Am I the only one cautious about using over 30 days?

[Lailaaq]

I have two doses left so could go to 8 weeks. I’ve done 6 weeks and feel extremely nervous about going further. I’m using 2.5 from a 5mg pen. is it really ok?

I've been using a pen that expired back in April. I'm sure you'll be fine 😂

I’m currently on the 3rd month of my pen 😬

Ive used a pen for 10 weeks before and I would do it again.

I have heard of doctors in the US prescribing higher dose pens so that patients can use them for up to 12 weeks to save money.

The drug doesn’t know that some of it has been used and to suddenly become dangerous or ineffective after 30 days!

I’ve done it but kept the pen in the fridge and been scrupulous about cleanliness.

The Dr at my provider told me 8 weeks is ok

I've done it twice now & it's been completely fine. Drug has still worked (no loss in effectiveness) and no issues at the injection site. Do keep it in the fridge at all times except when you're using it obvs, and be scrupulous about hygiene.

I’ve used one up to 16 weeks. Really careful hygiene and keep it in fridge. I started off like you and then went to 35 or 42 days with sub-dosing but then the prices went through the roof and my tolerance of risk with it. I’ve yet to hear of anyone attributing harm to length of time open and it’s common practice now. At worst it might get a bit less effective towards the end.

My brother is diabetic and gets his pens free. He sends me his leftovers in the post and they have been fine 🤷🏻‍♀️

How do you buy repeat pens with such a big gap?

I stockpiled then had a year ordering gap while I used them up. ‘Restarted’ with a supplier when I was close to running out with 2.5mg pen and ordered the next dose up for a few months in a row to get a new stockpile. Many suppliers will let you restart after a supposed gap if you can evidence you were on it in the past and that you are not currently underweight. Don’t share that you are subdosing as regulations do not allow them to approve that. A new style 10mg pen lasts 16 weeks if you are taking 2.5mg. 17 (and a bit) weeks if you get the extra bit out with a syringe.

You must have money to burn. Good for you.

They must know that people subdose and stockpile but I suppose as long as we and they are all seen to be acting within the rules they can’t do much about it!

Odd response!

Perhaps we are looking for ways to make it cheaper overall because we don’t have money to burn?

Your first 5 doses were within the 30 days, the 6th was only a few days past. So it would only be the next two doses that would be significantly past the 30 days.

The risks are that the product may break down and be less effective, and that there might be bacterial contamination. If you keep it in the fridge and are very careful with hygiene then those risks will be reduced. If there are particulates or it’s cloudy then don’t use it. Other than that, what you are risking is the medication being less effective, and possibly having a reaction to the injection if it’s broken down into component parts or it’s contaminated.

In what way does throwing a pen away after 30 days, save money???!

Mine usually last about 6-8 weeks.

I've used pens for 10 weeks with no adverse effects for a while - I stockpiled 15mgs and got down to 7.5 so taking half a dose plus bonus dose. I would never bin this stuff, it's so expensive

Why would the product break down after 30 days if it is still within the expiry date?

It doesn’t ‘know’ that it has started being used.

There’s no way I’d throw a pen away after 30 days. That’s the whole point!

It’s a totally personal choice. I’m gun ho about it (and more bothered about saving money) so I use a 12.5mg for 7mg doses so it lasts at least 8-9 weeks. I keep in the fridge. I sometimes feel that my first dose from a new pen can be more effective than my last dose from an old pen so do sometimes wonder if it loses effectiveness but that could be in my mind!

@WLIcurious the expiry date only applies to an unopened pen, so not exposed to air or contamination. The 30 day timeframe for an in use pen is what the manufacturer has tested and submitted as evidence that the product is guaranteed to be in the correct condition. After that timeframe the manufacturer cannot guarantee that the product will still be in useable and effective condition. So they give the instruction not to use it past that point. Of course anyone can decide to go past that timeframe and use the product but the manufacturer nor anyone prescribing can say that the product will be effective and free from bacterial contamination.

Swift doctor is fine with me ordering every 8 weeks, they’ve never queried it, only ask when I took my last dose. Of course I can’t benefit from the new reduced price they’re offering if you commit to ordering every 4 weeks but it’s still worthwhile for me to do it this way and less deliveries to worry about.

I understand about contamination and that is a risk that anyone using past 30 days takes, but I don’t understand why you would think air would get in, or if you keep
it in the fridge that the drug still in the pen would start to be less effective just because some of it had been drawn out.
The manufacturers give an expiry date which is when it presumably does start to lose efficacy, but what would trigger that loss if it is used anytime before that?

Maybe if they sold it at a consistent unit price then there would be no incentive to stockpile higher dosage pens and subdose.

I've spoken to doctors and they say there is in fact no reason that any of this would happen at all. If you are using fresh needles there is no contamination, and I'm not sure how you think air gets in to the chamber, it simply doesn't.

Each time you attach a needle the medication in the pen is exposed to the environment albeit via a very tiny conduit. When you inject, there is a chance of drawback into the pen so bodily fluids can enter the pen itself. It is a small risk and in most cases I’m sure the medication is completely fine. The point is that the manufacturer has to adhere to safety standards and produce guidance for prescribers and patients on safe use of the medication. The testing process that they go through had demonstrated that the medication will be safe for 30 days once in use, even if contaminated each time you inject with bodily fluids and bacteria. After that, they are not able to say that it is definitively safe. That’s all.

@SilenceInside
Thank you! Some actual scientific explanations. I’m not being patronising btw, you have set out solid and sensible reasons and I can now see why they have given a 30 day limit.

I am still going to use pens past 30 days though!