Jaqueline Eserian

Research Scientist at Instituto Adolfo Lutz

[Radoslaw Stupak @RadoslawStupak]

Hyperbolic tapering is increasingly recommended for the gradual reduction of psychiatric drugs to minimise withdrawal symptoms, yet available formulations rarely accommodate the small dose regimens required. https://t.co/nuRMX4YmdC

[Medicating Normal @MedicatingNorm1]

"Hyperbolic tapering is increasingly recommended for the gradual reduction of psychiatric drugs to minimise withdrawal symptoms, yet available formulations rarely accommodate the small dose regimens required."

https://t.co/nDvJQ9aZZi

[Mark Horowitz @markhoro.bsky.social @markhoro]

Just a brief summary of this immediately practical paper on off-label options for making up smaller doses to facilitate hyperbolic tapering, for haloperidol. The paper tested the off-label options that we put in the RCpsych guidance for stopping antidepressants (and also found in the Maudsley Deprescribing Guidelines).

It found that the following techniques all delivered doses that were within 90-110% of the target dose (which is the threshold normally used for manufacturers when making tablets):

- using a liquid with a dropper mechanism
- splitting tablets with a tablet cutter (halves and quarters)
- using a dosing syringe from a liquid preparation
- diluting a manufacturer’s liquid with water and dispensing with a syringe
- crushing up a tablet and dispersing them in water to make up a suspension, and then measuring with a syringe

A few points: although both were in acceptable range, diluting a manufacturer’s liquid was more accurate than suspending a crushed tablet in water.

Splitting tablets and drop based liquids were more inaccurate than measuring liquids with a syringe. The drop based liquids were most inaccurate at smaller doses (makes sense: where variations between drops becomes more important).

Overall using a manufacturer’s liquid with a syringe (the dropper mechanism on many such liquids can be removed to use a syringe) and then switching to using dilutions of this solution with water and measuring with a syringe when the volumes measured get below 0.2mL (which caused greater variability in measurement using a 1mL syringe). This happens to be the exact scheme we used as the default (when a liquid was available) in the Maudsley Deprescribing Guidelines.

Some drugs don’t come as manufacturer’s solutions so it is good to know that crushing a tablet and suspending it in water is a good fall back (also for people who don’t react well to manufacturer’s solutions).

The main technique not tested in this paper was measurement of tablet fragments using a weighing scale.

Link to paper in Radoslaw's post. What a brilliant contribution to the literature that will have practical consequences straight away.

[Mark Horowitz @markhoro.bsky.social @markhoro]

Very useful article in @TheBJPsych evaluating different off-lablel techniques for making small doses to make hyperbolic tapering feasible: reassuring that all were found to be within 90-110% of target values (the same standard used for manufactured tablets).

[Pharmacopsychiatry @Pharmacopsy]

Deprescribing is a complicated and underappreciated aspect of treatment. @JKEserian and team reviewed 47 cases/series of drug withdrawal and found that adverse events were the #1 reason for discontinuation. Large-scale studies of deprescribing are needed.
https://t.co/Jajw6iWnFC

[Jaqueline Eserian @JKEserian]

Ainda não se inscreveu? Corre que o 4º lote de inscrições está acabando!

https://t.co/ZIvjDr8wRc

[Jaqueline Eserian @JKEserian]

https://t.co/IA8RZVnYi9

[Carlos Prudencio @crprudencio3]

#ViBioM2023

The Adolfo Lutz Institute has four grants for young researchers to coordinate new research groups in the areas of bioinformatics, immunology, parasitology and viral metagenomics. (https://t.co/ZnZH51DLbc). Info: Dr. Carlos Prudêncio ([email protected]).

[Jaqueline Eserian @JKEserian]

@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab
@David_Uip

[APqC (Associação dos Pesquisadores Científicos) @AApqc]

Breve registro do nosso ato em defesa da ciência e da valorização do pesquisador científico, ocorrido diante da Alesp. Sem pesquisa, São Paulo não avança! #Apqc

[Jaqueline Eserian @JKEserian]

Pesquisadores científicos de SP precisam de VALORIZAÇÃO DA CARREIRA
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab
@FelicioRamuth

[Carlos Prudencio @crprudencio3]

Ola @David_Uip @tarcisiogdf @rodrigogarcia_ @carlaopignatari @AssembleiaSP @eleusespaiva @TJSPoficial @DelegadoOlim @guilherme_afif @gilbertokassab, pode ajudar os Cientistas dos Institutos de Pesquisacom isso?
https://t.co/UvPcAxQqkn

[Jaqueline Eserian @JKEserian]

@tarcisiogdf
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[Carlos Prudencio @crprudencio2]

@tarcisiogdf Ola @David_Uip @tarcisiogdf @rodrigogarcia_ @carlaopignatari @AssembleiaSP @eleusespaiva @TJSPoficial @DelegadoOlim @guilherme_afif @gilbertokassab, pode ajudar os Cientistas dos Institutos de Pesquisacom isso?
https://t.co/AsFWjf0ImH

[Cristina Rheims @CristinaPqc]

https://t.co/1ohYJLH2s2
#APqC #ValorizeaCiência
@tarcisiogdf
@FelicioRamuth
@AssembleiaSP
@carlaopignatari
@DelegadoOlim
@itamar_borges
@guilherme_afif
@gilbertokassab
@g1saopaulo

[Jaqueline Eserian @JKEserian]

@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[APqC (Associação dos Pesquisadores Científicos) @AApqc]

@BiancaClissa, presidente da APqC, sobre a manifestação dos Cientistas dos Institutos Públicos de Pesquisa de SP
@TJSPoficial @tarcisiogdf @rodrigogarcia_ @carlaopignatari @AssembleiaSP @eleusespaiva @DelegadoOlim @guilherme_afif @gilbertokassab

[Jaqueline Eserian @JKEserian]

@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[APqC (Associação dos Pesquisadores Científicos) @AApqc]

Manifestação dos Cientistas dos Institutos Públicos de Pesquisa de SP pela valorização da carreira
@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[Jaqueline Eserian @JKEserian]

Cientistas dos Institutos de Pesquisa realizam manifestação organizada pela APqC no Palácio dos Bandeirantes e ALESP por VALORIZAÇÃO DAS CARREIRAS
@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[Carlos Prudencio @crprudencio3]

https://t.co/T0GKmXaEl2

[Jaqueline Eserian @JKEserian]

@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[APqC (Associação dos Pesquisadores Científicos) @AApqc]

Pesquisadores científicos dos institutos públicos de São Paulo participaram hoje de ato pela valorização da carreira na capital paulista. A mobilização foi organizada pela Apqc.
https://t.co/ZdPvdXHEyx

[Jaqueline Eserian @JKEserian]

Cientistas dos Institutos de Pesquisa realizam manifestação organizada pela APqC no Palácio dos Bandeirantes e ALESP por VALORIZAÇÃO DAS CARREIRAS
@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[Elizabeth Nabeshima @BethNabeshima]

@AApqc @TJSPoficial @tarcisiogdf @rodrigogarcia_ @carlaopignatari @AssembleiaSP @eleusespaiva @DelegadoOlim @guilherme_afif @gilbertokassab Luta pela valorização da Ciência! Merecemos salário digno!

[Jaqueline Eserian @JKEserian]

@TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[APqC (Associação dos Pesquisadores Científicos) @AApqc]

Cientistas dos Institutos de Pesquisa realizam manifestação organizada pela APqC no Palácio dos Bandeirantes e ALESP por VALORIZAÇÃO DAS CARREIRAS @TJSPoficial
@tarcisiogdf
@rodrigogarcia_
@carlaopignatari
@AssembleiaSP
@eleusespaiva
@DelegadoOlim
@guilherme_afif
@gilbertokassab

[Cristina Rheims @CristinaPqc]

Cientistas dos Institutos de Pesquisa de SP solicitam o diálogo com o novo Governo. #APqC #ValorizeaCiência
@tarcisiogdf
@FelicioRamuth
@AssembleiaSP
@carlaopignatari
@DelegadoOlim
@itamar_borges
@guilherme_afif
@gilbertokassab
@g1saopaulo

[Cristina Rheims @CristinaPqc]

Cientistas dos Institutos de Pesquisa de SP pedem apoio ao novo Governo. #APqC #ValorizeaCiência
@tarcisiogdf
@FelicioRamuth
@AssembleiaSP
@carlaopignatari
@DelegadoOlim
@itamar_borges
@guilherme_afif
@gilbertokassab
@g1saopaulo