Bonus dose - safe or not?

[CandyMandy9]

I've just received my first Mounjaro pen and have been reading about the potential extra dose.

The official advice is to not use anything that's left in the pen after the four 'official' doses. But I keep reading about the 'bonus' dose, and using the bit that's left over.

Is it really safe to use? Do the suppliers just want you to buy more by throwing away the last bit? Has anyone had any different/unexpected side effects using the bonus dose?

I want to do things right and not make myself ill. But I also don't want to spend more than needed!

Thanks in advance.

I’ve used every bonus dose and I’m 30 weeks in with no problems. The dose is used within the 30 day guidelines so completely safe to use.

The "bonus" dose is buffer liquid in the pen, mainly to support accurate dosing and the pen design. Some say it is for priming, but as the pen stops after so many clicks you wouldn't be able to access the liquid if you primed too much so that logically doesn't sound like the entire reason.

The liquid is the same liquid as any other dose and you can get 5 doses out within the 30 day window - days 0,7,14,21,28. So no risk there.

The issue is getting it out the pen.

There are two options - hard twist which is breaking the pen, or using a syringe which potentially introduces hygiene issues. If you are careful with getting access to the 5th dose the risk imo is low.

It's completely safe to use. It's the same liquid as the others. Just need extra force to twist it after 4 doses. Once you twist it to 1, you can inject as normal.

I think it is perfectly safe as do many others but there is a crowd that will not do anything that deviates from the official prescribed guidelines.
You have to weigh the risk / benefits up yourself.
For me there is no risk and all benefit.

I use the bonus dose as for me, I checked if it poses any risk before I did it. For me, I said I’m using it within the 30 days and it’s the same liquid in the pen so why not. I can’t see any issue with it except more ways for pharmacies to profit if I discard it. Some people don’t use it and that’s fine as well.

Hi. Can anyone who had used the bonus dose doing the hard twist method confirm whether you can count clicks? I want to ensure that the bonus dose, if I use it, is accurate, because side effects have been an issue for me. But I'd rather do it that way that draw up into a syringe if possible. Thanks.

@raspberrymeringue No you can't quite count clicks with the bonus dose as the turn dial becomes a bit lose after you twist-break it. It stops clicking. To get a specific amount of liquid if you don't want to use all of it in one go, you'll need the insulin syringe to measure it out and leave the rest in the pen.

Once you've done the hard twist, the pen still needs to be wound out to the 1 position, which would be a full normal dose. Every time I've done it, it's not used all the remaining liquid, it's just done another dose from the 1 position back down to 0. That will be the usual 0.6ml. Using the syringes would be necessary if you want to use more than the standard dose.

I suppose you could count the line markers to do a dose less than the normal dose for the pen, as each line marker represents one "click".

@InItToLoseIt & @SilenceInside thanks both.

I had the same concerns, but after doing a lot of reading decided it was worth doing for me. Just took mine this morning, I found it easy to force the pen so I did it that way rather than use an insulin needle.

I've always done the bonus dose. I prefer to draw it up in a needle so I know exactly how much I'm giving myself. I've also heard the manufactures are getting wiser to the hard twist and some of the newer pens are not working after.

I do 3.75mg which is 45 clicks of my 5mg pen. What I do is mark the 45th click in the window with a biro on the first dose, and then when I get to the last dose hard twist to the mark.

I also took photos of where the plunger was in the vial before/after each dose to check it moved the expected amount.

It has worked for the last 4 pens and I haven't had to use a syringe yet.

@WeAllHaveWings thanks so much for this information. I’m definitely going to try this technique.
@WafflingDreamer that was what I suspected, but was hoping to avoid.

I think I’ll try lWeAllHaveWings suggestion first and see if it works. Shame if the pens are being adapted. Where did you hear that from?

My most recent pen wouldn't work after a hard twist. The two before that worked fine so I think increasingly the newer ones have been changed.

I am also using bonus dose. Didn't notice any difference between the normal and the bonus dose. It is just as effective. However I had a bit of a hit and miss situation when it comes to hard twist. Only 2 times I actually succeeded, on other occasions I had to use syringe. Maybe it depends on a pen? Someone mentioned a while back that the new pen batches are trickier to hard twist. Maybe the design has changed? Not sure. It is always worth to have syringes at home as a back up.

I tried to do the hard twist method. I managed to get the pen to the 1 marker but then the plunger failed to operate. Alas I had no needles to extract the liquid so I now have some on order

The last three pens I've tried to hard twist have broken. I've bought syringes now

Same, they have definitely changed the pens.

I think so too.

All useful thanks. I will therefore be using the syringe method when I get to it.

Its interesting that apart from my first pen all my supplies have had 6 needles in and not 4. I’ve only done one bonus dose and that was on the 2.5 pen to top up a week where I wasn’t feeling much suppression. I wouldn’t top up now because I have more side effects but I would contemplate using it on the 5th week given how expensive the higher doses are getting.

Very pleased to find this thread as I was wondering the same thing. What syringes do people use and it is obvious how to get the liquid out (haven’t got my first pen yet - waiting for it to be delivered)? Also, do you need cleaning wipes? Sorry if stupid questions!

I’ve been on Mounjaro since July and have used every bonus dose in every pen. Every time I’ve extracted the liquid with a syringe and injected it; I didn’t want to faff about with pens that might break or not. It’s been absolutely fine. There is no way I’m wasting something so valuable.

I've never managed to get thd twist to work for bonus dose, but I use an insulin syringe as I can see how much of a dose there is, a full dose is 0.6ml.

I get the syringes from my work. I'm a microbiologist and I know they are sterile as we use them at work

I used the hard twist method which worked to turn the dial but the plunger would not move when injecting so nothing was injected. I used a syringe instead. Done this twice now.