Using one pen for 10 weeks -advise

[TickingKey46]

With the price hike I'm trying to think of a more cost effective way of using my monjaro.
I want to go down to 2.5 and then come off it. So I'm going to order a 5 and split the dose and then use the golden dose. In total this one pen would see me through 10 weeks at 2.5. But would this be safe? I will keep the pen in the fridge the whole time and ensure it's used before its expiry date, using a new needle each time. Can someone advise me if this would be safe please. Thank you

So I think it says in the instructions that it's to be used within 30 days of first being used. However this might just be to get you to buy more.

I do know folk that do what you are proposing & they're ok - no ill effects.
I think that sounds like a very sensible idea & if it's in the fridge the whole time it'll be fine.

No one can say this is safe as pens have not been tested this way. As you know, the patient advice leaflet says to use within 30 days, so that's all anyone can say is 'safe'.

No one can or should advise that this is safe. You should be aware of what the risks are, and then make a decision based on that. The manufacturer states that open pens must be discarded after 30 days. The expiry date printed on the pen is only relevant to an unopened pen. You would be using it for 5 weeks past the 30 days, which will have an increased risk of the medication degrading and being less effective as well as an increased risk of contamination. Those risks can be mitigated to some extent by scrupulous hygiene, keeping it in the fridge and checking visually that the medication isn't cloudy or has particulates in it.

So, bearing that in mind, it is your decision to make as regards what you are comfortable with in terms of risk.

I’m planning on doing the same but 3.75 from a 7.5 pen. Am happy with the risks. Will keep it in the fridge, be meticulously clean and obviously not use if the fluid is cloudy. There is a similar thread on here and there are a few people doing/planning to do similar

It has to be your choice. Nobody can say at all that it is safe or not to do so as the manufacturer of the drug advises the pen is to only be used for 30 days.

For me I would have no problem slightly extending the 30 days usage but it would not be my choice to extend to 10 weeks.

I've used one that is several months old with no ill effect. I'm not advising that you do that, just sharing my experience.

FlexiSandi Sorry quite what do you mean? You used the same pen for several months? Or it was out of date by several months?
Tbh I'm not so worried about the monjaro being less effective as i plan on coming off it once this pen is used up anyway, I just want to come off it in a controlled manner.

I do this all the time.
The manufacturer doesn't say it's unsafe after 30 days, they say it's safe up to 30 days. Not the same thing at all. They didn't bother to test for longer than 30 days. Why would they if they can get you to chuck away good meds? That said, it's entirely up to you.

Kipperandarthur
I'm wandering if we are told only 30 days as a way of consumers throwing them away and buying more?
I always use the 5th dose so regularly go over the 30 days (on a 5 pen). But obviously this is only one week over. Maybe I won't risk it just for the sake of saving money.

Nevertrustacop
That's my thoughts to! So can I please ask what exactly do you do? And on what strength dose?

I would suspect (but obviously can’t be sure) this has more to do with discouraging people from buying higher dose pens and using over a prolonged period to enhance profits rather than genuine serious safety concerns starting on day 31.

But anyway if you use the 5th dose at the expected dosage that is within 30 days - yes it is providing 35 days coverage but opening in day 1 for first dose you are then using on days 7, 14, 21 and 28.

Don't forget that using a fifth dose from a pen doesn't take you over 30 days. Dose 1 is on day zero, dose 2 is on day 7, so dose 5 is on day 28 👍

There was a thread here that suggested in Europe is common place for advice to allow the pen if refrigerated to be used post 30 days (if in date). I've used one for 40 days before and didn't notice any deterioration in its efficacy.

I've done it with Wegovy. A pen has lasted me 12 weeks. I refrigerate it between uses and use a fresh needle. I've done this for over a year now. The medication still works.

Interestingly when I was on Ozempic it said it lasted 60 days. The ingredients are exactly the same.

As others say there is no data to show it is safe. You will get posts saying my friends uncles cat is a pharmacist and said it is ok to try to add credibility to something no one knows the answer to.

The risks are unknown so you have to make your own decision. Don’t base it off social media anecdotes. There have been a few posts on MN before of people unwell, I remember one in hospital after using an older pen by accident as they hadn’t thrown it out. What it the pen or just coincidence? Again, no one knows.

One thing I would be wary of, is you will have no prescribing history if you come off in 10+ weeks time and may struggle to be prescribed again if you have a non eligible BMI find you can’t cope without it. Make sure you keep a door open somewhere in case you need it, perhaps speak to your current prescriber and let them know you are going to try to come off and if they would prescribe again.

I heard it described like a can of beans - they have a shelf life of a couple of years, but once you open them and expose them to the air, if you used half a can, you wouldn't keep the rest for a couple of months and then eat them.

As soon as you pierce the rubber seal, you risk letting in bacteria, which can multiply and you then are potentially injecting that into your skin.

That being said, I go way over the 30 days as I use a higher dose pen and stretch it out. I have a friend who started, stopped, left it in the fridge and restarted after 6 months using the same 7.5mg pen with no ill effects.

So down to personal risk assessment.

Thank you foe your advise everyone, it's dont think I will risk it.

A friend of mine has been a healthy BMI for a while, she stocked up on pens and just does a jab once a month to keep her going. This means she has pens open for absolutely ages, and she's not died yet.

Like everyone else, I suspect it's fine and the medicine doesn't magically become useless/infected on day 31- and like many others with the price hike, I will be doing the same to spread the cost of my pens. However whilst I am pretty comfortable with taking this risk (I've certainly put worse things in my body in my time!), it sounds like you're not.

i used a 5mg pen for 2.5 and used it for 10 weeks.. Obviously its up to you, but yes, some countries suggest getting higher pens and doing this. some doctors prescribe higher and tell people to take less..

I plan on doing it again in a couple months when i start to come down the strengths

The pen was out of date by several months. My friend stopped taking it and gave it to me when I could no longer afford to buy it for myself.

My doctor prescribes a 15mg pen for me to use for up to 6 months (not in UK). Tbf, I note that what they precisely say is that their experience is that it remains effective for up to 6 months if kept in fridge. Not remains safe - they are careful not to write that. But I cheerfully use it for about 10 weeks and have not experienced any deterioration. On the other hand, I wouldn’t use if not kept in fridge or beyond actual use by date.

But the using of the pen doesn’t affect what’s left. It’s sealed. It’s not like you open it and it’s exposed to air. It’s that some is taken out and vacuum remains. So it wouldn’t degrade just because you’ve injected from it.
of course manufacturer wants you to discard and buy another pen. But it’s the same medication whether it’s used or unused

I'm confused by what you say about the vacuum- when a needle is attached to dispense a dose that creates a (tiny!) tunnel between the outside & the inside of the pen. If the inside was at lower pressure than outside why wouldn't air rush into the pen to equalise the pressure? (I don't think the pen needles have valves.)

Surely the design of the pen is to keep the inside under pressure (from the plunger) so as to stop air/body fluids flowing into the pen?

I’m doing this (making a 5mg pen last 10 weeks) but no one can tell you if it’s safe. I don’t know myself. I keep in the fridge the whole time.. I don’t care if it’s less effective as at goal and using for maintenance.

I did it and still do. I buy 10mg and use 15 clicks. I know it’s not recommended but it works for me.