Help - Need Plan For 0.5mg Ativan Titration

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BTW, if we are right about the liquid being the problem you may have gotten a clue as to your lag time.  You made the switch and four days later you felt it.  Your lag might be four days.  Good to know.

[[Gr...]]

BTW, if we are right about the liquid being the problem you may have gotten a clue as to your lag time.  You made the switch and four days later you felt it.  Your lag might be four days.  Good to know.

 

Well now I feel super crap with mostly anxiety and have no choice but to leave work. Now what do I do? I don't want to updose. I wouldn't even know how much to.

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Updosing is hard as we hate to give up ground and it is perceived as going backwards.  Heading this off and addressing it is the thing to do IMO.  You want to taper from as good a place as possible.

 

If it's bad enough to make you leave work it may have been a significant percentage.  Each 1% is .05mg.  IDK it's up to you.  You could try going back to .5mg or edge up a percent and see, so .55mg?  Or go up a few percent?  It's trial and error.  Sorry this is happening.

[[Gr...]]

It's obvious the strength of the liquid is off from the tablet. I was totally fine and stable before. I'm actually considering going back to dry cutting. At least I knew what I was getting. Such a shitty situation.

[[Gr...]]

So I called the pharmacist where I got the liquid suspension made and he's quite up on getting people off benzos. Good to know. Although he did say with my dose history I should be able to get off in about 8 weeks. So maybe he's not up to full speed. He also mentioned the possibility of a c/o to V. Says it will be easier. Again debatable. But the first thing he said was if I had shaken the bottle before dosing. I don't think I ever did. Maybe once and then saw it caused all kinds of bubbles. I was never told to shake it nor does it say so on the bottle. So he said try that first. And that some peoples bodies  react different to the liquid vs the tablet. So I remade my 2 other doses for today after shaking the bottle for like an hour and a half :-) We'll see where this leads.

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Well, that would do it!  For sure.  If it is a suspension and needs to be shaken.  Generally, I don't like suspensions as the drug is not truly dissolved and can become uneven over time.  But a good quality suspension is better than trying to suspend in water.  Glad you talked to the pharmacist and found this out.

[[Gr...]]

Well, that would do it!  For sure.  If it is a suspension and needs to be shaken.  Generally, I don't like suspensions as the drug is not truly dissolved and can become uneven over time.  But a good quality suspension is better than trying to suspend in water.  Glad you talked to the pharmacist and found this out.

 

Well is there a way of dissolving it? I look in the bottle and I see nothing but liquid. No particles at a all. I have a list of all the items they used if you want to know.

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The only info I know about is what I read here.  I've seen several members dissolve it in a small amount of alcohol.  There may be another liquid..either propylene or ethylene glycol.  What are the pharmacy ingredients?

[[Gr...]]

The only info I know about is what I read here.  I've seen several members dissolve it in a small amount of alcohol.  There may be another liquid..either propylene or ethylene glycol.  What are the pharmacy ingredients?

 

The ingredients listed are:

 

Lorazepam USP

Propylene Glycol

Glycerin USP

Distilled Water DT

Ethyl Alcohol 95%

Peppermint Oil

Sorbitol NF 70% Solution

 

 

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Okay.  It looks to me like it is dissolved and is a true solution.  Ethyl alcohol is "alcohol".  It is drinking alcohol.  And I see both propylene and ethylene glycol.  I am guessing by 95% alcohol they mean the alcohol used was 95% pure and 5% water (rather than meaning that 95% of the entire liquid is alcohol).

 

Odd though that your pharmacist, WHO MADE IT, asked if you shook it.  Once dissolved into solution it should never need shaking.  That's the whole idea of dissolving.  It is stable in solution and does not come out ever (it might if it got too cold though).  It might be worth it to check with him and ask if the lorazepam is dissolved and is a "true solution."  And if he says yes, ask why would it ever need to be shaken.

 

Generally this is good news though, right?  You are back to it perhaps being too weak.  You might also ask him what his mixing limit are and alert him that you need it dead on because you are tapering.  Above all else you need consistency from batch to batch.

[[Gr...]]

Okay.  It looks to me like it is dissolved and is a true solution.  Ethyl alcohol is "alcohol".  It is drinking alcohol.  And I see both propylene and ethylene glycol.  I am guessing by 95% alcohol they mean the alcohol used was 95% pure and 5% water (rather than meaning that 95% of the entire liquid is alcohol).

 

Odd though that your pharmacist, WHO MADE IT, asked if you shook it.  Once dissolved into solution it should never need shaking.  That's the whole idea of dissolving.  It is stable in solution and does not come out ever (it might if it got too cold though).  It might be worth it to check with him and ask if the lorazepam is dissolved and is a "true solution."  And if he says yes, ask why would it ever need to be shaken.

 

Generally this is good news though, right?  You are back to it perhaps being too weak.  You might also ask him what his mixing limit are and alert him that you need it dead on because you are tapering.  Above all else you need consistency from batch to batch.

 

They are closed weekends so I'll ask him Monday. I'm not sure if he personally made it. I was dealing with a "compound technician" first. When I called today asking questions about the strength she transferred me to him. What do you mean by mixing limit? Thanks for your help BTW.

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Nothing is ever exact.  I think when meds are made they need to be within certain tolerances (probably by law?).  By mixing limit I was trying to clumsily say ask him how far either side of the stated concentration can they go and call it good.

[[Ki...]]

Hey Green - I agree with SG57. I would go back up to at least .50mg for the reasons I mentioned to you earlier.

 

When I was having my liquid compounded I asked about the accuracy and such between batches. The batches of compounded medicine has to be under 1% either way (according to my pharmacist). They showed me how they check it. It was pretty neat. So, I would say that it's safe to assume a 1% variance in your compound vs. your tablet. 

 

Also - something else you may want to ask your pharmacist is what generic brand they are using. My tablets are TEVA-lorazapam and my compounded liquid was NOVO-lorazapam. I've read there can also be a difference between generic brands. 

[[Ju...]]

Also, Tweed I don't believe you're dealing with a solution.  Ativan is only sparingly soluble in alcohol.  This is poor solubility.  I'd shake the bottle as the pharmacist recommended.  It could be the propylene glycol increases the solubility a bit, but I still believe you're dealing with a suspension rather than a true solution.

 

Check out this link for more info on lorazepam solubility:

 

http://lib.njutcm.edu.cn/yaodian/ep/EP5.0/16_monographs/monographs_l-p/Lorazepam.pdf

 

"A white or almost white, crystalline powder, practically

insoluble in water, sparingly soluble in alcohol, sparingly

soluble or slightly soluble in methylene chloride."

[[Gr...]]

Hey Green - I agree with SG57. I would go back up to at least .50mg for the reasons I mentioned to you earlier.

 

When I was having my liquid compounded I asked about the accuracy and such between batches. The batches of compounded medicine has to be under 1% either way (according to my pharmacist). They showed me how they check it. It was pretty neat. So, I would say that it's safe to assume a 1% variance in your compound vs. your tablet. 

 

Also - something else you may want to ask your pharmacist is what generic brand they are using. My tablets are TEVA-lorazapam and my compounded liquid was NOVO-lorazapam. I've read there can also be a difference between generic brands.

 

Ok going back up to 0.5 is doable. I was only at 0.494 anyway. Thanks for your input as well. I know my tablets were NOVO. I'll find all this info out Monday.

[[Gr...]]

Also, Tweed I don't believe you're dealing with a solution.  Ativan is only sparingly soluble in alcohol.  This is poor solubility.  I'd shake the bottle as the pharmacist recommended.  It could be the propylene glycol increases the solubility a bit, but I still believe you're dealing with a suspension rather than a true solution.

 

Check out this link for more info on lorazepam solubility:

 

http://lib.njutcm.edu.cn/yaodian/ep/EP5.0/16_monographs/monographs_l-p/Lorazepam.pdf

 

"A white or almost white, crystalline powder, practically

insoluble in water, sparingly soluble in alcohol, sparingly

soluble or slightly soluble in methylene chloride."

 

Excellent. Thanks for the info Juliea.

[[...]]

Also, Tweed I don't believe you're dealing with a solution.  Ativan is only sparingly soluble in alcohol.  This is poor solubility.  I'd shake the bottle as the pharmacist recommended.  It could be the propylene glycol increases the solubility a bit, but I still believe you're dealing with a suspension rather than a true solution.

 

Check out this link for more info on lorazepam solubility:

 

http://lib.njutcm.edu.cn/yaodian/ep/EP5.0/16_monographs/monographs_l-p/Lorazepam.pdf

 

"A white or almost white, crystalline powder, practically

insoluble in water, sparingly soluble in alcohol, sparingly

soluble or slightly soluble in methylene chloride."

 

Hi Juliea, how are you.   The problem with the words used to describe solubility is they do not quantify it.  So we can get put off by a term like "sparingly soluble."  This does NOT mean it is insoluble!

 

Aweigh has researched this thoroughly and I have looked up his references.  They are valid.  You can dissolve up to about 18mg of ativan into 1ml of alcohol.  That's way more than we need!  Also, propylene glycol and ethylene glycol are also common drug solvents.  I am not sure how much ativan will dissolve in them, but I doubt they are being used for suspension purposes.

 

http://www.benzobuddies.org/forum/index.php?topic=102161.msg1345544#msg1345544

 

I think Tweed is dealing with a true solution.  It would be good to have the pharmacist validate this.

[[Ju...]]

Also, Tweed I don't believe you're dealing with a solution.  Ativan is only sparingly soluble in alcohol.  This is poor solubility.  I'd shake the bottle as the pharmacist recommended.  It could be the propylene glycol increases the solubility a bit, but I still believe you're dealing with a suspension rather than a true solution.

 

Check out this link for more info on lorazepam solubility:

 

http://lib.njutcm.edu.cn/yaodian/ep/EP5.0/16_monographs/monographs_l-p/Lorazepam.pdf

 

"A white or almost white, crystalline powder, practically

insoluble in water, sparingly soluble in alcohol, sparingly

soluble or slightly soluble in methylene chloride."

 

Hi Juliea, how are you.   The problem with the words used to describe solubility is they do not quantify it.  So we can get put off by a term like "sparingly soluble."  This does NOT mean it is insoluble!

 

Aweigh has researched this thoroughly and I have looked up his references.  They are valid.  You can dissolve up to about 18mg of ativan into 1ml of alcohol.  That's way more than we need!  Also, propylene glycol and ethylene glycol are also common drug solvents.  I am not sure how much ativan will dissolve in them, but I doubt they are being used for suspension purposes.

 

http://www.benzobuddies.org/forum/index.php?topic=102161.msg1345544#msg1345544

 

I think Tweed is dealing with a true solution.  It would be good to have the pharmacist validate this.

 

Hi SG57.  I'm doing great.  Thanks for asking.  Yes, the pharmacist should be able to give more information.  After he advised Tweed to shake the mixture, it made me want to look up a reference.  Whether it's a true solution or not, it should be easy to titrate.  Many folks even use water, (which we know does not dissolve most benzos), and are able to taper off. 

 

It's all good Tweed.     

[[Gr...]]

Well I feel better today. Still not sure what brought on those symptoms. I'm now wondering when I'll feel the cuts I made Wed & Thurs? So I'm holding at 0.494 now which was the cut I did Thurs. Loooong way to go. If I can just figure out what this hiccup was I'll feel a lot better. Once again all your help is amazing. Thanks x 1000.

 

GIT

[[Gr...]]

Here's my titration so far and I can't see a pattern. Maybe the fact that the strength of the liquid does not match my tablets and the non shaking aspect. If you can see something...

 

Day 1 (Sat) - start titration 0.498mg (bottle not shaken)

Day 2 (Sun) - titration 0.498mg (bottle not shaken)

Day 3 (Mon) - titration 0.498mg (bottle not shaken)

Day 4 (Tues) - titration 0.498mg (bottle not shaken - started to feel off)

Day 5 (Wed) - cut 0.496mg (bottle not shaken - felt a bit off too)

Day 6 (Thur) - cut 0.494mg (bottle not shaken - felt like shit)

Day 7 (Fri) - held 0.494mg (bottle not shaken - felt like shit - came home from work)

Day 8 (Sat) - held 0.494mg (felt better - now dosing after shaking bottle)

Day 9 (Sun) - held 0.494mg (feel pretty shitty mentally)

 

There you have it.

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Hi Tweed,  I still am inclined to think your liquid is below the advertised concentration so when the switch to liquid was made you actually took a cut.  The list of ingredients really looks like the intention is to dissolve the ativan, not suspend it.  But I think it is very important to find out from your pharmacist what type of liquid you are using - suspension or solution.  You definitely need to know if you need to shake it or not.

 

I used the Roxane valium prescription liquid and diluted it with water.  It was a true solution and I really liked knowing that once it was mixed I could rely on it to keep the drug absolutely evenly distributed.  One less thing.

[[Gr...]]

Hi Tweed,  I still am inclined to think your liquid is below the advertised concentration so when the switch to liquid was made you actually took a cut.  The list of ingredients really looks like the intention is to dissolve the ativan, not suspend it.  But I think it is very important to find out from your pharmacist what type of liquid you are using - suspension or solution.  You definitely need to know if you need to shake it or not.

 

I used the Roxane valium prescription liquid and diluted it with water.  It was a true solution and I really liked knowing that once it was mixed I could rely on it to keep the drug absolutely evenly distributed.  One less thing.

 

I'll call him tomorrow. I guess in the meantime I should hold at my current dose. Whatever that is. At least with the tablets I knew what I was getting and felt stable.

[[Gr...]]

So it is a solution. But I talked to another pharmacist as the other one wasn't in. He said technically you shouldn't need to shake it but it doesn't hurt to as sometimes separation can happen. So there goes that.

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To me that's contradictory.  Solutions do not separate.  Once in solution it is stable and will last forever unless it gets too cold or the liquids evaporate away.

 

Did he/she mean separation of the various liquid ingredients I wonder?  The liquid was actually a bit complex with about five or six ingredients as I recall.

 

I'd get another opinion.  But at the end of the day it will not do harm to shake a solution.

 

Can you see the liquid?  I had Roxane liquid valium and diluted it with water.  In a clear jar I could see the two liquids mix and become perfectly uniform.  There was no doubt I had a solution.  It was perfectly uniform and clear with a light peach color everywhere in the jar.  No solids or anything.  Just uniform peach colored liquid.

[[Gr...]]

To me that's contradictory.  Solutions do not separate.  Once in solution it is stable and will last forever unless it gets too cold or the liquids evaporate away.

 

Did he/she mean separation of the various liquid ingredients I wonder?  The liquid was actually a bit complex with about five or six ingredients as I recall.

 

I'd get another opinion.  But at the end of the day it will not do harm to shake a solution.

 

Can you see the liquid?  I had Roxane liquid valium and diluted it with water.  In a clear jar I could see the two liquids mix and become perfectly uniform.  There was no doubt I had a solution.  It was perfectly uniform and clear with a light peach color everywhere in the jar.  No solids or anything.  Just uniform peach colored liquid.

 

Not sure what you mean by see the liquid. It's in an transparent "orange" bottle. It looks crystal clear. When I shake it though it becomes cloudy. Not sure if some of that is bubbles?