FinalFantasy: compound Zoloft liquid vs capsules?

[FinalFantasy]

Hello,

 

I’m trying to post this under the “tips for tapering sertraline” topic. Totally new here and need some advice.

 

I will be tapering Zoloft 25mg by 10% in the new year, and from reading the post it says that liquid Zoloft is the best choice for slow, precise dosing/tapering. However, the switch to liquid Zoloft makes me a little nervous, especially since I’m already at 25mg so it’s hard to take half that dose in liquid and other half in capsule, plus I’m in Canada and from my knowledge we don’t have tablets that I could split… 25mg capsules is the lowest available dose and capsules don’t split precisely.

 

So my question is, why is the preference for liquid Zoloft over compounded capsules? I would think measuring liquid everyday would be harder than taking pre-measured capsules? Are capsules more expensive than the liquid? I feel the transition to compounded capsules would be smoother than the liquid and I can get doses made at whatever dose I need.

 

thank you so much for any input!

[ChessieCat]

Hi FinalFantasy and welcome to SA,

 

You have come to the right place for assistance and I am glad that you found SA before you started tapering.

 

I will provide the link here for future reference:

 

tips-for-tapering-zoloft-sertraline

 

Tapering using a liquid is more accurate.  However, I managed to do the majority of my taper getting my Pristiq tablets compounded.  At the end though, I used the contents of the compounded capsules to make a liquid.  If I had known that I could make a liquid I would have had capsules made up to use and I would not have needed as many so it would have been a lot cheaper.  The smallest Pristiq tablet in Australia is 50mg.  I would have had smaller doses made up to use.

 

It is possible to make a liquid from Zoloft tablets.  See Post #1 of the tips for tapering topic.

 

When changing form of a drug it is generally better to do a cross over, which is gentler on your system.  See:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

Note that you do not make a reduction at the same time as doing the cross over.  Also, because you would be taking the entire 25mg dose (from one tablet) in a combination of tablet and liquid, you do not have to be too concerned about being exact in the cutting of the tablet.

 

Tapering using compounded capsules can be convenient.  However you do not have the flexibility that you have with using a liquid.  You have to do a lot of pre-planning about what doses you will need and how long you will be staying on a dose.  If for some reason you need to stay on a dose for longer (eg you get withdrawal symptoms, get sick, have extra stress in your life) then you might have to get more of the dose made up.  And if that is inconvenient you might decide not to bother and make a reduction and then you might end up experiencing withdrawal symptoms.

 

I cannot say whether it would be costly to get compounded tablets where you live.  Here in Australia I got various quotes done and was very fortunate to find a compounding pharmacist who charged me the minimum amount for my capsules and he also kept the price the same for the duration of my taper (5 years of purchasing the capsules for a 6 year taper).

 

You would have to do your own research about how much you would be charged and whether you would need a prescription (in Australia you don't) and whether health insurance, if you have it, would cover or subsidise the cost.

 

getting-compound-custom-dosages-at-compounding-pharmacies-us-uk-canada-and-elsewhere

 

 

Please create your drug signature following these instructions.

 

Instructions:  Withdrawal History Signature

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your Introduction topic is the best place to ask questions specific to your own situation and where you can journal your progress.  This keeps your history in one place and means that you do not have to repeat your story.

 

There are many existing topics on SA.  I like to use an internet search engine and add site:survivingantidepressants.org to my search term.

 

[ChessieCat]

I forgot this topic:

 

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

 

[FinalFantasy]

Chessiecat, thank you so much for your thorough response. It is very much appreciated! 
 

I understand the “tablets” cut in half pretty easily to do half-dose tablet + half dose liquid to smooth the transition. However, here in Canada, we don’t have tablets (that I’m aware of), we only have “capsules”, so how would you suggest doing this with capsules? I don’t think opening the capsules and dividing them/weighing them works as the active ingredient is mixed in there with fillers so the dose would not be accurate. 
 

even if I choose to switch over to compounded capsules, I would first need to switch to “25mg” compounded capsules (so no dose reduction is made until I get used to the new form of medication), and this requires half-dose of what I’m taking now, capsules, along with half-dose of compounded capsules.

Do you think changing from capsule to compounded capsule would be as unbalancing/challenging as moving from capsule to liquid? I figure the capsule and compounded capsule would be more similar to each other and thus less destabilizing? Again thank you so much

[ChessieCat]

You are very welcome.

 

If you are going to change from standard dose capsule to a compounded dose capsule, then it might not be too much of an issue to do a straight switch across. 

 

I suggest that you check with the pharmacist about what they will be doing to create the new capsules.  If all they are doing is emptying the brand capsules and then re-capsulating the contents without any grinding of the ingredients (they will probably add more filler which will be mixed in, not ground) then all they will be doing is "diluting" the powder.

 

FYI if you ever decide to use the capsule contents to make a liquid, the fillers can get "gluggy" or lumpy when water is added.  The way I overcame this was by pouring the measured amount of water into a lidded container (needs to be leak proof) and then tipping the capsule contents onto the top of the water.  You can either leave it for several hours, covered, in the fridge, or give it a really good shake.  It will go frothy, so it cannot be used straight away.  I would make my new batch the night before I needed it so it was ready for my morning dose.  Before measuring out the dose, you need to give the liquid a gentle stir so as not to create too many bubbles in the mixture.

[FinalFantasy]

Thank you so much for your reply and advice Chessiecat, you are truly an incredible person to help all these people you don’t even know through such a hard time!! I hope you know that!

I’m going to call my local compounding pharmacy soon and ask how they make capsules. I did a google search and it seems that the pharmacies have access to the pure form of the drug (so just sertraline) and can mix in their own fillers/additives to make it work similar to the brand name, and that way they’re not opening capsules and re-capsulating or diluting the powder since the powder is made of several ingredients. 
 

again, just wanted to say a big thank you!! 

[Katiestanb]

On 12/12/2021 at 2:12 AM, ChessieCat said:

Hi FinalFantasy and welcome to SA,

 

You have come to the right place for assistance and I am glad that you found SA before you started tapering.

 

I will provide the link here for future reference:

 

tips-for-tapering-zoloft-sertraline

 

Tapering using a liquid is more accurate.  However, I managed to do the majority of my taper getting my Pristiq tablets compounded.  At the end though, I used the contents of the compounded capsules to make a liquid.  If I had known that I could make a liquid I would have had capsules made up to use and I would not have needed as many so it would have been a lot cheaper.  The smallest Pristiq tablet in Australia is 50mg.  I would have had smaller doses made up to use.

 

It is possible to make a liquid from Zoloft tablets.  See Post #1 of the tips for tapering topic.

 

When changing form of a drug it is generally better to do a cross over, which is gentler on your system.  See:

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

Note that you do not make a reduction at the same time as doing the cross over.  Also, because you would be taking the entire 25mg dose (from one tablet) in a combination of tablet and liquid, you do not have to be too concerned about being exact in the cutting of the tablet.

 

Tapering using compounded capsules can be convenient.  However you do not have the flexibility that you have with using a liquid.  You have to do a lot of pre-planning about what doses you will need and how long you will be staying on a dose.  If for some reason you need to stay on a dose for longer (eg you get withdrawal symptoms, get sick, have extra stress in your life) then you might have to get more of the dose made up.  And if that is inconvenient you might decide not to bother and make a reduction and then you might end up experiencing withdrawal symptoms.

 

I cannot say whether it would be costly to get compounded tablets where you live.  Here in Australia I got various quotes done and was very fortunate to find a compounding pharmacist who charged me the minimum amount for my capsules and he also kept the price the same for the duration of my taper (5 years of purchasing the capsules for a 6 year taper).

 

You would have to do your own research about how much you would be charged and whether you would need a prescription (in Australia you don't) and whether health insurance, if you have it, would cover or subsidise the cost.

 

getting-compound-custom-dosages-at-compounding-pharmacies-us-uk-canada-and-elsewhere

 

 

Please create your drug signature following these instructions.

 

Instructions:  Withdrawal History Signature

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your Introduction topic is the best place to ask questions specific to your own situation and where you can journal your progress.  This keeps your history in one place and means that you do not have to repeat your story.

 

There are many existing topics on SA.  I like to use an internet search engine and add site:survivingantidepressants.org to my search term.

 

Can you do the same to go back on them? I’ve been off them 8 months and having horrible withdrawal so it’s been suggested I re introduce by someone on here but tablets only come in 50mg

[ChessieCat]

Katiestanb has created an Introduction topic and is being assisted there.

[Katiestanb]

5 hours ago, ChessieCat said:

Katiestanb has created an Introduction topic and is being assisted there.

No one has replied though so I have jumped on here to ask 

[FinalFantasy]

Please help with reinstatement!

 

Hello,

 

Since January 2022 I’ve gone from 25 mg Zoloft to current dose of 14.5 mg, doing 10% drops every 4-6 weeks.

 

I’ve been extremely dependant on Vitamin D to get me to this point with manageable w/d’s. It helps with my anxiety, depression, chronic pain and sleep tremendously. Now, out of nowhere, it’s starting to cause urinary/bladder issues and I will have to either cut it down or stop it altogether. To say I am terrified and frustrated would be the biggest understatement. I just can’t catch a break. I am severely suicidal now since  I can’t see a light at the end of the tunnel anymore. I’m an emotional wreck. 
 

if I cut vitamin D down, I will severely destabilize and have debilitating insomnia. I will need to go back up to a dose of Zoloft where I was sleeping without the vitamin D - which might be around the 25mg. 
 

my question is will reinstating back to 25mg after 8ish months of tapering down, work to rebalance? Should i try a smaller dose first? I know going from 0 mg back to the drug is risky after so long, but I’m still on a relatively close dose and wondering what I should

Do and if anyones had experience with this? 

 

thanks for reading. 
- hopeless

 

Edited August 24, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

4 hours ago, FinalFantasy said:

my question is will reinstating back to 25mg after 8ish months of tapering down, work to rebalance? Should i try a smaller dose first? I know going from 0 mg back to the drug is risky after so long, but I’m still on a relatively close dose and wondering what I should

 

Please read Post #1 of the topic linked below, much of which relates to updosing as well as reinstatement.

 

NOTE:  SA recommends only making small increases and to only increase again IF NECESSARY. 

 

The idea is to bring the withdrawal symptoms to a bearable level, not to get rid of them completely.  Some members try to find the "perfect dose" and end up making things worse.  Keep in mind that it takes about 4 days for a dose change to get to a steady level in the blood and a bit longer for it to register in the brain, so you will need to be patient and give the dose time to take effect.  It is also a good idea to keep notes of your symptoms so that you can see how the updose is affecting your symptoms. 

 

About reinstating and stabilizing to reduce withdrawal symptoms

[ChessieCat]

4 hours ago, FinalFantasy said:

Now, out of nowhere, it’s starting to cause urinary/bladder issues and I will have to either cut it down or stop it altogether.

 

Q:  Do you know for sure that the Vitamin D is causing these issues?

 

If you are taking a fairly high dose you might consider just reducing the dose instead of stopping it altogether, but I suggest that you consult your doctor.

 

My own experience:  I recently stopped my Vitamin D after taking if for 12+ years and only 3 weeks later I got very sick with a flu and then 4 weeks after that I got a bad head cold.  Whilst I was taking the Vitamin D I rarely got sick and if I did I recovered quite quickly.