How to Microdose Medications

The best way to come off most psychiatric meds is to lower them slowly by very small amounts. This is particularly important for medications that cause withdrawal symptoms, such as benzodiazepines and serotonergic antidepressants (SSRIs and SNRIs).

People differ in their sensitivity to these withdrawal problems. Some can come off them quickly over a month, while others need to reduce them by 5-10% every month. Usually the first dose reductions are easier. It’s at the end of the taper, as the dose gets close to zero, that most of the trouble lies.

The problem is that most medications aren’t available in the microdoses you’d need to lower them by ever-so-small amounts. One solution is to chop it up with a pill cutter. If it’s a capsule, you might be able to open it up and sprinkle part of it out (you’d want to check with your pharmacist to make sure this won’t damage the medication). Another solution is to liquify the tablets.

Ora-Plus is a liquid that dissolves pills so you can take them in very small doses. It’s available in plainsweetened, or sugar-free sweetened versions.

How to Use Ora-Plus

  1. Crush tablets with a mortar and pestle to a fine powder. For capsules, spill the contents out and smooth out to a fine powder with the mortar and pestle.   
  2. Add a small amount of Ora-Plus and grind to a thick, smooth paste with the mortar and pestle.
  3. Calculate how much solution you’ll need to create the desired dose, then use 10% less to adjust for any losses in the process. Example. To create 0.1 mg/day of alprazolam. Start with 1 mg tablets, then add 10% less than 150 ml (=135 ml) Ora-Plus to the crushed tablet-paste. The solution is then 1mg/150 ml, or 0.1mg/15 ml. This can be taken as 1 tablespoon a day (= 15 ml).
  4. To create a flavored syrup, dilute the Ora-Plus with Ora-Sweet (regular or sugar-free) before the final mix.
  5. Refrigerate the solution in a tight, light resistant amber bottle and label with the medication, dose, and date. It should keep for 30-60 days in the fridge.

Updated 11/2020