The following post is an amalgamation of research and draws from a variety of sources. Clinical resources are subject to regular updates as scientific understanding improves. This post is for informational purposes, but it is not a peer-reviewed, controlled clinical document and should NOT be taken as medical information nor clinical guidelines.

 

Instead, it is provided for informational purposes and should serve as a useful prompt to do your own research, review appropriate clinical sources and seek qualified medical advice when making your own decisions.

 

Using Manufactured Liquid Antidepressants

 

When swapping from pill to manufactured liquid form you should always follow the crossover procedure found below:

 

 Crossover

This is a necessary step to prevent issues. Crossover is best done from a stable state.

 

- For 4-7 days, ¼ of your dose of the liquid solution/ ¾ of your dose in the pill/powder form.

- For 4-7 days, ½ of your dose of the liquid solution/ ½ of your dose in the pill/powder form.

- For 4-7 days, ¾ of your dose of the liquid solution/ ¼ of your dose in the pill/powder form.

- Full dose in the liquid solution.

 

If at any stage, if withdrawal symptoms show up, hold till they subside then proceed with the schedule.

 

Making small doses

If you need to make smaller doses up than your current liquid dilution allows you can do this if the manufactured liquid has water as an ingredient. You would only dilute a small amount, take what you need from that and discard the rest because stability/shelf life will be affected.

 

You can use the Cutting Calculator 2.0 to help you work out dilutions, calculate dose drops and required liquid.

 

Here is an example of how to do this from the Royal College of Psychiatrist website:

 

The liquid comes with a dropper mechanism that dispenses a drop of liquid. This drop is approximately 0.05ml and contains 2mg of the drug. 

 

To taper off this medication, you need to take a dose that is less than 2mg, but the dropper mechanism will not allow you to do this.

 

To measure smaller doses, you will need to remove the dropper mechanism from the bottle and use an oral syringe.

 

You may also need to dilute the liquid in water to create a weaker solution. This is because the smallest amount of solution that can be accurately measured with an oral syringe is about 0.2ml.

 

You can use oral syringes to measure out exact amounts of liquid antidepressant and water. These syringes come in 1ml, 5ml and 10ml versions.

 

You can buy these oral syringes from a pharmacy or online or ask your prescriber to prescribe them if you receive your prescriptions for free.

 

Example instructions

 

In this example, you are using a 40mg/ml liquid antidepressant. This means that every 1ml of this liquid antidepressant contains 40mg of the drug.

Therefore, every 0.5ml of this liquid antidepressant contains 20mg of the drug.

 

You are aiming to take just 1mg of the drug. To do this, you need:

 

-A 1ml oral syringe

-A container with a cap that won’t leak when you shake it

-Your liquid antidepressant

 

Steps

1. Measure out 0.5ml of the liquid antidepressant with a 1ml oral syringe 

2. Put this into the container

3. Measure out 9.5ml of water with your 10ml oral syringe

4. Add this to the container with the liquid antidepressant

5. Mix vigorously by shaking

6. This will give you 10ml of diluted solution, which will contain 20mg of the drug 

7. Clean your 1ml oral syringe with water

8. Use your clean syringe to take 0.5ml of this diluted solution, which will contain 1mg of the drug 

9. Dispose of the rest of the diluted solution*

 

You can make up other doses with the same approach; however, you will need to know

 

-How much of the drug is contained in the liquid antidepressant you are using (this is different for different antidepressants)

-Always check the liquid to drug ratio per ml by asking your pharmacist or reading the packaging.

-The equivalent dose in a tablet which may not always be the same (for example 8mg citalopram in liquid form is equivalent to 10mg of citalopram in tablet form)

 

This should make it possible for you to create smaller doses of your antidepressant, allowing you to follow a slower tapering plan.

 

*The manufacturer leaflet (also called the ‘Summary of Product Characteristics’) says once mixed with water, the solution should be consumed ‘immediately’. This means that after taking your dose of diluted solution, you should dispose of the rest and mix a new batch when you need to take your medicine next. Ask your prescriber for the manufacturer leaflet for the medication you are using.

 

Link to RCPsych page referenced above

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