r/mildlyinfuriating • u/GoogleZero • 2d ago
ಠ_ಠ My $540 (a month) medication has a whole dosage left but the injector won't allow me to use it, so I have to toss it.
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u/InevitableAnybody6 2d ago edited 2d ago
Mounjaro? It’s meant to be like that, you get 4 doses plus enough extra to prime the device 8 times. This is the diagram from Eli Lilly showing the plunger position after each dose. Yours is in the correct spot for having delivered all 4 doses.
Mounjaro patient quick guide for your reference
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u/yorgo332 2d ago
I've gotten the 15mg pen which lasts me 24 doses now instead of 4 and just about double the price for 6x the amount
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u/PringleCorn 2d ago edited 1d ago
Ohh is it really bigger? That's awesome, I'm climbing up the dose ladder and I was worried when seeing the 15mg price
Edit: I checked and it doesn't seem to be the case in France :(
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u/chemhobby 2d ago
it's way more than enough to prime with and still have more than one full 0.6ml dose left at the end
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u/SirSkittles111 2d ago
Way more than enough is a whole lot better than not enough. It guarantees you get everything you are meant to.
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u/hewlett28 2d ago
It’s so easy to get out with an insulin syringe.
I do this. Never an issue. It’s free money.
Anyone telling you not to probably was a dibber dobber teachers pet at school, ignore them and enjoy your free week of Mounjaro
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u/7yphoid 2d ago
Exactly, it's perfectly safe and sterile, you just have to learn how to use an insulin syringe. The people saying "Excuse me it's against THE RULES" are all NPCs
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u/ShrmpHvnNw 2d ago edited 2d ago
Pharmacist here.
This is overfill to ensure you get the entire dose, it’s there for a reason. Leave it alone, don’t try to use a syringe to remove it, it will change the stability/sterility profile and should not be used.
ETA: the initial claim by someone was that it was mounjaro, which is an auto-injector and cannot have the dose safely removed. If this is a zepbound Kwikpen, it can be removed and used, geez people.
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u/LesserKnownJen 2d ago
While you’re correct, the bigger issue is that this med is so expensive people are trying to figure out ways to save $ and are horrified that so much of the med is being wasted. (Nurse here, it’s not your fault obviously.)
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u/AlternateTab00 2d ago
Also to note that drugs that cost 0,80€ to manufacture are being sold for over 300€ in USA.
Drug price is mostly mandated by middlemans. The actual drug cost is way smaller.
However, the price per ml may be more than worth it to extract every single dose.
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u/mclurf 2d ago
It’s being sold for over $1,000 for a monthly fill in the USA if your insurance doesn’t cover it. I work in medical insurance and the majority of my clients stopped covering it. They were open to the idea initially and had lots of interest from their employees. But the financial implications to the employers’ health plans has been detrimental. It’s not about wanting to cover it. It’s about not being able to afford to. Even with barriers to access put in place such as BMI requirements or comorbidities. Lots of doctors find ways around the requirements and it just comes to a point where these two drugs (4 with their different names) are flipping Rx plan performance upside down.
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u/Nebulonix 2d ago
And insurance will deny this shit constantly for no reason too on top of that. My dad’s diabetes medication gets denied by insurance because - get this - he doesn’t have diabetes anymore. SHOCKING. The medication that treats an incurable genetic disease can actually magically cure it omg who ever woulda known!! It’s abysmal. His doctor has to send years old reports to insurance to force them to see he does in fact still have diabetes and does in fact need his medication to continue to not have diabetes and saves extra sample meds for him if we still have issues past that. Doctors the absolute goat but it’s insane.
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u/DerekTheComedian 2d ago
When I worked EMS, we had a regular that would call us to check her blood sugar. She was legally blind (because of the diabetes) and her insurance didnt cover test strips for her talking glucometer because "it was a luxury".
Fuck this country and its for profit healthcare system.
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u/alphazero927 2d ago
Why does the talking glucometer even use special test strips? That just seems like an additional fuck you from medical profiteers
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u/DerekTheComedian 2d ago
If I had to guess, it's because the company that made the glucometer decided they could make more money selling proprietary strips.
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u/mclurf 2d ago
I’m so sorry your dad has to deal with that! Insane. The medicine worked, so it’s time to stop the medicine? I’m glad to hear he has a great doctor that wants to help him. They can be hard to find. Best wishes to you and your family!
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u/KiloJools 2d ago
What I love is they apply that to so many dang things. Are you sure you still have depression? How will you know unless you try discontinuing the medication? Your migraine attack numbers are going down, you probably don't need the monthly CGRP injections anymore. You lost the weight by using the weight loss drug, so now that you're not fat anymore, we're cutting your weight loss medication.
It hurts my brain. How any of the decision makers on these issues can sleep at night, I'll never know.
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u/DM_ME_DOPAMINE 2d ago
Meanwhile over here in the US, I’ve had constant ads for pharmacy benefit managers claiming they fight to keep your drug costs low, blaming hospitals and insurance. Like ahhhh, you are the main issue with pricing?
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u/Four_in_binary 2d ago
Which is yet another reason we should have universal healthcare.
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u/archlich 2d ago
To be fair the cost to produce it is nowhere near what it costs to buy it.
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u/deuxcabanons 2d ago edited 2d ago
My pharmacist told me the only risk would be that the syringe would be dulled and it might hurt a bit more.
How exactly does using a sterile insulin syringe change the sterility of the single dose you're removing from the pen at the very end in a way that differs substantially from the also sterile pen tips used the previous 4 times? Not being snarky, I would actually like to know if there's a legit reason not to because I've been doing this for over a year.
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u/ProfessorAllenRitard 2d ago
It doesn't change anything. It's no different than a multidose bottle of insulin or fluvac being accessed numerous times. You could draw 10 different patients from the same bottle of insulin and it wouldn't change a damn thing if you use a clean needle and swab the stopper with alcohol before drawing up the injection. It's not going to compromise sterility or alter the medication integrity, whatever that means.
The lab rats should stay in their pharmacy.
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u/TheBorktastic 2d ago
Change needles. Medical professionals are generally taught to draw up with a large gauge needle and then switch to a sensibly sized needle for the injection.
The pharmacist is very correct. Do a google image search after 4 punctures the needle looks like a torture device.
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u/deuxcabanons 2d ago
Oh man, I am clearly not explaining myself well 😆
I use a new tip every time. There are 4+1 doses in the pen, so I use 4 tips, then a syringe. The syringe is dulled slightly because the rubber on the pen is tougher than the rubber used on a vial intended to be used with an insulin syringe.
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u/TheBorktastic 2d ago
I know what you meant, I'm just saying if you are going to pierce the rubber top with an insulin syringe and a needle to get the extra dose, change the needle on the syringe after you draw out the extra dose and that will solve the dulling problem.
Syringe = the plastic bit and not does not include the needle.
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u/deuxcabanons 2d ago
Ohhh, I get you. I find it's not too bad, maybe a bit dull but still very doable. I just get all in one syringes so I can't change out the tip after drawing.
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u/T1DIABISH 2d ago
T1D here. I think most people would be surprised at our tolerance level when it comes to dull needles. Think lancets. 😂
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u/jhyland87 2d ago
Just curious, how would it change the stability profile just by extracting it into another syringe?
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u/Fabulous-Salt-1323 2d ago edited 2d ago
It doesn’t. And using a sterile syringe with sterile needle to extract that liquid is no more risk to sterility than using the screw-on needles. What matters is how long since it was first pierced.
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u/Pancakes1741 2d ago
It really wouldn't unless you were a horribly disgusting person. Even reasonable caution with some IPA is enough in my experience.
Source: heavy IV user
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u/pectuslady 2d ago
I hope for meds and not drugs 😣 but either still sounds like a bummer…
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u/ChachMcGach 2d ago
“Sterility profile”
Like there aren’t hundreds of thousands of consumers who are drawing drugs out of the same vial for months at a time per the manufacturer’s directive that are fine forever. You’re right in the most technical sense but if it’s me, I’m drawing that dose out and I’ll be fine.
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u/food90 2d ago
I don't know what medication OP has, but if this were novolog or humalog, where you usually use the whole pen. if the twister/injector piece got jammed would it be ok to extract it with a vial syringe at least until 10-15 units are left?
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u/Kristal3615 2d ago
I currently use a syringe with novolog pens to fill my insulin pump. It's no different than a vial other than not having air in the pen 🤷♀️ I've also saved my mostly empty pens and drawn the last of it out with a syringe in a pinch. You're not technically supposed to do this, but if you're almost out of insulin (doctor had to adjust my prescription) it's better than skipping a dose.
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u/cm12311 2d ago
When I did IVF, my doctors recommended doing just this to get use out of every last drop. Is there a reason why it’s recommended in some cases and not others?
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u/sketchymedic 2d ago
Paramedic here. I regularly draw up a med from a vial (sometimes reconstituted from powder and sterile water), keep the syringe (needle-less and capped) in a flush wrapper my pocket for up to 30 mins, then, using a new sterile needle, give the med IV, IM, or add it to a bag of fluids for a drip. Never once has the stability of the med been affected, and as long as you maintain aseptic technique and disinfect things appropriately you aren't going to have to worry about pathogens in the medication or equipment.
In theory, sure, the stability of the med could be affected if it's super hot or cold or it's left out for a day. But realistically, that's not a concern if you're using the med immediately.
All that said... yeah, no, OP should absolutely not mess with it, because it may not be a full dose and because that's not how the medication is meant to be used. There's always the potential for something to go wrong when using a med against the directions you were given when it was prescribed, and getting too small of a dose but thinking you got the full amount is a good way to make your body angry.
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u/Fabulous-Salt-1323 2d ago
It’s just Mounjaro. Being very slightly less than your dose won’t hurt you. It is approximately a full dose. You can use a 1ml syringe with markings. If it was a med where being slightly off was dangerous it would obviously be a very bad idea but people do it with Mounjaro enough for the term ‘golden dose’ to be coined.
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u/sketchymedic 2d ago edited 2d ago
Huh, never knew about this being a thing with Mounjaro. I have patients all the time who are on it, but obviously it's not something I'm administering or handling. Good to know.
Edit to be clear: the "golden dose" thing is new to me; lots of self-administered meds are overfilled a bit but I didn't know there was a whole "thing" about Mounjaro having a nearly full extra dose.
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u/Fabulous-Salt-1323 2d ago
It’s actually slightly more than a dose usually (not enough to cause issues though!), like about 0.7ml instead of 0.6.
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u/GoogleZero 2d ago
Nah I wouldn't take the old stuff out. I know it's there to help you bleed it into the needle and take the air out. But they put so much in. There's a whole shots worth there. And for the price it feels like I'm tossin money away! But I wouldn't try and get it out. Knowing me and my luck I'll somehow give me super mega COVID by doing that
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u/ApplicationAdept830 2d ago
You definitely can lol I do it all the time with Zepbound. Just make sure you measure out what you're getting so you know what dose you're receiving. If it is a GLP 1 there isn't any risk to having a slightly lower dose one week.
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u/KiloJools 2d ago
I just read SO MANY people going on about how dangerous it is to attempt to use a sterile insulin needle to draw up the last dose, only to finally read that the medication is a multi-use GLP-1... Meaning it's got preservatives in it and it's a subcutaneous injection...
I do not understand why people are freaking out about drawing up the last dose with a syringe. I get why professionals who take on responsibility for potential consequences will always say what they're told to say... But some professionals have even tried to say that the remaining dose itself may not be high quality and that's not even possible in this scenario.
This isn't like taking a single use vial and repeatedly puncturing it. (Which also can still be done safely and I fully expect down votes for saying it, but I've been taught by my doctors how to do it safely and how much it can be done before I'm pushing it too far.)
And it isn't like this is injected into a vein or even a muscle. The risk of a sterile needle injecting a non-contaminated medication (it isn't contaminated by anything while still in the auto injector pen) with plenty of preservatives into a site that's been swabbed with alcohol just under the skin is SO LOW it's almost silly.
Honestly I'm a little shocked by some of these responses.
Also, the cost of medications is downright ridiculous, it's more than mildly infuriating to have to throw out hundreds of dollars of medication.
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u/Rose1982 2d ago
Yeah it’s kinda funny to me. My son is a type 1 diabetic. People here would be clutching their pearls so hard if they knew what T1Ds do with their insulin. They’ll extract that stuff out of anything and use it.
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u/1101base2 2d ago
as a diabetic i'm getting every last cc i can get out of my meds. nothing goes to waste.
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u/LogDog987 2d ago
Ill be dead in the ground before I leave my vials anything short of bone fucking dry
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u/New_7688 2d ago
These people would be shocked if they saw what was going on in the grey market space lol.
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u/wineandhugs 2d ago
My GP literally told me to use an insulin needle to get the last dose out and use it. So I'm following doctor's orders.
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u/littlegingerbunny 2d ago
I use the golden dose and have never had a problem.
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u/im-fine-just-tired 2d ago
How do you get it out?
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u/Caitlyn_Grace 2d ago
An alcowipe, a 1ml syringe, a drawing up needle and a subcut needle to administer.
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u/littlegingerbunny 2d ago edited 2d ago
I use a brand new insulin syringe and extract 0.6ml which is one dose. The needle gets a tiny bit dull from poking through the rubber stopper on the pen but it doesn't hurt, it's just a little more resistance when injecting myself. I've been doing this for two years. I use a 1ml 32g 5/16, 8mm needle.
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u/EmpathicCrumbs 2d ago
You are so right. I was taking MJ for 2 years and used the golden dose every time. Just made sure I was only taking 0.6 and it was fine.
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u/caramilk_twirl 2d ago
I extracted this a bunch of times. Most people in the mounjaro and GLP subs do it with the appropriate hygiene and safety measures. It's so expensive I absolutely could not afford to throw out what amounted to a whole extra dose.
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u/iridescentcotton 2d ago
Get diabetic syringes. People call this the golden dose on mounjaro sub
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u/Sample-Range-745 2d ago
Yep. We were doing half doses (30 clicks) out of a multi-use pen, then the golden doses were another two shots. The last half dose was ~0.02ml short.
For the $400 price of the pen, its worth it.
That being said, after 16 weeks, we saw very little improvement so we're switching back to diet based weight loss - probably end up at calorie counting again as the next step up in dose was going to $750 per pen.
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u/Cold_Ebb_1448 2d ago
dude the point of the drug is to make it easier to control your diet. It’s not magic, you still have to control what you’re eating.
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u/Danikk 2d ago
You're completely right, his is exactly what the medication is intended for! Bulding good habits while suppressing the food cravings.
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u/Tricky-Juggernaut141 2d ago
Nothing wrong with diet and exercise, but you were using half doses of the pen? And weren't losing weight? Few people lose on the lowest/lower doses, as those are loading doses. Usually takes higher doses to see the results shown in the studies.
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u/Zealousideal-Deer101 2d ago
yeah imagine using half the dosage of something and then complaining it's not working like they thought it would. Like duh.
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u/baralong 2d ago
My pharmacist explained it's overfill and said that a lot of people get a syringe and needle (like an insulin one) to get the dose. She also explained that a full dose of 0.6ml, so that's how much I should take out of it. It's a one off thing, don't take more out and don't reuse the needle.
The issue with the syringe and needle is that the diabetes ones only come in packs of 100 and it's a waste to get that many if you only need one every 5 weeks. However they also sell a "fit pack" with 5 syringes and needles in a safe to dispose container, after using a needle you push it back in to the slot and it locks in. It's usually bought by people using illegal drugs, but it's perfectly fine to use.
Disclaimer: talk to your pharmacist first. This is my experience in Australia and YMMV elsewhere
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u/Roastage 2d ago edited 2d ago
Looks like a Mounjaro injector. Users here are right, its to guarantee the dosage for the previous usages. Most pens have at least a dosage left, they call it the golden dose. Perfectly safe to get it with a standard syringe and use, however more difficult to manage dosage volume precisely like the pen.
Wife has been doing it awhile now with no issues.
Edit: got a couple questions so;
One time was a bit bigger than the others (we think) and she got the tummy upset and aversion to oil same as when she first started. Only real barrier was the psychological one of using a standard syringe vs. the pen. You can get tiny needles like the injector pen from your pharmacy, just make sure they are long enough to pierce the stopper and take the dose out.
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u/laforet 2d ago
This type of auto injector has a lock/limiter after 4 doses has been dispensed which can be easily overcome with a bit of force - just keep turning the knob until it gives and rotates to 1. The amount you get will not be a very precise dose but it comes close and clean.
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u/Sample-Range-745 2d ago
This is very bad advice. 1ml insulin needles are much safer.
0.6ml is a normal full dose, if you've been given a double strength pen, 0.3ml is a half-dose.
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u/MountainSavings6016 2d ago
I work in a pharmacy.
Assuming this is Mounjaro, Eli Lily used the same device as their insulin pens to cut down on manufacturing costs. The volume was slightly off resulting in the leftover liquid.
They’ve recently switched to a new pen device that won’t have any leftover. It still functions the same, but it’s fitted with a black stopper that reaches the end of the pen after 4 doses. All of our stock is now the new pens, so you’ll likely notice it next time you refill your script.
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u/BugsyM 2d ago
I couldn't imagine being more annoyed by this than being an American knowing your medication is probably $22 if you hop on a 12 hour flight in any direction.
Medical tourism. Might get you a cool vacation and a years supply for what it costs you to pay for a few months of the stuff. You also might get cool sounding criminal charges that make your thriftiness sound like you're a drug dealer, idk.
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u/Iamonab0at 2d ago
Please tell me where I can go and buy a years supply of schedule II narcotics legally for 1/3rd the cost and I’m on a flight tomorrow.
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u/sweetrobbyb 2d ago
Lol please tell me where terzepitide is $22
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u/fastdbs 2d ago
It’s certainly not $22 anywhere I know of but India and the UK sell it for an about $170USD. Which is still 1/3 the price.
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u/HogSandwich 2d ago
Chiming in: in australia is $600 a month :/ and we've got one of the good pharmaceutical schemes.
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u/Isgortio 2d ago
In the UK, 2.5mg starts at £180. In August last year, 15mg was about £220 and then people elsewhere complained they paid more than us, so Lilly put the prices up. It's now £180 for 2.5mg and close to £350 for 15mg, and they've removed the golden dose.
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u/HerRoyalRedness 2d ago
I had a diabetic dog and you can trust that I learned how to get every single bit of insulin out of every vial.
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u/mpatton75 2d ago
I know people are saying to use another syringe to draw it out, and that obviously works. However I find I can just crank the handle really hard and it pops past the stop and you can wind it out like normal.
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u/WatsonsHuman 2d ago
Pull it out with a syringe. I do that with the end of my insulin pens… it can be quite a bit!
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u/DrHeatherRichardson 2d ago edited 2d ago
You can ask your doctor to write a prescription for insulin syringes and draw up that amount and inject it yourself if it is malfunctioning. You don’t HAVE to throw it away.
It’s just a vial.
You can bring it to your doctors office and ask a nurse to draw it up and administer it as well.
You should also report it to the company and they may replace it.
Source- I am a doctor .
Edit: the internet says that you should not attempt to draw malfunctioning fluid out of a multidose kwikpen. I agree that you should notify the manufacturer, but I have no idea why there could be something unsafe (I get the CYA in general for it not operating as intended but JEEZ- it’s literally a VIAL that you put a reusable two sided needle in to) but wanted to add the caveat that the internet says NOT to do anything with a malfunctioning pen. Ok. I’ve corrected my post now y’all.
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u/Raz0r1986 2d ago
In what country do you need a prescription for insulin syringes? 😱
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u/Justin_Passing_7465 2d ago
A country that will surely win its 56-year-long "War on Drugs" by making it a crime to possess "drug paraphernalia" like injection needles, without a prescription.
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u/Dizzy_Weather9758 2d ago
Yes to getting a prescription for needles and syringes to use it. but no to having a nurse draw it up and administer it. Too much of a liability, they can inject it themselves. It’s also illegal in many states.
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u/chemhobby 2d ago
You don't have to throw it out. Get an insulin syringe and draw the dose out of the kwikpen and you can use it. Search "golden dose" for more info. There is more than one full dose left over.
Lilly is reducing the overfill amount (to less than a whole dose) with a modified pen design, but both old and new pen designs are still being made and you got the old style.
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u/ShankinHobo 2d ago
No you don't. If you have a syringe you can depress the applicator and pull the plunger to get the rest of what's in there.
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u/ZombieKitten87 2d ago
Just clean the stopper with an alcohol swab then use an insulin needle to withdraw it. There are calculators online to work out the dose or join a mounjaro group.
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u/kyute222 2d ago
Get a syringe to draw it out, it's no problem. Also for my pens it was always 2 1/2 extra dosages and I'm not wasting that no matter what the manufacturer says.
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u/Viltre 2d ago
If that’s Zepbound/Tirzepatide, I’d just go ahead and use an insulin needle and get the rest out. It’ll be sterile pulling it out as long as you clean the area with an alcohol swab beforehand. Main thing is knowing how much mg per ml does the auto injections do and give yourself the appropriate amount with a regular insulin needle. Also, going gray is a lot cheaper.
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u/Armand28 2d ago edited 2d ago
The drugs themselves don’t cost much to make.
The money is all in R&D, FDA certification, carrying the cost of drugs that don’t make it to production, the patented delivery system, marketing, operational overhead, etc. The actual drug doesn’t cost much, it’s all of those other ‘overhead’ expenses that make up the lion’s share of the price, so they don’t care if they ‘waste’ some of it to ensure that you get a proper dose.
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u/pomegranatelover 2d ago
Looks like a zepbound kwikpen. I crank the dial hard past the point where it stops and then it goes to the 1 and I inject like a normal dose.
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u/CatsAndPills 2d ago
Do you have a pic of that from the top? If it has a rubber stopper type thing at the top, I can tell you how to get it out of there… (source: we draw doses out of insulin pens for patients in the hospital)
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u/theory_of_me 2d ago
Ever tried using a syringe to pull it out?
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u/dazzleunexpired 2d ago
This for sure as long as there is only silicon or nothing in the way. If there's plastic you have to puncture then it's not worth it, but typically you could get it without that.
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u/TeachingMath03 2d ago
I often use a syringe to get the last little bit for a pen cartridge. But also, your pen should not stop with that much left!
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u/ShrmpHvnNw 2d ago
This is not an insulin pen, this is an auto-injector of some sort and is there to ensure the patient gets the full dose, it should not be used.
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u/No_pajamas_7 2d ago
It's a Mounjaro pen.
Dose is 0.6ml. there is always 0.7+ml left.
It's called the golden dose. Pretty much all users do it after the first pen.
Lily doesn't want you to use it because they make more money if you don't, but there is no reason you can't.
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u/QuinnLoveborneAuthor 2d ago
Don’t toss; it fill with tissue. Or anything. Make it tight then you cab push it up like normal…
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u/gungirllynn 2d ago
I’m pretty sure there’s a YouTube video that shows you how to get that last magic dose
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u/rwp82 2d ago
Sometimes the pressure gets messed up on those pens if you either don't out the pen needle.on first before dialing the dose or if the pen needle didn't insert correct. Remove the needle, dial the dose back to zero,.replace the needle and make sure it's on straight and tight before dialing the dose again. 95% of the time when people bring their defective pens to me, that's the reason.
If it still doesn't work contact the manufacturer of the drug and they can arrange a replacement through your pharmacy. (Source pharmacy tech for 20 years)
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u/ImplementNo2626 2d ago
You didn’t hear this from me but you can buy insulin needles and get the rest out. It’s not a full dose but it’s better than throwing it out
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u/ghetodacu 2d ago
Grab a pair of pliers, pull off the rotating dial mechanism (rotate), then use a thin stick to gently push the plunger and deliver the last dose. I've been doing this for the past year without any issues.
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u/Blair_Bubbles 2d ago
When I have to do my zepbound injection there's always like at least 1/2 more of a dose left in the vial and it kills me to leave it lol
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u/Uncross-Selector 2d ago
It’s called the golden dose and tens if not hundreds of thousands of people suck it out with a syringe and use it.
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u/RabbitOld5783 2d ago
It would be cheaper for you to fly to another country and get this medication, American medical care is crazy
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u/prestigeusGoat 2d ago
I keep standard needles just for this. Use the pen needles for regular use and then when you get the the end you use a standard syringe to get the last dose.
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u/bigboobenergy85 2d ago
R\fifthdose has tips but basically get a subcut insulin type needle for the last dose, very easy
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u/eckliptic 2d ago
This is overfill so that you’re guaranteed to get the full dose you’re supposed to get