Using an oral syringe and other tapering techniques

[DeterminedAnna]

Thank you everyone for the responses since my recent questions. In particular @Rachelina.. thank you for the reassuring words.

I've been looking over the weekend for a microlitre syringe (scary prices), but thanks to your comments I realise I may not need to go so low – I've found a .5ml syringe that I might be able to get shipped to the UK. Also, thinking laterally, I'm wondering if a pipette – the kind of thing that's more like a dropper – would work as well? As I'm based in the UK I'm trying to source here to avoid big shipping fees, and found there's some veterinary suppliers that sell teeny weeny pipettes. I'll share links on this thread when I've found something that fills me with confidence, not more questions or uncertainty.

 

All being well, I won't need to make any practical changes to my oral syringe setup for some time yet. One of the more pervasive themes of advice on this site is to be as consistent as possible, and not tinker too much with variables. And that's why when I get any equipment, I want to be 200% sure of my choices, so I don't have to buy an alternative item soon after and risk a series of tiny variations in my tapering.
 

As for one of my questions and one that you've also pondered @Rachelina – about ultra tiny doses of medicine – I was reading online over the weekend, doing searches for 'effects of tiny doses of medicine' and I came across the term 'microdosing'.

 

Sometimes having the correct term is the only way to find the information you're seeking, and information that's relevant and reliable. On my Google search for 'microdosing' the results are currently dominated by recent studies of LSD microdosing. But – and I'd really need someone with more pharmaceutical experience to vet this – I got the impression that microdoses still have an effect on the body. And, as such, microdosing is getting interest because it can be used to reduce the risk of adverse effects in clinical trials, meaning humans can be used in early trial phases, rather than other, less reliable methods, like animal testing. Maybe I'm being too simplistic, but if micro doses didn't have an effect on the body, then such studies would be a pointless waste of time and money from the outset, and wouldn't be happening.

I might be late to the party on the subject of microdosing – some of the articles I found date as far back as 2010. And microdosing might have already been discussed elsewhere on this forum, but it has given me reason to think my concerns about tiny doses are unfounded. It's also reminded me that, ultimately, everything in the human body happens at molecular level (not sure if that's the right term), so even a few microlitres – which will be many, many molecules – of Seroxat will have an effect.

Thanks again everyone, and for the reassurance and info Rachelina. 

PS. I never ever set out in my life to become an expert in oral syringes, but it looks like I might be at the end of this. Something else to put on my resume! 😉

[ChessieCat]

12 hours ago, DeterminedAnna said:

 

I've been looking over the weekend for a microlitre syringe (scary prices), but thanks to your comments I realise I may not need to go so low – I've found a .5ml syringe that I might be able to get shipped to the UK.

 

 

Where to get oral syringes

 

From the above post:

 

On 5/2/2011 at 6:56 AM, Altostrata said:

 

Where to get oral syringes

Many pharmacies carry the larger oral syringe and, as Brandy implies, veterinarians carry them, too, to give animals medication.

 

 

 

12 hours ago, DeterminedAnna said:

Also, thinking laterally, I'm wondering if a pipette – the kind of thing that's more like a dropper – would work as well?

 

Other members manage fine without these.  I know Rhiannon uses them but she's a lab technician.  From:  making-a-celexa-solution-yourself

 

On 5/2/2011 at 1:00 PM, Rhiannon said:

 

Then I add enough water to bring it up to 20 mL total. I mix it well and then draw up my dose for the day, and then pipette it straight into my mouth followed by a pipette full of water (both to rinse the pipette and to dilute the "shot"!)

 

My current dose is 5.25 mg of citalopram, so given the dilution I'm using (10 mg in 20 mL) I measure 10.5 mL as my daily dose.

 

All of this could be adapted easily to using syringes for measurement instead of a pipette. (And if you are more delicate than me you could measure it into a spoon or cup rather than squirting it straight into your mouth.)

 

But using pipettes is really easy too, very simple to learn and do.

 

 

12 hours ago, DeterminedAnna said:

PS. I never ever set out in my life to become an expert in oral syringes, but it looks like I might be at the end of this. Something else to put on my resume! 😉

 

None of us set out to be experimented on with psychiatric drugs either.  Some of the members, who have to crush their tablets, weigh their doses and make up capsules say they feel like druggies.  Either a druggie or a chemist.  A complete contrast.

[Cleerity]

21 hours ago, Rachelina said:

Thanks for all that info, Cleerity! Nice to find another syringe geek  

 

I will definitely check out those syringes. Do you find they stay smooth even after reusing them for weeks? Every brand I've used has been smooth at the beginning, but then gradually lost that smoothness over time until becoming unusable.

 

Well, I have not used them for weeks, yet.  I will see how it goes.

 

I just read more of this topic and see that the tape trick (to preserve the markings) was already mentioned a few times over!  

 

I am also interested in the microliter syringes mentioned in the topic, so will be looking into those as they may be helpful as I get to a really low dose.  

[ChessieCat]

13 hours ago, jozeff said:

🤗🤗

Well, a syringe has what is called a dead volume. This is the volume that doesn't come out the syringe when you empty it! This only applies for the first check mark, in this case the first ml. If you empty a 5 ml syringe let's say from 5 ml mark to 4 ml you gave exactly 1 ml liquid. Same for 4 to 3 ml same for 3 to 2 ml. Same for 2 to 1 ml. Same for 1 to 0 ml, but in the latter case you will have some dead volume left in the syringe. You should left this in the syringe because it is designed this way!

 

So, if you suck up liquid in a syringe let's say from nothing to 1 ml mark. Thet total volume of liquid in your syringe is maybe 1.2 ml. This is 1 ml + 0.2 ml dead volume. If you empty the syringe it will release 1 ml. The 0.2 ml dead volume stays in the syringe.

 

If you taper using syringes use the 5 ml syringe from 5 to 1 ml if possible. Below 1ml use the 1 ml syringe. 

Never fill a syringe with another one because the dead volume messes up your calculation.

 

If you need let's say 4.6 ml you take the 5ml syringe and fill it to 4 ml. 

Empty this in a small cup, leave the dead volume in the syringe (the liquid that stays in the tip).

Fill your 1 ml syringe to 0.6 ml mark and empty it in the same cup., Leave the dead volume in the syringe.

Drink your liquid and flush you cup with water and drink that too. 

Flush your syringe with water and throw that away. Dry the tip of syringe with some toilet paper.

Don't drink de dead volume because you will be getting more than 4.6 ml...

 

Hope this is clear. It's important to do the same every day. That way you get the most accurate dosage.

 

I use a volumetric pipette for this (an old one from the lab) but this is not necessary. A syringe will do, I mean we are not talking about 1/1000 of a mg right? One day 5.45 mg and next day 5.46 will be ok. Such a small difference is negligible.

 

 

Good luck!!!

 

Jozeff

Analytical chemist

 

 

[SkyBlue]

 

Actually we are talking about measuring to the 0.001 mark (thousandths of a mg)--incredible, but true! The microliter syringe is what has enabled me to continue my taper at the 2% rate, which at the tiny doses I am now on, needs to be measured in 5/1000 of a mg. 

[Rabe]

Have you water tapered the whole time?  

[jozeff]

Ok, when we approach the 0.1 mg area we have to make smaller increments of course. 

 

I assumed we all have plenty of tablet/liquids. In the Netherlands the healthcare assurance pays the medication. If I need 2 mg of citalopram I dissolve 10 mg and throw away 8 of them. That is not true for everybody of course.

 

I would rather dilute my solution and take a larger volume then use a concentrated solution and take a tiny volume. This is less accurate, especially when you don't have professional equipment.

 

A microliter syringe will do just fine. 

 

I also assumed people jump of meds at 0.1 mg so the 1/1000 wouldn't be necessary. I don't know how I will be tapering myself. Maybe I need to go much lower than 0.1 mg citalopram before jumping off.

If I need 0.01 mg I would dissolve my 10 mg pill in 1 liter and drink 1 ml and flush the rest down the drain. This is very spilling behavior but it is accurate.

 

I was trying to assist Carmie with her syringe issue. It is interesting to hear your solution to these problems.

 

Cheers

 

 

Jozeff

[ChessieCat]

9 hours ago, jozeff said:

If I need 2 mg of citalopram I dissolve 10 mg and throw away 8 of them.

 

You don't have to throw it away.  You can keep it for covered for several days in the fridge.

 

9 hours ago, jozeff said:

I also assumed people jump of meds at 0.1 mg

 

No, they go much lower than that.  When to end the taper and jump to zero?

 

9 hours ago, jozeff said:

If I need 0.01 mg I would dissolve my 10 mg pill in 1 liter and drink 1 ml

 

If I was making my own liquid I would be increasing the water to be able to measure my dose more accurately.

Edited January 23, 2019 by ChessieCat

[Figgy]

HI,  I am starting this new content because I have a questions I am hoping one of you can help me with.  I have been tapering off 5mg of Lexapro for more than a year.  I am closing in on needing to use a 1 ml syringe to continue my taper. 

 

I have  rubber stoppers I bought online that you shove into the top of the bottle of liquid lexapro so you can put the syringe in the hole, tip the bottle upside down and draw out your dose.

 

I cannot find any stoppers for a 1 ml syringe.  They are all too big to fit this small syringe tightly.  Does anyone know where I can find a stoppers for a 1 ml syringe?  It is SO much easier and less messy than pouring the dose out into a cup and trying to draw it up....much less wasteful too.

 

[ChessieCat]

Vets use very small syringes for animals.  You could ask if they use bung/stopper also called bottle adapter plug and if you might be able to purchase one.

 

You could also enquire at a compounding pharmacy.

 

Found these online but you'd have to enquire if they would fit the size syringe you are using.

 

https://www.totalpharmacysupply.com/staysafe-trade-self-sealing-bottle-adapters-24-mm.html?refSrc=613678&nosto=nosto-page-product1

 

https://www.totalpharmacysupply.com/bottle-adapter-plugs.html?refSrc=609907&nosto=nosto-page-product1

[Idlehnds]

1 hour ago, Figgy said:

HI,  I am starting this new content because I have a questions I am hoping one of you can help me with.  I have been tapering off 5mg of Lexapro for more than a year.  I am closing in on needing to use a 1 ml syringe to continue my taper. 

 

I have  rubber stoppers I bought online that you shove into the top of the bottle of liquid lexapro so you can put the syringe in the hole, tip the bottle upside down and draw out your dose.

 

I cannot find any stoppers for a 1 ml syringe.  They are all too big to fit this small syringe tightly.  Does anyone know where I can find a stoppers for a 1 ml syringe?  It is SO much easier and less messy than pouring the dose out into a cup and trying to draw it up....much less wasteful too.

 

 Hi Figgy.  Ask them for a small bottle to put the liquid.    I then bought this https://www.amazon.com/Syringe-Luer-Slip-Needle-Non-Sterile/dp/B01N01TO2O/ref=sr_1_1?keywords=1+mg+syringe&qid=1554933131&s=gateway&sr=8-1

 

You just put the dropper in and extract it from there.  Super easy.  I wouldn't worry about finding  the rubber stopper stuff.

 

Theres like 50 of them in there that you can reuse about every 3-4 times you use it.  Just rinse it with water.  

 

Easy solution

 

 

[Colonial]

 

I'm having trouble finding the smaller 0.5ml and the 0.3 ml syringes WITHOUT the needles manufactured "in" them.

If anyone sees them in their "online" purchasing travels please let me know! 😉

[Altostrata]

@Figgy @Colonial here is our topic about using an oral syringe. Read the posts above.

 

Contact medical supply stores for oral syringes. Many pharmacies carry them, so do veterinarians.

 

I have gotten small bottles with the correct cap for a small syringe from Walgreen's, for no charge. Be sure to describe the cap, it screws on and has a hole in the middle. The ones I got were blue plastic. A lot of pharmacy staff know nothing about oral syringes, you have to describe exactly what you want.

[Figgy]

On 4/10/2019 at 8:24 PM, Altostrata said:

@Figgy @Colonial here is our topic about using an oral syringe. Read the posts above.

 

Contact medical supply stores for oral syringes. Many pharmacies carry them, so do veterinarians.

 

I have gotten small bottles with the correct cap for a small syringe from Walgreen's, for no charge. Be sure to describe the cap, it screws on and has a hole in the middle. The ones I got were blue plastic. A lot of pharmacy staff know nothing about oral syringes, you have to describe exactly what you want.

Thank you.  I will try Walgreens.  

[ktp]

On 1/22/2019 at 6:27 PM, SkyBlue said:

 

"Actually we are talking about measuring to the 0.001 mark (thousandths of a mg)--incredible, but true! The microliter syringe is what has enabled me to continue my taper at the 2% rate, which at the tiny doses I am now on, needs to be measured in 5/1000 of a mg."

 

I've read through most of this thread on tapering liquids, and it appears that people are actually trying to measure impossibly tiny amounts of liquid.  What i havent seen is reasonable dilution instructions.  Seems to me that when you're down to such tiny doses, why not further dilute the med so you can take a larger (and thus easier to measure) amount to get your tiny dose?

 

For example, liquid Prozac comes in a concentration of 20mg/5ml.  If you're trying to take 1mg of drug, you need to drink 0.25ml of the liquid.  I submit that this is too tiny an amount to easily measure with any accuracy. 
pun-intended SOLUTION: Dilute the whole 120ml bottle with another 120ml of water, dropping the concentration to 10mg/5ml or 2mg/1ml.  that lets you take a far easier to measure 0.5ml to get your 1mg dose.  For easier measurement, add more water, "do the math", and take much more accurate doses than you'll ever achieve with super-tiny syringes.

 

For me, I'm planning to mix my own liquid prozac from 20mg capsules.  To get the "standard" mixture of 20mg/5ml, put 20 caps in 100ml of water, so a 20mg dose is 5ml of that solution.  5ml is pretty easy to measure to within 0.1ml with just a normal cheapo 5ml syringe.

Then as my taper continues, I'll simply add fewer caps to the same 100ml of water and continue taking 5ml doses.
 

When i want 17mg of drug, i can put 17 of the 20mg caps into 100ml of water and drink 5ml of the solution.  all easy measurements.

 

... put one 20mg cap in 100ml of water to get 1mg by drinking 5ml.

and when i want 0.1mg, I'll put one 20mg cap in 1000ml (yep a whole liter:-) and drink 5ml.

 

I hope that makes sense and i hope it will help with at least one person's micro-dosing.

 

 

[ChessieCat]

2 hours ago, ktp said:

I've read through most of this thread on tapering liquids, and it appears that people are actually trying to measure impossibly tiny amounts of liquid.  What i havent seen is reasonable dilution instructions.  Seems to me that when you're down to such tiny doses, why not further dilute the med so you can take a larger (and thus easier to measure) amount to get your tiny dose?

 

If a member isn't able to work out diluting to measure their dose more accurately, they usually ask for assistance and the mods provide help.

 

serial-dilution

 

Edited August 5, 2019 by ChessieCat

[Abella]

I'm tapering off fluoxetine in liquid form and have gotten some good info from this thread. I'm down to .14ml. and was going to try diluting it, because in order to stick to a 10% taper the amount of taper is so tiny and I've been noticing more pronounced WD symptoms with recent tapers. Sounds like the .5ml syringe does not measure any smaller increments than the 1ml, right?

 

SO, just wondering if someone could verify my math is correct.

 

So I would mix 1ml of the fluoxetine liquid and 9ml of water. Then my dose of this liquid would be 1.4ml, correct?

[ktp]

warning this will be hard to read. 

Prozac liquid comes from the mfr at 20mg prozac per 5ml liquid. 

How are you measuring 0.14ml?  that's way too tiny a volume to measure with a 5ml syringe, which typically has 0.2ml markings.  I'd trust that syringe to be close enough to measure 2.4ml but even that is quite error-prone. 
please verify the accuracy of  "1/2018 Prozac dropped to 10mg (5ml of a 20mg solution)"?  this can't be correct unless you're already diluting the liquid by half. 

"9/2018-12/2018 Prozac taper, .2ml every 2 weeks

2/2019 Prozac at .6ml (2.4mg I think)"

First thing i notice is you're steadily increasing your reduction.  Recommended by SA is to stick to (no more than) 10% reduction of your current dosage.  If you were taking 5ml of 20mg liquid, your next reduction should be no more than 0.5ml per month.  so (at ".2ml/2weeks") you started out about right, but continuing 0.2ml reductions every 2 weeks will quickly get you in trouble.  after that first 0.5ml reduction, your current dose is 4.5ml, and 10% of that is 0.45ml.  reducing by 0.45ml you get 4.05.  Notice please that it's much easier to do the math if you multiply by 90% instead of computing 10% and subtracting!  in other words, 5ml - 0.5ml = 4.5ml is more error-prone work than 5ml * 0.9 = 4.5ml.

so your recommended monthly reductions beginning 1/2018 are (note this is already an assumption, we need to really know what you were taking and it's not likely what you say)

1/2018 5ml

2/2018 5ml * 0.9 = 4.5ml

3/2018 4.5ml *0.9 = 4.05ml

4/2018 4.05ml * 0.9 = 3.645ml

5/2018 ...3.2805ml

6/2018 ...2.95245ml

7/2018 ...2.657205ml (i know, the precision is ugly; you'll really shoot for 2.66, already too fine a measurement but you're still okay. continuing...)

8/2018 ...2.3914845ml 

9/2018 ...2.15233605ml note that once this # is in your calculator display, press 4 keys "*.9=" to get the next value)

10/2018 ...1.937102445 (take 1.94ml)

so it's easy to compute the next dose, but as the volume decreases, the error in your measurement vastly increases.  let's digress:

When you measure 5.0ml with your 5ml syringe with its 0.2ml markings, the 5.0ml marking is "to the nearest 0.2ml" meaning when you see 5.0ml on the syringe you're actually getting anywhere from 4.8ml to 5.2ml, an error rate of 4%.  (0.2ml/5ml=0.04)

measuring 4.0ml gets you anywhere from 3.8 to 4.2ml; 0.2/4ml=5% error rate,

measuring 3.0ml gets you anywhere from 2.8 to 3.2ml, 0.2/3ml= 6.6% error rate

measuring 2.0ml gets you anywhere from 1.8 to 2.2ml, 0.2/2ml= 10% error rate

measuring 1.0ml gets you anywhere from 0.8 to 1.2ml, 0.2/1ml= 20% error rate.

even at full concentration 20mg/5ml, 1ml is 4mg+-20%

so hopefully you can see the futility of trying to measure 0.14mg with a 5ml syringe.  what to do?  dilute!

to your first question, YES you can dilute liquid prozac with water.  how much to dilute?  keep it simple should be your guide.  if you take 5ml of Prozac liquid (stated to be 20mg drug / 5ml liquid) and mix it with 5ml water, you now have 10mg/5ml.  to that 10ml of solution add 10ml water, that will halve the concentration so you have 5mg/5ml.  getting almost close enough to be realistic!  to the 20ml you have now add 20ml water to get 2.5mg/5ml.  so now if you trust your syringe and your #1 eyeball, 1.0ml is 0.25mg of prozac.  

brings me back to original question - HOW are you measuring 0.14ml? 

 

to your second question, yes your math is correct - 

if you start with 1part in 20, to get 0.1 part in 20, add 9*20 water to get 0.1part in 20.

actually thats 1part in 200 same as 0.1part in 20.

to change 1mg/5ml to 0.1mg/5ml, add 9 * 5ml water, gets you 1mg 50ml aka 0.1mg/5ml.

or as you stated it, 1mg/ml add 9ml to get 0.1mg/ml.

 

sure hope that helps.

 

 

 

 

[ChessieCat]

4 hours ago, ktp said:

that's way too tiny a volume to measure with a 5ml syringe

 

@Abella

 

You say that you are using a 0.5mL syringe but then mention 1mL increments.

 

9 hours ago, Abella said:

Sounds like the .5ml syringe does not measure any smaller increments than the 1ml, right?

 

What size syringe are you using?  It is possible to get 0.5mL syringes.  Where to get oral syringes

 

 

 

Edited August 30, 2019 by ChessieCat

[Rachelina]

It sounds like she was asking whether the increment markings on the .5 mL syringe are smaller than the ones on the 1 mL syringe. And no they are not. Apparently there is a .25 mL syringe with smaller increments (SkyBlue is using this I think), but it's very expensive.

 

Abella, I appreciate your question, as I am in the same position with Paxil. I know I'm not measuring it consistently with my .5 mL syringe. I need to start diluting. ktp (or anyone else) would you be willing to use your incredible math skills to get me started? I don't need a tapering plan, just a diluting plan. My liquid Paxil concentration is 1mL = 2 mg. My current dose is .3 mL or .6 mg and I plan to stay here a while. I'm using .5 mL syringes right now but I have plenty of 1 mL syringes and a few 5 mLs. 

 

My other question is, once you have diluted the liquid and taken your dose, can you refrigerate and save the rest? If so for how long?

 

I can testify to the importance of tapering by percentage rather than by a standard dose. Tapering by the same amount every time has gotten me into serious trouble. That's another reason why I want to dilute. I'm already dropping by the smallest increment, so all I can do is increase the time I stay on each dose. 

[ChessieCat]

11 hours ago, Rachelina said:

Apparently there is a .25 mL syringe with smaller increments (SkyBlue is using this I think), but it's very expensive.

 

You might be able to get one from a vet at a reasonable cost.

[ktp]

https://westendmedicalsupplies.com/collections/syringe-only/products/1-ml-oral-syringes-with-cap 1.00ml syringe for $2.95.  it has marks at 0.01 intervals, so you could reasonably measure 0.14ml without too much error.  Dilution seems a lot easier, but there might be reasons for tiny volumes - to each his own.  1cc (1ml same thing) syringes are also popular with diabetics so you might find them cheaper.  google is your friend!

[ktp]

Q1) liquid Paxil concentration is 1mL = 2 mg.  My current dose is .3 mL or .6 mg and I plan to stay here a while. I'm using .5 mL syringes right now but I have plenty of 1 mL syringes and a few 5 mLs. 

 

Q2) My other question is, once you have diluted the liquid and taken your dose, can you refrigerate and save the rest? If so for how long?

 

A1) at 2mg/ml and needing 0.6mg you need to take 0.3ml which is pretty tiny but doable with a 1ml or smaller syringe.  But if you dilute, you could take a larger volume, much easier to measure. 

For 10 days of med, measure out 3ml from the Rx bottle, add 27ml water, and you have 6mg drug in 30ml liquid.  your dose is 0.6mg so take 3ml each day. 

 

A2) don't know about Paxil, please look up Paxil ingredients in the patient information sheet.   for prozac, I switched to amber glass bottles to match the Rx version, which can be refrigerated for at least a month.

[Eastcoastgirl]

Does anyone want to help me out with diluting liquid Prozac? I'm not starting my taper yet, but I am having trouble wrapping my head around how to do it (i'm bad at math). 

 

Currently i'm using the standard 20mg/5mL liquid. My current dosage is .32mL or 1.3mg. I would like to taper by 2.5% at a time. If I go down by 1 line on my 1ml syringe, I will be making cuts higher than 2.5% with this liquid. So my question is, can someone show me how to dilute my first 2.5% drop from .32ml so that I have an idea how to do the calculations. It would be greatly appreciated

 

There are no topics here on how to dilute liquids. It would be great if someone started one and created a general template !

[ChessieCat]

16 hours ago, Rachelina said:

My other question is, once you have diluted the liquid and taken your dose, can you refrigerate and save the rest? If so for how long?

 

According to the manufacture undiluted prescription Paxil brand liquid can be kept until the use by date.  (Seroxat label says 1 month after opening).  See below:

 

On 8/4/2019 at 6:51 PM, ChessieCat said:

 

Reply I got after contacting the pharmaceutical company who manufactures product:

 

According to Dispedia/Apotex/GlaxoSmithKline:

 

Stability of product after opening - Paxil Oral Susupension

 

The product is stable until expiry date.  Store suspension at or below 25C / 77F degrees.

 

 

 

Once it is diluted (ie diluted prescription liquid) 4 days to a week is a reasonable limit for keeping homemade liquids (BrassMonkey's response).

 

If it was me I wouldn't keep it for longer than 4 days because of the growth of bacteria and I'd also be concerned that there might be some degradation of the drug so that the dose amount might change.

[ktp]

1 hour ago, KMart95 said:

Using the standard 20mg/5mL liquid, current dosage is .32mL or 1.3mg.
I would like to taper by 2.5% at a time.  Can someone show me how to dilute my first 2.5% drop from .32ml so that I have an idea how to do the calculations?

Rx concentration 20mg/5ml = 4mg/ml aka cc.  1.3mg/4mg/1cc=0.325cc.  conversely, 0.32ml at 4mg/cc=1.28mg. You choose whether to use 1.3 or 1.28, but I'm going with what you're actually measuring which is .32ml which equals 1.28mg.

You want to reduce By 2.5%, same as you want to reduce To 97.5% of current dose.  1.28mg*.975=1.248, your next dose.  at 4mg/cc,  1.248/4mg=0.312cc.  you knew that part.

to measure more accurately, dilute.  to maintain sanity, keep it simple.  

at 4mg/cc, 1.248mg/4=0.312cc.   

at 2mg/cc, 1.248mg/2=0.624cc and you get better accuracy. 

at 1mg/cc, 1.248mg/cc=1.248cc.  too big for your 1cc syringe. do it with 5cc but better is

at 0.5mg/cc, 1.248mg/0.5=2.496cc, perfect for 5cc syringe and still better accuracy.

so dilute to either 2mg/cc or 0.5mg/cc.

start with a known volume of 4mg/cc.  you want 14 doses til your next reduction, so a good place to start is 14*1.248mg=17.472mg.  from the Rx bottle, 17.472mg/4=4.368cc.  call it 4.37cc which you can get with your 5cc syringe.  for ease and a few drops to lose, make it 5cc. 

dilute 5cc of 4mg/cc to 2mg/cc by adding 5cc water.  dose will be 0.624cc.

or dilute 5cc of 4mg/cc to 1mg/cc by adding 15cc water.  dose will be 1.248cc. 

or dilute 5cc of 4mg/cc to 0.5mg/cc by adding 35cc water.  dose will be 2.486cc.

notice that when diluting you need to include all the liquid involved - original plus what you need to get desired dilution.  to turn 4mg/cc into 1mg/cc, you need 4 times as much liquid as you have.  to get 4x you add 3x.

confused yet?

 

[Eastcoastgirl]

4 minutes ago, ktp said:

Rx concentration 20mg/5ml = 4mg/ml aka cc.  1.3mg/4mg/1cc=0.325cc.  conversely, 0.32ml at 4mg/cc=1.28mg. You choose whether to use 1.3 or 1.28, but I'm going with what you're actually measuring which is .32ml which equals 1.28mg.

You want to reduce By 2.5%, same as you want to reduce To 97.5% of current dose.  1.28mg*.975=1.248, your next dose.  at 4mg/cc,  1.248/4mg=0.312cc.  you knew that part.

to measure more accurately, dilute.  to maintain sanity, keep it simple.  

at 4mg/cc, 1.248mg/4=0.312cc.   

at 2mg/cc, 1.248mg/2=0.624cc and you get better accuracy. 

at 1mg/cc, 1.248mg/cc=1.248cc.  too big for your 1cc syringe. do it with 5cc but better is

at 0.5mg/cc, 1.248mg/0.5=2.496cc, perfect for 5cc syringe and still better accuracy.

so dilute to either 2mg/cc or 0.5mg/cc.

start with a known volume of 4mg/cc.  you want 14 doses til your next reduction, so a good place to start is 14*1.248mg=17.472mg.  from the Rx bottle, 17.472mg/4=4.368cc.  call it 4.37cc which you can get with your 5cc syringe.  for ease and a few drops to lose, make it 5cc. 

dilute 5cc of 4mg/cc to 2mg/cc by adding 5cc water.  dose will be 0.624cc.

or dilute 5cc of 4mg/cc to 1mg/cc by adding 15cc water.  dose will be 1.248cc. 

or dilute 5cc of 4mg/cc to 0.5mg/cc by adding 35cc water.  dose will be 2.486cc.

notice that when diluting you need to include all the liquid involved - original plus what you need to get desired dilution.  to turn 4mg/cc into 1mg/cc, you need 4 times as much liquid as you have.  to get 4x you add 3x.

confused yet?

 

I appreciate the help but not one bit of that makes any sense to me 

[ktp]

>>I appreciate the help but not one bit of that makes any sense to me 

Give it a chance, please - you replied before my post was up long enough for you to read half of it.  go slow, read each sentence, and understand it before going on.  feel free to ask specific questions and you can pm me if you want.

to review, i first pointed out that your actual dose is not what you think it is and adjusted for that. 

second i reviewed how to comput your next dose.  you know how to do that.

then i suggested a way to choose how much liquid to start with.  you need to know this so you can calculate how much water to add.  

then i explain that to dilute to 1/4 of the current concentration you need to add 3parts water not 4 - you already have the first part of the liquid.

that's 4 chunks of fairly technical explanations; don't expect to get it as fast as you can read it.  and bear in mind it takes a lot more time to read and understand equations than the same amount of Dr Seuss. :=)

[ChessieCat]

@ktp

 

It is preferable to use mL, not cc.

 

[ChessieCat]

36 minutes ago, KMart95 said:

I appreciate the help but not one bit of that makes any sense to me 

 

I'm having difficult making heads or tails out of it too.  So it isn't just KMart that is having problems.

[ktp]

1 minute ago, ChessieCat said:

It is preferable to use mL, not cc.

preferable to whom, and why?  far as I know they are exactly equivalent.  and cc is easier to type, And easier to differentiate from mg.  btw ml is a perfectly valid abbreviation for milliliter, at least in the USA it is.  i'd prefer mL but it's just not necessary.  does ml stand for something else?  

[ChessieCat]

ml and mL are the same = milliliter and that is the term that we use here at SA.

 

To make it easier to distinguish between mg and ml we use mg and mL

 

43 minutes ago, ktp said:

notice that when diluting you need to include all the liquid involved - original plus what you need to get desired dilution. 

 

Even though this is technically correct, for tapering it is not necessary.  As long as you do everything the same way each time you will be getting the same dose.  It may not end up being the exact dose amount you are wanting to calculate but it is better to keep things as simple as possible.

 

The simpler it is the less chance there is of mistakes happening.

 

The only thing you need to ensure is that you are not reducing by more than 10% of the current dose.

[ktp]

2 minutes ago, ChessieCat said:

 

I'm having difficult making heads or tails out of it too.  So it isn't just KMart that is having problems.

i don't think it's over your heads at all. 

maybe you have a specific question?  snark: or would that indicate that you didn't bother to read the 1st 3 sentences?-)  please read the question in gory detail, then understand every single number you read in the answer.  
I'm happy to make it clearer but i'd rather not make it longer.

[ktp]

2 minutes ago, ChessieCat said:

ml and mL are the same = milliliter and that is the term that we use here at SA.

 

To make it easier to distinguish between mg and ml we use mg and mL

 

 

Even though this is technically correct, for tapering it is not necessary.  As long as you do everything the same way each time you will be getting the same dose.  It may not end up being the exact dose amount you are wanting to calculate but it is better to keep things as simple as possible.

 

The simpler it is the less chance there is of mistakes happening.

 

The only thing you need to ensure is that you are not reducing by more than 10% of the current dose.

ml and cc are the same, too.  you didn't answer the question or support your wish to use mL.  try again?

 

[Eastcoastgirl]

I understood that I thought I was taking 1.3mg but I am actually taking 1.28mg. I understood the calculation of how to get to my next dose. The options for different ways to dilute made sense to me & now i'm lost

[ChessieCat]

@ktp

 

Please stop being sarcastic and smart.  This isn't a game that we are playing.  It is very serious and if mistakes are made a member could end up suffering.

 

The aim here is to help Kmart work out how to dilute her drug in a simple way they she understands and can do without making mistakes.