Monjaro pen question

[Umy15r03lcha1]

I'm new to this.

I've had 4 doses from my first pen and there's still some in the pen, definitely looks like enough for another dose at least. However after priming the pen it wouldn't wind all the way down to the 1 mark so I couldn't get a 5th dose from it even though the pen wasn't empty. Im using a new needle obviously.

Is this normal? Are the pens made not to give extra doses even if there's some left in the pen?

That’s normal. That’s called the ‘golden dose’ by some. In reality it’s extra medication in the pen to ensure you get a full dose even after priming etc. the pen has locked because you have used up four full doses of the meds.

To get the rest you’d need to either extract it with syringe through the tip or ‘break’ the pen (sharp twist, many aren’t able to do it). However this is against manufacturers instructions. They state you should dispose of it.

I ordered some insulin syringes from UK medi to get the extra doses out. They are quite cheap.

Theres quite a lot left in the pen, enough for one or two more doses. Shame because it's expensive and seems a waste.

Plenty of people use it, as mentioned by previous posters, there is usually a bit more than a standard dose which can be extracted with an insulin syringe, there are loads of posts here on MN and links to buy syringes. I presume you are a new user so don’t know about the extra dose.
At some point probably this year, it is going to be removed by the manufacturer, so I’d suggest using it whilst it’s still available.

How do you actually draw out the golden dose? Is it a simple procedure? Anyone got any links to videos they can share. Does it then require injecting in a normal way with a big needle? I like the pen as it doesn’t feel like you’re actually injecting!

Look on YouTube for a video by FatOldClimber. It's quite simple.

Sorry can't add a link.

You can get small needle syringes. You just draw it out from the red seal on the end and inject. No real stress about air bubbles as its subcutaneous.

The 1ml insulin syringes come with needles that are as fine as the pen needles, and can be 4, 6 or 8mm long. It’s really not that different to the pen needle. So they’re not big needles at all.

if you are going to use the remaining liquid you would need to be sure that you know what a standard dose volume is (0.6ml) and how to calculate the dose in mg if you extract and use more than 0.6ml. That’s just very basic maths. There’s normally between 0.6 and 0.9ml left over.

It doesn’t just seem a waste, it is a waste. You’ve paid for it, so use it.
The insulin syringes are very easy to use, and similar length and thickness to the pen needles, so the injection is no more traumatic in any way.

I always used the 5th dose now - mad not to. I ordered the UK medi syringes, and used the Fat Old Climber YT video for guidance - I was really scared the first time, but it's easy as pie.
Keep the pen in the fridge.

Which syringes do you order @LovesLabradors.. so many to chose from!

@morningtrain these ones:

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

Madness to waste it, it is very easy to draw it out into a syringe and inject - I have been doing this since I started over 18 months ago.

I’ve always used it. It’s closer to one and half doses, I extract every last drop with an insulin needle. I’m maintaining now and taking 2.5mg from a 5mg pen so I don’t mind a smaller dose on the 11th week (I get 3 golden doses).

Ive always managed to get the '5 th' dose by hard twisting the pen and then using the spare needle without issue

Sorry if this is a stupid question, but do you then keep the pen in the fridge between doses so it lasts longer?

@NotDoinNuffin the pen can be kept in the fridge or at room temp once it’s in use. Whether it’s in the fridge or at room temp, the instructions say to use within 30 days. Using the remaining liquid for a fifth dose fits within the 30 day limit. So you can either keep it in the fridge or not as you prefer.

If you mean taking a 2.5mg dose from a 5mg pen and using it for 11 weeks then you are beyond the 30 day limit after week 5. Keeping it the fridge will likely reduce the risk of bacterial contamination and the risk of the medication degrading, past the 30 days.

Yes, I’m using beyond 30 days, (11 weeks) so clearly it lives in the fridge, just take it out for the injection and immediately back in. I don’t even let the pen warmup to room temp.

The communication from my online pharmacy even said the 30 days didn’t apply if kept in the fridge.

@MeridaBrave it’s a shame that your pharmacy are incorrect about the 30 days instruction, as it’s clear from all the patient info that the 30 days applies when the pen is in use regardless of whether it’s stored in the fridge or at room temp. I wonder if it’s worth feeding back to them?

If you want the correct dose, pull down the syringe to 0.6 before inserting the needle into the pen. Push the syringe all the way down and then hold upright. The fluid will automatically enter the syringe.

No point. I’m prepared to take the risk. I’ve seen it on the official documentation but it seems to be more about “we haven’t tested beyond 30
days once used”. And they have zero incentive to do the testing.

Out of the UK the pens are prescribed for longer than the 30 days regularly it seems, there are many people who do this also in the UK. The main issue is around how well it works after this time, the liklihood of other issues are so rare. I have been reading up on this for some time now. I feel comfortable using for longer than 30 days. I will probably use 5mg pens for 2.5mg going forward.

It works fine for the 11 weeks (kept in fridge). Suppose slightly higher infection risk but I’ll take the risk. I’m paying £169 for 5mg and getting 11 doses so that’s just over £15 a dose which seems quite reasonable to me.