The extra dose of Mounjaro

[mamabeeboo]

I'm really excited to start what I hope is my LAST weightloss journey and just on day 2.

I have heard about this extra dose at the end of MJ - and advice on what you all did for taking it? I'd like to save some money if it's just sitting there in the pen.

I have read that the extra dose is the same as the standard dose of 2.5mg.

At the 5th week, are you all taking the extra 2.5mg?

I looked at breaking the pen which looks easy enough, but I don't have any extra needles so will need to buy..? Or get a syringe...?

What sort of syringe would I need or ask for to buy from the chemist to get it out? (in the UK?)

I think this has been answered on the Jan thread but for clarity, the remaining liquid in the pen after taking 4 doses is usually around 0.6ml which is a full dose for the pen. So for a 2.5mg pen, it would be a full 2.5mg. It might be a bit more than 0.6ml or a bit less than 0.6ml, depending on how much you used to prime the pen each time for the previous 4 injections.

You would take your 4th dose as normal from your 2.5mg pen, then the next week, rather than start a new pen you would use the remaining liquid in the pen as a 5th dose. If you use the hard twist method to break the pen mechanism, then the dose will be 0.6ml or a bit less, and give you 2.5mg or a bit less. If you use a syringe, then you may be able to extract more than 0.6ml and inject a dose a bit higher than 2.5mg. You would need to check the volume in ml that you extract and work out what dose that would be, so that you know how much medication you've injected.

There's a risk you won't get the 5th dose out using the hard twist method. Lots of posts recently saying the pens won't work this way anymore.
To guarantee you can get it out I would buy some syringes to have on hand if necessary.

https://ukmedi.co.uk/products/fms-micro-syringe-32g-8mm-1ml-fms-fms-32g-10ml-ukmedi-co-uk

Clear and accurate explanation from silenceinside there!

I would say that I have never had less than 0.8ml left in my pens which has been great as a bridging dose when moving up but is hard to throw the excess when repeating a pen😁

These are the syringes I use

Oh and the same link from snozzle!

At the 5th week, are you all taking the extra 2.5mg?

I don't, I just take it as prescribed.

It is very low risk using the remaining liquid as long as you are careful with hygiene and know your numbers (full dose is 0.6ml). If you are paying privately it makes sense to do, otherwise you are just throwing away money.

I used the hard twist for my first 4 pens with no issues, but last one was much more difficult to twist and the dose knob went loose/turned freely. If that happens you will need to use a syringe, so it is worth having them on standby so you have the option.

It makes sense suppliers would try to sabotage this once customers have become wise to it!

Im guessing they probably have to provide extra because of the priming of the needle? In that some will get it a bit wrong (like I did) and squirt too much out?

Im off to Google those micro needles now!

Yes I use the extra dose. I'd be mortified to throw a full dose away. I use a syringe. I'm about to finish my second pen so tomorrow will be my second dose with a syringe.

How do you do the hard twist to get it out?

I've had to use pliers to grip the end that twists and then try to turn it using those. The first two times it worked, on the most recent pen the plunger mechanism inside the pen became detached and the pen was then unusable.

Some of it will be for additional priming, but if you prime too much the pen still locks ime after around 257-258 clicks (I have read some posts where excess priming prevented the poster doing the full 60 clicks on their 4th dose - it locked a couple of clicks short) with the bulk of the spare liquid left inside.

My guess is the liquid is partly there because of a mixture of assisting with accuracy of dosing and they are using similar design mechanism/component design/production equipment for their Humalog insulin kwikpens so it was more cost effective to make it the same size even if it meant sticking a bit of extra medication in. The medication itself is not that expensive, the reason these things are expensive is because big pharma needs to recoup their research costs quickly before the next big and better thing comes out. But that is just my guess.

Same here, dh might get his pliers back to fill the hole in his tool box (that he never seems to use, but has noticed they are missing!) next month if it happens again 🤣

Those doing pliers / hard twist, do be careful as a few posters on the FB groups have reported that they damaged the plastic of the pen which resulted in shards of plastic getting into the liquid.

I have never managed to do the hard twist and have just used syringes - they are inexpensive given the saving you get by using an extra dose.

@SevernWonders I can't see how any plastic from the pen mechanism, even if it got into the vial, would get past the rubber plunger, which is an inch away from the pen mechanism at that point and forms a seal tight enough to keep the liquid in place at the top of the vial. Doesn't make sense at all.

When people talk about extracting with a syringe, do you mean pushing a syringe needle through the red seal bit where the needle screws on?

Yes

Thanks!

That's interesting you say this as I managed to get extra dose out of the first 2 syringes and the 3rd one just snapped! So maybe they have made them differently as people know! 🤔 😔

They've defo started sabotaging the pens to stop people getting it. After all each extra shot is losing them about £40 per go!

I wonder if they'll do something to try and stop people withdrawing it with their own needles? Or stop putting the extra fluid in altogether?

I tried to get the 5th dose out tonight for the first time using a syringe. Previously I've always managed to keep twisting the pen!

Anyway, it was really hard to do. The liquid kept getting sucked back into the kwikpen. Eventually the syringe broke and I ended up with most of the extra dose on the floor! I managed to get 0.4 out of the pen with a new syringe, and pulled 0.2 out of my new pen. I'm always super careful when priming to barely waste any.

Why was it so hard to extract it, what did I do wrong?

@roycroppersshopper that's odd

I've only done it once - I'm in week 5 now - and I just sucked it out through the red bit with a regular insulin needle.
I was surprised how easy it drew out to be fair as I was expecting some resistance or pull back like you describe.

I did try to twist the pen hard but I felt that wasn't going to work on mine.

Hmm yes, evey time I got some in the syringe it was got sucked back. Eventually I had to do it really slowly over and over again and some stayed in the syringe each time so I got there in the end, but think there must be a quicker way to do it!

@roycroppersshopper It can be difficult because of the air. I just keep going and it eventually works but have read of some people injecting some air into the pen before they start syringing. May try it next month!

To stop the fluid being sucked back you need to overcome the vacuum in the pen. You do this by drawing your empty syringe plunger back to 0.6 before attaching it to the pen. Then push the needle on the syringe through the base of the pen and inject the 0.6 of air from the syringe into the pen. You can then withdraw the 0.6ml of Mounjaro into the syringe.

I am also using the 5th dose. Managed to hard twist on some occasions but also had to use the syringe a few times.