Making a Liquid Mixture Using Immediate-release Tablets or Capsules

liquid mixture gear

1. Set a schedule.

Back in Step 14, you decided whether you’d taper using a Daily Microtaper or Cut-and-hold schedule. If it’s been a while since you made that decision, you might want to go back and refresh your memory because some of the calculations you’ll do in Step 19 will depend on your chosen schedule.
 

2. Decide which liquid to use.

Generally, laypeople find that there is no single, “right” liquid to make a mixture with, but there can be pros, cons and risks to certain choices. And inevitably, there are of course some unknown risks to altering any drug’s original form into one that hasn’t been FDA-approved. Some people prefer to taper with a liquid that their drug is soluble in, while others have reported successfully tapering off using a liquid that holds their drug in suspension rather than solution. In the lay withdrawal community, the most commonly used liquids are water, full-fat milk (or milk substitute), or a commercially produced suspending liquid such as Ora-Plus. Some particularly important safety considerations include the following:

Choosing Water

  • Pros
    • Cost: Free
    • Visibility: Clear, so it’s generally pretty easy to see how well distributed a drug is in the mixture.
  • Con
    • Drug distribution: Though many people successfully taper using suspensions rather than solutions, some people prefer to use a liquid their drug fully dissolves in, and many psychiatric drugs are not soluble in water.
       

Choosing Full-fat Milk (or milk substitute)

  • Pros
    • Cost: Cheap
    • Drug distribution: Since it’s thicker than water, some people feel that it suspends a drug slightly more effectively.
  • Cons
    • Visibility: It isn’t possible to see into a liquid mixture to determine how well distributed a drug is, and it can be difficult to determine how much a tablet has broken down. (However, some people report that it’s possible to determine how much of the tablet remains by looking up through the bottom of the jar.)
    • If storing a mixture for any length of time, refrigeration is definitely required.
    • Some people find that full-fat milk just out of the fridge can bubble upon shaking, affecting syringe measurements because of air bubbles, but that letting it warm up a bit beforehand can help.
       

Choosing Ora-Plus (or other commercially-produced suspending liquids)

  • Pros
    • Drug distribution: Designed for the purpose of suspending tiny, solid particles of a drug, and similar to the liquids used by compounding pharmacies.
  • Cons
    • Cost: Pricey ($20+ per pint-sized bottle; depending on how much liquid is used in a liquid mixture, this might mean 2 or more bottles per month)
    • Safety: Preliminary research suggests that these suspending liquids may not necessarily be well regulated.
    • Some people do not like the additional ingredients, which can include additives, thickeners, and preservatives.
       

Choosing Other Drinkable Liquids

  • Pros
    • Some in the layperson withdrawal community prefer using a drinkable liquid that has specific chemical solvent properties (for example, ethanol) to help fully dissolve their tablet (though we haven’t found any evidence in the withdrawal community that this is necessary).
    • You’ll likely have a wider range of choices of liquid.
  • Cons
    • Requires more intensive, self-directed research into specific drugs and specific liquids to ensure safety and lack of dangerous interactions.
       

3. If taking a tablet, decide whether to crush it (Move on to #4 if taking a powdered capsule).

Tablets can be crushed using a common mortar and pestle, available at any store that sells kitchen supplies. Many in the lay withdrawal community have found that it is not absolutely necessary to crush a tablet prior to dropping it into a jar, though, as most seem to break down eventually in the liquid on their own. Below are some pros and cons of crushing versus not crushing based on gathered personal experiences in the layperson withdrawal community.

  • Pros and cons of crushing a tablet:
    • When a pill is crushed with a mortar and pestle, residue will remain behind when the powder is transferred to a jar. Laypeople have found that this can be compensated for, though, by consistently rinsing the powder off the tools with a small amount of the measured liquid that will then become part of the liquid mixture.
    • Some people feel that a fine powder more easily stays suspended in liquid.
    • It’s possible that unknown quantities of drug could adhere to filler, which might impact the active drug’s even distribution.
  • Pros and cons of dropping a whole tablet into the jar:
    • The potential loss of any quantity of drug is diminished.
    • There is no added work of crushing the tablet.
    • People report that some tablets take longer than others to break down, so it’s helpful to do a test run to determine how long a particular tablet takes to break down completely. Reports of wait-times range anywhere from 10 minutes to 24 hours.
    • If using a liquid that isn’t transparent, it may be a bit harder to tell when a tablet has broken down. However, people report that they can often make a determination by looking up under the jar to its bottom to see if there are remaining “chunks”; then they shake, stir, or wait longer until none remain.
       

4. Read up on layperson tips for choosing the volume of liquid to use for a liquid mixture.

In the layperson withdrawal community, people use a variety of different volumes of liquid to make their liquid mixtures, in part depending on whether they’re tapering using a Cut-and-hold or Daily Microtaper schedule, and in part as a matter of personal preference. However, some choices can also make the handling and math calculations simpler! So here are a few tips laypeople often share with one another to help inform this decision:

  • Choose a volume that’s large enough to allow for more easily made and more accurate reductions in dose based on a particular schedule and taper rate.
    Generally speaking, the larger the volume of liquid that a solid is distributed in, the fewer particles of solid there will be in a particular portion of that liquid. Therefore, a general principle in making a liquid mixture is that the more liquid one uses, the smaller a reduction in dose one can make at any given time. This is particularly relevant for people who are doing a Daily Microtaper since, all other factors being equal, the amount removed each day is teeny-tiny in comparison with a Cut-and-hold schedule, where bigger cuts are made less frequently.
     

  • Choose an amount that makes the measuring and math easier.
    To simplify the math calculations, some people opt for a liquid volume that will make it easy to remove cuts that fall cleanly into relatively simple numbers, given their chosen taper schedule and monthly taper rate. For more information, see 'Doing calculations for a Taper' and 'Special Tips for Calculations and Liquids' in Step 18.


5. Decide how to transition from tablets/capsules to liquid.

Note: The word “pill” here is used to refer to both tablets and powdered capsules.

Some people report being able to switch from all solid to all liquid right away with no or minimal problems. However, others report finding the transition to be disruptive to their central nervous system. It’s good to get informed about possible options for making the transition as smooth as possible.

Drugs in liquid form are absorbed faster by the body. Because of this, some people find the switch from solid to liquid can set off new or intensified emotional, mental, physical, or sleep-related problems. Those who experience these problems often report that they seem to resolve in a matter of days or a couple of weeks. Occasionally, however, some report feeling destabilized by a full transition from solid to liquid for weeks or even months—so much so that they end up going back at least partially onto a solid form of drug. Because there’s no way to know in advance how one’s own body will handle a rapid switch from tablet to liquid mixture, some laypeople have used these transitional approaches:

  • Option 1: They transition all at once from pills to liquid, but give themselves time to adjust.
    In this scenario, once a person has immediately converted all of her pills to liquid, she might wait at least two weeks before initiating a taper. Typically, people report this being enough time for the body to communicate any problems. If problems do emerge, she might hold steady at her normal dosages until the disturbances have been gone for a couple of weeks, or try switching to options 2 or 3 below.
     

  • Option 2: They transition gradually from pills to liquid before beginning to taper.
    In this example scenario, if a person is taking a total of 6 pills once a day, he might start by making a liquid mixture out of 1 pill, while continuing to take 5 pills in solid form. Over time he will then gradually increase the number of pills that he’s converting to liquid form. Alternatively, if he is taking multiple doses per day, he might convert a portion of each dose to a liquid form, and gradually increase the amount of each dose that he is converting to liquid. Once he is converting all of his pills to liquid form every day, and has given his body a chance to communicate any problems to him, he will then begin tapering.
     

  • Option 3: They transition only partially rather than fully from pills to liquid, while starting to taper immediately.
    In this example scenario, if a person is taking a total of 6 pills a day, she might continue taking 5 of them as pills while making a liquid mixture out of the sixth pill. From this liquid mixture she’ll begin making reductions from her dose. Once she has tapered the liquid dose all the way down and is taking just the 5 pills, she will then convert one of those remaining pills to liquid form and continue tapering. (Alternatively, if she’s taking multiple doses per day, she might convert a portion of each dose to a liquid form and then reduce a portion of each of these doses.) 


6. Record decisions.

Once you feel ready to proceed, go ahead and write down your decisions in your journal, because they will be essential to help guide you through the next few sections.

My taper schedule:
The liquid I’ll use:
(If I’m on a tablet) Crush or wait to dissolve?:
If dissolving, amount of time needed:
How I’ll transition to liquid: