Nomoreap4me: Tapering off Risperidone via oral solution

[Nomoreap4me]

Hi all, I appreciate this page. 
 

I recently decided to taper off of Risperidone by reducing the dosage by 5-10% per month. I got an oral solution manufactured that way. I had previously thought of making my own solution but found that Risperidone is not soluble. (Please correct me if I’m wrong.) 

 

Anyway, I stored the oral solution provided by the pharmacy in the fridge at 37 degrees Fahrenheit. However, the bottle says it should be stored at around 68- 70 ish degrees Fahrenheit. Has anyone had the experience of storing their medication at this temperature and not experiencing any difficulties? 

Edited January 30, 2022 by Karma
Name update

[getofflex]

Hello nomoreap4me, welcome to SA.  This could be a problem.  How long have you been keeping this risperidone solution in the fridge?  Keeping it at this too cold temperature can cause the solution to break down, or crystallize at the bottom, and therefore what you are taking could be weaker strength than it should be.  

 

How is your withdrawal going?  Are you having any symptoms?  Good for you for doing such a careful and slow taper.  

 

Can you please give us specific information about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some information about how these drugs actually work.  

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

 Video on Recovery from Psych Drugs

 

What is Withdrawal Syndrome?

 

Tapering is best done extremely slowly, and we taper by 10% of the current dose no more than once every 4 weeks, so that the taper becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Risperidone

 

Please let us know more information about the details of your taper, and how long you have kept this drug in the refrigerator, and then we will give you guidance on how to proceed.  Thank you. 

 

 

Edited January 30, 2022 by Karma
name update

[Nomoreap4me]

Hi Getofflex, 

 

Thanks for your response. I found the information helpful. I'm currently not tapering yet. It will be 2 weeks that the medication is in the fridge since I'm currently out of town. I'm taking 1 mg tablets of Risperidone right now. In the past I've mainly taken Risperidone but for a few months in the last few years I've taken Lamictal and Latuda. I have also tried to rid myself of medication with the psychiatrist's recommended rate of tapering without much success. I will update my signature with the dates and dosages when I have that information since I don't have it right now and can't recall.

 

My goal is to taper at 5% from the original dose because from what it seems, oral syringes are difficult to be accurate in hundredths of decimals. I understand that it'll be a linear downward progression instead of a hyperbolic one but I'm trying to mitigate the risk of consuming inaccurate dosages. That's also why I'm tapering at 5% from the original dose because it's more easy to read on the syringes and I hope the low rate will be somewhat safe. 

 

For now I'm informing myself as much as I can before I jump into this. Thanks again. 

 

 

[Onmyway]

Welcome to SA Nomoreap4me, 

 

have you checked if it is possible to dilute the solution to get accurate measurements so you don't have to use hundredths. You should read carefully the thread that geofflex has posted above on tapering risperidone specifically. It also talks that there may be a difference in bioavailability between liquid and pill form. 

 

I would also call your pharmacist or the number listed in the medication leaflet (if there is one) and see if you can still use the oral solution or you need to throw it out. Sometimes there is some leeway in the temperature - 68-70 is too narrow a range to be practicable.  

 

Good luck, OMW

 

Edited January 30, 2022 by Karma
Name update

[hayduke]

On 7/31/2021 at 2:49 PM, Nomoreap4me said:

oral syringes are difficult to be accurate in hundredths of decimals

 

Hi Nomoreap4me.  Once you're comfortable using a syringe to titrate, more accurate options are in reach.  A 10 or 25ml glass serological pipette can be ordered online.  Even better, I've wound up with this sort of thing https://www.ebay.com.au/itm/143635492949 which only requires very occasional calibrating and the rest of the time you just dial up the dosage and take it - really easy before bed time. 

 

Also bear in mind that you can still compound taper with fewer decimal places by rounding.  You may find that you will need to pick up a compound taper sooner or later.

 

Cheers

[getofflex]

My husband is a retired pharmacist, and he says that the liquid could be lower in strength than it should be from having it in the fridge.  So if I were you, I would not use that, I would dispose of it.  The liquid could precipitate (go out of solution) and form crystals.  That will mess up the strength and integrity of the medication.  Also, the molecules of the drug themselves could break down, because they are out of storage parameters.  You could contact the manufacturer and ask them for advice.  

 

On 7/31/2021 at 2:49 PM, Nomoreap4me said:

I will update my signature with the dates and dosages when I have that information since I don't have it right now and can't recall.

Thank you.  That would be helpful to us mods.  🙂 

On 7/31/2021 at 2:49 PM, Nomoreap4me said:

My goal is to taper at 5% from the original dose because from what it seems, oral syringes are difficult to be accurate in hundredths of decimals. I understand that it'll be a linear downward progression instead of a hyperbolic one but I'm trying to mitigate the risk of consuming inaccurate dosages.

We strongly suggest at SA that you do a 10% or less taper of the current dose of your drug.  If you read my link on "why taper by 10%" you will see why this is so.  This is especially true as we get to the lower doses.    The reason for this is that, even at very low doses, these drugs have a big impact on our brains. I realize this article is aimed at SSRI's, but we still suggest a hyperbolic taper for other psych meds.  

 

SERT Transporter Occupancy Studies

 

Please read "tips for tapering Risperidone" above.  @haydukegave you some good advice about tapering with a liquid, and liquid makes it easy to do a hyperbolic taper.  

 

 

Edited January 30, 2022 by Karma
Name update

[Nomoreap4me]

 

This all looks like very valuable information. I will be studying this more so I an learn how to titrate and use pipettes. I will also look at the other links again. I'm glad there's a possibility to taper at 10% of the current dose. Also, for some reason I thought it was less risky to taper at a lower dosage such as mine. 

 

This is what Amneal Pharmaceuticals said about the temperature: 

"As per the FDA approved Package insert:

STORAGE: Store bottle at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Keep away from children; avoid freezing and protect from light.

 

Amneal does not have excursion data or further stability information for Risperidone Oral Solution. Hence, we cannot guarantee its safety, efficacy and purity of the product when stored outside of the recommended storage condition."

 

Thank you all for the tips. 🙂

 

 

[Nomoreap4me]

Hello, 

I just wanted to give an update. I was tapering via the Brass Monkey Taper (I’ll update my signature) and was tapering down 2.5% per week and got to 900 uL. Then I realized that I accidentally used the micro pipette incorrectly for 1-2 weeks. This caused me to consume much more than 900uL. Should I revert back to the correct 900uL dosage or start all the way from the incorrect dosage that I consumed for 1-2 weeks? Yesterday I switched to the correct 900 uL and am fine except for anxiety at night. 
 

Thanks 

[Altostrata]

On 4/26/2022 at 9:30 PM, Nomoreap4me said:

Hello, 

I just wanted to give an update. I was tapering via the Brass Monkey Taper (I’ll update my signature) and was tapering down 2.5% per week and got to 900 uL. Then I realized that I accidentally used the micro pipette incorrectly for 1-2 weeks. This caused me to consume much more than 900uL. Should I revert back to the correct 900uL dosage or start all the way from the incorrect dosage that I consumed for 1-2 weeks? Yesterday I switched to the correct 900 uL and am fine except for anxiety at night. 
 

Thanks 

 

Hello, @Nomoreap4me What amount are you taking in milligrams? What times o'clock do you take your drugs, with dosages?

 

How has your symptom pattern changed since April 25?

[Nomoreap4me]

Hello @Altostrata right now I reverted back to 1 mg/ml Risperidone oral solution. I usually take my drugs within a window of 8pm-11 pm every day. I've had more intrusive thoughts but have been able to fake my way out of it with those not close to me. I'm waiting for another micropipette that can measure an amount greater than 1 mg/ml so I can see how much I consumed. I don't want to break the one I have that can only handle ranges less than 1 mg/ml. 

[Altostrata]

Please take your dose of risperidone closer to the same time each day, this will better show the effect of the dose. Irregular dosing can cause symptom fluctuation.

[Nomoreap4me]

Thanks @Altostrata, I'll take it as close to the same time as I can. Do you recommend that I stay at 1 mg/ml (what the psychiatrist recommended) for a while or increase to the dosage that I accidentally consumed for around a couple of weeks? Right now I seem to be fine. 

[Altostrata]

You'll need to take 1mg risperidone consistently at the same time of day for a week to see its full effect. It could be 1mg is sufficient.

 

How are you feeling now?

[Nomoreap4me]

Okay, thanks for the advice. I feel fine now since it's the weekend but during the week when I think about this misstep I get anxious. However, I'm able to regulate my emotions. I will keep the dosage at 1mg/ml for a week and will see what happens. 

[Altostrata]

Don't blame yourself, just about every member here has made similar mistakes.

[Nomoreap4me]

Thanks for the words of encouragement