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ADMIN NOTE For tips for tapering your drug , find the link in this list Important topics in the Tapering forum and FAQ You cannot make a liquid from extended-release drugs, such as bupropion SR or XL, or drugs with a protective coating, such as Cymbalta (the type of Effexor XR that comes in a capsule filled with tiny beads is an exception). Many extended-release tablets are held together by a glue to retard their absorption. Mixed with water or other liquids, these tablets become a soggy glob. Otherwise, given variable solubility of drugs, what you're usually doing when you mix a tablet or content capsules with water is creating a suspension, rather than a solution. High solubility is not a requirement for a suspension. Substances that dissolve in solutions will be more reliably distributed evenly throughout the solution, but we have to work with what we've got. A suspension does not require solubility. It's a bunch of particles hanging in a liquid, hopefully fairly evenly distributed. There may be flakes or particles visible in the suspension, some sinking to the bottom of the vessel. We recommend gently shaking or stirring before drawing out a dose from a homemade suspension (avoid creating a froth, because bubbles can throw your dose measurement off), to make sure the active ingredient (the drug) is distributed throughout the liquid. We have many people tapering successfully with homemade suspensions, as well as compounded suspensions and solutions. Also see Pharmacy liquids to make suspensions Questions and answers about liquid medications Compounding pharmacies (US, UK, and elsewhere) Described below, making a liquid from Celexa tablets is only one example of how to do it. Information provided here for Celexa is relevant to making liquids from tablets of other drugs. To skip the discussion about make a liquid with Celexa tablets specifically, jump to "How To Make Liquid from Tablets or Capsules" for more general information about making homemade liquids from many drugs. Also see @Faure's method for making a liquid described here. Also see music321's post about serial dilution of liquids PS Originally, Rhiannon was using a small amount of ethanol to dissolve her Celexa. She later changed her method and was successfully dissolving her tablet in water only. Her topic, Making a Celexa Solution Yourself, has been merged into this topic; the early posts about Celexa have a note added at the top of the posts. Making a Celexa solution yourself A couple of folks asked me to post here about how I dissolve my Celexa and liquid taper it that way. I use a shot glass and dissolve the tablet in a small amount of water (enough to cover it) and a couple of mLs of ethanol (very pure drinking alcohol, I use "Everclear" type, available at the liquor store.) The tablet doesn't dissolve quickly, so I usually leave it there and come back in about twenty minutes. NB: Rhiannon changed her method of dissolving citalopram. She stopped using ethanol. See below quote. I stir it with the pipette to get the drug to dissolve into the ethanol (citalopram is soluble in ethanol). I don't know how well it actually dissolves but as long as it's mixed well it doesn't really matter. Then I add enough water to bring it up to 20 mL total. I mix it well and then draw up my dose for the day, and then pipette it straight into my mouth followed by a pipette full of water (both to rinse the pipette and to dilute the "shot"!) My current dose is 5.25 mg of citalopram, so given the dilution I'm using (10 mg in 20 mL) I measure 10.5 mL as my daily dose. All of this could be adapted easily to using syringes for measurement instead of a pipette. (And if you are more delicate than me you could measure it into a spoon or cup rather than squirting it straight into your mouth.) But using pipettes is really easy too, very simple to learn and do. I'll be seeing my doctor again some time this summer and like I said elsewhere, I may see about getting the citalopram liquid already made up, but it's a $15 copay and the pills are only $5. And I'm already dissolving and pipetting my other meds anyway so it's not really any particular hassle to do it this way with the citalopram. Personally this is the method I would use to taper any med. I've done the dry cutting method using a scale, and I find liquid titration easier to control. I can get my cuts as small as I want by adjusting the dilution. _________________________________________________________________________________________________________________________________________________ Making Suspensions Some of the medications we use are insoluble in water. Even with a lot of time and shaking they will not dissolve. What happens is that the powder from a crushed tablet will get mixed with and float around in the water. This is called a suspension. It is a very temporary thing as the powder will precipitate out quickly and not be evenly distributed in the liquid. Medications that have a Dose Strength that is higher than their Solubility Rate will not fully dissolve fully and need to be used to create a suspension. The precipitation of the material can be worked around by stirring the liquid just before measuring the dose and trying to mix the liquid while the dose is being removed. It is not a good idea to shake the liquid because this will introduce many small bubbles that can throw off the accuracy of the dose. Many people have good success using this method, but it can lead to inaccurate dosing. If you have a 10mL syringe and want to use the larger tablets it is possible to mix a suspension right in the syringe. Draw water into the syringe to the 10mL mark. Place the cap on the tip so it won't leak and carefully pull the plunger all the way out of the syringe. Drop in the tablet and gently insert the plunger just enough so it doesn’t leak. Don’t worry about trapping some air in the syringe. Let it sit for an hour or so until the tablet crumbles, shaking it occasionally. When you are ready to take the dose, shake it up good, remove the cap and hold the syringe so the tip is up and carefully squeeze out the air bubbles. Shake it up again and for a full dose you would take the entire contents. When you start to taper you would squeeze out a set amount of liquid before taking the rest. The dilution ratio of the liquid is not important because you will determine each reduction by the marks on the syringe. As the taper progresses more and more liquid will be discarded. When a large portion of the dose is being discarded it is possible for some ADs to save that liquid for two or three days and use it to make up a “free dose”. By using this method there is no need to worry about the powder settling out. Another possibility is to use a suspension liquid that is thicker than water to hold the powder in place for a longer time. Suspension Media Because it is so thin, water is not always the best media for making a suspension. Even though it is quite fine in texture the powder made by crushing the tablets is still heavier than water and can settle out quite quickly. A better way is to use a thicker base material. There are several commercially made “Suspension Medias” available online or through your pharmacist. Ora-plus and Ora-sweet are two of the most common, but a quick online search will bring up other alternatives. There are some ways to make your own which can work quite well also. Believe or of not there are some people who have trouble drinking water because it is too “wet”. There is a product available at many drug stores or chemists referred to as “thick water”. It is thick enough to hold the powder in suspension quite well. Making a homemade suspension media can work well too. A common one is to use maple syrup; you could also use corn syrup or other cooking syrups. There are quite a few recipes available online using a variety of materials. All these media would be used in the same manner as water following the directions given in other parts of this article. Using fruit juice is also popular as a suspension media. Some juices are much thicker than water and suspend the powder quite will. They also taste much better. Because they contain fruit pulp it is hard to see if the powder is well mixed in. However, DO NOT USE GRAPEFRUIT JUICE, it reacts badly with many medications and can create a liquid that is dangerous to drink. It can seem that making a liquid from tablets borders on getting a degree on chemistry. But by following the process step by step it is pretty straight forward, and these techniques are being used by many people to facilitate their tapers.