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How to make a liquid from tablets or capsules

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Johanna

Thank you ChessieCat. 

May I gently ask if you have completed a water titration taper? Did you change the water drug ratio during the taper? Eventually, there will be very little (drops I suspect) left in the dose jar that will be difficult to stir and pull?

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ChessieCat

No I haven't used that method.  I am tapering Pristiq and get my tablets compounded.  I'll quote your post and respond in your topic.

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Johanna

Thank you.

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ChessieCat
39 minutes ago, ChessieCat said:

I'll quote your post and respond in your topic.

 

Please go here introductions-and-updates and create your own Intro topic so we can answer the questions you have about your own situation there.

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nolongeranxiousbut

Curious about anyone who has made their own liquid lexapro. From everything I've read escitalopram isn't water soluble or ethanl soluble.  The link on the lexapro main page requires 30 ounces to dissolve 5 mg.

 

Escitalopram oxalate occurs as a fine, white to slightly-yellow powder and is freely soluble in methanol and dimethyl sulfoxide (DMSO), soluble in isotonic saline solution, sparingly soluble in water and ethanol, slightly soluble in ethyl acetate, and insoluble in heptane.

 

Also saw this

Sparingly soluble materials are those, which have lowered solubility. Usually materials are treated as sparingly soluble if 1g of material requires 30 to 100ml of solute to dissolve. In other words, a material will be sparingly soluble if the amount which can be dissolved in 100ml of solute ranges between 1g and 3,3g.

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Altostrata

Please read this topic from the beginning. We have many people who have made their own liquid Lexapro. To read about their experiences, please go to the Introductions forum and use search.

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bubbles

Brand name Lexapro also exists in a liquid form, or at least it did five or six years ago. Not all pharmacies carry it where I live, so I needed to give them some notice when I wanted it. I never tried to make my own as the liquid was always available when I wanted it.

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carefulprayerful

Can you use Ora Plus with Risperidone?  

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Altostrata

Yes, but risperidone comes in a prescription liquid.

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carefulprayerful

The prescription liquid is 1 mg per 1 mL.  At 0.09 mg and below, since the smallest measurement on a syringe is 0.01 mL, the reductions would be > 10%.  

 

I guess I could switch to a compounded liquid at any point to get it more diluted.    

 

Can you further dilute the prescription liquid?  (I asked a compounding pharmacist this question, and he said he wasn't sure if the compounded liquid would mix with water.)

 

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Glosmom

Carefulprayerful,

A 10% reduction from 1mg takes someone to .9 mg NOT .09mg.  .09 mg would be near the very end of the taper.  You should never need to dilute the prescription liquid form of Risperidone.  People that are using tablets or capsules are diluting things down to get to easily measurable amounts.  The 1 mg per 1 ml liquid Risperidone is already in a very easily measured and titrated form.  No need to add water at all.   Not sure who told you that you have to dilute the liquid risperidone down further with more liquid because you do not have to do that.  Hoping you don't make this more complicated than it needs to be.  Best Regards, glosmom

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ChessieCat
3 hours ago, carefulprayerful said:

The prescription liquid is 1 mg per 1 mL.  At 0.09 mg and below, since the smallest measurement on a syringe is 0.01 mL, the reductions would be > 10%.  

 

I guess I could switch to a compounded liquid at any point to get it more diluted.    

 

Can you further dilute the prescription liquid?  (I asked a compounding pharmacist this question, and he said he wasn't sure if the compounded liquid would mix with water.)

 

 

From this site:  http://mcs.open.ac.uk/nlg/old_projects/pills/corpus/pil/data/JanssenCilag/Risperdal_Liquid/Risperdal_Liquid.html

 

"The liquid contains the following inactive ingredients: tartaric acid, benzoic acid, sodium hydroxide and water"

 

This means that it is okay to dilute the liquid with water.

 

Edited by ChessieCat

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ChessieCat
1 hour ago, Glosmom said:

A 10% reduction from 1mg takes someone to .9 mg NOT .09mg.  .09 mg would be near the very end of the taper.  You should never need to dilute the prescription liquid form of Risperidone.  People that are using tablets or capsules are diluting things down to get to easily measurable amounts.  The 1 mg per 1 ml liquid Risperidone is already in a very easily measured and titrated form.  No need to add water at all.   Not sure who told you that you have to dilute the liquid risperidone down further with more liquid because you do not have to do that.  Hoping you don't make this more complicated than it needs to be.

 

Yes this is correct:  "A 10% reduction from 1mg takes someone to .9 mg"

 

 

"People that are using tablets or capsules are diluting things down to get to easily measurable amounts. "

 

Yes, they do.  Some members find that they have difficulty accurately and consistently measuring small amounts.  Diluting the liquid may help them to do this.  Also, some members find that they need to reduce by very small amounts and diluting allows them to do this with greater accuracy.

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carefulprayerful
2 hours ago, ChessieCat said:

some members find that they need to reduce by very small amounts and diluting allows them to do this with greater accuracy. 

Yes, this is my case.  I would like to do a microtaper.  If I diluted the prescription liquid (an oral solution) in water, would I have a suspension or a solution?

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ChessieCat

It would be a solution.

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Jerome

The American Pharmacists Association Drug Information Handbook has begun inserting extemporaneous preparation procedures for suspensions of benzodiazepines and probably other drugs. As an example, on page 1190 of the 26th edition at the end of the monograph on lorazepam there is a section called extemporaneous preparations note:

"Commercial oral solution is available (2 mg/mL) 2 different 1 mg/ml oral suspensions may be made from different generic lorazepam tablets (Mylan Pharmaceuticals or Watson laboratories, sterile water, Ora-Sweet and Ora-Olus."

There follow extremely detailed instructions to the pharmacist for the preparation of 360 mL of suspension, one paragraph for Mylan and one for Watson. This would of course be scaled down, but I'm thinking it might be best for the pharmacist to make this solution, in fact they might insist on it. Another question is which doctor writes which prescriptions. I'd just as soon not even tell Kaiser about my outside doctor, but I don't think that will fly with controlled substances, and I'm not sure I'd want it to, anyway. It looks like Dr. shopping, even though the tiny amount involved makes that idea ridiculous. I'm seeking an outside doc because Kaiser will only treat me in their Chemical Dependency Program, I don't care for their method, and they don't have much flexibility.

Anyway, I have seen similar preps for a couple of other benzos in this same book and would guess there are some for other psych drugs. The book costs 35 or $40, but it might be worth it to be able to lay it down on the counter in front of the pharmacist alongside a letter from your doctor. Or you can get it from the library.

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Altostrata

Thanks, Jerome! Perhaps a pdf will become available.

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Cleerity

I have discovered that when titrating using a syringe to dose liquid preparations, not all syringes are created equal.  

 

To achieve accuracy in dosing, it is important to use a syringe that is, as I call it, a “smooth operator.”  This means one in which the plunger glides effortlessly through the tube, without gripping the sides.  This is important for accurate dosing.

 

When the plunger is gripping the inside of the tube, one has to apply more pressure than needed to get it to move, often moving past the point of the desired dose.  This causes one to have to back the plunger up, again drawing in more medicine, to make another attempt at achieving an accurate dose. With a grippy plunger, I found myself doing this over and again.  Frustrating.

 

The syringes I was having trouble with are made by CareTouch and I found them on Amazon.com.  I do not recommend these, despite their very positive reviews.

 

The ones that are working for me are by BSTEAN, also found on Amazon.com:  https://www.amazon.com/gp/product/B06ZZ4BZ15/ref=oh_aui_detailpage_o04_s00?ie=UTF8&psc=1

 

I am using their 1 ml syringes.

 

A couple nice things about the syringes from BSTEAN is that: (1) they have every 100thmarked and, (2) the plunger tips go all the way to the end of the tube.   Though, it is not a show stopper if the plunger does not go all the way to the end of the tube, as one can just suck the little remaining drop of liquid out.

 

I am sure there are other syringes out there that are “smooth operators” like the BSTEAN brand.  Just know that if you find yourself with a grippy plunger, you can change it out for one that works better.

 

Another trick when using the syringes for liquid dosing is to apply a strip of clear, glossy scotch tape over the length of the numbers.  This will keep them from rubbing and washing off, giving you an extended life on the syringe.  I read about this trick from other users, one on Amazon.com and also in @RubyJ's topic.

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thecowisback

what's the difference between an oral syringe and a normal one? i just searched syringe on ebay and bought a couple of sizes. now i'm wondering if i've bought the wrong type. the one i'm using at the moment is one the vet gave me for my cats medicine and has a small opening.

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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

 

 

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Orangeblossom77

Does this kind of syringe look OK?

 

2.5ml dose please!

 

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thecowisback

does anyone know how to deal with bubbles? i often get a bubble in the syringe when i draw up the liquid. at the moment i'm holding the syringe nozzle end up and squirting out a bit of liquid to push the air out. is there a better way of getting the bubble out without wasting the liquid?

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ChessieCat

See this post: 

 

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thecowisback

thankyou 😺

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thecowisback

i tried making my liquid as usual this morning but the capsules in the new packet are stubborn little buggers. i had to open four before i'd got all the powder in (i changed the water between each try) each time i twisted them they were tight and either spilled some powder or it stuck inside the capsule.

i presume it's vital to get every bit of the powder in? does it make a huge difference to the dose if a bit of dust goes astray? 

i preferred it when i was prescribed 10mg tablets in the beginning as i could just drop them in the water and they dissolved. 

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ChessieCat
Posted (edited)

You could use a blade (one of the retractable types) and slice the capsule up and put the whole thing in to dissolve the powder.  Mind your fingers though.

 

You could hold the capsule with tweezers.

 

Edited by ChessieCat

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thecowisback

thanks chessiecat. does the capsule just dissolve in the water?

 

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ChessieCat

My idea was to just dissolve the capsule contents and remove the capsule, with tweezers.  The capsule is made from gelatin so if you left it too long it would at least soften.  It would probably take a long time to dissolve completely.  You will need to make sure that you do it the same way every time (ie length of time you leave the capsule in the water).  If you just split the capsule into two and there was powder in the capsule, adding that to water there will be an air bubble and the contents won't dissolve.  You could try cutting both ends off the capsule (without splitting it in half) and then add all of it (pop the ends in) to the water, holding the capsule body with tweezers and using a tooth pick to poke out the powder inside.

 

The other option would be to split the capsule in two, hold one half in water with tweezers and use a tooth pick to get the water into the capsule.  If the capsule softens quickly you might be able to poke a hole in the end with the tooth pick.

 

Please note that I haven't done this, I'm just brain storming the ideas and you will need to try different ways to see which one works the best.

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thecowisback

thanks - will have to experiment ☺

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