Liquid titration schedule

[[Di...]]

Yes 2 mg/ml

[Guest [ba...]]

That seems wrong to me.  If it was 0.5 mg/ml (2 ml/mg), then the doses the pharmacist wrote down would be correct.  Make sure it's 2 mg/ml and not 2 ml/mg.  I've seen it written both ways.

 

If it's really 2 mg/ml, then I'd suggest contacting the pharmacy. 

[[Di...]]

Hi badsocref...OMG...I called the pharmacist like you suggested...he was wrong on the dosage!!!  I am so thankful that I didn't use the dose the way it was prescribed.  He told me to take 5 ml of the liquid lorazepam and mix 15 ml of water with it to make 20 ml.  I would then take .125 ml/day.  My head is spinning    What would your calculations be?  Could I increase the water so the daily amount would be more then .125 ml?

[Guest [ba...]]

If you dilute 5 ml into 15 ml of water (20 ml total volume), then the suggested doses (0.25, 0.25, 0.25, 0.50) should be right.  You'll be making a 0.5 mg/ml solution out of the 2 mg/ml solution.

 

You would have been comfortably numb with a 4x increase in your dose if you'd used it without diluting.

 

Pat yourself on the back.  You caught this error.  After your taper/recovery is thru, consider pharmacy school.

[[Di...]]

Oh wow!  Thank you so much. 

Pharmacy school you are too funny LOL!!!  Guess sometimes it pays to over think.

[[Li...]]

Way to go, Dianedeedee!

 

I agree with badsocref you should pat yourself on the back for catching this error and then consider pharmacy school.

 

It sounds like the liquid you were given is the 2 mg/mL FDA-approved Lorazepam Intensol™ Oral Concentrate USP.

 

Did the pharmacist also include storage instructions? 

 

In addition to being protected from light, this liquid requires refrigeration (lorazepam shows temperature-related degradation). 

 

Lorazepam is also subject to hydrolysis in both acidic and basic environments.  Did the pharmacist tell you how long it is safe to keep/use the liquid after you dilute it?

 

 

[[Di...]]

Thank you Libertas, yes I store it in the frig he said it was safe to keep it 7 days after dilution.

[[Di...]]

Badsocref since I've had my one moment of "smartness" lol I have a question about the titration schedule?  I need a new titration schedule right?  I'd still like to do a 10% reduction every 3 weeks.

[Guest [ba...]]

Badsocref since I've had my one moment of "smartness" lol I have a question about the titration schedule?  I need a new titration schedule right?  I'd still like to do a 10% reduction every 3 weeks.

 

Sure.  We're basically going to throw out the pharmacist's instructions.  I'll do this in a way that has you make up enough to last you 3 days.

 

Measure 1 ml of the 2 mg/ml solution using a syringe.  Transfer to an appropriate container and add water to give 300 ml.  Mix well.  You'll drink 20 ml 3x during the day, then 40 ml at night (100 ml per day).

 

For 10% cuts, you'll just multiply your most recent dose times 0.90

 

So for the first 10% cut you'll drink 18 ml 3x and 36 ml in the evening (90 ml total per day)

For the 2nd 10% cut you'll drink 16.2 ml 3x and 32.4 ml in the evening. (81 ml total per day)

3rd cut - 14.6 ml 3x; 29.2 ml at night (73 ml total per day)

4th cut - 13.1 ml 3x; 26.2 ml at night

5th cut - 11.8 ml 3x; 23.6 ml at night

6th cut - 10.6 ml 3x; 21.2 ml at night

 

When you get to the 7th cut, we can re-visit the initial formulation to help conserve the starting material.

 

This is a tiny up-dose to make the measurements easy.  If you want to do it more exactly, use 0.94 ml of the 2 mg/ml solution instead of using 1.0 ml.  Keep in mind that many people feel that they get a little less drug when they switch to liquid.  The small up-dose should hopefully cover that difference.

 

I hope this all makes sense.

[Guest [ba...]]

If you've been taking pills, you might want to introduce these liquid doses slowly to minimize the 'impact'.  You could, for example, use a pill for 3 or 4 of your daily doses and take the liquid just 1-2 times during the day.  See how that feels for a few days, then switch out another dose.  Continue until you're doing liquid exclusively.

[[Di...]]

Hi badsocref, thank you for all the work you've done for me.  I will take your suggestion and slowly introduce the liquid.  My doctor is trying but bless her heart she hasn't ever heard of the Ashton Manual or Benzobuddies...but she was all for the help I've been getting from both.  Can't wait to tell her what the pharmacist did.  Thanks again.

[[Pa...]]

Dianedeedee, you're amazing, I'm so glad you questioned the pharmacist's instructions, badsocref and Libertas, thank you for the fantastic teamwork!  BenzoBuddies is truly a valuable resource, wow! 

[[Di...]]

So thankful for benzobuddies!!!

[[Di...]]

Badsocref I did the crossover from ativan dry cutting to liquid slowly.  After a week on the liquid I followed you 10% schedule you worked up for me.  First week was good, second not so good third week has been bad!  Thinking I can't cut 10% any suggestions?

Thank you, Dianedeedee

[Guest [ba...]]

A lot of people don't do 10% cuts.  Try a 1% cut and see how that feels.

[[Di...]]

Ok thank you Badsocref.

[[Di...]]

Badsocref I need your help I am so confused.  As you suggested since my cut of 10% didn't go so well I did a 1% cut 7 days ago.  Would you help me understand the 2mg/ml of my liquid lorazepam?  What does that mean?  I pull out 1 ml mix enough water to make 300 ml and pull my daily doses from that mixture.  I just can't grasp the conversion of mg to ml.  Sorry to be so mixed up hope I'm making sense.  Thx Dianedeedee

[Guest [ba...]]

I think you're going to need to remind me of what you are actually doing right now (doses, schedule).  I think I recall you had a 2 mg/ml solution from your pharmacist and wanted to make enough for a few days.  I don't recall your doses, tho.

[[Di...]]

Badsocref since I've had my one moment of "smartness" lol I have a question about the titration schedule?  I need a new titration schedule right?  I'd still like to do a 10% reduction every 3 weeks.

 

Sure.  We're basically going to throw out the pharmacist's instructions.  I'll do this in a way that has you make up enough to last you 3 days.

 

Measure 1 ml of the 2 mg/ml solution using a syringe.  Transfer to an appropriate container and add water to give 300 ml.  Mix well.  You'll drink 20 ml 3x during the day, then 40 ml at night (100 ml per day).

 

For 10% cuts, you'll just multiply your most recent dose times 0.90

 

So for the first 10% cut you'll drink 18 ml 3x and 36 ml in the evening (90 ml total per day)

For the 2nd 10% cut you'll drink 16.2 ml 3x and 32.4 ml in the evening. (81 ml total per day)

3rd cut - 14.6 ml 3x; 29.2 ml at night (73 ml total per day)

4th cut - 13.1 ml 3x; 26.2 ml at night

5th cut - 11.8 ml 3x; 23.6 ml at night

6th cut - 10.6 ml 3x; 21.2 ml at night

 

When you get to the 7th cut, we can re-visit the initial formulation to help conserve the starting material.

 

This is a tiny up-dose to make the measurements easy.  If you want to do it more exactly, use 0.94 ml of the 2 mg/ml solution instead of using 1.0 ml.  Keep in mind that many people feel that they get a little less drug when they switch to liquid.  The small up-dose should hopefully cover that difference.

 

I hope this all makes sense.

[Guest [ba...]]

Here's a (hopefully) simple equation to calculate...

 

          DD (mg) / AD (mg) x FV (ml) = DV (ml)

 

FV - final volume (you're currently making 300 ml)

AD - drug added to final volume (you're currently adding 2 mg of Ativan to the 300 ml. You add 1 ml which contains 2 mg)

DD - desired dose (I think you're still using 0.125 3x a day and 0.250 at night)

DV - desired volume (this is how much of the 300 ml mixture that you will drink for your dose)

 

So for a 0.125 mg dose...    0.125 mg / 2 mg x 300 ml = 18.75 ml

 

For a 1% cut, simply multiply the previous DD times 0.99.  0.125 would become 0.124

 

So for a 0.124 mg dose...    0.124 mg / 2 mg x 300 ml = 18.6 ml

 

Now for a little handwaving...  I mentioned in the earlier note that I had done a little rounding up.  Instead of having you take 18.75 ml, I suggested taking 20 ml to start.  If that's what you did, then you should continue that same level of 'rounding'.  That's done by calculating cuts based on the rounded 20 (or 40) ml DV instead of using DD.  That's what I did when I calculated your first few 10% cuts.  So now you get to do it for 1% cuts.  A 1% cut from 20 ml is 19.8 ml (0.99 x 20).  The next cut would be 0.99 x 19.8 = 19.6 ml (obviously it's double that for the night dose).

 

Hopefully, all of that makes sense.

[[Di...]]

Thank you Badsocref...yes it does now I just need to absorb it all into my brain.  Thanks so much!!!  Dianedeedee