Continuing Mounjaro...part 17

[ObsidianTree]

Please note: Mounjaro will only be be prescribed initially if your BMI is above 30. If you have additional health conditions you can get the medication with a BMI 27. (Prediabetes, high blood pressure, high cholesterol or heart problems)

Pointers for newbies:
1 - For taking your first dose you need to twist the pen a lot to get to 1! Make sure the needle is twisted on tightly. Priming will help confirm if the needle is on securely and not faulty.
2 - When injecting, hold down the button until the number goes back to 0. Once at 0, keep holding down the button and count to 5 with the needle still in so no medication is lost!
3 - Your first dose may not have an immediate effect. For some people the effects build slowly. It could take 3 or 4 days to notice anything, it could take a few weeks. Some people don't feel the meds working until they get to 5mg. See titration chart which shows how the medication builds up in your system. Also below you can plot the effect of your doses.
https://glp1plotter.com/
4 - 2.5mg isn't a therapeutic dose, meaning you aren’t meant to lose on 2.5mg. You need to start on 2.5mg to get your body used to the drug and gradually introduce it into your system and get used to any side effects.
5 - Not everyone loses a lot in the first few weeks. Don't feel discouraged if you don't lose a lot initially. Again, you might need a higher dose to start losing. Also, inches can be lost without anything showing on the scales. Start your journey by taking measurements and check them as you go along.
6 - If you do lose a lot in the first few weeks, please don't assume you will continue losing at this rate. The first few weeks it is usually water weight that is lost, after that a good weight loss is about 2lbs a week. Some weeks you might not lose anything, but this is ok too…again, taking measurements might show inches lost instead.
7 - Some people find that they don't need to go up a pen dose each month if the current pen dosage is working well for them. If you are unsure when to go up, speak to your prescriber.
8 - If you are having bad side effects after titrating up or you are struggling to eat your calories each day, your dose may be too high so should consider lowering your dose. Speak to your prescriber if unsure.
9 - Constipation, coldness, nausea, diarrhea, vomiting, headaches, aches, are side effects. There may be other side effects also. Read info here :
www.medicines.org.uk/emc/product/15481/pil#about-medicine
10 - Taking Mounjaro can stop birth control from being effective. If you are on birth control, consider extra protection if you aren't planning on conceiving anytime soon!
11 - Once you take your first dose you can choose to keep your pen in the fridge or somewhere else. It's up to you.
12 - Don't reuse any needles as this could risk infection. If you damage a needle or one isn't working, you can buy a pack of about 100 spares. https://www.chemist-4-u.com/carepoint-pen-needles-31g-4mm-pack-of-100?gclid=Cj0KCQjwiYOxBhC5ARIsAIvdH51rLZBVFQxuvS7mDJooegtK8BMiyT0PwREMRHhH_1atfQIo8TEbsmkaAkA0EALw_wcB
Also there is a 5th dose in each pen. To extract it you can either try a hard twist or use an insulin needle.
https://medbasic.co.uk/bd-micro-fine-30g-1ml-syringes-needles
13 - Protein is important as eating less protein can cause muscle wastage and hair loss.
Some natural sources of protein:
https://www.bbcgoodfood.com/howto/guide/best-sources-protein
https://www.medicalnewstoday.com/articles/321522#high-protein-foods
14 - You can use supplements, some that people use are magnesium(for sleep and constipation), protein(to reduce muscle wastage), collagen (skin elasticity), aloe vera(for constipation), psylum husks(fibre for constipation), electrolytes.
15 - Drink lots of water. Water helps with the weight loss. Try and drink at least 2ltrs a day.
16 - Don't be afraid to feel hungry. It is entirely normal and healthy to feel hungry. Just eat something. Treat it as an opportunity to start good habits around hunger. Eat a nice balanced snack or a meal if it's a meal time. It's ok.
17 - Does it makes any difference where you inject? yes it does! Drugs get absorbed at different rates depending on injection site
In order of fastest absorption, it goes:
• Tummy
• Arms
• Thighs
further reading about injection sites and the effects: https://www.medicalnewstoday.com/articles/316618
18 - Abdominal side-effects are much easier to control with smaller meals. For example, having 4 small meals in the day vs 2 big meals can have an improvement in nausea and burps.
19 - You can track your calories / protein on apps such as My fitnessPal, Carb Manager or Nutracheck. Nutracheck is quite useful and easy to find foods /build recipes.
20 - Some of the places you can order from are:

MedExpress:
2.5mg and 5mg. £149.99. 7.5mg £169.99, 10mg £189.99. 12.5mg £209.99. 15mg £209.99 Coupon codes no longer working!
The Family Chemist:
2.5mg and 5mg £149. 7.5mg £169, 10mg £169, 12.5mg £194, 15mg £199
Zava medical:
2.5mg £139, 5mg £139, 7.5mg £169, 10mg £189. 12.5mg £204. 15mg £204. Zava offer refer a friend discount of 15% off. Ask for a code on here.
Simple online pharmacy:
£149 2.5mg, £149 5mg, £169 7.5mg £189 10mg
Bolt pharmacy:
2.5mg £149, 5mg £149. 7.5mg £169, 10mg £179, 12.5mg £199, 15mg £199
Asda:
2.5mg and 5mg £179. 7.5mg £189, 10mg £189, 12.5mg £204 15mg £204
There are others not listed.
21- You will still be prescribed Mounjaro when your BMI falls below 30. However, it may be harder to move suppliers once you BMI is below 30 if you wanted to move.
22 - Worried about your supply being cut off when you get to a healthy BMI? Below is some info on some places maintenance plans.
The Family chemist :Would consult you as approached healthy BMI to discuss maintenance under close supervision(if you started with family chemist)
Curate: up to 2 years
Cloud: up to 2 years
Boots: Cut off at BMI 23
Asda: Cut off at a healthy BMI
Pharmacy2u: Will supply for maintenance
Bolt:Individual assessment once BMI 22 and does offer maintenance
Zava:Once healthy BMI will stop prescribing this treatment
Med Express: BMI 25 and cut off.
23 - If you want to switch suppliers, make sure you have pics of your Mounjaro box with your name and dose. This will come in useful when other suppliers ask for evidence.

1st thread:
https://www.mumsnet.com/talk/weight_loss_chat/5007744-mourjano-starting-soon?page=1
2nd thread:
https://www.mumsnet.com/talk/weight_loss_chat/5028495-continuing-murnjaropart-2?page=1
3rd thread:
_https://www.mumsnet.com/talk/weight_loss_chat/5037623-continuing-mounjaropart-3?page=_1
4th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5044316-continuing-mounjaropart-4?page=1
5th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5048290-continuing-mounjaropart-5?page=1
6th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5057916-continuing-mounjaropart-6?page=1
7th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5062935-continuing-mounjaropart-7?page=1
8th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5068850-continuing-mounjaropart-8?page=1
9th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5074054-continuing-mounjaropart-9?page=1
10th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5080755-continuing-mounjaro-thread-10?page=1
11th thread:
https://www.mumsnet.com/talk/weight_loss_chat/5085436-continuing-mounjaro-thread-11?page=1
12th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5090788-continuing-mounjaro-thread-12?page=1
13th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5096704-continuing-mounjaropart-13?page=1
14th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5102149-continuing-mounjaropart-14?page=1
15th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5107426-continuing-mounjaropart-15?page=1
16th thread:
https://www.mumsnet.com/talk/weight-loss-injections/5115015-continuing-mounjaropart-16?page=1

Thread for newbies just starting out in July:
https://www.mumsnet.com/talk/weight-loss-injections/5101435-mounjaro-july-2024
Video on how to inject:

I'm also in a stall that's been weeks now. Although I have had two heavy weekends of parties with drinking so probably has something to do with it. Also the hot weather /water retention etc. Was also thinking, now that I'm lighter I need to eat less calories to achieve weight loss as my BMR would be lower. I have basically stopped calorie counting. Didn't mean to but just got bored of it and while I was losing weight, I didn't see the point. So I think it's something I need to start up again now to make sure I'm in calorie deficit. I guess I don't mind my losses slowing down, but want to get to into the 12s 🤣 Also will start the gym soon! The time has come!

@ObsidianTree My time has come too, I haven't exercised a great deal during this journey yet but know I need to start.

I put in a second order with Zava yesterday, it says processing. Does anyone know what this means, ie has it been approved by a doctor?

I’m not sure if I will need to send fresh photos? The delivery time was quite a wide range just trying to work out when it’s likely to arrive

Weigh in day (official one, I weigh daily). I started on March 20th.
18 weeks on MJ, down 18.7kg/41lbs and BMI down from 35 to 29. I've just passed my halfway mark, as I've got 17kg to go until my goal weight and 13kg to go until a healthy BMI (I'm tall, it takes a lot!).
I might manage to hit my goal by Christmas, though I expect losses to slow as I get closer.

You should be notified once it's approved by the prescribing pharmacist. And they should email if they need photos. I didn't have to second photos for my second order with them.
Have a look at the messages section on your account. Any requests or updates from them will show there.

So in my saga with zava over the delivery of a warm pen, they have now said I should use it within 30 days and discard at that point. As I don't plan starting it until a week on Sunday, that will give me two doses only before I have to throw it away.
Internet searching suggests the issue is lowered effectiveness rather than a health risk of using beyond this point. I absolutely can't afford to just throw it away.
Internet searching has also provided two equally strongly held views on the out of the fridge issue:

1. Once the pen is at room temperature it must be used within 30 days as once degradation starts it will continue regardless of whether it is refrigerated.
2. Any degradation started will be paused once the pen is at the correct temperature so the countdown clock is resumed (but not reset to zero)

I've found several reddit threads where people have contacted Eli Lilly for clarification but none that have received a definitive answer.

Has anyone used a pen for longer than 30 days after it reached room temperature? How effective was it?

Thanks

@Ivytheterrible morning! Good to hear the order from Care is going well😁 Sorry to be a pain but have seen a comment about them only taking payment through PayPal - is this how you had to pay?

For any Bolt customers: I am a previous MedExpress customer before switching to Bolt who I am very happy with. But I got the MedExpress maintenance email yesterday. I have forwarded it on to Bolt to ask if they share the same approach that I can order meds for 2 years even when at a healthy weight. Will update when I get a response.

I would encourage anyone with other suppliers to ask them if they are also going to allow access for 2 years. By asking and them realising that we can take our custom elsewhere they will hopefully start making commitments to do the same as MedExpress.

@Fromthesidelines have you put the pen in the fridge now?

It definitely isn't clear at all. The pescribers say use within 30 days because that's what the guidance says, but we have no idea what happens if it's used beyond that time! I would say that the meds probably haven't been tested outside of 30 days so they can't say what the effect would be. It's bad that Zava say use within 30 days as if everyone is ready to use the pen straight away as soon as it arrives. No one is going to leave it until they have run out of meds before ordering the next pen! Especially as Zava seem to be taking about a week now to get a pen to you once ordered. So a bit cop out of from them as they clearly don't want to refund /send new pen etc.

In your case, if it was me, I'd put it in the fridge and i'd still use the pen until it's finished. Keeping it in fridge between uses.

I’ve just received this from MedExpress. Doesn’t matter to me as I have a full pen anyway, but just FYI case anyone is close to the wire with ordering.

Came here to share this news too! And good of them to let us know i will say. Unlike zava who just ignored the problem til I kicked up a fuss 😏

I came on here to say the same thing. At the start, I was doing strength training but as time went on, I was just too tired all the time, work was busy, etc. Now I'm more used to being on mounjaro and eating less, it's time to up the exercise.

Also, I have generally been more active than usual anyway lately - lots of days out, walking, even playing sports and it's easier! I've lost about 35lbs and still have a long way to go, but I really am noticing that I can do more active stuff than I used to, and it doesn't tire me out like it did.

And, after a 3-4 week stall, I seem to be shifting the weight again. Have lost almost 2lbs since a week ago. Thank goodness. (Assuming I don't inexplicably gain it again)

Sorry I've really not kept up with this thread, but I've also been sulking on account of being in a stall. Arrival of my period seems to have broken it and finally dropped 1/2lb since yesterday.
Anyhow I feel bad because I'm popping on for a bit of advice.
I've was buying from MedExpress then switched to Zava. Just seen the email from MedEx re maintenance and the 2 years and think that is luring me back as no way do I want to face life without MJ until my weight loss has stayed off a while! It's also doing amazing things for my mental health and I need it.
So, I am at BMI of 28 ish and plan to lose another 2 stone. I have a 7.5mg and a 10mg in the fridge ready to go and have my bonus dose from existing 10mg pen to take this week. Side effects totally manageable. Do I order a 12.5 from MedExpress? It's less than 8 weeks since my last order with them so no hassle to return. But I do have the 15% off from Zava to use, though I think the MedExpress stance on maintenance is more important.
So what would you do? Move up to 12.5 and keep my 10 & 7.5 for weaning off later on? Use current pens and titrate up to 12.5 and not order yet since stockpiling no longer required?
For some reason I'm really struggling with decisions like this right now!!

@ObsidianTree Thanks. Yes I put it in the fridge as soon as I got it on Sunday afternoon (21st). Zava say they despatched it on the 20th so delivery was within the 48 hours so all is well. However their despatch note and dispensing says 19th so suspect it may have been sitting with them out of storage at least overnight before transferring to RM so potentially more than 48 hours. For interest, I refrozen the gel pack overnight and repackaged everything (except the pen) as it came. At 24 hours, the gel pack was still cold with some residue ice crystals. At 36 hours it was at ambient temperature as I had received it.
Will be using as I can't afford not to!

Morning all! I haven’t heard from Med Express since late May when they sent me 3 x 7.5ml pens instead of 1. Maybe I’m blacklisted?!

I’m 157cm (5’2) & just into the 75kg (11st) bracket. I can’t believe it. I’m almost half way to my goal.

Fo anyone else who uses the ‘my weight’ app - does your goal date keep getting further away? Mine was mid sept initially in the early days when I was dropping weight like a stone. Now it’s creeping back. It was Xmas day for ages but now it’s further back. I don’t mind particularly - just wondering.

I have my final call tomorrow with my NHS dietician as part of the tier 3 weight loss service. I am going to try to get these injections via NHS but not holding my breath. It has taken exactly 1yr to jump thru hoop number 1.

Hi @AgathaMystery I use the app and my date also gets further out on the occasions I enter my weight and it isn't following the plotted graph line based on previous entries. I do find if I have a good loss and I plot it, it moves nearer the projection and is reflected in the predicted dates given on the Home Screen.

For those in maintenance or nearing it, are you taking or considering berberine? I am titrating down currently and trying to sir on my hands and not order another pen since I've got enough left for approx 6 or 7 weeks. I've heard it can help with hormone issues (I don't have PCOS but it was investigated and I was diagnosed with a "mild hormone imbalance" whatever that means) and also curbing cravings. I think I'm going to get some even if it just creates a placebo effect of thinking I'm doing something that'll help me maintain. Probably a lot more cheaply 🤞🏼

@AgathaMystery I use it! Was thinking this morning I should post a recommendation of it on here as I love it. There is always something good to focus on eg getting to the next BMI digit, getting under the next 10lb barrier, celebrating the next 5lbs lost.

Re the date that you will hit target on the graph moving further away yes I have that too. It is calculated (I think) using your average weight loss per week. As an example of you lost 5lbs in your first week on Mounjaro and was trying to get to 50lbs loss, it will tell you will reach target in 10 weeks as it assumes future loss will be at the same rate as recorded losses. If you only lose 2lbs in week 2, your average loss per week is only 3.5lbs so now it will be about 14 weeks to get to target.

I used to have an average weight loss of 1.5lbs but after a few holidays / weekends away / real life it's now only 1.3lbs a week. I was looking at @Thebaldprimadonna weekly losses this morning and thinking that is in line with her recent losses and although I might manage to increase it a bit if I am stricter with myself this phase I about slow and steady losses.

I'm exactly the same, even down the parties! Only I want to get into the 13 stone bracket! Been jumping between 14 and 14.1 for 2 weeks now!

I was planning an order today (generally I order at 6pm on Wednesday for a Friday delivery - or Saturday if for any reason it gets delayed knowing I can be at home to receive) but I may wait until next week.

Hmmmmm, this is the thread below a med express Facebook advert.
Slightly contradicting their maintainance stance.

Is this them letting the trainees do their social media!

They have never had a BMI 30 cut off!

Yes I feel pretty rubbish on it & never had the calm spell either. I’m also so tired on it. I’ve probably got another 3 months minimum to goal but sometimes this puts me off as there’s no real break from it due to the nature of the weekly injections.

That seems to be a case of an employee not knowing what they’re talking about! My BMI is below 30 and MedExpress have been happily re prescribing (it was just over 30 when I started).

Hi!
Me too, how are you feeling?

Well it was a bit of a silly question as BMI of 29.9 is still overweight not healthy but it was a MedExpress trainee on day 1 answering that question!

@NCfor24 I have the same dilemma. Also being sulking and quiet as I'm not losing 🤣

I have the 15% off vouchers for Zava but want to move where they do maintenance! I would say tho, be aware that 12.5mg has an expiry of Nov 24, 15mg expiry Oct 24! So think about that before ordering. 10mg expiry April 25 so maybe order that from med express if you want to keep your account open?

Not sure about the Zava discount. If you wait too long then will med express put you back to the start? I suppose you could use proof of orders from Zava to switch back to med express when you are ready?

I am not sure what to do about myself. My BMI is around 27/28. I want the Zava codes, but want a maintenance pescribers but also have a stock of a few pens! I am thinking bolt as they let you move with an under 30 BMI. But will probably wait with Zava until I have got my discounts!