looking for dose splitting advice/thoughts

[faenor1916]

Hi, new here! Glad I found this forum as it's been a great resource already and I really appreciate the honesty and civility I've seen here.

I'm one of the new folks transitioning RS from compounding to reconstituting and I've got a question I'm hoping y'all can help me with. Before I move to reconstituting for RS, I've got a decent stash of compounded TZ that I picked up from my local compounding pharmacy. The TZ is frozen in syringes with luer lock caps. I've been instructed to thaw individual shots, throw on a sterile needle, and use immediately. This has worked great and RS has been doing it since June. The shots are listed as good for only a month in the freezer (that tells me at least this is the safety time that the compounding pharmacy was ok with, whether or not they could actually last longer). The pharmacy said I should keep the shots stored in freezer, not the fridge.

Each shot is 5 mg, which has been RS's current dosage, but—long story short—because of TZ side-effect issues, RS is going to microdose 2.5 mg every 3.5 days instead of 5 mg once a week and see how it goes.

Here's my question: I'd love to thaw one 5mg shot, put a sterile needle on it, inject 2.5mg into RS, put luer lock cap back on, put rest of syringe (with remaining 2.5 mg) back in the fridge, and then have RS inject it 3.5 days later with a new sterile needle. Is this safe?

I don't know what constitutes the base of the shot (I know it only has TZ and no added vitamins/supplements), though I could find out if that's important. I'm basically trying to figure out the risk associated with putting half the shot back in the fridge to use 3 days later. Or could I even refreeze it? I know that's generally frowned upon in case it damages the TZ, but it would be for 3 more days only.

What do you all think?

Thanks for the help!

 

[nonyabizznez]

Just want you to know someone has read your post and has nothing to offer ... Things that come to mind:

*Frozen? (I know it's done)
*Why prefilled syringes (I know it's done)
*Your proposal sounds equivalent to those UK pens (multi use)
*Backflow?
*Perishable additive in your Tirz?
*1mo expiration date to drive sales (?)

 

[faenor1916]

Just want you to know someone has read your post and has nothing to offer ... Things that come to mind:

*Frozen? (I know it's done)
*Why prefilled syringes (I know it's done)
*Your proposal sounds equivalent to those UK pens (multi use)
*Backflow?
*Perishable additive in your Tirz?
*1mo expiration date to drive sales (?)

thanks for the response!

-Backflow: yeah, hadn't thought about that.
-perishable additive: makes me think I should figure out all the ingredients in the syringe to see.
-1mo expiration date: yeah, that's part of what I'm trying to figure out... I would assume to cover their liability instead of driving sales since they only do prefilled, single-dose syringes.
-frozen and prefilled: I don't know why they chose to go that route, and I know some folks have been concerned about such things, but I haven't had any problems with it (definitely has TZ in it and haven't had any sterility issues that we can tell). It's a 503B and PCAB compounding pharm that my PCP uses often, so I trust they know what they're doing.

 

[nonyabizznez]

Maybe cuz they wanted to see you ($) but only once a month (?)

I get what you're saying though about your PCP lending credence... Makes a difference

 

[faenor1916]

haha, yeah, maybe so!

 

[Dee X]

Read the patent on Tirzepatide.

https://patentimages.storage.googleapis.com/6e/ea/64/6dc49bc3fc7df9/US11357820.pdf

It talks about which temperature to store it at (in Celsius).

Your pharmacy is also wrong, you should not freeze it when it is reconstituted , nor should any meds be stored in a syringe for over 24 hours. Can dig that standard up for you too if you're interested.

www.glp1plotter.com is a great reference for how much is in your system at any given time.

 

[tangoecho311]

Are you in the US? There have been studies that show lomg term storage in syringes *could* be safe, but no syringes are FDA approved for long term storage or primary storage.

I find it interesting the pharmacy advised to freeze it, especially in syringes. My compound pharmacy advised a 6 month life of reconstituted tirz if it's kept in a dark box in the fridge.

 

[scarywood75]

I very doubt your pharmacy follows FDA and Elli Lilly recommendations and it's honestly quite concerning given they should know better

 

[Bacchus]

This sounds like stuff I would do myself (except freezing reconstituted peptides), but not recommend to a customer

Though it’s probably fine, I’m rather surprised you got these instructions from a phrmacy

 

[scarywood75]

This sounds like stuff I would do myself (except freezing reconstituted peptides), but not recommend to a customer

Though it’s probably fine, I’m rather surprised you got these instructions from a phrmacy

That'd certainly give another excuse for Elli Lilly's lawyers to end compound

 

[Dee X]

Out of curiosit... was this a pharmacy, or a MedSpa "pharmacy"? I've seen this practice mentioned on Reddit my people using MedSpas quite often.

 

[faenor1916]

Thanks everyone! This is all super helpful. This was actually a pharmacy, PCAB certified, too (so no medspa).

I just heard back from the pharmacy and they said they're using sterile water and sodium chloride as the base with the TZ, hence why I'm supposed to freeze it. Obviously, as y'all have pointed out, this is problematic, so it's good I'm moving towards reconstituting myself anyways! But I still have this 9 week supply of 5mg that I would like to distribute into 2 shots a week instead of 1 if I can do it safely. After that, I'll then move to my reconstituting stash I got through Tydes.

So now I guess my question is this: how risky would it be to thaw two shots (10 mg total in 1ml total), immediately inject them into a sterile vile with sterile needles, add 1 ml of BAC, and then keep in the fridge to be used by RS over a 2 week period with one 2.5mg/0.5ml shot every 3.5 days? Does that make any sense or is that pretty risky?

I totally recognize no one can fully assess the risk for me and RS, but just looking for opinions from this community. Thank you!

 

[Bacchus]

Thanks everyone! This is all super helpful. This was actually a pharmacy, PCAB certified, too (so no medspa).

I just heard back from the pharmacy and they said they're using sterile water and sodium chloride as the base with the TZ, hence why I'm supposed to freeze it. Obviously, as y'all have pointed out, this is problematic, so it's good I'm moving towards reconstituting myself anyways! But I still have this 9 week supply of 5mg that I would like to distribute into 2 shots a week instead of 1 if I can do it safely. After that, I'll then move to my reconstituting stash I got through Tydes.

So now I guess my question is this: how risky would it be to thaw two shots (10 mg total in 1ml total), immediately inject them into a sterile vile with sterile needles, add 1 ml of BAC, and then keep in the fridge to be used by RS over a 2 week period with one 2.5mg/0.5ml shot every 3.5 days? Does that make any sense or is that pretty risky?

I totally recognize no one can fully assess the risk for me and RS, but just looking for opinions from this community. Thank you!

I have packed pre-filled syringes in the case for my glasses. In my toiletry bag, on a 14 hour flight. Then left them in said case and bag in the bathroom for 4 weeks while using them on vacation. Definitely not recommended, but it was perfectly fine. (As a disclaimer for the next paragraph, this was with oils and not sterile water).

I also reconstitute with sterile water, rarely wipe the vial before drawing and leave it in my fridge for 4-8 weeks. I strongly recommend not doing this, and it is not advice - it’s just to give you a scale of what “might probably maybe be fine”

As far as I can tell, your risk here should be quite low. But as long as it’s not best practice you shouldn’t let anyone make that decision for you