How to make a liquid from tablets or capsules

[lxjuice]

On 3/31/2020 at 3:59 PM, Pokeshaw said:

Hi all - on my long slow micro taper I have  been having brand Lexapro compounded. The compounding pharmacy uses a slow release filler - Methocel E4M.  I am down to  0.1 mg and they cannot make capsules at lower doses. They offered an aliquot (10 caps of 0.01 mg ea) which I tried and my brain went sideways for months. I switched back to the individual capsules of 0.1 mg.  I have gained some stability but seem to be experiencing both w/drawal and side effect symptoms.  Over the yrs of my taper the side effect symptoms were always what prompted me to make a reduction.  And i feel i need to do that soon.

Unfortunately the filler Methocel E4M is not water soluble. it clumps up and really sticks to the side of the glass.  Very hard to make a suspension. it only dissolves in very hot water but I dont want to do that.

So I had the pharmacy make me 0.1mg caps in Methocrystalline cellulose which dissolves nicely in water but is fast release. I am trying to transition over by taking it (capsules for now with the idea of dissolving in water later) every 3 days but already feeling w/drawal aggravation.  Not sure how to do this?

Is there a way to make a suspension with the slow release Methocel E4M filler?

Or should I go more slowly with the transition from the slow release to fast release capsules?

Any ideas would be very helpful!

Thank you!

Poke

 

Escitalopram has a half life of somewhat over 24 hours, you could switch to twice a day liquid dosing to stabilize the blood concentrations more. You wouldn't have been able to make a liquid from the methocel E4M solution even if it hadn't clumped up because you would have lost the slow release.

The only way I can think you can transition from slow release to fast release is if you take the 0.01mg aliquots every 2.4 hours and then reduce the time between them until you are taking 10 aliquots at once, then you can direct swap to 0.1mg IR/liquid. You would have to set an alarm at night though. You could try taking them every 1.6 hours for the 16 hours you're awake but there will be a bigger immediate adjustment before you can shrink the schedule.

[Pokeshaw]

Hi LX - Thanks for getting back to me.  I can't use the liquid since it only comes in generic and I had a bad reaction to it back a few yrs ago. I have been using brand Lexapro for the compounding. Also, I had tried the aliquot the pharmacy made for me over a year ago and was not able to stabilize on it so I went back to individual caps of 0.1 mg

 

Here's what I've been doing - and so far so good.

 

for a couple weeks I took the 0.1 mg fast release every 3 days and the other days I stayed with the 0.1 mg slow release. It was a bit bumpy as I mentioned in my post but then that passed. So I waited a few days and then I moved to every other day and that is where i am now. Doing OK 

Will stay here another week or so and then when I feel OK go to daily on the fast release. Will stay there until I feel pretty stable before starting to dissolve in water and do reductions.

One of the big 'side effect' issues for me that always indicated it was time to make a reduction is the 'lexapro clench'. Neck arms jaw and all the issues that ensue such as carpal tunnel, nerve pain and TMJ.  all stuff i suffered with along with constipation when I was on full dose of Lexapro and all went away when i stopped. unfortunately i stopped too fast and then went into a horror show of w/d. Then reinstated months later and have been on this seesaw of tapering and dealing with w/d and side effect symptoms for yrs. This final stretch is very hard! But good to have someplace to check in where people have a clue about this!

I have ordered a graduated cylinder and some oral syringes and have been reading about how to do it. But I'm sure I will post again once i get to the dilution phase.

Take good care and thank you again for responding!

Poke

[Johni]

Don't you know that cipralex is soluble in water?

 

MOD NOTE:  This is incorrect.  Please see this post: 

 

 

Edited July 10, 2020 by ChessieCat
added mod note

[brassmonkey]

Sorry Johni, but that isn't true.  According to rxlist.com 

 

 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. (RED highlight added)

 

Your best bet would be to use a homemade isotonic saline solution (9% salt in water) as methanol is poisonous and DMSO is hard to get and hard to work with.

[Bruci]

I’m having a bit of trouble finding information on the forum so excuse me if someone has already answered this. 
 

I would like to make a suspension of Celexa for tapering. A compounding pharmacist told me that a suspension will not last longer than two weeks. Has anyone else been told this?

 

I am at the beginning of my taper from 30 mg down to zero. Is there a guide somewhere here on how to make appropriate suspensions without waste?

 

Bruci

[ChessieCat]

30 minutes ago, Bruci said:

I would like to make a suspension of Celexa for tapering.

 

Check out Post #1 of this topic.

[DavidH888]

Hello, Can anyone tell me how much water I should use to make a solution from 150mg Effexor HCL? Can I use distilled water?

[ChessieCat]

If you haven't already done so, please check out this topic from the beginning because there is a lot of information already provided.

 

You can use any amount of water that you want, but it needs to be enough to dissolve the dose.  The more water you use the more accurate the dose you can get.  You can use distilled or bottled if you prefer, I'm using tap water here in Australia and it seems to be fine, kept covered in refrigerator.

 

As a guideline:

 

150mL of water with 150mg of drug will give you a 1:1 ratio.  This means that each 1mL of liquid will give you 1mg dose.

 

If you double the water:

 

300mL of water with 150mg of drug will give you a 2:1 ratio.  This means that each 1mL of liquid will give you 0.5mg dose.  Or the other way around, 2mL liquid will give you 1mg dose.

 

If you halve the water:

 

75mL of water with 150mg of drug will give you a 1:2 ratio.  This means that each 1mL of liquid will give you 2mg dose.  Or the other way around, 0.5mL of liquid will give you a 1mg dose.

[DavidH888]

Thanks for your help! Just one last question, since I have HCL capsules, should I empty the capsules into the water? Or leave it in?

[ChessieCat]

Generally you empty the contents but sometimes they are hard to open and sometimes some of the contents gets stuck inside.  The gelatin capsule may not "dissolve" because you will be using cold water.  Gelatin dissolves/melts better with heat.

 

If you can't get the contents out you could try putting in the whole capsule but it would be better without.

 

 

Edited October 26, 2020 by ChessieCat

[ChessieCat]

Well I received my two graduated cylinders today, both 100mL volume, plastic.  One of them has a wobbly base.  I've even placed in hot water then put it into a flat based container, pressed down on it and poured refrigerated water over it and it still won't sit flat.  I'm going to request a refund for one of them because it's not accurate, which is exactly why I was buying them.  😏

 

Edited to add:  I was able to take a fairly good photo showing that the bottom wasn't sitting properly and the seller has refunded me half of the money so I've only had to pay for the okay one.  I've put it aside as a spare in case I ever need it (might come in handy for something else - if I throw it away I'll end up needing it or finding a use for it 🤣).  I did think of trying to file off some of the bottom but didn't think it was worth the effort.  However, I did find that if I press the base to the table it will sit flat long enough for me to pour in the water and measure it.

 

Edited October 27, 2020 by ChessieCat

[ChessieCat]

Well I used my graduated cylinder for the first time this morning and found it difficult to get the exact amount of liquid measured.  I tried using the second (faulty) cylinder to top it up to the 100mL mark but it was difficult to control the amount of liquid I tipped in.  So I had a bright idea 💡:

 

HELPFUL TIP:  When using a graduated cylinder it can be difficult to fill it to the exact measurement you need.  To make this easier to do, use a medicine eye dropper so you can gradually add more water a drop at a time.

 

TA DAH!!!

[ChessieCat]

On 10/26/2020 at 11:00 AM, DavidH888 said:

Thanks for your help! Just one last question, since I have HCL capsules, should I empty the capsules into the water? Or leave it in?

 

@DavidH888

 

I did a test this morning and put my empty gelatin capsule into water (straight from the tap) to see what happened.  It softened but did not dissolve.

[DavidH888]

Is it possible to make a solution from Effexor XR? I read that it won't work with extended release capsules. How can I tape then?

[ChessieCat]

Please read Post #1 of tips-for-tapering-off-effexor-and-effexor-xr-venlafaxine ehich contains a lot of information about how to get the dose you need.

 

 

 

Edited November 10, 2020 by ChessieCat

[bubbles]

Just a note that my ground up sertraline tablets took about 3 days to thoroughly dissolve/disperse in the suspension I used. Will have to be organised in future! Looks thoroughly distributed now. I ground it first with mortar and pestle. In future will grind more to see if I can avoid those bits that took longer as I imagine they should have been visible and perhaps the dissolve time could be shortened.

 

[ChessieCat]

Are you could buy a grinder.  That might be better.

 

But then again if you are only doing one tablet it probably wouldn't be as good at the mortar and pestle.

 

Just found this.  They suggest wetting the tablet to make it softer.  Obviously you'd have to use a measured amount.

 

How to Crush a Pill: 14 Steps (with Pictures) - wikiHow

https://www.wikihow.com/Crush-a-Pill

Use a small bowl-spoon or mortar-pestle method. Place your pill in a clean, dry cup or mortar. Soak the pill in a small amount of water for five minutes. This is optional but may help soften the pill. Less pounding/grinding may be required too.

 

 

Edited November 12, 2020 by ChessieCat

[hayduke]

Titled:  Adjustable volume pipette

 

How'd it take me so long to find these!  Can be found relatively inexpensive for our purposes.

 

Now it's as simple as measuring out 25ml for the base volume in my old glass pipette and putting into my fridge storage bottle, cracking open and suspending the 2.5mg tablet in there, mixing thoroughly then dialling in 0440 on the device, drawing it out, ingesting my 0.44mg and I'm done for the night.

 

https://en.wikipedia.org/wiki/Pipette#Air_displacement_micropipettes

 

While it's fundamental to understand the manual process this is super simple at bed time and easy to travel with.

 

Cheers

Edited December 21, 2020 by manymoretodays
added title, merged with topic

[manymoretodays]

Thanks @hayduke

Where did you find them?

Do tell.

And then, I"ll go ahead and add this information, to post one of this topic too.

[hayduke]

Hi @manymoretodays

 

Plenty here

 

I spent around 40AUD and can't complain for what I got.  If it doesn't hold up to this light household use I'll report back.  So far, so good.

 

Cheers

[HardTimes]

Question: How long does the suspension/solution last?

 

Apologies if this has been answered - I searched but found nothing so far. I've been successfully making suspensions of Citalopram, where a 20mg tablet is put into 80ml of water (so: 10mg = 40ml, 1mg = 4ml, 0.5mg = 2ml, etc.). A couple of days ago I tried to go UP from 0.75mg to 1mg (as I'm trying to reinstate and stabilize). I was doing comparatively well at 0.75 for over two weeks, and thought a bump up would further resolve my symptoms. However, I quickly had a reaction to the increased dose (heart palps, jittery, nervous, felt like some sort of bad "high"). But that was also a fresh batch of solution. So I'm wondering if the efficacy of the solution goes down over time or not? Meaning a fresh batch might pack a larger punch? Theoretically, taking 1mg per day would mean the solution could last for 20 days (though I've generally made a new batch after 10-12 days). I'm too new at this to notice whether a fresh batch had a larger impact previously. I keep the solution in the fridge, as suggested.

 

SO: Does the efficacy of the solution diminish over several days? Meaning a fresher batch is more powerful? Or perhaps my reactions are just fairly coincidental, part of the waves and windows randomness of this whole thing?

 

(And FYI: I dropped right back to 0.75 the next day, but am still feeling super depressed, with weird bouts of nervousness, boiling blood, hot flashes, self-loathing thoughts, etc etc... THIS STINKS!)

[manymoretodays]

Hi HardTimes,

I went ahead and quoted you over to your Introduction topic and answered there.

 

Best, mmt

[ChessieCat]

I have discovered that there are a couple of things that you need to be careful of when taking liquid.  No 1 make sure that the syringe is not pointed to the back of your throat so that you end up coughing.  For me it was an issue for at least 1/2 hour which made it difficult to relax and settle down to sleep.  No 2 make sure that the syringe is pointed into the mouth so that the liquid does not hit the side of you mouth or teeth and some of it splashes out of your mouth.

[bubbles]

On 1/24/2021 at 7:50 AM, ChessieCat said:

I have discovered that there are a couple of things that you need to be careful of when taking liquid.  No 1 make sure that the syringe is not pointed to the back of your throat so that you end up coughing.  For me it was an issue for at least 1/2 hour which made it difficult to relax and settle down to sleep.  No 2 make sure that the syringe is pointed into the mouth so that the liquid does not hit the side of you mouth or teeth and some of it splashes out of your mouth.

 

Oh no!

 

I've been doing two things - sometimes squirting the liquid from the syringe straight into my mouth. More often I squirt it into a little medicine measure cup, and then I add water, drink whole thing, add more water, repeat another time or two - to make sure I'm getting all of the drug.

 

[bubbles]

On a different topic, I have a bit of a conundrum.

 

The issue is because I'm feeling a bit uncertain if I'm getting the volumes correct - with all my adding a bit here and there I'm wondering if I'm ending up with less than I think. Am I starting each subsequent "bit" with a little left on the sides of the measuring cup?

 

I think if I can work out how much volume the ground up tablet takes, I can simplify my process.

 

To work that out, I think if I start with, say, 2ml of water in a medicine measuring cup, add a ground up tablet, and then draw it up into 1ml syringes, I should be able to work out how much extra I have as compared to the original 2ml. I don't think it would matter if it wasn't even fully ground up as long as all the bits go into the syringe.

Does that seem reasonable? If I can determine that, say, the tablet volume is 0.3ml, then I can simplify my process in making up the suspension. I could first grind up the tablet and put it in to the bottle, then add 49.7ml or whatever amount of liquid I've determined I need using (larger) syringes and that will eliminate the "some left on the sides of the medicine measure" issue. The 1ml syringes have graduations down to 1% of 1ml, so it should be fairly accurate.

 

I'm also not sure if I should do this now, with water, and sacrifice a tablet, or just do this next time when I make up my next bottle and just be very careful. Hmmm. I am using up to 50% water when making up the suspension (so as to make the Ora Plus last as long as I reasonably can).

 

 

[hayduke]

@bubbles interesting question. 

 

I was thinking your hypothesis might account for noticing a difference in taking the same tablet in different volumes of water (say when going from 50 ml to 25 ml base volume), but given how some people struggle with the full amount of the tablet once they make the switch to suspension and drink it all, there might be more in play than that.

 

I've always treated the tablet's volume as negligible.  It's probably more important to be consistent through the taper rather than have absolute accuracy at any point - our bodies probably care more about keeping the relative dosages accurate as we taper.

[bubbles]

@hayduke

 

Ultimately I'm trying to make a 1ml=1mg suspension, so I'm taking a 50mg tablet and using Ora Plus to make up the 50ml (or rather Ora Plus diluted with the up to 50% as per manufacturer instructions). I've been trying to achieve the kind of accuracy that a compounding pharmacy might achieve, which is not very realistic.

 

I agree that consistency is likely (by far) the most important thing so treating the tablet as "nil" is probably smarter. Whatever is the "baseline", I'll adapt to it as long as it's consistent. Actually, since treating the tablet as negligible volume will make a fractionally less potent suspension, it will make my jump off dose slightly lower, which can only be a good thing at that end of the process.

 

I'm also going to buy larger syringes and use them to measure out the suspension instead of using the medicine measuring cup since I think that will be more accurate.

[hayduke]

@bubbles you might want to look at the adjustable volume pipettes I linked above.  Way less of a production titrating around bed time.

 

Cheers

 

[bubbles]

23 hours ago, hayduke said:

@bubbles you might want to look at the adjustable volume pipettes I linked above.  Way less of a production titrating around bed time.

 

Cheers

 

 

I bought a 25ml syringe and a 5ml syringe, so making up my 50ml suspension (which lasts about a month, or at least it should, lol) is going to be a whole lot easier.

 

I have a packet of expired tablets that I've been hanging on to (lots of meds last just fine after their purported expiry date, though I have no idea if sertraline is one of them) - they are approximately the same size/shape as the batch I'm currently using. I started with 2ml of water and one of the crushed (expired) sertraline tablets. 2ml of water wasn't enough as I had some tablet powder left in the medicine measuring cup after drawing up the contents so it was imperfect, but looks like the tablet takes up a bit under 0.1ml. That means that, yes, considering it as nil makes an imperfect 50:50 suspension. It will make 50.1ml = 50mg, which means each 1ml actually equals 0.998004mg, but since I'm not a compounding pharmacy that's a degree of accuracy I can't hope to achieve anyway so I will ignore that and consider it 1:1.

From the next batch I will do this:

• Disinfect bottles etc with baby bottle disinfection tablets, leave (covered with a clean tea towel or a paper towel) to air dry until completely dry (about 24 hours)
• Crush up a tablet using a mortar and pestle (with the mortar lined with baking paper to aid in pouring into the bottle)
• Try to get the powder directly into the bottle I'm using
• Add 50ml of Ora Plus, or Ora Plus and water (cooled, previously-boiled water is probably best?) to the recommended ratio of up to 50% water
• Shake before use to distribute the powder as thoroughly through the suspension

I try to do it a day or two earlier than needed to give any bigger tablet fragments. I like to dilute the Ora Plus as recommended to make the expensive Ora Plus last longer.

 

 

[Sacam7]

I’m trying to wrap my fried brain around all of this. I have read everything at least a few times. Some things I hope can be clarified. I am taking 20 mg of paxil (paroxetine) a day. If I want to make a liquid, can I just do it with my one 20mg pill every day, ingest what I need, and throw out the rest? I see people asking about storing the liquid, but I’m wondering if I can just make it every day from my one pill, and take my reduction. I’m terrible at math and conversion s and all that so I will be asking for a lot of help here (sorry) I’m not sure if it would be easier for me to just crush and weigh. But if someone can help me figure out the making the liquid, that would be so appreciated. Another question, does the brass monkey slide method work well with making your own liquid? How do you do the calculations for a 2.5% drop on a liquid? What is the best ratio for this? Thank you for any answers. I am completely lost and I’m so embarrassed. 

[ChessieCat]

@Sacam7 I'll respond in your Intro topic

[Janece]

Ok so to make my own liquid suspension with water to taper slowly .. I should do a 1:1 ration right ? Which mean if I want to taper off 150mg then I would need to add the 150 mg tablet to 150mg of water right? 

[ChessieCat]

You can make any ratio that you want or is best for the dose you need.

 

Sometimes it is easier to measure the dose you need if you use more water.  I've been making a 1:100 ratio using the contents of 2mg compounded Pristiq capsules with 200mL water for the last few reductions but this time I've used 400mL, a 1:200 so that instead of measuring 11.5mL of liquid I can measure 23mL.  It's not just easier but more accurate.

 

Making a 10% reduction will be 135mg, so making a 1:1 ratio for that reduction should work okay.  However the next one will be 121.5mg.  You could make a 1:2 ratio.  150mg tablet in 300mL water so each 1mL contains 0.5mg = 2mL contains 1mg ) so to get 121.5mg you would take 243mL liquid.  However if you decide to round the amount always round up so that you reduce less than 10% not more.  And remember to calculate the next reduction on the rounded up amount.

[Janece]

33 minutes ago, ChessieCat said:

You can make any ratio that you want or is best for the dose you need.

 

Sometimes it is easier to measure the dose you need if you use more water.  I've been making a 1:100 ratio using the contents of 2mg compounded Pristiq capsules with 200mL water for the last few reductions but this time I've used 400mL, a 1:200 so that instead of measuring 11.5mL of liquid I can measure 23mL.  It's not just easier but more accurate.

 

Making a 10% reduction will be 135mg, so making a 1:1 ratio for that reduction should work okay.  However the next one will be 121.5mg.  You could make a 1:2 ratio.  150mg tablet in 300mL water so each 1mL contains 0.5mg = 2mL contains 1mg ) so to get 121.5mg you would take 243mL liquid.  However if you decide to round the amount always round up so that you reduce less than 10% not more.  And remember to calculate the next reduction on the rounded up amount.

Ok I see,  but what I dont understand is how do you calculate the percentage ?

[ChessieCat]

10% reduction:  150mg x 0.9 = 135mg

 

5% reduction:  150mg x 0.95 = 142.5mg

[Janece]

5 minutes ago, ChessieCat said:

10% reduction:  150mg x 0.9 = 135mg

 

5% reduction:  150mg x 0.95 = 142.5mg

So when I try to multiply 150 by 0.10 it gives me 15 , you would think that if you want to reduce by 10% you would multiply by 10 but its 9 I dont understand that and when it comes to reducing my 5% you multiplied by 0.95 which is a bigger number and a different equation . So to get 5% multiply by 0.95 how come to get 10% multiply by 0.100 doesn't work... I'm gonna use you're equations and tha k you but I really want to understand.