Technical information on weaning methods and dosages

[kylelost]

OMG - I looked at the syringe measurements and I'm not on 1.5 mgs of paxil, I'm down to .8 mgs. LOL

What a wonderful Christmas gift!!!

By the way, I just did a victory dance in my family room!!!!

Thank you for re-posting!!!

Suzanne

[Grimmy1985]

thank you

[Grimmy1985]

thank you!!!

[kylelost]

Well crap!! I just looked at the syringe again and I am on 1.6 mgs!!! Oh well, I needed some exercise. So much still to be thankful this year so I won't complain!!

Suzanne

[binny]

Originally Posted by kylelost

Well crap!! I just looked at the syringe again and I am on 1.6 mgs!!! Oh well, I needed some exercise. So much still to be thankful this year so I won't complain!!

Suzanne

I read your first quote Suzanne and I celebrated for you! I read your second post and was a little sad for you, but wow - good for you for your attitude! Way to keep your head up, get a little exercise with your dance and enjoy your time on the low dose. I am so happy for you!

[thinkpink]

Can anyone here advise me about Liquid Paxil please? I have now been prescribed this for weaning by my GP with a 5ml oral syringe. Betsy in your post you say not to get a teaspoon type syringe because they are inaccurate. What is a teaspoon type syringe? Also this is probably a really silly question (so I apologise for asking) but is the liquid exactly the same as the tablet version? For example my GP has told me to swap now from tablet to liquid before I begin weaning. Will I have any problems or withdrawl symptoms simply changing from solid to liquid? And finally does any one combine the tablet with the liquid during withdrawl or do people from experience tend to solely use the liquid? Thankyou for all your help.

[TryingtoGetWell]

thinkpink, I'm bumping this because I don't know the answers to all your questions because I've never used the liquid paxil. Many people here have and can give you better answers, if they haven't already.

But I do want to suggest that once you start taking the equivalent (same) dose in liquid as you were taking in the tablet form, that you stay at your dose for a little while before starting to taper.

As long as you're taking the same number of mgs as previously but in liquid form, the amount of actual medication in your body will be the same. But sometimes people feel a little different briefly from the different inactive ingredients, so it's best to hold at a dose for a little while before tapering, so you'll know what's from getting used to the new medium (liquid) and what's from your taper when you start that.

[Honeysuckle]

Hi Thinkpink,

I have recently started on liquid paxil. Mine is not made by GSK though, rather a compounding pharmacist. This means they literally grind the tablets into a powder and mix them into a liquid suspension. No idea how it works but my medicine is 5mg of paroxetine per 5ml of liquid. This makes it very easy for my dosing.

I think overseas there are other formulations with different concentrations per mg.

I use a syringe that comes with a childrens liquid painkiller here called Neurofen-I found the traditional 5ml syringe was too large and the rubber stopper doesn't last that long and I was getting lots of air bubbles. The one I use now does not have rubber and is very accurate. I also have a 1mg calibrated syringe for when I have to get down to very small accurate dosages. It cost around $10 but I feel worth it.

Hopefully others will chip in with their experiences with liquid.

As TTGW said, it's also probably a good idea to start out on the dose equivalent to what you take in a tablet- I didn't and wish I had as found my body did need some time to adjust to the new medium.

Good luck!

[Songbird]

A few people have trouble swapping to liquid, but most people swap from pill to liquid with no problems. The 5ml syringe is probably okay for higher doses. You can use a 1ml syringe for more precision with smaller doses.

[thinkpink]

Thankyou everyone for your responses, I really appreciate them. Im learning so much from this forum, it might sound silly but before today I have never heard of a compounding pharmacy- I didnt realise that some pharmacies will compound your tablets into a liquid form. Honeysuckle yes I have the GSK liquid Paxil- I havent compared the ingredient list on the bottle but I guess it must be exactly the same as the tablet with the exception of, as you say, some different inactive ingredients. I will certainly take your advice and switch to my full dose on liquid before I start the wean just in case I have any issues with liquid. Im probably worrying way to much about this but Im not sure about the best syringe to use. Honeysuckle you say you have a 1mg calibrated syringe for the smaller does- what is a calibrated syringe? What makes it different from others? My current 5ml syringe came from my GP -it does have a rubber seal inside and Im concerned about accuracy because the seal is quite thick and it doesnt seem that clear to me-you really have to squint to line it up accuately against the right measurement line! I may ask my pharmacist for advice. Its weird isnt it because if it was any other medication I wouldnt worry but because of all the horror stories, you feel that you have to be spot on with measurements otherwise you could end up feeling awful! Can I also ask if anyone uses both the liquid and tablet at the same time? Before I started this whole process I imagined that to get say 18 mg of medicine I would simply break my tablets down to get 10mg, 5mg in tablet form and then take the last three 3mg in liquid. It was my gp who said just do the whole thing with liquid as saves cutting up tablets! I have never thought of this (stupid as it may sound) so do others here have experience of doing the whoel taper on liquid? Thankyou for your time in reading this- Im sure once I ger my head around it all I'll be fine, Im just a bit of a worrier! Thankyou.

[Honeysuckle]

Hi Thinkpink-sorry to confuse you-a calibrated syringe is just one with the measurements printed on the side. The one I got from the chemist is a dropper one. In hindsight, I think when i got it I was anxious and just got it as it was suggested to me. I think either will do fine, as long as you replace the one with the rubber stopper once it starts to get sticky- therefore harder to measure

If you google -'how to use/read an oral syringe' there's heaps of good info-especially where to read the line when the rubber stopper is quite thick

I just found this on eBay and am going to get some as they come with an adaptor for your bottle making it really easy to draw up the liquid.

http://www.ebay.com.au/itm/ORAL-SYRI...#ht_3586wt_879

I've had problems in the past, especially when my bottle is low (I only have small 200ml batches made up) and I can't get the syringe into the bottle far enough. You also need to be careful of air bubbles from the shaking!

Id start with a larger syringe, and then work your way down as your dose reduces. Eg: I've been using a 5ml syringe while tapering down to 3.5 and then I think I will get a 3ml one for the next stage.

I also found this article about the oral syringes being the most accurate:

http://adc.bmj.com/content/96/Suppl_1/A7.1.abstract

I have never taken the tablets and liquid together, but maybe someone else can shed some light on this. Personally I'd take all liquid for convenience and then you know you are getting the accurate dose (it's quite easy to cut tablets inaccurately)

Don't apologise for asking questions-you are doing the right thing and getting informed- and I'm a worrier too so completely get it

[thinkpink]

Honeysuckle- you're a star, thankyou so much for this. I havent had time yet to read all the links you've included but I will do some research this weekend- your info is really helpful so thankyou :-) Yes as Im on 20mg currently I guess I dont need to worry about smaller syringes until my dosage gets much smaller. My GP has given me 2 x 5ml syringes which is the full 20mg so I guess to decrease from 20mg- I will need to use both of these syringes for now. Does that sound right to you? Also just out of interest have you been decreasing using the suggested 10% taper method? Also your post has made me realise something that Id never thought of before- how am I going to get the liquid out of the bottle lol!! These adaptors can you buy them from a drug store? Once again sorry to bombard you with questions- this is all new territory to me so your advice and experience is really useful. Thankyou

[Honeysuckle]

You are very welcome I'm only relatively new here too but glad to be of help.

Yes, using 2x5ml sounds fine for your dose-if it's a hassle you can always get a 10ml one from the pharmacy/chemist. The GSK bottle may very well have an adaptor of sorts to dispense the liquid-if not yes, you can get one from the pharmacy or even Ebay

I am using the spreadsheet at the beginning of this page/thread and aiming for 10% drops every 6-8 weeks. I'm only into my third taper, so still feeling my way-this last one has by far been the best one yet so am hoping that it continues this way down to zero. The most important thing is to listen to your body and if you need to sit for a while longer than planned on a dose, then do it and drop again when you feel ready.

Good luck! There's so much great support here you will never feel alone

[Songbird]

I didn't know you could get adapters. I just pour some of my liquid from the big bottle into a smaller bottle that I can get the syringe all the way into.

[Honeysuckle]

Originally Posted by Songbird

I didn't know you could get adapters. I just pour some of my liquid from the big bottle into a smaller bottle that I can get the syringe all the way into.

Hi Songbird! Yes, I'm very excited-have ordered one from Ebay-though i'm pretty sure you can get them from a larger chemist-just never noticed them.

Like you, I've had to pour it into a glass or something smaller when my liquid gets below the halfway mark. Having an adaptor means you can tip the bottle right up and measure accurately.

I was so desperate that I got one of these bottles http://www.nurofenforchildren.com.au/products/baby.php
-washed it out and it was great-but couldn't get the taste of the medicine out of the bottle despite numerous washing in hot water.

I'll keep posted on here how the adaptor works

[Honeysuckle]

I thought I would add this to the technical info as I noticed a few people asking about how to taper with pills. Hope it helps

Originally Posted by Brassmonkey

Here is a copy of post #287 from my journal talking about how to make smaller doses from big pills.

I am going to add this to my journal so it will be available to everyone who needs to find out how to shave their pills. It is a lot easer than it sounds and with a little practice you can get results to the half of a milligram of active ingredient. I am tapering using 40mg Paxil tablets, so I ill be using that as an example.

There are a few tools that will be needed. The most important is a jewelers scale that can weigh to 0.001 grams. These are readily available on line for around USD$30.00. You will also need a sharp fine blade knife such as an Exacto #11 or a single edge razor blade. A nail file, some “00” gel caps, a calculator, and a pair of tweezers.

The first step is to find the average weight of the pills you will be cutting down. The normal prescription is for thirty (30) pills, but your scale won’t fit that many so we will use ten (10). Put ten (10) tablets into the pan of your scale and record the weight. Mine is 5.047 grams. Using your calculator divide your number by 10. I get .504 grams, which is also called 504mg, to make things easier I will call it 500 because the 4 is not enough to count. So now we know how much one of the tablets weighs.

Now we need to know how much active ingredient there is for how much tablet. With the calculator divide the average weight of the tablet by the amount of active ingredient. For me 500 divided by 40 which gives me 12.5. This means that for every 12.5mg of tablet I am getting 1mg of active ingredient.

The scales we are using are very accurate, but have to be used properly. They are not as accurate at the bottom of their range, so it is best to place the 10gr weight in the pan and press the tare button. This will put the scale in the middle of its range and give you a reading of 0. If you put a full size tablet on the scale you should get the average weight, but it is not important.

So lets do a 10% drop. We know the average weight of our tablets, mine is 500mg. With the calculator multiply the average weight by .9, this gives me 450. That means that if I cut one of my 500mg tablets to weigh 450mg I will be getting 90% of the active ingredient of the full tablet, a 10% reduction.

To cut the tablet, hold it firmly against the cutting surface and using the sharp blade, chip off a piece that looks like it will be about 10% of the total size. Now weigh the tablet. With luck it will be right on your target weight or a little over it. If it is over weight use the sharp blade or nail file to scrape just a little tiny bit off and weigh the tablet again and repeat as needed until you hit the target weight. It is surprising how little needs to be scraped off to change the weight. With a little practice you can get the weight very close. Also remember that, in my case 12.5mg of tablet equals 1mg of active ingredient, so it is very easy to be very accurate.

Save the little bits that are cut off. These are weighed and placed in the gel caps so there is no waste. These can also be used if you cut off a little too much, make up the proper weight of large and small pieces and put into a cap.

That’s basically all there is to it. Your numbers will vary, but that is the process.

[thinkpink]

Ok so Im about to begin a slow taper from 20mg Paxil and Im just trying to get my head around all the percentages and doseage changes etc. My understanding is that as a guide we stick to the 10% taper but I notice that in the diagram that Scotty posted of the syringe the reductions are smaller than 10% arent they? Apologies if Im asking silly questions, just want to try and get my head around it all. My main aim is to reduce to 10mg first (dont want to run before I can walk) but Im just wondering if this diagram means that after 10mg you have to taper even slower because presumabley you cant measure out 10% drops in a 5ml syringe?? Does this make any sense to anyone? Thankyou for your help.

[Songbird]

Scotty's diagram is just showing how to read the syringe markings. It also shows you the relationship between ml and mg for the commercially made liquid (2mg per 1ml). I would get the spreadsheet first and see what dose you need for each drop. Then you can find the dose on the syringe.

[CeciZahn]

I want to start tappering from paroxetine, but here in mexico i havent found any liquid paxil. How can i disolve my pills so I can make the change...what a dilema

[thinkpink]

Is there anyone here who can help with using the Syringe? Ive just started using mine (a 5ml) oral syringe and Im finding it a little tricky! Im not sure what its called but the syringe has a small tip and my medicine keeps filling the tip, but Im assuming, the medicine should only go as far as the top line and not fill the actually tip. I realise this is only a little extra of the medicine but it could make all the difference! Does this make sense to anyone? Can anyone advise please? CeciZahn, have you spoke to your GP about liquid Paxil? Is there a compunding pharmacy near you do you know? Im sorry I cant help with this one, perhaps someone else can advise?

[Songbird]

Originally Posted by thinkpink

Im not sure what its called but the syringe has a small tip and my medicine keeps filling the tip, but Im assuming, the medicine should only go as far as the top line and not fill the actually tip. I realise this is only a little extra of the medicine but it could make all the difference! Does this make sense to anyone? Can anyone advise please?

The measurements on the syringe take into account the amount of liquid in the tip so you don't need to worry about that. Just make sure it is all filled with liquid right up to the mark for your dose and that will be the right amount.

[Songbird]

Originally Posted by CeciZahn

I want to start tappering from paroxetine, but here in mexico i havent found any liquid paxil. How can i disolve my pills so I can make the change...what a dilema

You might be able to find a compounding pharmacy who could make up liquid for you (this is what I do as the commercial liquid is not available here either). Another option is to cut the pills and use a digital scale to weigh the pieces.

[Lissa]

Thank you to ALL of you for this great information. I found this site today while searching for help with tapering advice, since I have been having horrible physical and muscular pain for about one week now.

I am so encouraged by the success stories, and am bolstered by others who (unfortunately) are having symptoms like mine. I now need to figure out a new tapering plan based on your collective advice!

[Brassmonkey]

Hi Lissa-- welcome to the group, you'll definitely find the help you need here. I would suggest doing a post in the General Discussion forum 'cause more people will see it there. That said, your dropping too fast, which is why you feel so badly. Your first drop to 35 was a little big but very doable, but you need to hold there for 4-6 weeks before dropping again. That gives your brain time to adjust to not not having as much of the Paxil. Your next drop would be to 31.5mg when the time comes. I would suggest going back up to 35 and wait six weeks to stabilize then start tapering again. I know it is disheartening to go back up but you will feel a lot better for doing it.

Also the increase in the Wellbutrian may be having some affect on how your feeling, it's not my drug so I can't say for sure.

[Lissa]

Thanks, Brassmonkey -- I really appreciate the follow-up. I took 35 last night. You're right, it was a little disheartening to do it, but I literally cannot stand the pain anymore! Hope it helps.