Can compounding pharmacies lower doses?
December 2, 2013 2:19 PM   Subscribe

My partner infrequently takes medicine that was originally prescribed overseas. The USA version of the pill is too high a dose for them. Is it possible to obtain a lower dose from a US compounding pharmacy, and how does that work?

My partner very infrequently takes 5 mg of temazepam to treat a balance disorder. They were originally diagnosed in a country where temazepam is dispensed in 10mg tablets, which can be cut in half with a tablet cutter.

Now we are in the US, which seems to only have temazepam in capsules, in increments of 7.5mg. My partner got a prescription for the lowest dose, but 7.5mg is too high a dose for them, making them sleepy and dopey. (This makes some sense, since it is usually prescribed as a sleeping pill.) Since the US version are capsules full of powder, they can't be cut up to lower the dose.

We were wondering if it was possible for a a US doctor to have drugs like this* re-compounded to lower the dose? Our doctor wasn't sure. It wouldn't have to happen very often, since they only need to take a dose every couple of months or so.

*Possible complications:
- temazepam is a Schedule IV drug in the US
- this is an off label use for it
posted by anonymous to Health & Fitness (11 answers total) 1 user marked this as a favorite
I know this seems like an obvious answer, but... call up a couple of compounding pharmacies and ask? No one will know the answer to this -- or know how to find it out -- better than they will.
posted by brainmouse at 2:21 PM on December 2, 2013

I have gotten medicine compounded before. You will need to find a compounding pharmacy and ask what your options are, and then your doctor will need to give you (or them) the prescription.
posted by florencetnoa at 2:22 PM on December 2, 2013

Wouldn't a little scale sort this pretty easily? Empty capsule, weigh contents, discard 1/3? has lots of little cheap scales.

(I take it you already asked at a few pharmacies about different generics...?)
posted by kmennie at 2:40 PM on December 2, 2013

If you're going to need a different dose and the med under the US trade name, won't you need to revisit the US doctor anyway to tell thrm you need less? Communicate with the US doc.
posted by discopolo at 2:44 PM on December 2, 2013

Actually, visit another doctor if your doc isn't sure. Or go to a local pharmacist and discuss with them what you can do because PharmD's here are very resourceful and eager to help.
posted by discopolo at 2:47 PM on December 2, 2013

Scales weighing in the milligram range are quite expensive.

An alternative solution would be to lower the dose yourself by emptying the capsule onto a glass or mirror tile and dividing it using a razor blade.

You'd only be lowering towards a more reasonably tolerable dose, so any slight inaccuracies in division around the 2/3 mark wouldn't really matter.

The only danger is that to your reputation should friendly neighbours or inquisitive family come knocking at the wrong moment...
posted by protorp at 2:52 PM on December 2, 2013

Ask a pharmacist. It may not be a good idea to simply open the capsule and take the powder inside. The outside of the capsule may be timed to release the drug slowly and if you remove it, you will get 5mg all at once instead of slowly released over time. This may make the drug be ineffective or it could be dangerous, depending on the drug.

There are other things capsules can do, this "slowing of release" is just one potential action. Your pharmacist will know what the capsule on your brand of drug does, and if it can be discarded safely.
posted by holyrood at 2:59 PM on December 2, 2013 [6 favorites]

When I wanted to have the same thing done (with a different drug) the compounding pharmacy I called said they couldn't, because the pills came in capsules. This made no sense to me, but there you have it. You might as well call some compounding pharmacies and ask.

I don't know if this will work with temazepam, but with Vyvanse if you want to take a smaller dosage than what the capsules come in, the drug company recommends emptying the whole capsule into a cup of water, dissolving the powder in the water, and then measuring and drinking only half the cup. (Or at least that's what they used to recommend; it's been years.)
posted by The corpse in the library at 3:38 PM on December 2, 2013

P.S. OF course, check with your doctor first before trying the half-a-glass method.
posted by The corpse in the library at 3:39 PM on December 2, 2013

I use Belmar Pharmacy in Denver for my HRT. I get stuff that's normally suspended in oil or rubbed on your skin added to my Estradiol. Good stuff. Work with the pharmacy and your doc to get what you need.
posted by Ruthless Bunny at 5:41 PM on December 2, 2013 [1 favorite]

Compounding pharmacies actually specialize in this sort of thing. Yes, they could help you out. Find one in the area and get your prescriber to call them to discuss your prescription. The fact that temazepam is a controlled substance doesn't matter, nor does the off-label use.
posted by eldiem at 9:25 PM on December 2, 2013 [1 favorite]

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