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How to make a liquid from tablets or capsules

77 posts in this topic

ADMIN NOTE This topic is a general discussion of how to make a liquid from drugs. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because such detailed discussion will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 
For those interested in reviewing pharmacy techniques for making liquid suspensions, see:

 

Pharmlabs Suspensions

 

Suspensions

 

Liquid Dosage Forms Extemporaneously Prepared from Commercially Available Products – Considering New Evidence on Stability- PDF

 

 

Also see
Important topics in the Tapering forum -- find the topic in this list about tapering your specific drug

Why taper by 10% of my dosage?
Using an oral syringe and other tapering techniques
From Current Psychiatry: Tablets that may be split or crushed...
How to cut up tablets or pills
Using a digital scale to measure doses
Making a Celexa solution yourself
 
 
Haywood, 2013 Liquid dosage forms extemporaneously prepared from commercially available products - considering new evidence on stability. (refers to suspensions made with pharmacy liquids)
Liquid medications -- use past expiration?
 



 
A liquid preparation of an antidepressant or other psychiatric drug makes controlled tapering much easier. Taking part of your dosage in tablet form and part in liquid form makes the transition from tablet to liquid go smoothly.
 
Some psychiatric drugs are available from the pharmacy as a liquid, many are not. Compounding pharmacies can make liquids from many medications. A prescription is required for both types of liquid.
 
(Some medications, however, cannot be made into a liquid. Extended-release drugs such as Effexor XR, Cymbalta, and Pristiq are protected by a coating that cannot be broken. To find tips for tapering your particular drug, see Important topics in the Tapering forum and FAQ .)

If a compounding pharmacy is not an option, many people make liquid preparations themselves.
 
(This list from a UK medical group confirms that many drugs can be made into liquids: http://stockportccg.org/wp-content/uploads/2012/01/34838_Med_Admin_Dysphagia.pdf )

Note: Most do-it-yourself liquids are suspensions -- particles of the drug float around in the liquid, and the mixture needs to be shaken for relatively equal distribution of the particles.
 
How to make a medication in tablet or capsule form into a liquid
 
As an overview, here is a video about making a liquid from a naltrexone tablet. Naltrexone is not a psychiatric drug, but the principles are the same:


 
(Refrigeration of the batch is not necessary while the tablets dissolve. Refrigerate the liquid afterwards, though.)
 
Below are general instructions for making your own liquid with water or pharmacy liquid.
 
Basically, you need
- the drug, as a tablet or powder from a capsule
- water or Pharmacy liquids to make suspensions
- a way to measure the amount of water or pharmacy liquid (oral syringe, pipette, measured container or graduated cylinder)
- a clean container with a cap in which to keep your liquid

Try to be very consistent with your method every time you make a batch of liquid -- do everything in the same order, with the same equipment.
 
Assemble your equipment
1. Obtain a way to measure the water or pharmacy liquid
  • A 10cc (10mL) or 20cc (20mL) oral syringe (as seen in the video) OR
  • A 100cc (100mL) medicine bottle from the pharmacy. These usually have markings showing 100cc or mL (ask for the cap with the hole in it, so you can fit the oral syringe in it to draw from the bottle). There should be no charge or a very small charge. OR
  • A graduated cylinder marked with ccs or mLs. Graduated cylinders are more exact than oral syringes or medicine bottles and best for large volumes of liquid)

2. A small clean transparent wide-mouthed jar with a water-tight top or an empty tinted plastic medicine container with a top.
 
3. If your medication is in tablet form, a pill cutter or crusher. (This is optional. You can cut a tablet with a knife and crush it, if necessary, with the back of a spoon.)
 
4. Depending on how much medication you wish to take, a .5mL, 1mL, 5mL, or 10mL oral syringe to take a measured amount of the drug.

How to mix the liquid
 
1. Prepare the drug.
 

....
If you want to make your own liquid you may not need to crush the pill. I don't recommend it, because small amounts are lost as powder. First just try putting it in water and see if the pill dissolves on its own. It may take a little while, my one that's coated takes about ten minutes. If it doesn't dissolve in water then try to crush it directly in the container that you're going to be adding water to, so powder won't be lost.
....

 
Alternatively, if your medication is in tablet form, you can

  • cut the tablet up into rough quarters with a pill cutter or knife
  • crush the tablet into powder using a pill crusher or mortar and pestle
  • cut it up and carefully crush it with the back of a spoon on a piece of waxed paper

If your medication is a powder in a capsule, carefully open the capsule above the container and pour the contents into the bottom of the container.

To open a capsule, grasp each end in your fingers and gently twist. The capsule should come apart in the middle. Do this over the open container, to catch the powder in the container.
 
2. Measure the water (or pharmacy liquid)

  • With an oral syringe: Draw room temperature (not hot, not cold) water into an oral syringe and convey it to the container. A 10mL (10cc) or 20mL (20cc) oral syringe is handy for this purpose.[br][br][br]

    For example, if you wish to make 30mL of a solution, fill the 10mL syringe 3 times with clean water and inject it into your container.
  • With a graduated cylinder: For example, if you wish to make 30mL of a solution, fill the graduated cylinder to the 30mL mark and pour it into the container.
  • With a 100cc (100mL) medicine bottle: Fill carefully to the 100cc or 100mL line. You'll have to bring the bottle up to your eye level to do this. Please note the measurements on these bottles are less exact than the graduated cylinder.

To mix, put the cap on the container, tightly, and shake it gently. You will be able to see particles swirling around in the water (some of the filler used in tablets and capsules is insoluble).
 
Wait until the tablet chunks are dissolved before taking a dose.
 
How much liquid should I use to make my suspension?
The only tricky thing about making a solution is creating and remembering the concentration: the ratio of drug to liquid.

The easiest concentration is 1:1 or 1mg medication in 1mL solution. Examples:

  • If you want to take 18mg Prozac, for example, you can mix 20mg with 20mL water and take 18mL, which contains 18mg Prozac.
  • You could put a 10mg Paxil tablet in 10mL water for a 1:1 dilution. There would be 1mg in 1mL and 0.1mg in 0.1mL. The 1:1 dilution would require a small 1mL oral syringe. To reduce 10% from 1.1mg, you would take 1mL. Another 10% reduction would be 0.9mL.
  • You may find a 1:1 dilution to be a little thick or grainy. For convenience, you may wish to make a higher dilution of a 10mg tablet in 20mg water for a 1:2 ratio. There would be 1mg in 2mL and 0.1mg in 0.2mL. If you made this liquid, your dose would be 2.2mL (1.1mg). To reduce by 10%, you would take 2mL (1mg).

For doses of hundreds of milligrams, you may want to make a higher concentration. Examples:

  • To taper from 100mg Lyrica to 90mg, you can mix 100mg Lyrica in 50mL water, making a 2:1 concentration, each 1mL containing 2mg Lyrica.
  • Or, you can mix 100mg Lyrica in 25mL water, making a 4:1 concentration, each 1mL containing 4mg Lyrica.

Keep a note of the concentration! Be sure make a note of your recipe ("100mg Lyrica in 50mL water") and dosage instructions to yourself: "Take 45mL for 90mg Lyrica."
 
What if my medication is "insoluble" in water?
About solubility or insolubility, our esteemed member Rhi, who has lab experience, has made many, many homemade liquids:


.... I just wanted to toss in my usual bit on the subject of making preparations for liquid tapering, which is: I personally don't worry about solubility.
 
None of the meds I'm tapering are actually soluble in water. But the pills dissolve into small enough particles that I can stir them up and keep them suspended in water while I measure them out, and that seems to work for me. I stir well before I measure, I stir a little while pipetting them up; I dissolve the pills in glass and pipette out of glass so that I can see visually how evenly everything is suspended, and that's good enough for me.
 
I use water as a medium because I like it that I can easily see for myself how evenly the little particles are suspended or if they seem to be settling out. Also because it's handy and cheap and I don't have to carry it with me if I travel.
 
Mostly I would just say, I don't think it really matters if the medication is soluble in whatever vehicle you're using, as long as it can be evenly distributed. What really matters is that it be evenly distributed and that your method be repeatable and consistent.

 
Measure your dose and take it
With a liquid, you use an oral syringe to take the dosage you wish.

  • Get your oral syringe ready.
  • Put the cap on the container and shake it gently. (You may see particles swirling around, this is normal.)
  • Using the oral syringe, draw from the middle of the liquid, not from the top -- there may be less drug there, it sinks to the bottom.
  • If your bottle cap has a hole in the top, draw the liquid from the bottle by following these instructions.
  • If this is still confusing, ask your pharmacist to show you how to use an oral syringe

Ex: If your liquid is a 1:1 concentration, containing 1mg in 1mL, and you want to take .5mg, you would take .5mL of the liquid. You can adjust the amount you take as you continue your taper. See Using an oral syringe and other tapering techniques

Also see http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__50942
 
Refrigerate homemade liquids
Most homemade solutions may keep for at least a few days, refrigerated. Drugs tend to be degraded by heat and light, which is why pharmacy containers are tinted.
 
Refrigeration delays the growth of bacteria and mold in your homemade liquid, which was not made under sterile conditions.
 
To find tips for your particular drug
See Important topics in the Tapering forum and FAQ . (You can also Google your "medication soluble stability" to see how long yours will keep.)
 
For more information, consult a pharmacist.

Edited by Shep
updated links

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Where do I buy these syringes. I see some on amazon. They don't say graduated though.

 

I'll PM you with local info. Most syringes are graduated, so you usually don't see this in the description. Those from compounding pharmacies are best as they are made for repeat dosing and the print does not smudge.

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If only I'd had this information 10 years ago (sigh).

 

I know right. I feel for the people that had no help and information like this. Do you know if an oral dropper is as accurate as an oral syringe?

 

Posted Image

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A dropper is not likely to be as accurate as a syringe.

 

However, if it's all you can get, it's better than nothing.

 

If you're using a fairly concentrated liquid, accuracy is more important. If you're using a really dilute solution you can get away with less accurate measuring apparatus.

 

Also, Alto wanted me to mention something about the use of graduated cylinders.

 

I use graduated cylinders and pipettes for my own taper and measuring. (Pipettes are basically equivalent to syringes--just bigger.)

 

If the biggest syringe or pipette you have is 10 mL, and you want to measure out more than about 40 mL of water, it's better to use a graduated cylinder. (Otherwise you can do four or fewer pulls on the syringe)..

 

If you Google "graduated cylinder" or look on Amazon, you can see what a graduated cylinder looks like. It's tall and cylindrical with small markings all along its length for measuring. You may want to Google "beaker" too so you can see the difference and not get them confused.

 

Graduated cylinders are easily available via Amazon or other websites.

 

And before you use the cylinder, if you haven't used one before, read this: http://chemistry.about.com/od/chemistrylabexperiments/qt/meniscus.htm

 

To repeat, if you need to measure out more than about 40 mL and you don't have a syringe that large, you'll get the most consistent results using a graduated cylinder. (If you do more than about four pulls with your syringe, you're going to be introducing a lot of random error into your total measurement, enough that it could affect your dosing.)

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Thanks Rhi, again :)

 

I was wondering why the graduated cylinder was more precise in measuring than a regular measuring cup. That article helped, as it does stand to reason now that the wider the cup, the more accuracy is lost due to the "meniscus" issue. Good information. I went ahead and accepted the graduated cylinder I bought at Amazon. I got a plastic one and it was only about $7.

 

I need the syringe for pulling out my reduction amount. After my failed attempts at sloppy tapers with the Xanax, I want to be precise and get it right now.

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I was on a powered capsule benzo and it tended to dump too quickly for me to get an adequate removal. I went to see a compounding pharmacist who made up a suspension agent to mix my capsule with. I shook the powder and agent together in a closed jar. The powder was distributed more equally and stayed suspended in the mixture. I got a much more accurate removal each time. I was able to keep the mixed portion in the refrigerator to reuse for 4-5 days. The suspension agent was about $ 10.00 (about one pint) which I was able to use in new mixtures over a few weeks.

 

I measured the amount of suspension agent I needed for calculated titration into the calibrated tubes. It was like being a chemist but it worked for me.

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Thanks for that excellent suggestion, Aria -- rather than water, get a liquid from a compounding pharmacy to mix with your medication.

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Precision Versus Accuracy:

 

When tapering, precision is more important than accuracy.

 

For this sentence to make sense you need to know the difference between "precision" and "accuracy." It's not a distinction commonly made in everyday speech.

 

Accuracy is how correct a measurement is. If you measure using a certain container or syringe, is the amount you measure really correct? You could have a container that's off, that says it holds 10 mL when it really only holds 9.5 mL, or says it holds 2 cups when if carefully checked it actually holds two and an eighth cups. If you measured using those, your amounts would not be accurate.

 

Precision is how close and how repeatable a measurement is. If you have a measuring device that says it measures 1.5 mL but when you use it you actually get 1.4 mL, it's not accurate, but it can still be precise. If when you use it five times you get, say, 1.41 mL, 1.4 mL, 1.415 mL, 1.39 mL, and 1.385 mL, that's pretty precise, even though it's not accurate. But if you get, say, 1.7 mL, 1.2 mL, 1.85 mL, 1.6 mL, and 1.1 mL, it's not only not accurate, it's also not precise.

 

This is the concept that's tricky. When I learned it there was a picture of a dartboard. Unfortunately I don't have that picture, so I'll describe it and hope that works.

 

Imagine a dartboard. It has the usual round target shape with the central circle that you're shooting for. Now imagine that someone has thrown five darts at it.

 

Case 1: The five darts are all in a tight cluster the middle at the target. That's accurate and precise.

 

Case 2: The five darts are kind of in a circle around the center of the target. That's accurate, but not precise.

 

Case 3: The five darts are all in a tight cluster but on some other part of the board, not at the center of the target. That's precise, but not accurate.

 

Case 4: The five darts are all over the place. That's neither precise nor accurate.

 

So how does this apply to tapering? Well, in tapering, what really matters is how closely you can control changes in your dose. It doesn't really matter so much if you're measuring exactly 1.5 mL, but whatever you ARE measuring it needs to be pretty much the same each time, not all over the place so you're getting really different doses each time.

 

So, for example, I don't think syringes are as accurate as pipettes, but I think they're just as precise, so for tapering purposes they're just fine.

 

A cooking measuring cup isn't as accurate as labware, and unfortunately it's not very precise either; 2 mL more or less isn't going to make much difference in a recipe, so you don't need to use graduated cylinders to make a pie.

 

An eyedropper or medicine dropper is probably fairly accurate, give or take, but it's not precise--very difficult to control the measurement so that it's really the same amount each time.

 

A plastic graduated cylinder that was made in China for science fair experiments is probably not going to be as accurate as quality labware, but as long as you use it the same way every time (measure with the meniscus in the same place every time) it's going to be just as precise.

 

The important thing with tapering is that the measurements need to be consistent and repeatable and done the same way every time, so you don't get big variations in dosage, and they need to be done using equipment that's designed to be precise.

 

Hope this makes sense! If it doesn't, don't worry about it. You'll be fine regardless. But I thought I'd explain it for people who are doing their own liquid tapers and might find these concepts helpful to play with.

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Very good point, Rhi. Consistency in measurement, which often means using the same devices the same way each time you measure, is the key.

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Hi

 

Please may I ask a question?

Use the oral syringe to measure room temperature (not hot, not cold) water and convey it to the container. A 10mL (10cc) oral syringe is handy for this purpose.

Why does the water have to be room temp?

 

Thanks

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Because the powder may not dissolve in cold water, and hot water might damage the chemicals.

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Another way to look at it. It is ok if the measuring instrument that you are using is " precisely inaccurate " . IOW , as long as it is measuring "consistently wrong" you can be confident that you are taking the same dose. Precisely inaccurate is a much, much better way to understand the concept but consistently wrong may make more sense until you can wrap your head around what Rhi so eloquently explains.

 

I think the key here is that we all want to make sure that we are reducing our dose by as close to exactly the same amount each day so that we can eliminate second guessing like " I wonder if I have this symptom because I took a slightly different dose yesterday or the day before or the day before that " .

 

 

Consistency in measurement, which often means using the same devices the same way each time you measure, is the key.

 

Exactly. Or I should say. Precisely :P

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What about the colored coating of the pills? Would you just mix this in the water as well?

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What drug are you referring to? Does it have a hard coating?

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What drug are you referring to? Does it have a hard coating?

I'm referring to brand name Paxil, which all have a soft colored coating.

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I would crush it, dissolve it well, and make sure to shake the suspension before drawing out a dose.

 

Paxil is available in a liquid, which would be preferable.

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I would crush it, dissolve it well, and make sure to shake the suspension before drawing out a dose.Paxil is available in a liquid, which would be preferable.

I know, but it's insanely expensive if you are uninsured. Like $250 a bottle or something. I'm also scared of the switch, since some people do not tolerate the liquid Paxil well. I can't even tolerate generic Paxil so I always figured I would be one of those unlucky ones who wouldn't be able to tolerate the liquid Paxil. I'm just scared that my shaving and weighing is not giving me an accurate dose, and at these low doses that's so important.

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I have been experimenting today with effexor beads (brand rodomel). I dropped from 

4 beads to 3 on 2nd November, a reduction of 25% because there was no choice. The 

capsules are slow release and contain 400 beads. Who would think that just 1 bead

could lead to withdrawal symptoms? All was fine for around 4 weeks then the dreaded 

insomnia came. 

I decided to try and dissolve the beads for the rest of my  taper.

 

After 5 hours sitting in water they were still whole and floating on water.

 I took a fresh one and crushed it in a pill crusher then added a teaspoon of water.

The shell did not dissolve but went clear and floated on top of the water.

The powder seemed to settle on the bottom so I picked off the shell with tweezers.

I swirled the liquid around but couldn't see the powder in the liquid so I assume it dissolved

 I will be trying this when it's time for my next drop, 

Watch this space! 

Edited by mammaP
Corrections

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The easiest concentration is 1:1 or 1mg medication in 1mL solution. If you want to take 18mg Prozac, for example, you can mix 20mg with 20mL water and take 18mL, which contains 18mg Prozac

 

Alto if I am taking 50mgs. Serzone what size syringe should I get and does this mean I would fill a syringe with 50mgs. or 50mL of water - crush a 50mg. tablet - mix and then withdraw 40mgs. to drop one mg.?

 

This stuff confuses the daylights out of me

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Nikki, you explained it yourself.

 

If you make a 1:1 solution of 50mg in 50mL, you would take 45mL to accomplish a decrease of 5mg (10%).

 

It might be handier to make a solution of 50mg in 10mL (5:1). To decrease by 10%, or , you'd take 9mL.

 

Either way, it might be easiest to remove the decrement and throw it away, then drink the rest.

 

Please ask a pharmacist to help you decide on what oral syringe to use.

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thank you....yes I did answer it myself but I made a typo meant to type 49 instead of 40...

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It seems to the rule that you should not store your DIY liquid for more than 3-4 days.

 

Doesn`t that prove the fact that the liquid is losing it`s medical effect very fast? So even if make only 3 days worth of medicine, every dose is less effective that previous?

 

I`m noticing a pattern that I feel better when I take my 1st dose. Days 2 and 3 are downhill and things get a little better when I make a new patch. I can not be sure about this yet but I`m very scared to experiment any further.

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It's possible it will degrade. Heat and light usually will accelerate this process. Keep homemade liquids refrigerated, preferably in a dark-colored container.

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I'd like to just add that if you switch from pill to liquid you likely should updose because your body will interpret it as a withdrawal. I could not stabilize on liquid and had to resort back to cutting/filing which is not as accurate unfortunately,

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ks, that is not always so. Many people switch to liquid without a problem. Others experience it as too strong because a liquid is absorbed faster.

 

It's an individual thing. Once you make the switch, give it some time -- it takes about 4 days for your system to register a change in dosage -- and then see if you need to adjust the dosage of the liquid.

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I updosed and after two weeks became more and more unstable. Now I am in a worse position than before if I had just stayed with dry cutting, I didn't say everyone would have to but it is likely you might. Just putting it out there since I didn't see anyone say it.

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There are always uncertainties when you make any changes in these drugs, which is another reason they are dangerous.

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It seems to the rule that you should not store your DIY liquid for more than 3-4 days.

 

Doesn`t that prove the fact that the liquid is losing it`s medical effect very fast? So even if make only 3 days worth of medicine, every dose is less effective that previous?

 

I`m noticing a pattern that I feel better when I take my 1st dose. Days 2 and 3 are downhill and things get a little better when I make a new patch. I can not be sure about this yet but I`m very scared to experiment any further.

 

Can you test this by just making it up fresh each day for a week or so, keeping a log of your symptoms, then experiment with two days at a time, then three?

 

As long as you don't make large changes abruptly, I encourage you to experiment and find out what works for you. All we have here are our own experiences, no real large-scale data, so the safest and best way is for everyone to become expert on herself or himself.

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Zoloft is available as a liquid in many parts of the world. Ask your pharmacist.

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ks, that is not always so. Many people switch to liquid without a problem. Others experience it as too strong because a liquid is absorbed faster.

 

It's an individual thing. Once you make the switch, give it some time -- it takes about 4 days for your system to register a change in dosage -- and then see if you need to adjust the dosage of the liquid.

 

I have been wondering about the same thing. I suspect that the body absorbs the drug maybe differently, if it's swollowed in a capsule or drank in water solution? I'm thinking of going to prozac water solution soon, in order to make supersmall cuts. those seem to be better to me. 

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Found this extensive article about stability of drugs in suspending agents like Ora Plus. It's a bit of a dense read but the basic take home message is that of the 60-something drugs reviewed only something like 8 are unstable in aqueous suspending medium. There's a list of those in the first paragraph.

 

Solution in water isn't quite the same as an aqueous suspending medium like Ora Plus, but for me it's close enough--if water was going to degrade the chemical it would do so in the Ora Plus as well.

 

However if you want to make your own, you can buy Ora Plus from Amazon and probably other places on the Internet.

 

http://www.ualberta.ca/~csps/JPPS9_3/MS_973_Review/MS_973.html

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Thanks, Rhi!

 

Those drugs that you can't mix with a suspending agent:
 

captopril, hydralazine hydrochloride, isoniazid, levothyroxine sodium, phenoxybenzamine hydrochloride and tetracycline hydrochloride

 

....Interestingly, the instability in these formulations is primarily due to interactions between the drug substance and the excipients rather than degradation of the active pharmaceutical ingredient by standard routes such as oxidation, hydrolysis, photolysis or thermolysis. This low percentage however illustrates the low risk associated with these dosage forms investigated. It may be concluded that when considering the safety and efficacy of liquid dosage forms prepared extemporaneously, it is thus important to consider not only the stability of the drug substance but the entire formulation.

 

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Does anyone know if you can use oraplus with Remeron instead of using water as a mixing agent??

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You can use Oraplus with Remeron if you wish.

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Feel free to move this if it is not in the right place. I looked around and could not find any other place that looked more appropriate to post this question.

 

I will try to be as clear as possible.

 

In liquid tapers, the advice I have seen looks like this:

1)Make suspension

2)Pull % of liquid out that would equal your intended cut, throw it away

3)Pull doses for the day

 

It is easier for me to do it this way for some reason...

1)Make suspension

2)Pull doses for the day

3)Throw out excess liquid at the end of the day...this liquid is the % cut.

 

 

This way is ok...? There is a distinct possibility I am overthinking this, given my current mental state :(

 

I just don't want to make mistakes.

 

Again, please move this if it isn't in the right place.

 

Thx

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