Dose-splitting - don't care anymore

[Glowingup]

Just venting about the ridiculous situation with pharmacies putting their prices up by insane amounts. All along they have told us that buying higher doses and splitting them to get more use of the pen isn't allowed and is dangerous. I have friends in other countries (Sweden and Germany) who are on them who have been explicitly advised by medical professionals that the 30 day rule is pure bullshit when the medication is kept refrigerated and are prescribed 15mg to be split into doses of 5mg (or 7.5 mg). I have also been following a former olympic athlete called Jo Fargus who is on tiktok. She is Australian and her doctor tells her to split the doses and click-count and she gets 15mg pens prescribed by that doctor and takes a 5mg dose. They've been taking the piss out of us all this time and the price-hike thing is an example of even more piss-taking.

Anyway, through my entire journey, I have click-counted and I have lost two and a half stone and am a couple of kilos from healthy BMI. I have used pens for at least double the 30 days. I now have half a 7.5mg pen, a full 7.5 mg pen and have just been approved for a 10mg pen. I will inject 3.75mg every 8 days rather than every 7 to make it last a bit more. By my counting, I have 30 doses left and at every 8 days, that is 240 days so well into 2026. That should be enough to get the last few kilos off and some maintenance. I will take pleasure in taking every single last golden dose too. Greedy fuckers.

I know he told me recently that refrigeration wasn’t strictly necessary and why that was but I can’t remember what he said 🤦🏻‍♀️

I’ve micro dosed since reaching gaol. A 15 mg pen take 3mg lasts 25 weeks so even at the price hike, it’s well worth it for me.

I worked for big pharma so very happy to take the risk with the knowledge I have.

And I don’t keep it in the fridge after first use.

@Sparklywolf that's shit. I would have though the nhs would gaurd against this with some of back up plan? They must have had a heads up?

Back to angry other posters. I never get why people get so angry about this. But I have a disabled child so I don't have the luxury of raising my blood pressure on other doing legal things that are none of my business.

But.. I do have high blood pressure. I'm 6 stones overweight mainly from being a carer to my disabled child. I can afford this drug.i diet. I exercise and always have. Yet people are hoping I go blind and die? Makes sense! I hope then the nhs picks up the cost of my obesity and socail care and the life time care of my child costing the tax payer millions. Because sheltered accommodation with 1:1 for 70 plus years will never come from my families pocket that I can assure you. It will come from yours as I will be dead and my son will never work.

I have a pen I've been using for nearly 3 months! I use a new needle each time and refrigerate it after every use. The medication has been just as effective for me.

So much anger & judgment...🤯

Anyway, I suspect there may be some delays with orders for probably 2 weeks, down to suppliers still processing any backlog, then delivery services being at capacity, but if EL have the confidence to say yesterday that there are no shortages, it just confirms that they've been holding stock back since the price increase was announced & orders should be ok again soon.

Not the PP but my friend who has been a pharmacist for decades says it's absolutely fine.

With respect you know nothing about my journey. I was obese when I was prescribed the medication and I have been significantly heavier than I was at the start of this journey. I have been losing and gaining the same amount of weight for many years so I disagree with your claim that I can do it myself. Anyway I don’t owe you or anyone an explanation.

Why is it okay by medical professionals in other countries to split doses and use pens longer but it’s somehow dangerous in the UK?

Anyway my I don’t care was about the pharmaceutical guidelines not to use the pen past 30 days. And I really don’t.

The issue with that is how to keep on ordering 15mg pens. The maintenance pharmacies I found told me that once at goal, if you take a break over 2 months need to start again at 2.5mg.

The 30 day thing isn’t made up, but it also doesn’t mean the medication suddenly goes bad on day 31. It is to do with the bacteria that will accumulate on the pen when piercing with needles. 30 days is considered the safest length of time before the risks of that bacteria increases beyond what they consider acceptable.

Lots of things have similar dates, eg eye drops and contact lens solution. It is thought this is due to the preservative in the liquid. Again using at day 31 or 32 will probably be fine, but as the preservative deteriorates, it becomes more risky.

The manufacturer has to choose a point at which it is no longer an acceptable risk for infection. The active ingredient is also thought to be less effective the longer it is unsealed.

I had 3 stone to lose I was obese. I did try by myself, but years of dieting, plus steroid medication and menopause meant that it wouldn’t shift. I likely have insulin resistance.

Losing weight is as easy as fewer calories, but achieving that isn’t always easy if your body has changed its set point weight, if you are medication that causes weight gain and prevents weight loss, if you body doesn’t release hunger hormones at the right time.

Obesity is a very dangerous ans risky condition. Most obese people have tried to lose weight before.

Anyone know how many doses of 3.75mg or 45 clicks of a 5mg pen I would get (including the golden dose)?

My maths is terrible but assume I’d get 5 doses of 5mg… is it 6.6 doses??

So a pen has 240 clicks plus some extra.

So you’d get 240/45 = 5.33 normal doses.

3/4 * 0.6 =0.45

You’ll get another almost 2 golden doses.

so assume it will last 7 weeks

5 using clicks 5X 45

1 using clicks and some liquid with syringe

1 using syringe

I think it was more they tested it open to 30 days and not beyond.

makes no sense it lasts 30 days out of fridge safety or in fridge…

I’m not sure there is no risk just it’s not been tested

The OP might not care but this thread is getting dangerously close to misinformation, and whilst I'm all for informed adults making their own risk assessments these have to made on the basis of decent evidence.

Drug manufacturers don't pull expiry dates out of thin air. Thirty days is the period of time for which there is published safety data. That doesn't mean that your mogwai suddenly turns into a gremlin on day 31. It simply means that after that point there is an unknown risk which increases with time and which needs to be balanced against other factors. People who choose to follow the guidance to the letter aren't stupid and I resent this implication, which I fear has become the subtext of this thread. They simply have a different risk threshold. If a person chooses to suddenly disregard guidance because it feels like they are getting one over on The Man then I wish them good luck.

Different jurisdictions have completely different attitudes to risk, and HCPs evaluating risk in those contexts will be influenced by multiple factors. I was in a coastal Nordic city recently and was struck that there were miles and miles of roads and pathways next to open water which were completely unfenced. The cultural expectation is that citizens take responsibility for their own safety even though there is theoretically nothing to stop someone driving or cycling straight into the Baltic Sea. In a more litigious culture the whole stretch would have been fenced. This sort of cultural messaging starts from birth and it is the water in which we swim.

I am unsure about Mounjaro pens but they are very similar to Ozempic pens or Wegovy pens and they were always six weeks once started so I would have no problem going six weeks with a Mounjaro pen.

I really appreciate the honesty of this thread.
I am firmly in the camp of the OP when it comes to assessing risk vs following the rules.

I'm curious if anyone has experienced any actual risks after going over the 30 days? I very much doubt it. (Anecdotal, I know, but interesting nonetheless).

Also how is everyone managing to go over the prescription dates and still titrate up through the pens? I've been swapping supplier (not for deliberate deception, but for cost saving) which has meant I've been able to go slightly longer than the 4 weeks , but eventually time will catch up with me. Any suggestions?

How would a person know that they had experienced those risks, and how would they distinguish them from other possible side effects of the drug?

@VelociraptorsVelociRappinggood point.
I suppose they would have to be new symptoms that appeared only after day 30 and onwards, that had not existed before?
(Great username btw, my 7 year old knows all the words!)

I've done 6 doses and been fine, zero side effects, it was just like standard jabbing. I am currently getting 7 doses out of my 15mg pen because it was too strong and I wasn't going to waste it with the new price increases that came out 2 days before I opened the pen. I'm tapering down on it from 12.5 to 10. I then have 2 x 10mg pens to go down further and will again get as many doses as I can. I am a registered nhs health professional and work in a lab as a manager with massive emphasis on risks and safety, so I'd like to think I know about keeping clean and preventing bacterial contamination. At the end of the day it's my body, I don't smoke or drink which I actually think is worse for the damaging effects they cause on the body and brain.

Do you use a syringe to withdraw a specific volume? Or do you count clicks? I suppose counting clicks would be more hygienic?

Also is it cheaper to micro-dose from a 15mg pen than any other - has anyone done the maths?

How about winding your neck in.

Dont like them? Don't take them.

The manufacturer does have to take into account the worst possible scenarios. Such as someone going to the toilet and not washing their hands before using their pen. And not using the sterile wipes to clean the septum. All while keeping their pen at 30 DegC just to make sure any bacteria on the top of the pen makes its way inside to flourish. So even with the bacteriacides and preservatives inside the pen, they limit the life to 30 days. That’s the type of scenario the manufacturers have to consider. People have to similarly decide for themselves what risk they wish to take.

Hi, where do you get the extra needles for split dosing?

Not quite what you asked, but I take 3.5mg (42 clicks) every 5 days as this level works well for me at balancing the side effects and maintaining suppression.

I have been taking 6 doses on days 0, 5, 10, 15, 20, 25 & 30. But plan to take a 7th dose on day 35 for as long as the pens have enough volume to allow me to do that.

I am aware that the extra 5 days is a very small additional risk. I mitigate these by keeping my pen refrigerated even though it is safe at room temperature for 30 days and by using sterile, single use insulin syringes to extract 0.42 ml each time instead of applying a needle to the KwikPen. I also alcoswab the rubber bung and allow this to dry for 30 seconds before withdrawing the liquid.