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Using an oral syringe and other tapering techniques

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Altostrata

Insulin syringes are widely available at very little cost. In the US, you do not need a prescription for them. Remove the needles, as mammaP did, to use as oral syringes (dispose of the needles safely).

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Skyler

Just a PS.. I tried using an insulin syringe and was not able to get the needle off... and I seem to remember the pharmacist was not able to either.  Maybe some are adaptable while others are not? 

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Altostrata

Next time you are in a medical supply store, please ask them what to do.

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primrose

You can buy Terumo hypodermic syringes online, the needles come detached from the syringe, so you don't need to mess about taking a needle off. You can get these on Amazon or other places online, pretty cheaply. I used them in my valium taper and they were great. Keep them in the fridge and wash them out regularly.

They did get a bit stiff, but I found that the milk I used lubricated them with a tiny film.

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primrose

Primrose... were you able to get the .5 ml size?  I can't find that size on Amazon and I sure could have used this at one point.

 

When I was tapering tiny tiny amounts of diazepam, I could have used this size syringe... my eyes were going in circles trying to measure .025 mg cuts, etc.

Hi Skyler

 

I used the 1ml size syringe. I was able to get the really tiny cuts measured this way.

You need the 1ml one with markings, and to get the smaller cuts, I would just use a more dilute mixture.

A handy thing to do is to put some clear sellotape on the markings on the barrell, that way, they stay on when washed, because otherwise, the markings quickly come off.

This is a UK link, but these were the syringes I used.

http://www.amazon.co.uk/Economed-Terumo-1ml-Syringe-100/dp/B002ZGVR7M

I may have a spare that I can send you if you want, I will have to check as I am not sure I have any left, would you want me to send you one?

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Skyler

The problem was, I could not do this with the generic diazepam liquid, which I used for that taper... though I think it may be possible with the suspensions we make ourselves.  When I said the pharmacist told me it was not possible to get the needle off the syringes it was for a .5 ml syringe size.

 

Thanks for your info.

 

PS... us folks over 40 or 50 sometimes don't have near vision that is as acute as yours! :)

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primrose

The problem was, I could not do this with the generic diazepam liquid, which I used for that taper... though I think it may be possible with the suspensions we make ourselves.  When I said the pharmacist told me it was not possible to get the needle off the syringes it was for a .5 ml syringe size.

 

Thanks for your info.

 

PS... us folks over 40 or 50 sometimes don't have near vision that is as acute as yours! :)

Hi Skyler, sorry i didn't realise you were using liquid, I missed it in the thread, my apologies.

I have known, however, people do successful micro tapers by diluting the diazepam liquid.

 

I got diazepam liquid, sandoz and actavis brand, and I swapped them back for pills, as they got on my nerves and I found actavis pills worked really well with milk.

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Altostrata

The 1 milliliter syringes show hundreds of a milliliter.

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Newbeginning

Hello,

 

I just realized I've been doing the syringe wrong. I've been putting the syringe directly inside the bottle (my bottle does not have a cap with a tiny hole for the syringe). The nurse never told me I needed that. I will try to get one from the pharmacy, but I'd like to know: what difference does it make if I put the syringe directly into the bottle?

 

I'm following the advice in this thread and using the uppermost black plastic level as the target to align with the dosage numbers on the syringe. I did not realize I was being insonsistent before. I also realized I was using less medicine than intended many times because the syringe would give the ilussion that it was fuller than it actually was. Nut sure if it was air or left over liquid from before or what, but it would show there was liquid at a higher level than it actually was.

 

Anyone else had this issue? How did you address it?

 

I believe I experienced withdrawal again because of this, so I'm back to the dose I started with when I switched to liquid prozac 3 months ago and will taper from there, making sure I measure right and consistently now.

 

Hoping to get some advice because this measuring with the syringe is turning into a very confusing and scary activity (scary because I'm never sure i measured right!)

 

Thanks!

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Altostrata

You can dip the syringe in the bottle. The problem with this method is you'll probably get air bubbles in the syringe along with your liquid. You'll need to tap the syringe to get the air bubbles to go out the nozzle. This is frustrating, but doable.

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Newbeginning

Thanks Alto. I think that might explain why I kept seeing the level of liquid higher than it actually was. I had read your posts about getting rid of air bubbles, but I'm not sureI understood them correctly.

 

Do you just tap the syringe against the table or tap it on several sides or? How do you know the air bubbles are gone or even that they're there? I see what lookslike liquid inside but apparently it's not liquid.

 

The worse part is I noticed this too late. Now I've been havong apathy and depression for amonth. Some of the symptoms subsided after a few days on the higher dose, but for the most part I'm not better. Usually it just takes a few days of a stable dose to stabilize me, but this time it's taking longer so maybe it's not just withdrawal.

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Altostrata

  1. Draw more liquid into the syringe than you will need.
  2. Hold the oral syringe with the nozzle pointing upward.
  3. Look for air bubbles. Snap your fingernail against the air bubble in the oral syringe. (In old movies, you'll see the doctors and nurses doing this before giving someone a shot.) This will dislodge it and allow it to float to the top. Several snaps or taps against a tabletop may be required.
  4. Tilt the syringe to guide the air bubble upward to the nozzle so it will go out of the syringe.
  5. You may need to press on the plunger to push the air bubble out.
  6. Press on the plunger to measure your desired dosage.

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Newbeginning

Just want to share that I found another way to use the syringe that minimizes air bubbles and other measurement errors: I put a little liquid in one of those small measuring cups (the ones you often get with liquid medicine) and draw the liquid from the cup instead of the bottle. I put about half an inch high of liquid. After I'm done drawing I just deposit the rest of the unused liquid back into the bottle.

 

I have no idea why, but it works a lot better than drawing directly from the bottle

 

I'm sharing in case anyone else has difficulty finding a bottle that has a "cap" with a tiny hole to insert the needle of the syringe. I did. my pharmacy doesn't offer it, and the bottle I bought does not come with it.

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Newbeginning

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Rachelina

So, after crashing in November I've finally come to feel stable enough to start tapering again. I wanted to make a tiny drop of around 2.5%, so I went from 2 mg to 1.96 mg, which is two tiny lines on my syringe. But today I noticed that when lowering the plunger from the 1 mL (2 mg) mark down two lines, nothing comes out!! In fact it takes a whole five lines, or .05 mL (.1 mg) before a drop comes out! And it's kind of random whether the drop is going to come out or not. Sometimes it just hangs there, undecided. So now I'm really worried about the accuracy of tapering by liquid. Is it really impossible to make drops any smaller than .1 mg? Why are the smaller lines even there if they don't mean anything? Or do they mean something after all, am I somehow getting a lower dose on average by going down two lines even if nothing comes out? 

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Rachelina

Can anyone who uses a 1 mL syringe tell me how many drops come out when you push the plunger from 1 mL to 0? The consistency of the liquid makes some difference - when I do this with Paxil, 20 - 22 drops come out, but when I use water, only 15 or 16 drops come out. But my point is, unless you are getting 100 drops to come out, aren't those smaller lines meaningless? And the fact that sometimes I get 20 drops and sometimes 22 raises a whole different concern, which is that even if you only care about using the larger lines, you could be getting a different amount of medication each time you dose. 

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Altostrata

Do not measure by drops -- use the ticks on the syringe to measure your dose. If you can't figure them out, please go to a pharmacist and ask for an explanation.

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Rachelina

Thank you Alto. I have always used the ticks and it's not that I can't figure them out. I just don't see how the smaller ticks mean anything if it takes going down five of them for any liquid to come out. That means I haven't actually dropped my dose by going down two lines.

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Altostrata

What size syringe are you using, for how much of a dose in milliliters? When you push the plunger all the way down, everything that's in the syringe should come out unless it's full of air. (There will be a tiny bit of liquid left in the nozzle, disregard this.)

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Rachelina

I'm using a 1 mL syringe and have been taking 1 mL for a few months. I decided to make a tiny drop of .02 mL (so, two lines on my syringe). My concern is that when I lower the plunger from 1 mL down two lines, no liquid comes out. So it seems I have not dropped at all. I have to push the plunger down 5 lines before any liquid comes out.

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Altostrata

Thank you, now I understand better. No drops are coming out because they're going into the nozzle, which is filled with air. When the nozzle fills with liquid, drops will come out. You need to make sure you get the air bubbles out.

 

The best ways to fill a syringe to reduce air bubbles:

 

- Using the adapter ("korc"), put the syringe in the adapter, turn the bottle upside down, then draw exactly the amount you need into the syringe. (If you draw a little more, push the plunger up to push the liquid back into the bottle.) Turn everything right side up and then detach the syringe.

 

Check for air bubbles. If there are any, attach the syringe to the bottle again, push the liquid back into the bottle, and draw again.

 

- Push the empty plunger all the way down, dip the tip of the syringe into the container, draw a more than you need. Turn the syringe with the nozzle pointing up and examine for air bubbles.

 

Most likely, there was air in the nozzle when you put the nozzle in the the container. If there are air bubbles in the syringe, snap your finger against the syringe or tap it against something to shake the air bubbles loose of the sides of the syringe and float to the tip. Gently push the plunger to force the air bubbles out of the nozzle and the liquid into the tip. Then carefully push the plunger to get your desired dose, capturing the extra drops in the container.

 

The last method is fiddly, you will need patience, but you need to get the air bubbles out for an accurate measurement of dose, especially when you're working with such tiny amounts.

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Fresh

Try turning the syringe upside down after filling it , and giving it a couple of flicks so that any air goes up to the top.

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Altostrata

Upside down meaning nozzle end up!

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Rachelina

Thank you! The air in the nozzle could definitely explain why no liquid comes out between the 1 mL line and the next two lines. But the weird thing is that when I push the plunger from 1 mL to 0, the liquid keeps coming out at a rate of one drop every five lines. So I'm going to have the same problem all the way down. I don't see how air bubbles could account for this, because it happens even when I can't see any bubbles. I will try the dosage korc and see if that changes anything. And thank you for the tips on getting rid of bubbles, which I agree is essential when working with such small dose changes.

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Skyler

Hi Rachelina... I had the same issue when I reduced liquid diazepam by very small amounts.  I managed this by touching the tip of the syringe to my tongue when discharging the liquid .. that way I even got half a drop!  I could tell because the liquid had a distinctive taste.  You could also touch the tip of the syringe to your finger, and wipe off the amount by which you want to reduce; you should see a tiny wet mark when you do, then ingest what is left in the barrel.

 

edited last line.

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ChessieCat

Just a thought so putting the idea out there.

 

Would it be okay to dilute the liquid so that you measure out a larger amount???

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Rachelina

That's exactly what I have been wondering, ChessieCat! Ladybug kindly found me a thread where someone discussed doing this, but I couldn't tell if they ended up doing it or not. Anyone know if this is OK to do?? The issue would be whether or not the medication was mixed exactly evenly in the solution.

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Skyler

I used to dilute mine, and when I got to low doses, would put the tip to my tongue as described above.  Are you making your own liquid, or using some made up by a compounding pharmacy.. if the former, there is no problem adding more of the same diluent, if the latter, I'd suggest you ask the compounding pharmacy to make sure what you are diluting with is okay, as the compounding pharmacies use different solutions at times.  When medications are diluted with water they should be stored in the fridge, and for not longer than 3 days.

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Altostrata

Excellent suggestions all, thank you.

 

The gradations of the 1mg syringe are very small, it could be one drop is all there is between ticks!

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Fresh

I've been looking for syringes that measure smaller than 1mg , and may be onto something.

 

This glass syringe can measure down to 10ul (gas volume measurement).  

 

250ul = 0.25ml.    This implies you can measure down to 0.01 ml accurately.

I'm sure there would be less expensive ones if you look on Amazon or Ebay.

 

1701N 10µL Syringe (26s/2"/2)
$27.00/EA 1/EA

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Rachelina

I used to dilute mine, and when I got to low doses, would put the tip to my tongue as described above.  Are you making your own liquid, or using some made up by a compounding pharmacy.. if the former, there is no problem adding more of the same diluent, if the latter, I'd suggest you ask the compounding pharmacy to make sure what you are diluting with is okay, as the compounding pharmacies use different solutions at times.  When medications are diluted with water they should be stored in the fridge, and for not longer than 3 days.

I am using the manufactured liquid. If I could find a compounding pharmacy, would they mix it to the concentration of my choosing? That might be worth a try. Thanks for the information about storing diluted medications, I was wondering about that. And by the way, with my benzo taper I'm noticing the same thing you did when measuring very low doses. Nothing really comes out when I'm trying to measure .1 mL or .05 mL. I don't worry much about it because my Klonopin liquid is so diluted, I'm using a 50 mL syringe for most of it and just use the 1 mL syringe to make up the decimal point. But with my Paxil it's so concentrated that a drop makes a big difference.

 

Excellent suggestions all, thank you.

 

The gradations of the 1mg syringe are very small, it could be one drop is all there is between ticks!

Alto, if I were getting one drop between ticks that would be wonderful! The problem is that I'm getting one drop every five ticks. So going down one or two ticks is not reducing anything, except once in a while when it's reducing by a lot. Anyone using a 1 mL syringe is going to have this problem. You just don't tend to notice, because while you're measuring your dose your eyes are focused on getting the plunger to the right line, not on what's coming out (or not coming out) of the nozzle. 

 

 

I've been looking for syringes that measure smaller than 1mg , and may be onto something.

 

This glass syringe can measure down to 10ul (gas volume measurement).  

 

250ul = 0.25ml.    This implies you can measure down to 0.01 ml accurately.

I'm sure there would be less expensive ones if you look on Amazon or Ebay.

 

1701N 10µL Syringe (26s/2"/2)
$27.00/EA 1/EA

 

Thanks for this, Fresh. Another option to consider.

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Rachelina

And then there's the fact it's kind of random whether a drop is going to fall out or not. Sometimes it just hangs there as if undecided. Do I catch it with my tongue or let it fall back into the bottle? There's .1 mg in that drop, so it makes a pretty big difference! What it comes down to is that this liquid is too damn concentrated. 

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Skyler

And then there's the fact it's kind of random whether a drop is going to fall out or not. Sometimes it just hangs there as if undecided. Do I catch it with my tongue or let it fall back into the bottle? There's .1 mg in that drop, so it makes a pretty big difference! What it comes down to is that this liquid is too damn concentrated. 

 

Rachelina... I'm kind of stymied here because I don't see the importance of a drop falling out?  If you wipe off the liquid residue, either on your tongue, or on your hand, it does not matter if a drop falls.  Going by drops is not a good way of getting an accurate measurement.

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Rachelina

 

And then there's the fact it's kind of random whether a drop is going to fall out or not. Sometimes it just hangs there as if undecided. Do I catch it with my tongue or let it fall back into the bottle? There's .1 mg in that drop, so it makes a pretty big difference! What it comes down to is that this liquid is too damn concentrated. 

 

Rachelina... I'm kind of stymied here because I don't see the importance of a drop falling out?  If you wipe off the liquid residue, either on your tongue, or on your hand, it does not matter if a drop falls.  Going by drops is not a good way of getting an accurate measurement.

 

It matters because each drop is roughly .1 mg, which is more than the amount of the reductions I'm trying to make. So of course it matters whether the drop goes into my mouth or back into the bottle. I'm not measuring my dose by drops, I'm using the lines on the syringe. I just happened to notice that a drop is equivalent to around .1 mg. Maybe I never should have bothered figuring that out, but now that I know it I can't unknow it. 

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Altostrata

Thanks to Lise:

Thanks for the answer! :)
Since I last wrote I have been questing all over Ye Olde Internet and found out that:
such a thing as microlitre syringes actually does exist - and I've ordered one (100 microlitre with 0.2 microlitre intervals) at a very reasonable price (around five dollars) from Germany.
I've also found a microlitre pipette and will test that out.

A microlitre is 0,001 ml.

If that doesn't work, the next step is ordering an electronic pipette. Price is steeper, but still somewhat affordable (120 dollars).
Also, I'm contacting Lundbeck to ask if water is indeed usable for diluting liquid Lexapro (it says alcohol for the liquid on the bottle). They were very helpful with a question about exposure to sunlight last year!

Will of course share my experience/info in here. Wondering if this is the right thread to do so? Or if another is preferable?

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Bellatrix

I have liquid escitalopram. My psychiatrist told me to measure out my dosage and squirt it into some water and drink it. The pharmacist said to squirt it right into my mouth and the water would dilute it. Whose right? 

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