6 mg
Next 2- weeks 3 mg
Next 2 weeks 1.5 mg (held for 5 weeks as scared)
10th February 2013 Jumped to zero

Within 3 weeks sadness, led to anxiety.  Restarted suppliments - helped a bit.  Stressful move to London. A lot of fatigue and DEEP emotions. Crying LOTS. Took suppliments on and off, moved back to Ireland after being back in London for only eight weeks as felt too sad and unsettled. 

 

No suppliments when moved back.  Unhappy at being back, scared I wouldn't ever find happiness - deep deep sadness, anger, STUPIDLY went back to doctor and decided I must just be a 'depressive'.  Given Citalopram/Celexa 20mg.

 

Took it for seven days, changed my mind, decided to be 'strong' and put it behind me. (No particularly adverse effects that I recall, save for day 5 having inner vibrations in arms and legs) Still had pack of tablets however and every time emotions got hard felt I had to 'go back onto tablets'.  I did this from July until November. (On them off them on them off them) ........

 

Started to get body vibrations and told myself it was 'anxiety' and I was 'giving myself panic attacks.  I continued to cry as I 'started' the tablets again and again - not wanting to go back there but not sure what else to do. 

 

More vibrations - but didn't make the connection that I had a compromised CNS -  thought it was anxiety....chest started to pound in Sept, vibrations continued...lost weight, became anxious, sleep was awful and I tried a variety of remedies to replace the tablets and calm my anxiety and lift my mood.  I think they made things worse.

 

(These included, St.Johns Wort, Rescue Remedy, Homeopathic treatments, Chinese herbs, Passiflora, and suppliments from the online company who state they are experts in assisting people get off meds)

 

Also did the following:

 

Talking therapy

Human Givens Therapy

Homeopathy

Narcotics Anonymous

 

October 23rd took Citalopram (20mg) for 12 days - no relief

 

November 6th Started Seroxat 10 mg (to be safe) stupidly upped to 20 the next day.

 

Stayed on 20 for 18 days, no relief, stopped for two days suddenly, relief came - short lived, vibrations and torture came after 72 hours.  Suicidal for days.  Upped to 30 thinking it would improved.  Even more suicidal.  Dropped to 20 again (December 9th) not suicidal, but not better. Started liquid 28th December reduced to 18 mg in effort to reduce and stabilise.  Don't know where to go from here.  Living with parents who are supportive beyond words.

Sweetcreature

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Altostrata

Very sorry. You'll need a prescription for the liquid formulation. Perhaps they're asking for the prescription?

 

With a prescription, Seroxat liquid, supplied by GlaxoSmithKline UK, can be purchased in liquid form from the pharmacy http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Anxiety&medicine=seroxat&preparation=Seroxat%2020mg/10ml%20liquid

 

This is probably why the compounding pharmacies don't make it. It's already available.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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MollyN

Altostrata thank you thank you thank you!! I just went through the link here to the New Zealand compounding pharmacy. The people there are fabulous and happen to be just down the road, and for around $45 US they are making up 300mls liquid paroxetine for me, I am DELIGHTED xxxxx thank you so much again xxxxx


 

Drug history

  • 20mg paxil in 2001 - 4 months use  
  • 20mg paxil in 2003 - 2 months use 
  • 20mg paxil in 2008 - 8 years continuous

Withdrawal history:

  • March 2014 - disastrous alternate day taper
  • Jan 2015 - 15mg to 10mg. Disaster
  • Sept 2015 -  10mg to 5mg. Disaster. Reinstated to 6mg. Relief
  • Oct 2015 - started slow 10% taper 
  • Oct 2016 - at 4mg- stop taking paxil (not recommended)

 

I'm not a medical professional. Seek advice from a knowledgeable medical practitioner.

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dalsaan

Here is a link to the professional association for compounding chemist in Australia. You can search for a compounding chemist vis their website:

 

http://www.pccarx.com.au/contact-us/find-a-compounder?param_zip=3000


Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

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Altostrata

Recommended by a correspondent on Facebook:

Randy's Compounding Pharmacy and Nutrition Center
1851 State Ave NE, Suite 105 Olympia, WA 98506
Brad Livingstone, R.Ph. Pharmacist/Owner. 360-491-0607
http://www.RandysCompoundingPharmacy.com
Brad at SoundCompounding%com

She said he's particularly knowledgeable about titrating benzodiazepines.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

Nikki, read all of http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

We know many drugs are not very soluble. But people do successfully make homemade suspensions with them. (You cannot make a suspension from an extended-release drug such as Effexor XR, or Cymbalta or Pristiq.)

 

Yes, if you wish, you can get Serzone made into a liquid by a compounding pharmacy. You will have to ask your questions there.

 

Compounded drugs are often quite expensive.

 

Ordinary pharmacists are often poor sources of information about do-it-yourself titration methods, or of compounding information.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

That sounds about right, Nikki.

 

For those in San Francisco, the best compounding pharmacy I've used is Parnassus Heights Pharmacy across the street from UCSF on Parnassus.

 

Koshland Pharmacy has a good reputation http://www.koshlandpharm.com/


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

I went to the site International Academy of Compounding Pharmacists (IACP) which is really good

 

Unfortunately when it comes to Europe, according to their locator there are compound pharmacies only in Germany, Span, Turkey and UK (identified 1 per country...)

 

But since the EU has a common market, I guess it should be possible to order products within the EU from anywhere in the EU so I will explore those options...

 

bubble, those few pharmacies might be the ones that are members of IACP. Most likely, there are many compounding pharmacies in Europe that are not members of that organization, which is based in the US (and seems to be for the purpose of lobbying the US government).


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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chicken

I'm adding Kare pharmacy in Danville VA to the list. They compound.

 

http://www.kare-rx.com/index.html


Prozac 1999-2009 quit semi cold turkey.

 

2012 Placed on Seroquel 25 mg, Tranxene (Clorezepate) 3.75 mg 3x a day, Remeron 30 mg for anxiety/akathesia.

 

Weaned off Seroquel and Tranxene .to Remeron 15 Mg.

In May 2014 tried quitting Remeron at its lowest dose. Had severe withdrawals.Reinstated Remeron at 30 mg by doctor. August 5 2014 entered hospital. Doctor pulled the Remeron and bridged it to Pamelor (Nortriptyline) 40mg and Zyprexa 2.5mg.After removing the Remeron all my bad symptoms went away and I am stable.

 

9/11/14 - 7.5 mg tranxene, 40mg Pamelor, Zyprexa 2.5mg

12/29/14 -  20mg Pamelor, 1/6/15,  7/31/15 3.5mg, 8/10/15 3.2 mg, 9/15/15 2.2mg, 10/15/15 1.8mg

(Feb 2016 - 1.4mg Pamelor only -  OFF OF TRANXENE AND ZYPREXA SINCE DEC 2014 BENZO FREE Since 2014. Nortrityline (Pamelor) .8mg Aug 2016

March 2017 DRUG FREE

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Altostrata

Koshland Pharmacy in San Francisco, California is a superior compounding pharmacy.

 

I happened to get a prescription here recently (for allergy) These people really know what they're doing and the pharmacists will answer questions, for example: How long a specific drug is stable in water. They run their own tests to determine this!

 

The pharmacist didn't blink at the idea I would titrate with a homemade suspension with water and was quite helpful with suggestions.

 

Their prices are about the same as any compounding pharmacy. They will mail a prescription for an extra $4 or so. I don't know if they will ship outside the U.S. http://www.koshlandpharm.com/

 

(They will also supply the superior Baxa oral syringes at no charge with an order.)


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Wildflower0214

If I can afford to go to a compounding pharmacy, is there any reason I should lean towards doing it at home?

 

It's a question for the future. It would be with Ativan.

 

I was wondering what they use as a liquid at a pharmacy, and if there is a risk in having a reaction to it. Also, if what we make at home only lasts a few days at most, how does what they make last for a month??


2005-Zoloft bad reaction.....2006-Lexepro......2012-Upped Lexepro.......2013-Upped Lexepro......2/2014- Attempted Taper Lexepro...2/2014- Updosed Lexepro.......3/2014-Ativan.....5/2014- CT switch from Lexpro to Effexor.....

5/2014-7/2014-Tapered Ativan from 1mg to .25mg.....6/2014-Bad reaction to Effexor........7/2014- Rapid taper Effexor every other day......7/5/2014- Off Effexor.......7/2014-12/2014 - Ativan .25mg.......12/25/2014 -Taper Ativan by 4% due to paradoxical reaction .24mg...11/18/2015-Taper Ativan 1% CURRENTLY ON: .2376mg Ativan taken in 6 .0396mg doses.

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Altostrata

It's a matter of preference and, as you note, cost.

 

Compounding pharmacies follow recipes and have information from tests demonstrating long a drug compounded according to formula will hold its strength.

 

The information we have about DIY liquids is incomplete.

 

We have a couple of people here who had bad reactions to compounded liquids. They can contain a lot of additives, such as flavorings. You would need to discuss making a hypoallergenic compound with your pharmacist.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Altostrata

Our member BethSimmons recommends Roy at http://www.customrx.com/ in Minnesota; he understands tapering at 2.5% if need be.

 

He will make up custom duloxetine (Cymbalta) capsules.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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MapleleafGirl

Pharmasave In Vancouver, B.C. Canada..i used this all 4 years of my taper..compounding capsuls..


Michele aka MapleLeafGirl

Paxil Free Since June 1st 2014

Was on Paxil for 8.5 years on and off from 2001

Did a 4 year successful taper off 20mgs of Paxil

My Successful Tapering Story: http://survivingantidepressants.org/index.php?/topic/7812-mapleleafgirl-successfully-tapered-off-paxil/

Tapering Schedule:

3rd attempt at withdrawal going slow..compounded pills
05/27/2010 - 03/12/12: Tapered From 20mgs - 6.2 (2nd year into Taper)
04/11/2012 - 6.0 - 3.4 - 05/05/2013 (Third year into Taper)
06/04/2013 - 3.2 - 1.0 - 05/31/2014 (Fouth and Final Year of Taper)

February 9th 2016 month 20 off paxil and four year taper..experiencing a horrible wave bad bad bad

May 2016 Made the decision to go back on an SSRI  - Currently on Escitalopram 10mgs but planning to taper at some point in the near future

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Altostrata

Another good compounding pharmacy in the U.S. that will fill prescriptions by mail order: Clark's Pharmacy
Address: 15615 Bel-Red Rd, Bellevue, WA 98008
Phone: (425) 881-0222
 
Others in Washington state:

The Falls Pharmacy
Brock Nyberg, R.Ph.
8112 Railroad Ave SE
Snoqualmie, WA 98065
(425) 888-6858

 

Arlington Pharmacy
Brian Henley, Pharm.D.
540 West Avenue
Arlington, WA 98223
www.arlingtonpharmacy.com
(360) 435-5771

 

Bellegrove Pharmacy 
Mark Holzemer, R.Ph. 
1535 116 Ave. NE - Suite. 103
Bellevue, WA 98004 
(425) 455-2123

 

Key Pharmacy 
Jonathon D. West, R.Ph.
23422 Pacific Highway South
Kent, WA 98032
www.keynutritionrx.com
(206) 878-3900

 

Juanita Bay Pharmacy Inc. 
Donald W. Hanson, R.Ph.
13520 100th Avenue NE
Kirkland, WA 98034 
(425) 821-4009

 

Fairwood Pharmacy 
Elwin Blair, R.Ph.
17254 140th Ave. SE
Renton, WA 98058
(425) 226-7000

 

Kelley-Ross, Inc. 
John Oftebro, 
616 Olive Way
Seattle, WA 98101
(206) 622-3565

 

Rxtra Care Pharmacy
Holly Whitcomb Henry, R.Ph.
11003 35th Avenue NE
Seattle, WA 98125
(206) 417-8066

 

Univ. of Washington Medical Center
Virginia Leland, R.Ph.
1959 Pacific Street
Seattle, WA 98195
(206) 598-6060

 

Kusler's Pharmacy 
Janet Kusler, R.Ph.
Dawn Ipsen, Pharm.D.
700 Avenue D
Snohomish, WA 98290

www.kuslerspharmacy.com
(360) 568-7787

 

Mike's Eastside Drugs 
Mike Graeff, R.Ph. 
8506 E. Mill Plain Blvd.
Vancouver, WA 98664 
(360) 694-3353

 

Union Avenue Pharmacy 
Bruce Ruckenbrod, R.Ph. 
2302 S. Union Ave - Suite C25
Tacoma, WA 98405
(253) 752-1705

 

Medical Center Pharmacy
450 NW Gilman BLVD
Suite 107
Issaquah, WA 98027-2483
(425) 392-8650 phone 
(425) 391-8624 fax


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Altostrata

Compounding pharmacy in Sydney, Australia http://www.freshtherapeutics.com.au/

 

Importing from outside Australia https://www.tga.gov.au/personal-importation-scheme


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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ActivistScientist

Compounding pharmacy in South Orange County, CA .... https://stores.healthmart.com/thedruggistpharmacy/stores.aspx
 
The Druggist Pharmacy, 24022 Aliso Creek Road, Laguna Niguel, CA 92677PHONE(949) 643-0740


Dec. 2013-April 2014: 75 mg Lyrica once daily for tingling in feet and pain from back issues

Early April 2014:  W anted to go off Lyrica and reduced to 50 mg - withdrawal bad with anxiety, tremors, insomnia; tried to make liquid Lyrica in water but made symptoms worse even at full dose of 75 mg

May to June 2014: back to 75mg capsules

July 2014 - January 2015: Tapering 5mg every 10 days till 40 mg using compounded capsules; then started reducing by 10% every 10 days using compounded capsules

Most recently: 2/21/15 23mg; 3/3 21mg; 3/13 19mg; 3/23 17mg; 4/2 15.5mg; 4/12 14mg; 4/22 13mg; 4/29 12mg; 5/6 11mg; 5/16 10mg; 5/26 9mg; 6/5 8.5mg; 6/15 8mg(will hold for 20 days as new WD symptoms appeared on day 4 of new dose - rapid heartbeat, high-pitched ringing in one ear), reduced by 0.25 mg every 6 days and finally done on 1/9/2016!!!!

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greenwell3977

Hi all,

 

I am tapering off Nefazadone (which is generic Serzone).  I was using a pill cutter with a digital scale.  On the scale, it showed 32.  Given that the uncut 50mg pill showed 100, I calculated by 32 pill to be 16mg.

 

Since cutting up a pill is a pain and not precise, I decided to give a compound pharmacy a try.  They made me 16mg capsules of nefazadone.  Today is the first day I am trying the capsule and I am unable to sleep. 

 

My questions: Is there an adjustment period going from a tablet to the compound capsule?  Should 16mg from the cut up tablet be the same as the 16mg compound capsule?   Or is there a difference (perhaps because of a difference in the active/inactive ingredient ratio between the two)?

 

Thank you.


Serzone (Nefadazone) and Wellbutrin (Buoproprin) for over ten years
Nefazadone Starting Point 150 mg
12/2 135 mg, 12/16 130 mg, 12/21 125 mg, 12/24 120 mg, 1/5 110 mg, 1/26 100 mg, 2/9 90 mg, 3/1 80 mg, 3/22 70 mg, 4/12 60 mg
5/3 50 mg, 5/15 55 mg, 8/15 70 mg, 10/15 90 mg, 11/1/12 100 mg, 10/1/13 90 mg, 10/15/13 85 mg, 10/20/13 90 mg, 3/29/15 16 mg

Buproprin Starting Point 300 mg

5/1/13 270, 5/15/13 240, 6/1/13 230, 6/15/13 200, 7/1/13 185, 7/20/13 170, 8/20/13 185, 3/29/15 170

Completely off Serzone: 10/1/17; Completely off Buprioprion 5/21/18

 

 

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Altostrata

greenwell, it looks to me like your math was correct. However, it could be the compounding pharmacy used a different brand of nefazodone than your tablet, and there is variation in strength between them. (Often, they grind up tablets.)

 

For example, what you thought was 16mg nefazodone in your tablet was actually 14mg, and the generic nefazodone tablet used by the compounding pharmacy contained more nefazodone than yours.

 

Or, the compounding pharmacy might have used pure generic nefazodone powder and their capsule is stronger than your tablet fragment.

 

If you phone them, they will be able to tell you what they did. If they used the pure powder, it's likely your capsules are stronger compared to the tablets you had.

 

If they ground up a tablet, there's no way to tell if what you got in the compounded capsule is stronger or weaker than your nefazodone tablet (unless you had a chemical analysis done of each).

 

If they used a different brand, you might simply be sensitive to the change in brand. How many times have you taken a capsule?


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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greenwell3977

Hi Altostrata,

 

Thank you for your response.  I have only taken the capsule once.  How long do you suggest I wait until I make a change (perhaps back to the tablet or a different brand)?

 

I am concerned that i put all this effort and time into lowering my tablet nefazadone to 16mg only to start taking a stronger version of it.  In other words, I will be at a higher level of strength and have additional tapering to do.

 

Thank you for your feedback.


Serzone (Nefadazone) and Wellbutrin (Buoproprin) for over ten years
Nefazadone Starting Point 150 mg
12/2 135 mg, 12/16 130 mg, 12/21 125 mg, 12/24 120 mg, 1/5 110 mg, 1/26 100 mg, 2/9 90 mg, 3/1 80 mg, 3/22 70 mg, 4/12 60 mg
5/3 50 mg, 5/15 55 mg, 8/15 70 mg, 10/15 90 mg, 11/1/12 100 mg, 10/1/13 90 mg, 10/15/13 85 mg, 10/20/13 90 mg, 3/29/15 16 mg

Buproprin Starting Point 300 mg

5/1/13 270, 5/15/13 240, 6/1/13 230, 6/15/13 200, 7/1/13 185, 7/20/13 170, 8/20/13 185, 3/29/15 170

Completely off Serzone: 10/1/17; Completely off Buprioprion 5/21/18

 

 

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Altostrata

If you still have tablets, you might want to take a tablet fragment (as you were doing before) until you can talk to the pharmacy and get a better idea of what's in the capsules.

 

If it's simply a brand change, it's possible your nervous system will settle down in 4 days or so of taking the capsule. Or, if you're convinced it's too strong, you may wish to take a little powder out of the capsule. Use your scale so you can keep the amount you take consistent.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Altostrata

Mark Drugs in Illinois will ship throughout the continental US http://markdrugs.com/shipping2.html


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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indigo

I had tapered my dose of prozac to 3.4 gms and had decided to stay at that level for several months to totally stabalize.

To avoid the fiddle of measuring the liquid prozac with a one mL syringe every day, I decided to have a compounding pharmacy (Lauden Compounding Pharmacy, Santa Cruz, CA)

make up capsules of 3.4 of prozac. After a week on the new capsules I was a mess, high anxiety and dark thought withdrawal. At first

I thought it was just the bump from changing from liquid to capsules. However I decided to weigh the each capsules with my accurate gram scale.

I was shocked at the discrepency between each capsule. Lowest was 264 mg the highest was 289 mg. Of course these weights include the filler powder

and weight of capsule, but clearly the dose of actual prozac in each capsule was way variant.

I'm in the last stages of tapering and am super sensitive to even the slightest variation in dose.  Had been at 3.4 for four months and had stabalized great.

Now I'm all screwed up again.

Is it common for compounding pharmacies to be this careless in their measurement of medication in capsules?


On 20 mg of Prozac for about ten years. Sept 2012 started reducing 10% a drop using gram scale, with average of one month holds.

When I'd reached the half way mark, taking 10 mg  powder out of the 20 mg capsules, I switched over to 10 mg capsules and cutting

down from those. Withdrawals got harder the lower I dropped.  May 2013 changed to 5% drops, holding until all withdrawal symptoms gone.

January 2015 changed to liquid prozac (concentration of 20MG per 5 mL) using a 1mL oral syringe.

Current dose of fluoxetine solution equivalent 3.4 mg. Any effort to drop below this has been disastrous so for the time being I'm staying at this level.
Adding 200 mg Tryptophan and 200 GABA a day has helped with anxiety.
Also take 1,300mg Omega- 3,  875mg  Magnesium, 1800mg Curcumin, 1000mg Vit C, 5000 Vit D.
 

 

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Altostrata

Not usually. I would phone the pharmacy and get an explanation of the discrepancies.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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peggy

i spoke at length to a compounding pharmacy about compounding effexor for me.  the pharmacist told me they have quality control guidelines but they are by law able to be out by 3% on each capsule.  I decided that was too much discrepancy for me - it might be okay for people who are not highly sensitive.

 

For effexor, the process she told me went like this.. they get a prescription for a specific number of whole capsules (usually one box which would be 28 capsules)  They open ALL of them at once and put into a machine. So, if they are working with 75mg capsules and they are compounding into 25mg capsules they would then have 2100mg of effexor in the machine. That will make 84 x 25mg capsules.  They add the filler so they will make whole capsules mix well and then make 84 capsules.  I asked her how can they be sure that the effexor is evenly distributed between the capsules and she said the machine mixes well. 

 

We can't get immediate release effexor here-if we could then i could have a liquid made up which i would think would give you a more accurate dose.

 

I still haven't worked out how i can proceed with my taper - i might just have to continue counting beads out - but tiny, tiny drops each month - it's just so tiresome and i get crosseyed.


Started in 2000 - On 150mg most of the time, (but up to 225mg at highest dose for 6 months in the beginning)
Reduced off easily first time - but got depressed (not too much anxiety) 6 months later
Back on effexor for another 9 months.
Reduced off again with no immediate w/d - suddenly got depressed and anxious ++ again 3 or 4 months later.
Back on effexor - this time for 3 years
Reduced off over a month - 6 weeks later terrible anxiety - back on.
Rinse and repeat 4 more times - each time the period before the anxiety comes back got shorter and shorter
Jan - July 2012 75mg down to 37.5mg;, 8/3/12 - 35mg. 8/25/12 - 32mg. 9/11- 28mg, 10/2 - 25mg, 10/29 - 22mg, 11/19 - 19.8mg; 12/11 - 17m,
1/1- 15.5mg; 1/22 -14mg, 2/7 14.9mg, 2/18 - 17.8mg - crashed big time: back to 75mg where i sat for 2 years....

4th  March 2015 - 67.5mg;   31st March - 60mg;  24th April - 53mg; 13th May - 48mg; 26th May - 45mg;  9th June - 41mg; 1 July- 37.5mg; 20 July - 34mg; 11 August - 31mg; 1st Sept - 28mg;  1st Dec - 25.8mg;  28th Dec - 23.2mg; 23rd Jan-21.9mg; Feb 7th- 21mg; March 1st - 20.1mg, March 30th - 18mg

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