bubbles

[ChessieCat]

11 hours ago, bubbles said:

They're currently supplying 0.1mg capsules. I'll ask for a quote for smaller doses next time.

 

To be honest, I think going with liquid would give a more accurate dose.  When they get to really small doses they have to add such a large amount of filler that there is no knowing if the drug has been evenly distributed so there is likely to be a higher degree of error than at larger doses with less filler.

 

On a side note (and a bit of wry humour) I've sometimes had the thought that perhaps the chemist has been providing me with capsules containing no Pristiq and that he and his cohorts are having a good laugh at me because I think I'm still taking it.  However, I know that the compounder has a friend who reduced his drug too quickly and had withdrawal symptoms so I know that he knows how serious this is.

[bubbles]

30 minutes ago, ChessieCat said:

On a side note (and a bit of wry humour) I've sometimes had the thought that perhaps the chemist has been providing me with capsules containing no Pristiq and that he and his cohorts are having a good laugh at me because I think I'm still taking it.  However, I know that the compounder has a friend who reduced his drug too quickly and had withdrawal symptoms so I know that he knows how serious this is.

 

I switched to the compounding pharmacy that I currently use because they have a very good reputation. The one I used to use made a calculation error and I had an unexpectedly large drop. I actually didn't really notice the drop but I did notice I'd started to brux again when I did the next "drop" (which was really an up due to the previous error). I wasn't game to repeat the large drop though if it had been identified I'd have just stayed on that dose for a few months. I'd noticed previously that withdrawal seems to be cumulative - I do a few drops and don't notice much, and then the fourth, say, I start to have symptoms and need a longer hold. Not sure why, but it's been a fairly consistent pattern, so perhaps that one big drop was equivalent to those several drops before I start to get the wobbles.

 

The big drop, from memory, was something like 29mg, 10mg, 9mg, 25 mg - quite a huge drop, but I don't recall the details. I think I was going down in 2mg drops at that point and the "up" was to half a tablet, so 25mg. I looked back on this thread and didn't notice the huge drop at all by the look of it - or at least not enough to comment, though I came back a few months later rather than commenting "live" so who knows. It obviously wasn't bad. Anyway, I'll not use that pharmacy again.

 

Anyway, I've reached the point where I'm needing to make decisions with my reductions with regard to the dose combinations I can do. Do I make less than or more than 10% drop each month (or you know, because it's me every few months, lol) because the percentages no longer work neatly into the 0.1mg that I've been using. I feel that going to a liquid suspension would allow more accuracy and probably finer drops than 0.1mg. If I do a 1:1 mg:ml suspension as intended, my syringe thingy will easily allow 0.1mg. The liquid can also be diluted by water by 50%, so I can draw up some amount (as time goes on I'll be able to "waste" some as the suspension will reach the four week point before it is consumed) and dilute it by 50% and get 0.05mg at a time. It will require some calculations but I'm a dab hand with an Excel spreadsheet so that's all good. I may also be able to dilute the amount I'm using in that moment by more than 50% to get a finer dilution but that will require some experimenting.

 

Wouldn't it be nice to find out that we'd been on nothing at all for the last year or so!!! I mean, it would be annoying to have paid so much but on the other hand it would all be over! No, like you, I doubt it.

[bubbles]

Oddly, despite it being a much worse time of year for hay fever, my allergies seem to be better. I have stopped taking daily antihistamines and am not using the sprays at all. I think all of the sprays gave me throat symptoms, suggesting my technique is poor and at least some of it was going down my throat. I'm taking them occasionally as needed (on a work day, for example). I'm having itchy symptoms (eyes, nose, face) but not a whole lot of the "is that a cold" symptoms so I'm just pushing through, especially if I am at home for the day.

 

It's in the back of my mind that itchiness might be a withdrawal symptom from  having had so many allergy meds in recent months, but it's not unbearable.

 

This might change again as we get further into spring, but I'm happy to have had a break from both the symptoms and the extra meds.

[bubbles]

Allergies up and down. I'm taking antihistamines if I have to be out/at work and avoiding them if possible.

 

I've been developing a toothache for the last few days. Today it's blown up a bit and I've had to go and get antibiotics and I'll have to see a dentist on Monday, which thankfully is a day off for me. I've had this sort of dental issue before (it's damage from the bruxing and flares up from time to time), and antibiotics helped, but realistically I'm looking at a root canal. I can delay it a bit if the antibiotics settle it down, but it will have to be done some time. Meh.

 

My sertraline capsules will expire soon so I'll switch to trying the liquid shortly. I need to get something to disinfect my little medicine bottles before I do that. I can get that Monday and start then. I'll have at least a few weeks still at 2mg on the new method before I consider dropping.

 

Still down 98%, on 2mg.

 

 

[ChessieCat]

Not sure if it's been mentioned before (easier to repeat than to look for it in your topic 😉) or you are aware of it, but you can request an injection which does not contain adrenaline.  I have found it made a huge difference and I haven't spent the whole of the treatment having to calm myself down and convincing myself to stay sitting in the chair.  dental-surgery-dental-medications-tooth-discoloration

 

[bubbles]

Thanks @ChessieCat

 

Update. I've had a second dental procedure for this tooth and am now on a second round of strong antibiotics. The pain was quite bad until yesterday's procedure and now it's much improved. So much improved that I slept well last night, only waking once with the pain (it was 7 or 8 times the night before), and today I've just had ibuprofen for pain - what a huge difference. If it continues to settle down, I'll probably get to keep the tooth and have the rest of the root canal.

 

So this has added an antibiotic, ibuprofen and codeine/acetaminophen into my meds mix, but I don't think I'll need the codeine again if it continues like this. Fingers crossed.

 

 

 

[bubbles]

Part 2, I forgot to mention. My capsules have "expired". I put that in inverted commas because the pharmacy said they'd be okay a bit past that. Nevertheless, it's coming to the point where I'm getting wary. So today I'll grind up the tablets in my handy dandy new mortar and pestle and start the suspension version of the meds tomorrow. I'll keep on the same dose and cross my fingers. Not ideal timing with all the dental nonsense going on but it is what it is.

[ChessieCat]

57 minutes ago, bubbles said:

codeine

 

I tapered mine by reducing the dose over a few days, but I was on it for several weeks.

 

29 minutes ago, bubbles said:

My capsules have "expired". I put that in inverted commas because the pharmacy said they'd be okay a bit past that.

 

My compounder said they are required to put a sticker on them with use by date.  But I've used mine well after that date with no obvious issues.

 

BTW I've started using my capsule contents to make a liquid (just tap water) and it seems to be going okay.  But it is only 0.06mg of a 0.56mg dose so not that easy to tell.

 

32 minutes ago, bubbles said:

So today I'll grind up the tablets in my handy dandy new mortar and pestle and start the suspension version of the meds tomorrow.

 

Ooooo what fun.  Like me with my new graduated cylinder and syringes.  Playing the mad scientist.  Perhaps we should get ourselves a lab coat too.  And gloves and masks, I think most of us already have those.  And don't forget the goggles!

 

Also I found it hard to get the exact measurement with the cylinder so I've ordered a 5mL baby eye dropper but it won't be here until January.  It will make it a lot easier to top it up to the 100mL line instead of trying to pour in extra which I found very frustrating.

[bubbles]

Quote

Ooooo what fun.  Like me with my new graduated cylinder and syringes.  Playing the mad scientist.  Perhaps we should get ourselves a lab coat too.  And gloves and masks, I think most of us already have those.  And don't forget the goggles!

 

I know, right!? I should have found myself a job in a lab, lol. I got the 2ml syringe/dropper yesterday and am now belatedly wondering if it is big enough to get the suspension through the little end. Will check before I use the (now extremely expensive) suspension vehicle. It's been something of a rough week, I was catching up a bit with myself yesterday and didn't get to mixing up the med. It can be diluted 50:50 with water so that will make it thinner. Will try and see.

 

My compounding pharmacy said much the same thing as yours, that it would be good for a bit after the date. I just don't know how long after. Still, maybe this isn't the time to be experimenting, not with the extra meds and procedures etc and it's likely to be well within the "a bit after" stage.

 

Stopping the codeine cold was imperceptible. I wasn't on it very long.

 

Things are still good. It's not 100% comfortable, but it's night and day from before/after the second procedure and I'm increasingly hopeful I'll get to keep the tooth.

 

[ChessieCat]

6 minutes ago, bubbles said:

I'm increasingly hopeful I'll get to keep the tooth.

 

I hope so too.  I ended up losing mine unfortunately.  It was the only "meeting" molar on the left side.  I'm now ensuring that I do exercises for my jaw.  I expected to have dentures many years ago and I've got to 63 not bad considering that I had huge fillings done as I was growing up (due to close teeth and not getting braces).  Back in the "old days" for even a small bit of decay they used to drill out a huge amount of the tooth.

 

11 minutes ago, bubbles said:

wondering if it is big enough to get the suspension through the little end

 

I hope this works okay for you.

[bubbles]

 

Quote

I hope so too.  I ended up losing mine unfortunately.  It was the only "meeting" molar on the left side.  I'm now ensuring that I do exercises for my jaw.  I expected to have dentures many years ago and I've got to 63 not bad considering that I had huge fillings done as I was growing up (due to close teeth and not getting braces).  Back in the "old days" for even a small bit of decay they used to drill out a huge amount of the tooth.

 

Oh no! :(

This tooth has been a problem for quite a few years, but we can mostly blame the SSRIs for it - all that worsened bruxing. I'd like to keep it, but my dentist is very conservative on anything like that, so if the recommendation is to extract, well I will follow the recommendation. I'll be annoyed and sad, but I'll be sensible.

[bubbles]

It's still uncomfortable but still the pain is no worse, and still dramatically better from late last week. I'm still hopeful about the tooth, but time will tell. I'll know on Thursday when I see my dentist again. It's been quite a couple of weeks.  I expect a call from the dentist this morning, but I don't think there's any real need to bring forward my Thursday appointment.

[bubbles]

Dentist again tomorrow to have the dressing changed. Still doing much better and I think it's promising to keep the tooth.

 

I tried grinding and dissolving a tablet but after 48 hours there were still a couple of visible lumps in the liquid. I'll check again today.

[Rosetta]

I’ll keep my fingers crossed for you, bubbles. It’s great that you are down to 2 mg!  Hang in there, Rosetta 

[bubbles]

I left it several days and then it appeared to be fully dissolved. Or dispersed at least. I guess I'll need to be making up the next batch a few days before I need it, but that's okay.

 

I tried it last night. So far so good. Will see if I notice anything over the next few days.

 

I'll do at least a month with the suspension before dropping dose again. Hopefully that will also get me through the rest of the dental stuff but I'll know more about all that today when I see the dentist.

 

 

[bubbles]

Dental appointment today, looking promising. Not going to be quick though.  

 

Will plod on.

[bubbles]

Tired. Have had a few very busy days. Today and tomorrow will be busy too but I'll be able to schedule in a few sit downs. Hopefully just that and not the change in meds.

 

Teeth pretty comfortable. Blimey, what a few weeks.

[bubbles]

Bit anxious. There was a trigger so I don't necessarily think it's from the med change, but I won't push the lifespan of the suspension. I'll change it after a week or so.

[bubbles]

Feeling a bit better.

Have been doing a digital declutter. Am in far too many facebook groups etc. Have been leaving groups left and right, and have deleted my Twitter account and things of the sort. Also unsubbing from various email lists - not quite sure how I have ended up on soooo many. Big improvement - too much "stuff".

 

 

[Rosetta]

I’m glad you are feeling better! Rosetta

[bubbles]

Not feeling all that well. Tired, and an, err, "delicate" stomach. Two family members are also unwell so I think it's a bug. Gastro bugs usually pass fairly quickly, so fingers crossed.

 

 

[ChessieCat]

I'm not glad to hear that your relos have it too, but at least you can assume that it's what is causing your issues.

 

And at least it's not covid!

[bubbles]

Went to 1.8mg yesterday.

 

[ChessieCat]

Ooooo, so exciting.  Remember update your drug signature please!

[bubbles]

@ChessieCat Will do, once I'm at my computer. I'm on my phone just now.

 

[bubbles]

All right, updates.

 

First of all, the switch to the home made (but using a commercial liquid) suspension has been fine. I made 50mg of suspension and used it for about 23 or 24 days. There was no noticeable variation in the potency from the beginning to the end, or indeed to the switch to the new bottle. I disinfected the bottle before using it. I lined the bowl with baking paper to aid in getting every scrap of powder after grinding. I had a full bottle worth of 2ml/mg doses before lowering the dose.

 

When drawing up the correct dose, there is always a bit on the outside of my medicine dropper thingy, which is washed off and lost, so I'll never get the full number of doses based on the mls I mix up. The second batch I made was fine, I made sure to grind it up fully before putting it into the bottle with the liquid and it was completely dissolved about 24 hours later when I checked. I've been shaking up thoroughly but not excessively and while there are little bubbles in there it's consistent so I'm not too concerned.

 

When I reached the point in the bottle where there wasn't enough for a full dose, I just switched to the new bottle. and also lowered the dose.  The 10% drop seems to be completely fine. I think it will be fine next time to go to 1.6mg as it will be approximately 10% (10% would be a .18 mg/ml drop and I can't get that kind of accuracy at present). After that I might start to get fancy with further dilution of the suspension (ie draw up 1.6mg, dilute, discard whatever amount) but for now I think the .18 or .20 ml drop is within the tolerance for accuracy I can achieve. I'm planning to try to keep going down without  my long holds as much as I can. I've had long holds where needed, but sometimes it's easy to get parked on a dose for longer than necessary and that makes it all longer.

 

For posterity, this is the procedure I'm trying to follow, but missed a step last time, oops. Disinfect bottle, allow to dry. Line bowl with the baking paper (silicone coated) and grind tablet thoroughly. Add to medicine measure. Add enough Ora Plus to 15 ml. Decant into bottle using funnel. Add another 10ml of Ora Plus. Add 25 ml of water using the same 15ml/10ml. This 15/10 thing is due to the size of my medicine measure! This should allow for whatever volume the tablet takes up not to mess with the number of mls I get and make a perfect mg:ml suspension. I say perfect, it will never be perfect but I'm doing my best. Once I get to the point where I need to do further dilution to get accurate doses I'll just use 50mls of Ora Plus at this stage.

 

As mentioned, the suspension seemed to be entirely stable for 23/24 days. I'll use this next bottle again until I can't get a full dose out. At 1.8ml/day it's almost four full weeks of doses in that bottle, though I'll lose a day or so again in the wasted amount so probably 26 ish days. After that as the dose gets lower I will have to start keeping a closer eye on the dates and discarding at 28 days or whatever earlier time I deem to be necessary as obviously the bottle will have more doses in it. As the weather starts to get hot I'll keep it in the fridge to help it stay stable a bit longer - I keep the tablets in the fridge until needed too. Summer is hot where I live.

 

My root canal is okay too. I'm at the stage where the pain is totally gone and the infection seems to be gone too.  I have at least one more visit to go - it was seriously infected and dentist wants to make sure it's completely fine before finalising the treatment which sounds prudent.

 

I'm very hay fevery again - start of summer here, lots of sniffing and sneezing all around. I enjoyed the reprieve over the start of spring (which was weird - why spring and not winter - but I'll take it). So, back to the antihistamines again. I'm taking them daily (often 2 different ones, and the fast acting nasal spray as a top up) if I have to work, and trying to do without if I can be at home. Imperfect, but it is an imperfect world and one can't be out and about with visible allergies in 2020.

 

Very busy with work and life in general just now, so busy and distracted, and tired too. Sorry for writing the equivalent of a small novel here, I've been very slack with updates so it's updates for about a month all in one go!!

 

Final summary: down 98.2mg; at 1.8mg.

 

[ChessieCat]

1 hour ago, bubbles said:

I lined the bowl with baking paper to aid in getting every scrap of powder after grinding.

 

Excellent idea.

 

Could you please add the details of your process using Ora Plus to these topics?  Thanks.

Tips for tapering off sertraline (Zoloft)

 

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

 

And this one too please:

 

pharmaceutical-liquids-to-make-suspensions

 

 

Edited December 5, 2020 by ChessieCat

[bubbles]

20 hours ago, ChessieCat said:

 

Excellent idea.

 

Could you please add the details of your process using Ora Plus to these topics?  Thanks.

 

 

Before I add it to any "official" thread I might wait until the next time I do it and make sure my process as remembered here is correct. :) It will be in a few weeks. The baking paper helped. I'm trying to scoop it all out without having to use a brush and therefore risk losing some of the contents in the brush itself.

 

I found a 1ml syringe so I will be able to do finer dose graduations, as it measures much smaller graduations than the 3ml one I've been using. After only a month or so of use the graduation markings are wearing off in places on the 3ml one so I'll need to ensure a regular supply of these.

 

[bubbles]

Note: In typing up the procedure above, I have realised that the second time I made up my suspension I added the tablet directly to the bottle, NOT to the medicine measure to which I added the Ora Plus. This was bad on two fronts - (a) it stuck to the sides of the funnel and I had to try to wash it down into the bottle with firstly the Ora Plus and secondly the water; and (b) the 1:1 mg:ml ratio is probably off as the tablet volume wasn't in the medicine measure when I first added enough Ora Plus to come to 15ml.

 

I'm not going to worry about this as (a) I'm 6 days into the new dose and doing fine (b) there is always going to be a margin of error. I suspect this means instead of being on 1.8mg I'm probably on 1.78something. I'll go down to 1.6 as scheduled next time and be sure to follow my procedure more carefully. I will print out the procedure once I'm happy with it and laminate it so I have it to hand each time and aim at being more consistent.

 

Another note for anyone considering using Ora Plus - it tasted odd (sort of oddly tasteless) at first. I'm not adding any sweetener, just water. I got used to it within a few days.

[ChessieCat]

29 minutes ago, bubbles said:

After only a month or so of use the graduation markings are wearing off in places

 

I've covered mine with thick (good quality) sticky tape / cellotape.  I haven't worried about it getting wet, but I also haven't left it in water.

 

The way I did it was to cut of a length of tape and spiralled it around and then cut off the excess.  I think there was one syringe that I had to do 2 lots.  You need to be careful to get it on in one go because if you pull it off then the marking lifts off too.

 

32 minutes ago, bubbles said:

Before I add it to any "official" thread I might wait until the next time I do it and make sure my process as remembered here is correct. It will be in a few weeks.

 

Good idea.  And thanks.

 

32 minutes ago, bubbles said:

The baking paper helped.

 

I think this was a brilliant idea.

[bubbles]

I was a day behind, I've now had 8 days on the new dose.

 

@ChessieCat the tape - so you're being careful not to plunge the whole thing in to the liquid, I imagine. I've been putting the whole thing deeply into the bottle. Actually I can't see far enough in to do much else as it's a brown bottle with a narrow mouth. If I poured some off into a medicine cup I could only insert the tip. Will try today. The increments were so worn off yesterday I was forced to switch to the 1ml one already.

 

[ChessieCat]

35 minutes ago, bubbles said:

so you're being careful not to plunge the whole thing in to the liquid

 

No I haven't worried about trying to keep the tape out of the water.  It is only in there for a short time.

 

It might be different for you because you are using the Ora Plus.  I think using the medicine cup would be a better option.

[bubbles]

So today marks 11 days (this evening, when I take my dose) on this 10% reduction. I'm find, feeling no noticeable withdrawal and generally feeling fine.

 

I generally find I can do three or four drops before I feel the need for a longer hold, but assuming I continue to do well, I'm planning out the rest of my taper. This is how I intended to do it:

 

1.8   29/11/2020 (10% drops)

1.62 27/12/2020

1.46 24/01/2021

1.31 21/02/2021

1.18 21/03/2021

1.06 18/04/2021

0.96 16/5/2021

0.90 13/06/2021 (this is less than a 10% drop)

0.8 11/07/2021 (0.1mg drops from here on)

0.7 8/08/2021

0.6 5/09/2021

0.5 3/10/20201

0.4 31/10/2021

0.3  28/11/2021

0.2 26/12/2021

0.1 23/01/2022

0  20/02/2022

 

From reading the "endgame taper" thread, I think I can probably do a more aggressive taper for either the last 1mg (or perhaps even now, I need to re-read it, but I wasn't sure where to start the more aggressive taper).

 

Assuming the last 1mg, this is how it would look - the first few are the same:

 

1.8   29/11/2020 (10% drops)

1.62 27/12/2020

1.46 24/01/2021

1.31 21/02/2021

1.18 21/03/2021

1.06 18/04/2021

0.96 16/5/2021

0.72 13/06/2021 (25% drop)

0.47 25/07/2021 (33% drop)

0.24 5/09/2021 (50% drop)

0 17/10/2021 (100% drop, finished)

 

I'm using a home made suspension using Ora Plus and with a 1mg syringe/dropper, I can do 0.01mg/ml drops without too much drama. The more gentle taper I'd planned only adds a few months onto the taper. 

 

 

[ChessieCat]

I was going to do an aggressive reductions with a longer hold each reduction due to the capsule doses I could get.  Then you posted about making a liquid from the capsule contents which worked for mine so I've decided to just stick to a gentle taper for the remainder.  Personally after doing 5 years up until now, I can't see any sense in risking things when I know I can be off by the end of next year.  As my signature says:  I don't need the drug, my brain does.

[bubbles]

2 hours ago, ChessieCat said:

Then you posted about making a liquid from the capsule contents which worked for mine so I've decided to just stick to a gentle taper for the remainder.  Personally after doing 5 years up until now, I can't see any sense in risking things when I know I can be off by the end of next year.  As my signature says:  I don't need the drug, my brain does.

 

I was planning on 10% until 1mg and then 0.1mg drops after that but that was when I was using capsules. I can get a finer dose calibration now that I'm using a suspension (with tablets, not the capsules, much cheaper now that I've got my head around it).

 

Doing 25%,  35%, 50%, 100% only takes four months off since the holds are longer. I'm not sure what's best but I want to have my various options clear in my mind. I've left a message on the endgame taper for brassmonkey to see if it is possible to work things out without weighing a tablet.

 

[brassmonkey]

I would take the slower more controlled route. The "aggressive taper" from the Endgame Taper article is meant for people who are crushing tablets and tapering using scales to get a small measured amount of powder and then visually dividing it into smaller doses. It is a very crude method, but will work for people with no other option.

 

Because you are using a liquid I highly recommend taking your time and doing the smaller 0.1mg reductions that your listed, or continue to follow the 10% rule.  Either method will work. The Endgame Taper is more about listening to your body and tapering accordingly than to following a set schedule, but slow and gradual is still the way to go.

 

You should be aiming for a Theoretical Exit Dose of 0.06mgai.  This is not a hard and fast number but rather a theoretical target that will give a sufficiently small dose for making the jump to "0". The actual jump off point is determined by how your body is reacting to the reductions at the time. A little higher, a little lower, a long hold it's all about listening to your body.