Combining tablets or capsules with liquid to taper

[lionboy]

hi

i have been on 25mg citalopram / celexa for just over a year now down from 30mg.

i take a 20mg tablet and half a 10mg tablet which i split with a pill cutter.

my withdrawal symptoms are much better now than they were a few months ago, however they are still there.

mainly tremour and agitation now on and off.

I do wonder whether the fact that i am taking a slightly different dose each day (due to inacurracies when cutting the tablets)

has any bearing on this ?

With this in mind I am considering asking my doctor if I can transfer to liquid to allow precise dosing.

I don't know whether I would need to take my full dose as liquid ? or whether i could take a 20mg tablet and the 5mg as liquid.

does anyone know if you can take both together.

the other thing I am unsure of is that it is suggested on the internet that with the liquid you take a slightly reduced dose i.e 16mg as apose 20mg as it is supposedly more readily absorbed by the body thus the same effect is achieved.

Does anyone have any experience of this ?

Another reason I would favour taking liquid is that when I decide to reduce again I can cut accurately by much smaller amounts.

 

any advice is much appreciated.

[Altostrata]

Lionboy -- yes, you can take the tablet and liquid together to get to the full intended dosage.

 

If you are very sensitive to reductions in dosage, variation in the tablets fractions could cause you problems. Phil, for example, is very sensitive to minute variations in Lexapro doses.

 

Utilizing the liquid will make it possible for you to make very precise doses.

 

This would eliminate one variable in your withdrawal and enable you to taper by amounts smaller than 2.5mg.

[lionboy]

thank you Alto.

you are so well informed on so many issues surrounding AD's, i'm sure you are of great help to many people who visit this site !

 

Am I correct that when taking the liquid you take a slightly lower dose due to how your body converts the drug ?

 

If this is the case do people normally experience any problems when switching from pills to liquid ?

 

thanks again Alto.

[Altostrata]

Thank you for the compliments, lionboy. I don't know everything, but I've dealt with lots of liquid medications!

 

No, do not take a lower amount of the liquid. If you need to take 5mg, take the equivalent of 5mg.

 

The tricky part is understanding the concentration of the liquid. The pharmacist can help you with this. For example, if the medication is concentrated to 10mg in 1mL, to get 5mg, you would take .5mL.

 

People have trouble switching from tablets to liquid, or brand-name to generics, because of very small differences in formulation and absorbability. A liquid may be absorbed faster.

 

But many people do not have difficulty with these switches.

[lionboy]

hi alto

thanks again for the advice.

regarding the doseage of liquid please see the following product info i have cut and pasted from a website.

this same info is on a few different sites so seems to be standard advice from the drug companies.

as i am on 25mg, if i follow this i would need to take one 20mg tablet and 2 drops (4mg) of liquid to equal my current dose ??

 

 

Method of administrationMethod of administration

 

For oral administration after mixing with water, orange juice or apple juice.

 

Cipramil Oral Drops can be taken as a single daily dose, at any time of day, without regard to food intake.

 

Citalopram oral drops have approximately 25% increased bioavailability compared to tablets. The tablet corresponds to the number of drops as follows:

 

For oral administration after mixing with water, orange juice or apple juice.

 

Cipramil Oral Drops can be taken as a single daily dose, at any time of day, without regard to food intake.

 

Citalopram oral drops have approximately 25% increased bioavailability compared to tablets. The tablet corresponds to the number of drops as follows:

 

 

Tablets / dose Equivalent / Drops

 

10 mg 8 mg (4 drops)

 

20 mg 16 mg (8 drops)

 

30 mg 24 mg (12 drops)

 

40 mg 32 mg (16 drops)

 

60 mg 48 mg (24 drops)

[Altostrata]

According to this site http://www.medicines.org.uk/emc/document.aspx?documentId=6153#COMPOSITION with manufacturer's (Lundbeck) information:

 

Oral drops 40 mg/ml (44.48 mg citalopram hydrochloride corresponding to 40 mg citalopram base per ml).

It's 15mL (600mg) per bottle.

 

The Ciprimil drops above have 40mg in 1mL. To get 5mg, you would take .125mL (1/8 of 40mg or 1/8 of a milliter).

 

If the dropper that comes with the bottle isn't marked in tenths, you would be able to measure this out with a 1mL oral syringe (the small one). (Mine, from Baxa in Denmark, is nicely marked with lines measuring drops, also.) See http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__view__findpost__p__2284 for more info about oral syringes, which you can get from the pharmacy or a veterinarian.

 

Now, you may ask, what about when I want to take dosages smaller than 5mg? Well, then you would dilute Cipramil liquid with water (don't use juice, it's too sticky).

 

For example, say you want to take 1mg:

- Using a 10mL syringe to measure out the water, put 9mg water in a clean, small pill bottle.

- With a dry syringe, put 1mg Cipramil (40mg) in the water. Now you have 40mg in 10mL of liquid.

- To take 1mg, take .25mL (1/40 of 10mL).

 

And so forth. Thank God for the metric system.

 

You'll have to ask the pharmacist how long the diluted solution will last, and if you need to refrigerate it.

[lionboy]

alto

thanks again, they don't make it easy do they !

what do you say regarding the manufacturers claims that liquid is 25% more readily absorbed by the body, thus you take 20% less in liquid ?

that is to say when switching from 20mg tablet you take the equivalent of 16mg in the liquid for the same resulting dose ?

[Altostrata]

No, don't try to adjust the amount of liquid to take account for increased bioavailability. It's supposed to be an equal exchange.

 

If you find when you change to the liquid that it's too strong, you can adjust it then.

[lionboy]

sorry to labour this point, but i am concerned about switching over.

you say "it supposed to be an equal exchange" can you elaborate ?

if you look at the link you sent me further up this thread and scroll down it has a table showing 10mg tablet = 8mg liquid 4 drops etc.

are you saying the increased bioavailability of liquid is just nonsense ?

do you have direct experience of this ?

[Altostrata]

The liquid is intended to be taken as a direct equivalent, e.g. 40mg tablet = 40mg of liquid (1mL).

 

"Bioequivalent" is a pharmacokinetic term referring to the action in the body. It means the drug gets into your bloodstream faster. It is not intended as information for dosing.

 

We expect that liquids are absorbed faster. This may or may not have an affect on you, or it may be something you get used to in a couple of days.

 

I use liquid preparations all the time and I dose them as indicated by the concentration, e.g. 1mg/mL, 40mg/1ml, etc.

[Altostrata]

Rhi makes her own Celexa liquid with water. She describes how she does it here: http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/page__p__7769#entry7769

[daniel0708]

Hi,

 

I didn't know whether to post this in my Introduction thread (moderators feel free to move post) but I had a question about alternating between liquid medication and tablets. I am new to taking oral solution with syringes and don't know if it is safe or recommended to alternate between liquid and tablets. For example, in my planned tapering schedule in my signature, you can see that I am planning to use all of my remaining tablets of Abilify and the oral solution, which I just got a prescription for today. I would use liquid for the whole taper but unfortunately my prescription is only for one bottle of the medicine, which is 150ml. (1ml = 1mg of Abilify). I would quickly run out if I used solely liquid for the taper. I have many small pills which I can use to assist me in completing my taper. Additionally, this will likely be my last prescription for my liquid medicine as the oral solution is being discontinued in less than one month. I have to make it last. I realize my tapering schedule is not totally ideal but I hope it is slow enough for my body to handle.

 

Is it O.K. to alternate between liquid medicine and pills, as long as I am getting the proper dosage in my body? Or is it recommended that I stick to one method?

 

Thank you!

 

P.S. I did a quick search through the forums and I couldn't find a topic with this question in it....I hope this isn't a stupid question.

[Altostrata]

Daniel, I'm confused. According to Tips for tapering off Abilify (aripiprazole), it comes in this dosages:

 

- Tablets 2 mg
- Tablets 5 mg
- Tablets 10 mg*
- Tablets 15 mg*
- Tablets 20 mg
- Tablets 30 mg
- Abilify solution, oral 1 mg/mL 150-mL bottle NDC 59148-013-15
*also available in DISCMELT® Orally Disintegrating Tablets

 

How are you getting the other sizes in the tablets?

 

People can take part of their doses in liquid form and part in tablets. Some people are sensitive to the differences between liquid and tablets; others are not. If you are a person who is sensitive to the differences, you may not wish to change forms of dosage often.

[daniel0708]

Hi Alto,

 

I have a prescription for 3.75mg tablets from my psychiatrist, who is away on leave. These are 1/8 of 30 mg tablets (he wants me to take half the tablet. I've been forced to get off the drug by stealth because he won't allow me to do it.) Then, I went and saw a primary care doctor who agreed to help me come off the drug. He wrote me a prescription over two weeks ago for 5mg tablets, which I cut into halfs, quarters, and eighths. Finally, on Friday he wrote me a prescription for liquid Abilify (150ml). The bottom line is I have a lot of Abilify, both in tablet form and liquid. I want to use the tablets as well in my weaning process since I paid quite a lot of money for them. I just didn't know if taking tablets for two weeks, then liquid for two weeks, and then switching again, is throwing my body for a loop. I hope I am not sensitive to the difference.

 

I am not planning on "playing" both doctors. I plan to terminate my relationship to the psychiatrist when he comes back from paternity leave in late May. I also will stop seeing the primary care doctor when the taper of Abilify is complete. The nature of the game, as you know, is sometimes you have to sneak around in order to become drug free. It sucks, but it is what it is. At least I am under medical supervision with the primary care doctor.

[Altostrata]

Did you get the 3.75mg made by a compounding pharmacy?

 

You can combine tablets and liquid. If I were you, I'd use the liquid to supplement for intermediary dosages. You don't have to decrease by .75mg or 0.5mg, which are more than 10% of your dosage at every step of the process you've outlined, which by our standards is too fast:

 

Abilify 3.75mg (tablets) to 3mg (liquid) to 2.5mg (tablets) to 2mg (liquid) to 1.5mg (liquid) to 1.25mg (tablets) to 1mg (liquid) to 0.625mg (tablets) to 0.5mg (liquid) to 0.4mg (liquid) to 0.3mg (liquid) to 0.2mg (liquid) to 0.1mg (liquid)

 

 

Again, there's no way to predict how you will react to alternating the tablet and liquid forms.

[Jlynn]

I have a question and I am unable to find it in my search. If this is already a topic being discussed will someone please post the link for me!

 

I am wondering about using a combination of paroxitine tablets at 5-10 mg and the rest of the tapered dose in liquid. I.e. 10 mg tablet and 2 ml of liquid for 14 mg. is this safe or not recommended? For me the pills are much cheaper than the liquid so I didn't know if using both is an option?

 

Thanks for any information!

[Altostrata]

Yes, you can use a combination of tablets or capsules and liquid.

 

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

If your doctor prescribes the liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

[Jlynn]

Thank you Alto! I was concerned the metabolism might be to different and cause problems. Does it matter that my pills are generic paroxitine and the liquid is name brand Paxil? My pharmacy said they didn't see an option for generic liquid.

[Altostrata]

The liquid is absorbed faster.

 

Generic and brand-name paroxetine shouldn't be a problem.

 

Taking part in tablet and part in liquid is probably the easiest way to convert to liquid, which you'll want to do at the end.

[Jesse12]

Can I dilute zoloft, klonopin and lamictal once I reach the very low dosages? Is it only certain medications? These are the ones I'm going to taper off.

Thanks

[Altostrata]

Please use search in this forum regarding tapering zoloft and lamictal. For klonopin, go here.

[Jesse12]

I glanced there and I can see already it's different and more difficult. Thanks