HELP - Compound pharmacy not open

[[Li...]]

Have you considered a slight updose?

[[Ho...]]

Have you considered a slight updose?

 

I have but it scares me. It feels almost as if my body is reacting to the method? I’m not sure.

 

The reason I’m scared is I updosed from .201mg to .225mg last year to go to a liquid oil compound (not PCCA) only to go back to cutting pills a couple months later because each tiny .001mg cut was horrid. So it was a wasted updose.

 

It’s almost like my body has issues metabolizing it or something. It’s strange and I feel very stuck.

 

I feel like I’m the only person that has had this bad of an issue.

[[Li...]]

First and foremost, please know you are not the only member who has had issues with one or more of the different types of liquids (i.e., commercially manufactured, professionally compounded, homebrew).  If you feel better with dry tapering, then that’s what you should do.  Many members over the years have had success with this method. 

 

If a higher-end weighing device would give you the confidence and reassurance you need to finish your taper, this online vendor has an extensive inventory and offers pre-sales support via chat or telephone:

 

Digital Scales, Weight Scales, & Balances. Shopping Made Easy.

[nobbc]https://www.oldwillknottscales.com/[/nobbc]

[[Ho...]]

First and foremost, please know you are not the only member who has had issues with one or more of the different types of liquids (i.e., commercially manufactured, professionally compounded, homebrew).  If you feel better with dry tapering, then that’s what you should do.  Many members over the years have had success with this method. 

 

If a higher-end weighing device would give you the confidence and reassurance you need to finish your taper, this online vendor has an extensive inventory and offers pre-sales support via chat or telephone:

 

Digital Scales, Weight Scales, & Balances. Shopping Made Easy.

[nobbc]https://www.oldwillknottscales.com/[/nobbc]

 

 

Libertas, you know my issues with going to the compound liquid. The one that had alcohol that was PCCA stability tested made me very ill.

 

Is there another liquid option that's stability tested with very little ingredients?

 

I am currently dry cutting but worried about the instability the lower I go and bigger cuts I have to make. (it's inevitable with cutting this small)

 

Thought about asking if they can just do a little PG, pure lorazepam powder and water - is that an option?

 

I am thinking it might be worth one more try - if not I will have to make cuts and hold that will get bigger the lower I go.

 

Thank you so much!

[[Li...]]

Hello again, HopeForTomorrow.

 

Here’s the information I have about stability-tested formulations for lorazepam oral solutions that contain propylene glycol: 

 

(1) The FDA-approved, 2mg/mL oral Intensol (concentrate) manufactured by West-Ward/Hikma contains three ingredients:

 

lorazepam API (Active Pharmaceutical Ingredient/pure drug powder)

polyethylene glycol

propylene glycol

 

We have members who dilute this with water to taper.

 

(2) Pharmacists in The Netherlands (citation below) developed a formulation for a 1mg/mL oral lorazepam solution. It contains the following ingredients:

 

lorazepam API (Active Pharmaceutical Ingredient/pure drug powder)

87% glycerol

10% polyethylene glycol 400

3% propylene glycol

Orange essence (taste corrector)

 

I suspect the above formulation could be diluted with water to obtain a lower concentration but you would want to confirm this with a knowledgeable compounding pharmacist.

 

 

Citation:

Vossen, A.C. & Velde, I. & Smeets, O.S.N.M. & Postma, D.J. & Eckhardt, M. & Vermes, A. & Koch, Birgit & Vulto, Arnold & Hanff, L.M.. (2017). Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug. European Journal of Pharmaceutical Sciences, pp. 205-210. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0928098717300490

 

[[Ho...]]

Hello again, HopeForTomorrow.

 

Here’s the information I have about stability-tested formulations for lorazepam oral solutions that contain propylene glycol: 

 

(1) The FDA-approved, 2mg/mL oral Intensol (concentrate) manufactured by West-Ward/Hikma contains three ingredients:

 

lorazepam API (Active Pharmaceutical Ingredient/pure drug powder)

polyethylene glycol

propylene glycol

 

We have members who dilute this with water to taper.

 

(2) Pharmacists in The Netherlands (citation below) developed a formulation for a 1mg/mL oral lorazepam solution. It contains the following ingredients:

 

lorazepam API (Active Pharmaceutical Ingredient/pure drug powder)

87% glycerol

10% polyethylene glycol 400

3% propylene glycol

Orange essence (taste corrector)

 

I suspect the above formulation could be diluted with water to obtain a lower concentration but you would want to confirm this with a knowledgeable compounding pharmacist.

 

 

Citation:

Vossen, A.C. & Velde, I. & Smeets, O.S.N.M. & Postma, D.J. & Eckhardt, M. & Vermes, A. & Koch, Birgit & Vulto, Arnold & Hanff, L.M.. (2017). Formulating a poorly water soluble drug into an oral solution suitable for paediatric patients; lorazepam as a model drug. European Journal of Pharmaceutical Sciences, pp. 205-210. Accessed online at: https://www.sciencedirect.com/science/article/pii/S0928098717300490

 

 

Thank you so much, Libertas! I spoke with my compound pharmacist. He is incredible. He is able to do the FDA liquid solution. He will dilute it in purified water to make the solution .1mg/1mL. He is not charging a compound fee to do this either which is amazing because insurance covers the FDA formula.

 

He says good for 30 days. I chose this option because there are less ingredients and no alcohol.

 

I am praying it is the answer to my issues.

 

Thank you again, Libertas. You are a gem.

 

 

[[Li...]]

Thank you for sharing this encouraging news with us, HopeForTomorrow.  By doing so you are helping not only yourself but other members of the community who read your thread.

 

Here are some questions/suggestions for your consideration:

 

(1) Is your compounding pharmacist willing and able to fill your prescription with the Lorazepam Intensol™ Oral Concentrate manufactured by West-Ward?  That’s the one I would use.  West-Ward’s parent company, Hikma Pharmaceuticals, seems to have the most experience with manufacturing liquid formulations of benzodiazepines. The other manufacturers (e.g. Amneal, Hi-Tech Pharmacal) haven’t been in the market as long.

 

(2) If you have not already done so, I suggest you ask your pharmacist to provide you with specifics on what your prescriber needs to include on your prescription.  My understanding is that different states have different rules about DAW (Dispense As Written) prescriptions. Here are examples of the info that may be needed:

 

Lorazepam Intensol™ Oral Concentrate USP

NDC Code(s): 0054-3532-44

West-Ward Pharmaceuticals Corp.

 

(3) If it were me, I’d ask my pharmacist to make up a small test batch for me to try, say 1 week. Why? First, you seem to react very quickly to changes in dosage forms so it won’t take long for you to get a read as to whether or not this approach will work for you.  Second, to my knowledge, we do not know how long these diluted liquids remain stable (i.e. retain their potency and therapeutic effectiveness).  My hope is your pharmacist may have additional information he can share with you and hence us.

 

(4) If you haven’t already done so, I encourage you to ask your pharmacist about storage conditions for the diluted liquid.  Here are the storage conditions and use-by date for the undiluted Intensol (concentrate) from its official FDA drug label:

 

PROTECT FROM LIGHT

Store at cold temperature. Refrigerate at 2° to 8°C (36° to 46°F)

Discard opened bottle after 90 days.

 

(5) If you haven’t already done so, you might try searching and/or posting to the Tapering off Ativan Support Thread (link below) to learn about past and current members who have used/are using the lorazepam concentrate.

 

Link:

Tapering off Ativan Support Thread

http://www.benzobuddies.org/forum/index.php?topic=44903.0