Can Bystolic be Compounded (made into a liquid)

My cardiologist wants me to taper off Bystolic. I've been on it 10 years, and knowing my system the way I do I need to taper much more slowly than some folks might do. I am trying to find out if it can be crushed and made into a suspension using Ora-PLus which is a pharmacy grade suspension liquid. In a past life I used this method to taper off an antidepressant. Making a 1mg/ml solution allows one to make small cuts and accurate cuts. Bystolic is a triangular shaped pill so it's a little tricky to cut it accurately, certainly can't do quarters. Id like to cut ~10% per week so I don't get any rebound of any kind. Just wondering if others here have done so and how it worked for you? Thanks

It's a coated tablet, so I doubt you can crush it. Those coatings are usually intended to allow the pill to pass through the stomach without dissolving, so crushing it would probably result in a tablet with no effect. But to be sure, I would find a compounding pharmacy and call them and ask.

Well hopefully Its ok to cut the pill with a pill cutter? Im supposed to cut the dose 25% per week? Cutting the tablet but it’s not going to be an exact science to get an exact 25% cut since the pill is triangular shaped. Somehow I have to reduce the dose in increments so I can gradually get off.

Googling around I can't find an authoritative answer. The pills aren't score so that usually means they can't be split. You need to ask a pharmacist. Walk into your local pharmacy and ask to speak to the pharmacist. Not a clerk, not a tech -- a registered pharmacist. They will know or can find out for you. That's what they're trained for and what they do and they're seriously under-utilized by the public.

Or better yet, find a compounding pharmacy and call them and ask. This kind of thing is exactly what compounding pharmacies do.

I contacted a compounding pharmacy and they want $200 to compound it. My doc’s nurse claimed the other day when he bumped me down from 5mg that he tried me on but that was much for me and I was told me to go back to 2.5 I could split the 5s in 1/2. But then today when my doc talked about getting off entirely said take the 2.5mg every other day. BUT IN doing that when do you just stop. That would be going zero pretty quickly. If I can’t cut them I’ll never be able to get off I don’t think as I don’t think my system could tolerate the sudden stop.

You can also taper off by spacing out the oral doses. Bystolic serum half-life is 10 hours. So just take one a day for a couple of days, then one every other day for another couple of days, then stop. Yes, you’ll get little spikes in serum concentration every time you take a pill but on average it’ll go down. Whatever you choose, clear it with your physician first, but I don’t see it being a big deal. Cutting pills that aren’t meant to be cut is a bit risky, either because they’re time released and you’ll risk overdose or they won’t survive your stomach acid and you’ll get nothing from it.

I am seeing various takes on getting off this stuff on different sites. Some suggest cutting, but who knows if they know what they are talking about, it is the internet after all. One doc makes the point that when you take a beta blocker it causes an increase in the receptors that the Bystolic binds to. In turn it shuts down the increase in production of Adrenalin that is produced as a result. If you pull away the BB then you get a surge of the Adrenalin in your system. I found the phone # of the maker of Bystolic who has a customer affairs dept and will call them tomorrow and see what I can find out. There package insert only says "your doctor will have you taper slowly" if you need to get off. Like most drug companies, they are really good at getting you on their stuff, but offer little help in getting you off. I know that from my experience in getting off a benzo that took 20 months and an antidepressant that took over a year. I'll also check with my local pharmacist

Just an FYI. Drugs.com says Bystolic can be cut because it does not have a “modified release coating” AN Ask aPharmacist site and Ask A Doctor site also claims Bystolic can be cut. Still I’ll check with the maker of the drug and ask my local pharmacist.

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Pokey
I contacted a compounding pharmacy and they want $200 to compound it.

Then I would pay them. You've spent who knows how many thousands of dollars over the years and now all you have to do is pay somebody who knows what they're doing $200 per month for a month or two to do it right. Problem solved. Really, don't try to cheap out on stuff this serious.

That’s a legit argument Carey. I’m going check with another compounding pharmacy today to see if they can offer a better price.

I talked with Allergan who makes Bystolic and they have NO data on how to get off Bystolic so they had no recommendation on cutting tablets or compounding. The tech said “well just reduce your dose to the lowest dose tablet and then stop“ 😳 When I told her that I’ve been on the lowest dose they make for 10 years she had nothing further to recommend. No surprise. She did say however that Bystolic is not a coated tablet. So it would seem a pharmacy should be able to crush it and put the powder into a 1:1 suspension

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Pokey
I talked with Allergan who makes Bystolic and they have NO data on how to get off Bystolic so they had no recommendation on cutting tablets or compounding. The tech said “well just reduce your dose to the lowest dose tablet and then stop“ 😳 When I told her that I’ve been on the lowest dose they make for 10 years she had nothing further to recommend. No surprise. She did say however that Bystolic is not a coated tablet. So it would seem a pharmacy should be able to crush it and put the powder into a 1:1 suspension

Not suggesting you do this, but if it were me, I'd DIY it. I'd crush the tablet with mortar & pestle, & put it into a liquid suspension that I measured accurately, then take measured doses of the suspension. Here is a description of doing this for low dose naltrexone. Ideas for suspensions. I'd likely use a gram/milligram/microgram scale. to weigh out the suspension.

Yeh I suggested that to a pharmacist I talked with. I shared that I had made my own suspension to get off mirtazapine. She was concerned that perhaps the Bystolic would tend to clump in the suspension liquid and you might not get a consistent dose. One would think though if you shake it good at each dosing it would be all good??? The advantage of doing it yourself you’d have no limits on how fast or slow you went in getting off.

If it's not coated then sure, you can do it yourself, but if it's not soluble in water you're going to have a really hard time getting a consistent dose even with vigorous shaking.

Starts dissolving right away in water, I tested that this morning. but I wouldn't use just H2O, Would use 50% Ora-Plus which is a pharmacy suspension liquid made for making liquid meds and 50% water. Will research the clumping thought more and try and figure which way to go. My other thought is just cut approx the same amount off the pill each day for so many days, then cut off a little more for another few days, etc. Im not sure getting an exactly a precise, down to the nearest 10th of dose each day is that critical. Would certainly be less stressing than taking a tab every other day and then just stopping. One of the pharmacist' I talked with said my docs suggestion of a pill every other day or so and stop was not a good protocol since the 1/2 life of Bystolic is so short. I would get rebound affects with that