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How to know to if liquid pharmacy compound K is working or not?


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Made switch to liquid compound from pharmacy a couple weeks ago (held my dose from .162mg/ day, dose once at night)…. Held the last 2 weeks and have had pretty bad symptoms. Sleep 1-2hrs (I only have gotten 0-4hrs over last year+ And managed), can’t stand up straight bc feel so weak, low blood pressure, can’t get good breaths even doing deep breathing. Akathesia mental and physical on and off, on couch or bed most of day but try to walk a little if I can… maybe 3minutes about 4x day and then have to sit. Used to be able to walk 1mi slowly over course of day through Jan of this year.

 

I crashed in Feb (barely able to eat, no sleep, akathesia, crying all day, bedbound), held for 7wks but then got a tiny better with sleep holding. Still had bouts of akathesia during that and skin burning got worse so I thought I might need to start tapering again bc didn’t know what could be tolerance. So April restarted dry taper and had a tough time…. Was dry shaving .001g every week until mid May and switched to liquid compound from pharmacy at .162mg/day. Held dose from .162mg a week before liquid change and then through liquid the last 2 wks.

 

How do I know if liquid is an issue? How does one know if symptoms would happen if still doing dry taper Vs liquid or if body just isn’t taking to liquid?

Also liquid has some bubbles in syringes …. Is this an issue or not? Pharmacist made a very simple suspension given he understood I’ve cut out the sugar, dairy, gluten, etc, but I don’t know exactly what’s in the formula.

Not a huge change in symptoms bc I was bad already, but def worse-  less mobile and have had breathing issues last few days where I don’t feel like can get good breaths even though breathing from stomach and not anxious. Just a consistent not getting a good breath. Stomach is very tight every day until take med.  Zero strength, light sensitivity, stomach issues on and off… basically majority of symptoms people discuss I have.

 

Hard to know what is considered stable bc I’ve had a very symptomatic tough taper from beginning. Have adrenal issues bc of this(and very low almost 0 cortisol in morning), and vitamin levels aren’t great. Do blood work every month and can’t take supplements bc too sensitive. Have low thyroid and take Armour last 15yrs. Used to be a very healthy, active (ran a few nights a week) person who worked in US and overseas, traveled, volunteered, loved life.

I got food poisoning during early covid days march ‘20 and hospital thought could be covid, put me on antibiotic for 2 days - cleared up fever and nausea but then tongue swelled and I had hives. I had a panic attack during sleep bc tongue and was by myself and they gave me Ativan which I didn’t know what it was. They gave me that for next 4 nights… I kept telling nurses I didn’t feel like I was sleeping at all(didn’t know blacking out), then after neg covid test I was sent home and told to talk to psychiatrist bc I prob had anxiety due to having a panic attack. Talked to psychiatrist he said take klonopin for sleep and panic disorder (never had a panic attack before) and rest is history.

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I’m sorry you are having such a difficult taper, Boges11. Let’s see if we can help you answer your question about whether or not the liquid is a contributing factor to your current distress.

 

Questions for you

 

(1) On a scale of 0 to 10, what was your anxiety level regarding switching from dry cutting to the liquid?  (0 = no anxiety whatsoever, I was confident it would work; 10 = off-the-charts anxiety, I had major concerns that the liquid would not work)

 

(2) What is the concentration of your liquid (the label should state how many milligrams of drug are contained in each milliliter of the liquid)?

 

(3) How many milliliters are you ingesting for your current dose?

 

Questions for your pharmacist

 

(1) Did you use regular tablets as the drug source?  If so, were they from the same manufacturer as the tablets I have been taking?

 

(2) What are the ingredients in the liquid?

 

(3) Has the formulation you used been stability-tested?

 

Possibilities to consider

 

(1) The dose you were taking via dry cutting was not what you thought it was.  When you switched to liquid at what you thought was the equivalent dose, you actually made a reduction in dose.

 

(2) The pharmacokinetics of the liquid dosage form are different than those of the solid dosage form.  Your body is experiencing these differences as a reduction in dose.

 

To address the above, one option to consider is to increase your dose slightly. For example, you could try increasing your dose by 5%.  If that doesn’t help, try a 10% increase.

 

One action to take

 

Learn how to prevent and/or eliminate the air bubbles in the syringe (too many/large bubbles = inaccurate and/or inconsistent dosing).

 

Does your bottle of liquid include a bottle adapter cap (aka a syringe adapter)? If not, ask your pharmacist to provide one for you and show you how to use it with an oral syringe.

 

I’ve also included a link to a video form on how to use an oral syringe with a bottle adapter (referred to as a  ‘stopper’ in the video).  The relevant segment starts around the 2 minute mark. However, the opening segments on how to select the right-size syringe and how to read the syringe may also be of help/interest.

 

Link:

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Thank you Libertas.

1- I’d say maybe a 4, I was more worried about throwing it up and not knowing what to do at that point. After keeping it down I was hopeful bc I really wanted it to work since I want off this so bad and I’ve struggled so much.

2. .25mg/10mL

3. 6.45mgL

4. I know this bc I asked him, he’s using pure powder bought from wherever Accord gets their drug from. He’s not using pills and crushing, he’s using the pure Clonazepam powder which was also a plus given it doesn’t have the fillers and binders.

5. I’ll get back to this.

6. He said there is a study he’s using that says this doesnt lose potency or break down for 60 days. I made sure to ask all this upfront!

7. I was hoping it would be the other way around since this is using the pure powder and the pill you aren’t sure exactly how much Clonazepam there is.

8. Frustrating bc pharmacist and he’s super knowledgeable and smart said my body should recognize the drug the same whether it’s in pill or liquid form.

 

I hate to go back up bc I guess I just have felt so bad this whole time I don’t know what my gauge would be. I’ve had numerous symptoms this whole time(prob 20 at least every day) and never felt decent. I know that’s diff person to person but my deal was if I could eat, sleep 2-3hrs, and walk that I was making it. Still had a ton of symptoms and health stuff that is a result of the K.

 

I’ll take a look at video. Yes I have a stopper in the bottle form the pharmacist and I use his syringes at 5mL, 3mL, and then a 1mL to get the .45. So 3 syringes to get my 6.45mL. I use some water to flush them out and drink yhay too.

 

Thanks. I just am scared of how sick I am and making the wrong move forward. I’ve seen how some peoples say they didn’t take to the compound liquid or body didn’t like it and I wonder how did they know? Maybe bc they just weren’t so sick to begin with and so could tell by increase in symptoms.

I just have no way to know what does what (a food I try, or walking a little bit close to bedtime, a car ride in evening(I can’t drive), everything is hard and it’s frustrating to not be able to figure out what will help be successful in making it off this. I’ve had naturopath test and he said my detox pathways look great and besides being low in a couple of the vitamins (d and b12, 6) that my tests look really good.

 

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Hello again, Boges11.

 

Thank you for responding so quickly, thoroughly, and thoughtfully.

 

Based on your responses so far, it doesn’t sound like anxiety about changing dosage forms has been a major factor.  We also now know that you are ingesting the right amount of liquid to achieve your target dose (despite the unusual concentration of your liquid — well done!)

 

We still need to find out more about the formulation your compounding pharmacist is using.  I hope he will be willing to share both the ingredients he used as well as the study he referenced.  (We have located less than a handful of stability-tested formulations for clonazepam so it would be a boon to the community if you and your pharmacist can contribute another one.)

 

There are multiple reasons why individuals report they didn’t ‘take to liquid.’  Two of the more common ones I’ve encountered are (1) they didn’t give themselves enough time to adjust to the new dosage form and (2) they made a (too large) reduction in dose at the same time they switched to the liquid.  You have avoided both of those pitfalls.  However, we can’t discount the possibility that the dry-cut dose you were taking wasn’t what you thought it was (i.e. you were taking more milligrams of drug than you thought you were so when you switched to what you thought was an equivalent dose of the liquid, you actually made a reduction in dose).

 

I hope the video is helpful. Preventing and/or eliminating bubbles in your syringes will increase the likelihood of getting an accurate and consistent dose.

 

I hear you about not wanting to increase your dose.  You’ve fought long and hard to go in the opposite direction.  However, if I were in your shoes, I would be inclined to try a small (5%) test increase. If my withdrawal symptoms began to lessen, I would have evidence that under-dosing of the liquid rather than the liquid itself is the more probable root cause.

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  • 1 month later...

Hi there, so found out suspending agent for my liquid is methylcellulose. Is this something commonly used for liquid compounds people use to taper off benzos?

Thank you for any help!

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Thanks Libertas. So formulation of .25mg/10mL shouldn’t be a problem even though this talks about .1mg/mL?

 

I’ve had a harder time after switching to liquid so it’s frustrating bc I thought things would even things out some, but bed/couchbound now every day. So hard to know the right thing to do to successfully get off this stuff.

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You’re welcome.  I am not a compounding pharmacist so cannot address whether a formulation of 0.25mg/10mL would ‘be a problem’ compared to the 0.1mg/mL formulation.  I can make the observation that the concentration is lower (0.025mg/mL versus 0.1mg/mL).  Given clonazepam’s high potency, using a liquid with a lower concentration would have benefits.

 

I’m sorry you are suffering.  Were you relatively stable before you switched to the liquid? 

 

It would helpful if you could update your signature.  What dose were you taking when you switched to the liquid?  Have you made any reductions since then? If so, when and how much?

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[c2...]

I have the exact same issue at the moment that I’m trying to figure out.

 

For me it’s a little worse, as I have COVID again.

So my breathing is worse from that too.  :(

 

I’ll respond more tmrw!

 

Cheers winnie.

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Libertas, I was not doing well and why I switched to liquid compound to see of symptoms evened out some like people say. Ives updated profile.

 

I only dose at 10pm, could this be a factor? I didn’t want to mess up and try to split doses bc initially was on this for sleep…. So didn’t want to rock the boat at night but I only sleep 1-2hrs as it is.

 

Everyone said when I restarted tAper last year that Clonazepam one dose should be fine. Yet now I talk to people and they say they dose 2/3x a day for Clonazepam.

 

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Boges, I thought I'd just share my experience. I was not on klonopin, I was on valium. And ppl told me that dosing 1 X daily would be okay due to its long half-life. Well, it wasn't. When I got up the nerve to divide my dose, things went so much better. I found it hard to believe I was having interdose wds, but I was. Splitting my dose and having those miserable s/x go away proved it to me.

 

So . . . just a thought. A "success story" if you will. Sometimes you just have to think/go outside the box to get good results. And everyone's different. One dose a day might be good for some, but not for all. I've noticed over the years that plenty of buddies dose multiple times a day.

 

Best to you,

 

Katz

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Thanks Oregonkatz….. did you split exactly in half? Change times at all of your initial dose or just keep that and do 12hr difference?

 

Thank you!

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I split exactly in half  or as close as I could measure -- I was doing a DLMT so it was pretty easy. I dosed 9 a.m. and 9 p.m. So the doses were 12 hours apart. That seemed to really help the interdose w/ds.

 

Best,

 

Katz

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I'm DLMT' ing 0.480 mg of k now. This is actually my second taper. I  split the doses three times a day: Morning (liquid reducing dose),afternoon (Pill cut at 0.125) and night (larger cut pill dose of 0.250 mg). I may end up with 2 doses close to end. I tried with one dose and had issues.

I'm using oral plus as vehicle 0.1mg/ml concentration (10x 0.5 pills mixed with 50 ml of Ora Plus). I make the suspension myself using a mortar and pestle. The reduction rate is aprox 0.005 mg x day. I use a 1ml syringe. 

yes, there is a reaction when you switch to liquid but your body will get use to it. I used to hold the first week when I switch to liquid then start reducing afterwards.

Clonazepam would allow you to mix pills and liquid until the pill dose is 0.125mg ( 0.5 / 4) after that liquid is the only way unless you weight and grind the pill.

Hope my experience helps!

Mice 

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Thanks Katz and Mice! (That made me laugh)….

 

I am worried I’m going to rock my nights if cut that dose in half at this point in my taper….. geezo it’s frustrating bc if dosing 2x a day will be beneficial, I’d like to help my body out! My nights can be rough at times as I know a lot of people go thru, and yet I take my dose at 10pm so it’s frustrating.

 

Maybe I should see if doing 3/4 dose at night and 1/4 late morning would help at all?? I the don’t know how the heck I would approach tapering… take a little from both, leave morning since it’s lower.

 

After changing to liquid a couple months ago, I don’t want to rock my body again. Wish I had made the change higher up to two doses :(.

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