I feel a bit dense asking this basic Mounjaro question, but please can you help …

[JMSA]

Hi. I’ve been on Mounjaro for the past 8 months. I have lost a good amount of weight and it works well for me. Despite the price increases, I am not ready to give it up. I’d rather make small sacrifices in other areas of my life.
I’m on the highest dose, so 15mg, and have been for a while. However I remember being on 7.5 and having decent appetite suppression (anything lower just didn’t work for me). I reckon I could settle on 7.5. It would obviously work out cheaper to buy a 15mg pen and use it for twice as long, taking half doses. Is this possible and if so, how does it work? How do you know when to stop turning the pen for the half dose? 😳
I also take the golden dose these days, which is a life changer. I wish I’d done so with my earlier pens!
Your help would be much appreciated 😊

60 clicks of each pen is a full dose. So a half dose is 30 clicks

Oh, thank you. Can you tell I never paid attention to the number of clicks while fixing my dose?!

It is literally just counting the clicks and doing the ratio of a full dose of 60 you want. So in this case half is 30 clicks. If you will do the whole pen at same dose my top tip is to count 30 really slowly the first time then pop a sharpie mark in the window.

you will also need extra pen needles. Chances are you have a stash after 8 months as providers usually send a few spares. But if not Chemist4u do a box of 100 for a few pounds.

if also using extra dose with syringes this would be 10 weeks on same pen. That’s your own risk assessment but way over the guidance. I do this and am extremely careful with hygiene and cold storage and checking the fluid is still clear each time.

final issue will be order history. You can stretch the gaps with some providers but they are unlikely to keep giving you 15mg 10 weeks apart as it’s so obviously for sub-dosing. You may need to order more regularly, which means accumulating pens and working out ahead when to stop. It would be wise to move to a maintenance friendly provider so when you do stop they won’t cut you off when you have a big order gap.

A lot of people bought multiple high strength pens from multiple pharmacies during the August price hike panic that they are still working through so there is a lot of experience of this on here and on Reddit for advice on subdosing.

Be aware that a pen should only be used for 30 days once opened though so you can take a maximum of five injections if injecting once weekly.

CLICK CHART here

Why can’t you do the extra dose with a spare pen needle - instead of getting a syringe?

I’ve been doing this. Keep it in the fridge. I’m on a 15mgs one and I’m weening off. Currently taking 20 clicks which is 5mgs.

Because the pen has a limited number of clicks in it and won’t turn all the way for a 5th dose. Some people force it but in my opinion it’s much safer to use a separate syringe. No chance of losing the valuable dose and also means you can measure it as there is often quite a bit extra and if you are forcing the pen you won’t know exactly how much you have taken.

This is indeed the recommended guidance. But it doesn’t expire at midnight like a pumpkin carriage. It’s absolutely a personal risk assessment but anecdotally many users now do this, far more since the price hike, and there are yet to be any reports of issues due to this. The main risks are reduced efficacy (not dangerous) and contamination of the pen leading to bacterial growth. Keeping it in the fridge (guidelines are that it’s ok at room temp after opening) and using stringent hygiene minimise that risk to a level I am personally happy with for 10 weeks. Check each time that the guild remains clear. You should all make your own judgements on how long you are ok with. Incidentally doctors in some other countries prescribe it this way as standard.

Ah ok that’s me out then. Hate needles. I can just about cope with the pen!! 🙄

Thanks very much for your helpful thoughts, everyone. I had completely forgotten about prescription issues because of the extra timing.
Hmm, food for thought.

People seem to understand about the needles, et cetera here

I'm supposed to go up to 5 mg next month
Does the needle box you can buy from chemist work the same way or do I need a syringe as well?

I don't want the extra dose, but I don't want to just double my dose

Is it dodgy to ask for extra needles? I would like to do 3.75 but provider sends 5 mg automatically I think. I didn't get sent any spare. I am with. Voy

@RoundandSad as a separate point, you should be able to contact Voy and change what dose of pen they send you if you don’t want the 5mg pen and would rather have another 2.5mg. Also, they should send out a spare pen needle rather than just 4 each time. It’s very possible to have an issue with attaching it, and then you’d need a spare.

If you want to use the remaining liquid in your current 2.5mg pen for an extra dose, of 3.75mg rather than 2.5mg, you will need separate syringes. You can buy 1ml syringes, often called insulin syringes, and you want ones that are 30 or 32g in gauge. That’s a measure of how fine (thin) the needle is. You can get them in 4, 6 or 8mm length. Any of those lengths are ok. I use 32g 8mm syringes.

You then insert the syringe needle into the pen via the red bung and extract the remaining medication. From a 2.5mg pen you would need 0.9ml for a 3.75mg dose. Usually there is around that much medication left but you might find it’s less than that. It depends how much came out of the pen each time you primed for the four normal injections.

Sorry, I didn't really understand any of that

Is there no needle that just attaches to the top?

I thought it was odd that I only got for needle cap things because as you say if anything goes wrong, you haven't got any spare

I don't want the spare dose thing because it's not complete is it?

I just wanted a little bridge before starting on 5 mg so maybe two doses of 3.75

So I think that's the right dosage for them to send me, but I will need to contact them about spare needle

Ok, so I think you just want to know how to do a 3.75mg dose from the 5mg pen that you’ll get next?

So, to do 3.75mg from a 5mg pen, you turn the dial for 45 clicks rather than the full 60 that you would do to turn the dose to the 1 position. Other than that, you do the same steps as a normal injection.

If you don’t have enough pen needles, you can buy ones like the box of 100 mentioned up thread. But, if you want to do two lots of 3.75mg and then two lots of 5mg, then you would need 4 pen needles which you should get with the pen. You wouldn’t need any extra.

Thanks that's really helpful

if you do that, do you just ignore the zero in the one as they go past?

So I'm looking at the box of care point needle it looks right

I will contact Voy though because I think it's odd they only give four one of them could be damaged or something

@RoundandSad I don’t really know what you mean by “if you do that, do you just ignore the zero in the one as they go past?”?

Normally, you turn the pen from the 0 position to the 1 position before injecting. That takes 60 clicks but you don’t normally have to count them, as you know you are just turning to the 1 position. If you turn it slowly you can count each click, you would count 45 of them and that’s where you’d stop turning the pen. Then you’d inject as normal, until the pen has returned to the 0 position. Hopefully that makes sense?

I’ve not used Voy but have used 5 other pharmacies and they all sent around 6 pen needles. Very occasionally (it’s happened to me once in 7 months - a needle is blocked / you know as nothing comes out when you try to prime) so you have to discard and use a spare. Also I’ve been clumsy and dropped one before after opening so discarded it for hygiene.

advice from PP is correct. I did the same, 45 clicks from a 5mg pen to give 3.75mg doses.

a whole pen contains 60x4 clicks =240 plus quite an excess more than you need for priming. (Typically it locks after another 20ish clicks)

45x5=225 clicks so you can do 5 doses just using the clicks and normal pen needles with normal priming. This is also within the recommended 30 days of opening. Day 0,7,14,21,28 which new users don’t always realise so if 3.75 works for you it’s a great way to be more cost effective with zero additional risk or pen hacking.

However syringes are not difficult and you can easily get 1 more 3.75 dose out of that same pen only taking you to 35 days after opening.(0.45ml is same as 45 clicks) And if you are careful about priming (prime with 1 click, it works 90% of the time I only use a second click if font see the bead of liquid after 1) you can get a 7th dose of 3.75mg.

This was always useful but really worth knowing now that the prices are so crazy. Each of us have to decide what’s right for us of course, some hate needles too much for this, and some are not ok with going past the 30 day guidance.

final tip. If you want to do 3.75 more than once. Count the 45 clicks really slowly the first time and put a sharpie mark in the window to save the position for the subsequent doses. There is also a subtle wee indent in the pen barrel that lines up at 15/30/45.

knowing all the above has really helped me stay on low doses that work for me and also keep costs manageable since the price hikes. I thank this board for that. If you had told me a year ago I would be confidently injecting myself and subdosing medication if never have believed it! I would also never have believed I would be 4 stone lighter and feel comfortable in my own healthy body, able to do all the things that I had stopped.

Thank you both thats really helpful

You are welcome to disagree but this is the guidance from prescribers and the manufacturer.
Just posting needless rudeness and misinformation helps nobody and is the sort of thing which is ruining mumsnet.

Its not rudeness or misinformation. They puttue 30 day rule on there so that people buy more, rather than micro dose. Many countries do not have this '30 days' nonsense and some prescribed it with a micro dosing purpose in this very way. When my friend was prescribed hers (before me) the dr actually said that its a load of nonsense and the risk is so minimal that its hardly justifiable to print it on there. Its a money making scheme because they know people will make a higher dose pen last alot longer in this way. The same way they stopped the pen from breaking for the golden dose.

I thought the 30 days was only out of the fridge? In the fridge its the date the box says?

30 days from opening, ie first use.