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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Squiggles on March 30, 2007, at 8:30:47
Most drugs come in tablets or capsules of set amounts. For example, clonazepam comes in 0.5mg, 1.0mg, and 2.0mg. The same goes for many other drugs. I have found the increments to be too large for certain purposes which the drug company may not have considered. For example, when i tried to reduce clonazepam, it was very difficult to cut the tablet, powdering and never getting small enough to avoid withdrawal disaster. The advice to switch to liquid preparations, i found audacious. The same goes for lithium, which comes in 300mg caps. Some people may actually do better on 800mg or 700mg, but you can't cut a cap. Furthermore, when your doctor wants to practive polypharmacy, it is much easier to do with smaller product preprations.
I think that the drug companies should make smaller dose preparations.
Squiggles
Posted by Larry Hoover on March 30, 2007, at 10:42:39
In reply to Dose and Drug manufacturing, posted by Squiggles on March 30, 2007, at 8:30:47
> The advice to switch to liquid preparations, i found audacious.
It is the optimal way to titrate small doses. That's why pediatric formulations are so often liquids, as dose in that population is generally a function of body weight, a variable of an order of magnitude range.
For liquid medication, dose is directly proportional to volume. Moreover, nothing could be easier to measure, as pharmacies supply syringes for that purpose. Even if you had to make your own drug solutions, the syringes are not restricted access.
What is audacious about this?
> The same goes for lithium, which comes in 300mg caps. Some people may actually do better on 800mg or 700mg, but you can't cut a cap.
It's easy to cut a cap. I do it all the time. Measuring piles of powder by eye is still an option. Powder a pill/open a cap. Divide with razor blade. Done.
Or just do a variable dosing pattern. 900/600/600 averages 700. 900/900/600 averages 800. The peak/trough concentrations will only be slightly more extreme than if the manufacturer complied with your desires.
Another alternative is to visit a compounding pharmacy. They'll make up exactly what you want. Low-dose naltrexone therapy is only available by this method, for example.
If you're not willing to titrate *as your body apparently requires*, don't blame somebody else for that. There are numerous options, none of which are audacious in the least.
Lar
Posted by Squiggles on March 30, 2007, at 10:52:23
In reply to Re: Dose and Drug manufacturing » Squiggles, posted by Larry Hoover on March 30, 2007, at 10:42:39
> > The advice to switch to liquid preparations, i found audacious.
>
> It is the optimal way to titrate small doses. That's why pediatric formulations are so often liquids, as dose in that population is generally a function of body weight, a variable of an order of magnitude range.
>
> For liquid medication, dose is directly proportional to volume. Moreover, nothing could be easier to measure, as pharmacies supply syringes for that purpose. Even if you had to make your own drug solutions, the syringes are not restricted access.
>
> What is audacious about this?
>
> > The same goes for lithium, which comes in 300mg caps. Some people may actually do better on 800mg or 700mg, but you can't cut a cap.
>
> It's easy to cut a cap. I do it all the time. Measuring piles of powder by eye is still an option. Powder a pill/open a cap. Divide with razor blade. Done.
>
> Or just do a variable dosing pattern. 900/600/600 averages 700. 900/900/600 averages 800. The peak/trough concentrations will only be slightly more extreme than if the manufacturer complied with your desires.
>
> Another alternative is to visit a compounding pharmacy. They'll make up exactly what you want. Low-dose naltrexone therapy is only available by this method, for example.
>
> If you're not willing to titrate *as your body apparently requires*, don't blame somebody else for that. There are numerous options, none of which are audacious in the least.
>
> Lar------------
Thank you for the tips. I hope they help others here too. I didn't know all that and as for liquid, thought it just came in a bottle where you measured the stuff yourself - haphazardly. I would prefer that pharmaceutical companies were as refined as cosmetic ones though; actually preparing ready-made smaller dose caps and tablets.
Posted by notfred on March 30, 2007, at 11:10:00
In reply to Re: Dose and Drug manufacturing » Squiggles, posted by Larry Hoover on March 30, 2007, at 10:42:39
One goal is to save you money so you don't have to buy several different strengths, which can get expensive. Each is a seperate co-pay or if you are paying retail the pills cost about the same no matter whet the strength is.
Posted by Phillipa on March 30, 2007, at 12:12:53
In reply to Re: Dose and Drug manufacturing, posted by notfred on March 30, 2007, at 11:10:00
Pill cutters help too. Sometimes I break them sometimes a pill cutter. Love Phillipa
Posted by JaneB on March 30, 2007, at 14:00:08
In reply to Re: Dose and Drug manufacturing » Squiggles, posted by Larry Hoover on March 30, 2007, at 10:42:39
Is it ok to save money by opening a 20 mg capsule of fluoxetine, dumping about half in a glass of water and saving the capsule for the next day with the remainder? In other words, does fluoxetine mixed in water have any adverse affects? And if I don't get an exact measurement isn't it probably ok since fluoxetine has such a long half life?
> > The advice to switch to liquid preparations, i found audacious.
>
> It is the optimal way to titrate small doses. That's why pediatric formulations are so often liquids, as dose in that population is generally a function of body weight, a variable of an order of magnitude range.
>
> For liquid medication, dose is directly proportional to volume. Moreover, nothing could be easier to measure, as pharmacies supply syringes for that purpose. Even if you had to make your own drug solutions, the syringes are not restricted access.
>
> What is audacious about this?
>
> > The same goes for lithium, which comes in 300mg caps. Some people may actually do better on 800mg or 700mg, but you can't cut a cap.
>
> It's easy to cut a cap. I do it all the time. Measuring piles of powder by eye is still an option. Powder a pill/open a cap. Divide with razor blade. Done.
>
> Or just do a variable dosing pattern. 900/600/600 averages 700. 900/900/600 averages 800. The peak/trough concentrations will only be slightly more extreme than if the manufacturer complied with your desires.
>
> Another alternative is to visit a compounding pharmacy. They'll make up exactly what you want. Low-dose naltrexone therapy is only available by this method, for example.
>
> If you're not willing to titrate *as your body apparently requires*, don't blame somebody else for that. There are numerous options, none of which are audacious in the least.
>
> Lar
Posted by kaleidoscope on March 30, 2007, at 14:48:56
In reply to dose dividing » Larry Hoover, posted by JaneB on March 30, 2007, at 14:00:08
Taking one 20mg fluoxetine capsule on alternate mornings would be a more logical option. Fluoxetine has a long half-life, alternate day dosing is perfectly acceptable with this drug.
Ed
Posted by Squiggles on March 30, 2007, at 16:09:10
In reply to Re: dose dividing » JaneB, posted by kaleidoscope on March 30, 2007, at 14:48:56
Maybe i'm just a spoiled brat, but i think
that not only *i* and the many poor people who are less educated in third world countries, as well as the drug companies, and the doctors, could actually benefit by making smaller denominations of tablets and caps. Why rely on folksy solutions, when the technology is there to solve the problem? And another thing (lol) why don't we have a li-detector, now the lithium has become the Cinderella drug?Squiggles
Posted by DStupid on March 30, 2007, at 16:52:54
In reply to Re: dose dividing, posted by Squiggles on March 30, 2007, at 16:09:10
I totally agree with the original poster. The minimum dosages put out by the manufacturers are way too high.
Actually, there is a way of going around it. My dad had to take Coumadin, a blood-thinning drug, for several years, with monthly INR (blood thickness) monitoring. If the INR was too high, he could have a bleeding episode. So arriving at the exact dosage was necessary. Coumadin is manufactured at smallest dosages of 1 and 2 mg. However, he needed to take something like 2.15 mg. daily. Obviously, you can't split pills to get to 2.15 mg. What he did was to arrive at the total weekly dosage: 2.15 x 7 = 15 (roughly). And he took his pills in the dosages that, taken on a weekly basis, were equal to that total number. He used a razor blade to cut pills. He took the drug every day but the size differed depending on where the day fell in the week. He didn't skip any days (skipping days is a bad idea in my opinion). He made it through those years, but he is very disciplined.
As long as you're consistent, do it on a weekly basis, and not afraid to cut pills or open capsules, you can beat the drug manufacturers.
Posted by Squiggles on March 30, 2007, at 17:03:29
In reply to Re: dose dividing, posted by DStupid on March 30, 2007, at 16:52:54
> I totally agree with the original poster. The minimum dosages put out by the manufacturers are way too high.
>
> Actually, there is a way of going around it. My dad had to take Coumadin, a blood-thinning drug, for several years, with monthly INR (blood thickness) monitoring. If the INR was too high, he could have a bleeding episode. So arriving at the exact dosage was necessary. Coumadin is manufactured at smallest dosages of 1 and 2 mg. However, he needed to take something like 2.15 mg. daily. Obviously, you can't split pills to get to 2.15 mg. What he did was to arrive at the total weekly dosage: 2.15 x 7 = 15 (roughly). And he took his pills in the dosages that, taken on a weekly basis, were equal to that total number. He used a razor blade to cut pills. He took the drug every day but the size differed depending on where the day fell in the week. He didn't skip any days (skipping days is a bad idea in my opinion). He made it through those years, but he is very disciplined.
>
> As long as you're consistent, do it on a weekly basis, and not afraid to cut pills or open capsules, you can beat the drug manufacturers.
These are the narrow therapeutic index drugs; lithium is one of them - they require special attention in manufactuing imho - no generics, and small denominations (though the denominations should apply to many psychiatric drugs.I think that the manufacturing of the drugs has not caught up with the sometimes 20-year reality results of how they act. Clonazepam for example is a benzo, but much more potent than Xanax, yet they are both started 0.50.
Also, skipping days can be very dangerous with drugs that have a cardiac "punch" or even a cerebral one - e.g. stroke;
In Britain you can get much smaller denominations, so maybe it is a government thing.
Squiggles
This is the end of the thread.
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