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Medical Forum / General / Pharmacy / December 2006Do it yourself medicine preparation
Hi all, A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He has got down to a single .5mg tablet a day, which is the smallest preparation available. His doctor has insisted there is no way to get any other preparation to aid in tapering the doseage off. I am sure I could use a pestle and mortar to grind the tablets into a powder, and then weigh and measure that powder into a gelatin capsule. That way I could prepare 0.4mg, 0.3mg, 0.2mg, 0.1mg doses. However, since I know nothing about pharamdynamics or whatever the science of medicine absorption is, I don't know if there is a clinical difference between taking a straight tablet, and taking the same medicine in a capsule. Could anyone advise please ? [uk.misc and uk.diy added as I'm in the UK, and they sometimes have some clever people [1]] [1] not often though [2] [2] that's a joke >A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He >has got down to a single .5mg tablet a day, which is the smallest >preparation available. > >His doctor has insisted there is no way to get any other preparation to >aid in tapering the doseage off. [etc] When I have come off various meds at various times, I've gone from (for instance) .5mg a day, to .5mg every other day, then after a couple of weeks, every third day, then stopped. It saves messing about, and avoids any problems with enteric coated meds.  SignatureJAF anarchatntlworldfullstopcom Keep Science Scientific BCSE http://bcseweb.org.uk >>A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He >>has got down to a single .5mg tablet a day, which is the smallest [quoted text clipped - 9 lines] > every third day, then stopped. It saves messing about, and avoids any > problems with enteric coated meds. Much better idea than grinding up the pills. Signature"Other people are not your property." [email me at huge [at] huge [dot] org [dot] uk] > >A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He > >has got down to a single .5mg tablet a day, which is the smallest [quoted text clipped - 9 lines] > every third day, then stopped. It saves messing about, and avoids any > problems with enteric coated meds. I know what you mean, and that was my first thought. Sadly the half-life of Rivotril won't allow that approach .... >> >A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He >> >has got down to a single .5mg tablet a day, which is the smallest [quoted text clipped - 12 lines] >I know what you mean, and that was my first thought. Sadly the >half-life of Rivotril won't allow that approach .... I take rivotril, nightly. The tablets have two break lines on one side, which suggests you can get as low as a .125mg dose, safely. SignatureJAF anarchatntlworldfullstopcom Keep Science Scientific BCSE http://bcseweb.org.uk > >A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He > >has got down to a single .5mg tablet a day, which is the smallest [quoted text clipped - 9 lines] > every third day, then stopped. It saves messing about, and avoids any > problems with enteric coated meds. I understand what you mean (sort of time-division multiplexing). The problem is Rivotril (unlike diazepam) has a very short half life, so withdrawal symptoms become apparent over a 2 day break. I have since discovered that Roche now supples wafers in 0.125 and 0.25 mg doses. However, my friends doctors don't believe the Roche website, and won't even try to order them. On a tangential note, this entire sorry saga is characterised by **** all help from his "healthcare professionals". The more I read about benzodiazepienes, the more I am convinced the "war on drugs" should start at home ..... jethro_uk@hotmail.com jethro_uk@hotmail.com wrote in <1166193926.443759.126140@73g2000cwn.googlegroups.com>: > > >A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He > > >has got down to a single .5mg tablet a day, which is the smallest [quoted text clipped - 21 lines] > On a tangential note, this entire sorry saga is characterised by **** > all help from his "healthcare professionals". Time to change GP IMO. If it's at all possible. If they are crap then get another. If there isn't an alternative locally then demand to be referred to a specialist. If they won't do that then contact your MP's office. Heads can be jumped on. > The more I read about benzodiazepienes, the more I am convinced the > "war on drugs" should start at home ..... They should only be prescribed if there is no alternative. That's been the official position since the late eighties. The problem is that lay GPs see that they are effective look at the toxicology (the only way you can kill somebody with benzodiazepines is to beat them over the head with a case full), and since it's a problem for the future they don't pay attention to the fact that they are absolute hell to get somebody off. Signatureeric www.ericjarvis.co.uk "live fast, die only if strictly necessary" > The more I read about benzodiazepienes, the more I am convinced the > "war on drugs" should start at home ..... Yes. All benzodiazepines are highly addictive and generally speaking should not be prescribed for more than three weeks at a time. Someone dear to me had a terrible time withdrawing from Lorazepam. Disclaimer: IANAD Signature^Ï^ > > The more I read about benzodiazepienes, the more I am convinced the > > "war on drugs" should start at home ..... > > Yes. All benzodiazepines are highly addictive and generally speaking > should not be prescribed for more than three weeks at a time. > Someone dear to me had a terrible time withdrawing from Lorazepam. That's odd. I take 5mgm of valium a week for Ekbom syndrome and feel not great addiction. > > > The more I read about benzodiazepienes, the more I am convinced the > > > "war on drugs" should start at home ..... [quoted text clipped - 5 lines] > That's odd. I take 5mgm of valium a week for Ekbom syndrome and feel > not great addiction. Have you tried to stop taking it? Signature^Ï^ Yes, you could take a lower dose, whether through splitting the tabs, or crushing them to aid division. The issue with crushing / weighing is the weight is very small: do you have apparatus to weigh such a small amount? You could alternately take a crushed tab and put the powder on a counter and divide it with a knife or razor blade. The issues here are that you may loose some powder during the procedure, the method looks like you are using illegal drugs, and passing children might grab some. Pharmacists sometimes use a related method: crush a tiny amount, then mix it into a large amount of some inert powder, which makes weighing easier. Another method is to dissolve the tabs in water, and drink some portion. The problem here is that I have no idea if the active ingredient is soluble in water. I also have no idea of the stability: I think the first dose would be fine, but if you retain the remainder fluid for later use, I can't guarantee the stability. Finally you could ask your doctor and pharmacist about switching to a different benzodiazepine which would be available in a liquid preparation: it would be easier to measure smaller amounts for weaning, and I would suspect any BDZ would substitute for the weaning. I believe diazepam might be available. Also, not sure of the half life of the agent in question, but a BDZ with a longer half life might be easier to taper off. > Yes, you could take a lower dose, whether through splitting the tabs, or > crushing them to aid division. The issue with crushing / weighing is [quoted text clipped - 23 lines] > Also, not sure of the half life of the agent in question, but a BDZ with > a longer half life might be easier to taper off. We had a pt who had used Valium for years. The Dr. prescribed Valium and Promethazine supps. He wrote the rx for three weeks. After three weeks, we would compound a new rx with a little less Valium and phenergan. This was over 20 years ago, so I don't remember the details, but the pt ( who passed on a few years ago) successfully tapered off long term BZD use. Eli >> > The more I read about benzodiazepienes, the more I am convinced the >> > "war on drugs" should start at home ..... [quoted text clipped - 5 lines] > That's odd. I take 5mgm of valium a week for Ekbom syndrome and feel > not great addiction. If you have been taking any benzo for more than a month, you probably have a depencence, maybe not a full addiction. You can find out easily. If you truely have Ekbom, switch to one of the other good treatments (nothing that is a controlled drug) and see what happens. If the non-controlled-drug treatments don't work and only the benzos "work" then you have a dependence or possible an addiction. > >> > The more I read about benzodiazepienes, the more I am convinced the > >> > "war on drugs" should start at home ..... [quoted text clipped - 12 lines] > treatments don't work and only the benzos "work" then you have a dependence > or possible an addiction. Having STFW for Ekbom syndrome I see that it's sometimes called "Restless Legs", which makes me wonder whether cramerj is taking any other meds. It sounds a lot like akathisia, which is a common side effect of the old fashioned phenothiazine group of antipschotic meds such as chlorpromazine (Largactil, Thorazine) or Haloperidol. IANAD Signature^Ï^ > A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He > has got down to a single .5mg tablet a day, which is the smallest > preparation available. > > His doctor has insisted there is no way to get any other preparation to > aid in tapering the doseage off. And doesn't this doctor know the pharmacy can help in this, by compounding the tablets to capsules? Perhaps after first switching to an equivalent dose of diazepam first? In the town where I work, when someone wants to stop a benzo, the doc will tell them to go see me. I then talk to the patient, calculate the appropiate dosage, devise a tapering schedule and then have the doctor write the prescriptions needed. Quite a few people have succefully stopped their benzo's in this way! Cheers, Menno > > A friend is trying to withdraw from Rivitrol (Klonopin/Clonazepam). He > > has got down to a single .5mg tablet a day, which is the smallest [quoted text clipped - 12 lines] > write the prescriptions needed. Quite a few people have succefully stopped > their benzo's in this way! Hi Menno, I suspect you haven't had experience of dealing with the wonderful National Health Service here in the UK. I have no doubt UK pharmacists are as competent as anywhere else in the world, and could easily devise a system for delivering lower doses of Rivotril. However, everywhere I have asked (all 5 hospitals locally) have claimed it can't be done. What they really mean is they can't be bothered. And since there are no consultants who are prepared to help my friend quit, there's no pressure to try. The NHS is free (mainly) but sometimes you get what you pay for :-( |
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