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Compounding pharmacies (US, UK, and elsewhere)


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#37 indigo

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Posted 19 October 2015 - 12:52 PM

I had tapered my dose of prozac to 3.4 gms and had decided to stay at that level for several months to totally stabalize.

To avoid the fiddle of measuring the liquid prozac with a one mL syringe every day, I decided to have a compounding pharmacy (Lauden Compounding Pharmacy, Santa Cruz, CA)

make up capsules of 3.4 of prozac. After a week on the new capsules I was a mess, high anxiety and dark thought withdrawal. At first

I thought it was just the bump from changing from liquid to capsules. However I decided to weigh the each capsules with my accurate gram scale.

I was shocked at the discrepency between each capsule. Lowest was 264 mg the highest was 289 mg. Of course these weights include the filler powder

and weight of capsule, but clearly the dose of actual prozac in each capsule was way variant.

I'm in the last stages of tapering and am super sensitive to even the slightest variation in dose.  Had been at 3.4 for four months and had stabalized great.

Now I'm all screwed up again.

Is it common for compounding pharmacies to be this careless in their measurement of medication in capsules?


On 20 mg of Prozac for about ten years. Sept 2012 started reducing 10% a drop using gram scale, with average of one month holds.

When I'd reached the half way mark, taking 10 mg  powder out of the 20 mg capsules, I switched over to 10 mg capsules and cutting

down from those. Withdrawals got harder the lower I dropped.  May 2013 changed to 5% drops, holding until all withdrawal symptoms gone.

January 2015 changed to liquid prozac (concentration of 20MG per 5 mL) using a 1mL oral syringe.

Current dose of fluoxetine solution equivalent 3.4 mg. Any effort to drop below this has been disastrous so for the time being I'm staying at this level.
Adding 200 mg Tryptophan and 200 GABA a day has helped with anxiety.
Also take 1,300mg Omega- 3,  875mg  Magnesium, 1800mg Curcumin, 1000mg Vit C, 5000 Vit D.
 

 


#38 Altostrata

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Posted 30 October 2015 - 03:33 PM

Not usually. I would phone the pharmacy and get an explanation of the discrepancies.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#39 peggy

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Posted 30 October 2015 - 04:56 PM

i spoke at length to a compounding pharmacy about compounding effexor for me.  the pharmacist told me they have quality control guidelines but they are by law able to be out by 3% on each capsule.  I decided that was too much discrepancy for me - it might be okay for people who are not highly sensitive.

 

For effexor, the process she told me went like this.. they get a prescription for a specific number of whole capsules (usually one box which would be 28 capsules)  They open ALL of them at once and put into a machine. So, if they are working with 75mg capsules and they are compounding into 25mg capsules they would then have 2100mg of effexor in the machine. That will make 84 x 25mg capsules.  They add the filler so they will make whole capsules mix well and then make 84 capsules.  I asked her how can they be sure that the effexor is evenly distributed between the capsules and she said the machine mixes well. 

 

We can't get immediate release effexor here-if we could then i could have a liquid made up which i would think would give you a more accurate dose.

 

I still haven't worked out how i can proceed with my taper - i might just have to continue counting beads out - but tiny, tiny drops each month - it's just so tiresome and i get crosseyed.


Started in 2000 - On 150mg most of the time, (but up to 225mg at highest dose for 6 months in the beginning)
Reduced off easily first time - but got depressed (not too much anxiety) 6 months later
Back on effexor for another 9 months.
Reduced off again with no immediate w/d - suddenly got depressed and anxious ++ again 3 or 4 months later.
Back on effexor - this time for 3 years
Reduced off over a month - 6 weeks later terrible anxiety - back on.
Rinse and repeat 4 more times - each time the period before the anxiety comes back got shorter and shorter
Jan - July 2012 75mg down to 37.5mg;, 8/3/12 - 35mg. 8/25/12 - 32mg. 9/11- 28mg, 10/2 - 25mg, 10/29 - 22mg, 11/19 - 19.8mg; 12/11 - 17m,
1/1- 15.5mg; 1/22 -14mg, 2/7 14.9mg, 2/18 - 17.8mg - crashed big time: back to 75mg where i sat for 2 years....

4th  March 2015 - 67.5mg;   31st March - 60mg;  24th April - 53mg; 13th May - 48mg; 26th May - 45mg;  9th June - 41mg; 1 July- 37.5mg; 20 July - 34mg; 11 August - 31mg; 1st Sept - 28mg;  1st Dec - 25.8mg;  28th Dec - 23.2mg; 23rd Jan-21.9mg; Feb 7th- 21mg; March 1st - 20.1mg, March 30th - 18mg


#40 Castor

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Posted 31 October 2015 - 01:18 PM

I am getting compounded capsules of Seroquel from Johnson Pharmacy in Waltham, MA. They can create sustained-release capsules. They also appear to ship nationwide.

2006-11: rx-ed klonopin for anxiety from life trauma  

2011: accidentally c/t klonopin....lots of healing but reinstated on 20mg valium 8 months later after alchohol use (stay away from booze!)

-tapered valium over the course of a year  2012: hospitalized for 8 weeks after major s/a bc of failed valium taper and put on Seroquel 350mg xr and multiple drug trials w/SSRIs, mood stabilizers, etc. 2013: multiple hospitalizations and failed drug trials

-tapered all other drugs and "stabilized" on Seroquel xr and started tapering 2014: re-hospitalized after failed taper, added amitryptaline

-bounced around on different doses of Seroquel xr, maximum 600mg 

2015: finally found good doctor and therapist, tapered amilitryptaline to zero

=looking to start taper again from 550mg Seroquel xr but rough somatic symptoms, especially at night

-failed reduction of 12.5mg in late August, updosed back to 600mg seroquel xr, intense somatic sx at night

-starting in november, using compounded capsules to drop 3mg every 5-8 days


#41 Fresh

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Posted 22 March 2016 - 03:50 PM

Anyone having capsules compounded should get a few quotes - the price range is astonishing!

 

I got quotes recently for 200 and 300 x 1mg capsules of pristiq (with slow-release additive).

Pharmacy 1:  $100 per hundred , so 300 caps.costs $300:00

Pharmacy 2:  $ 55 for 200 caps. , 300 caps. costs $80:00

 

About the "slow-release additive"  (necessary for pristiq and some other meds.):

""We are PCCA (Professional Compounding Center of America) approved pharmacy and we use PCCA ingredients for our compounds. PCCA has approved us to use Methocel (E4M) as the only ingredient for slow released formulated compounds. 

 
 PCCA approved pharmacies use Methocel (E4M) as their slow-released ingredient, however, we will have no access to other independent pharmacies's medical data on what slow-released ingredients would they use. "

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg
2010-2012Cymbalta 120mg
Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta
Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.
July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.
Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.
October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.
March 2016 , 21mg

#42 ChessieCat

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Posted 08 September 2016 - 09:12 PM

Put my Pristiq tablets in to be compounded today and I asked the compounding pharmacist about the slow release and he told me it is in the capsule, not added to the ground up tablet.

 

My compounder charges me $75 for 500 capsules based on a bulk order.  I provide my own tablets.  And he uses different coloured capsules for different doses :D

 

If anyone in the Sydney area is interested, please PM me and I can provide the details of this pharmacy.


Podcasts:    Let's Talk Withdrawal

 

Antidepressants:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft; Cipramil CTed (very sick for 2.5 wks soon after)

Pristiq:  50mg mid 2012, 100mg beg 2014 (mild Serotonin Toxicity)     Current:  Pristiq 28mg (from 3 March 17)

 

Tapering history & graph

My website - includes my brief history + links to videos & information on the web

 

I've still got a way to go ... but I've already come a long way!!!

 

PLEASE NOTE:  I am not a medical professional.


#43 Altostrata

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Posted 10 September 2016 - 10:02 AM

Chessie, that sounds like a brilliant solution to tapering Pristiq. How long does the prolonged-release additive extend the effect of the drug?


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#44 Bethsimmons

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Posted 10 September 2016 - 10:24 PM

Roy Katz of www.customrx.com can ship to any state in the U.S. with a doctor's prescription. Roy will speak with your doctor to explain how it works. He is an expert in custom compounding Cymbalta and has helped hundreds from the Facebook group " Cymbalta Hurts Worse ". We have used him about 3 years with no complaints. About $60.00 a month. He will provide the paperwork for the patient to file insurance reimbursement if needed.
 
 

Dec. 29, 2016 -- Update

Update on Roy Katz, customRX. He is no longer practicing.

I am now working with a new compounding pharmacy in called Pharmacy Solutions. www.pharmacysolutionsonline.com - Important to ask for Michelle Wong.

They can fulfill prescriptions in 34 U.S. States. I'm working to get them up to speed on Cymbalta tapering, as well as co-coordinating with the prescribing doctor. There is a learning curve for sure as this drug is like no other for some people.


Edited by scallywag, 29 December 2016 - 06:59 AM.
add update on pharmacy


#45 Altostrata

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Posted 13 September 2016 - 06:17 PM

BethSimmons, as I asked before, how does Roy Katz compound Cymbalta, other than put the beads into other capsules?


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#46 ChessieCat

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Posted 02 February 2017 - 10:21 PM

I thought I would post this here to help anyone who is trying to calculate their doses for compounding.

 

I will be dropping by less than 10% so I hope to only have to hold for 3 weeks to start but I will have additional 2mg x 42 and 1mg x 21 if I need them.

 

Col 1 = No of days on the dose
Col 2 = dose
Other columns are how many tablets I need of each dose for the no of days

Col 1                2        3            4            5           6          7

No of Days     MG     20mg     10mg      5mg      2mg      1mg
21                   29       21                        21         39          6
21                   27       21                        21         21
21                   25       21                        21
21                   24       21                                     42
28                   23       28                                     28        28
28                   22       28                                     28
28                   21       28                                                 28
28                   20       28                                                    .

21                   19                    21           21         42
21                   18                    21           21                     21
21                   17                    21           TBA
21                   16                    21           TBA
21                   15                    21

Row 1                         196       Later       105       200        83

Row 2                           200                     100       200      100
Row 3                           20mg                   5mg     2mg      1mg

Row 4                           4000                    500      400       100     5000
Row 6                                                                                        50
Row 7                                                                                        50 tabs needed

Rows below the underlining are the start of my next batch of compounded tablets.

Row 1 = total number of capsules needed of that particular dose
Row 2 = rounded to nearest 100 (which is the minimum quantity of a dose)
Row 3 = is just for ease of seeing what quantity I need of each dose for ordering
Row 4 = this is the total of the dose to work out how many 100mg tablets are needed
Row 6 = Row 4 total divided by 100mg tablets
 


Podcasts:    Let's Talk Withdrawal

 

Antidepressants:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft; Cipramil CTed (very sick for 2.5 wks soon after)

Pristiq:  50mg mid 2012, 100mg beg 2014 (mild Serotonin Toxicity)     Current:  Pristiq 28mg (from 3 March 17)

 

Tapering history & graph

My website - includes my brief history + links to videos & information on the web

 

I've still got a way to go ... but I've already come a long way!!!

 

PLEASE NOTE:  I am not a medical professional.