Storage
- Refrigerate at 2 to 8 degrees Celsius. Most products also permit a defined period at room temperature once in use, but that window is product-specific and is on the label. Read yours rather than assuming.
- Do not freeze. A product that has frozen is discarded, not thawed. This applies even if it looks normal afterward.
- The fridge door is the warmest and most variable spot in the fridge. The back of a middle shelf is better.
- Keep it in its original carton. Light protection is part of what the packaging is for.
Reconstituted vials
- Once a lyophilised vial is mixed, a different clock starts and it is shorter than the unmixed one.
- Bacteriostatic water contains benzyl alcohol as a preservative, which is what allows a vial to be entered more than once. Sterile water contains no preservative and is single-use. They are not interchangeable and the labels look similar.
- Label the vial with the date you reconstituted it. You will not remember.
Drawing a dose
This is where the serious errors happen, and they happen by factors of ten.
- Insulin syringes are marked in units, not in milligrams or millilitres. 100 units is 1 mL on a U-100 syringe.
- Your dose is prescribed in milligrams. Your vial has a concentration in milligrams per millilitre. You cannot draw correctly without both numbers and the conversion between them.
- Work the arithmetic twice, on paper, the first time at any new concentration. If a calculator tells you to draw almost the whole syringe for a small dose, stop and recheck rather than proceeding.
- Subcutaneous injection uses short, fine needles. Air bubbles matter less here than people fear, but they displace volume, and displaced volume is a dosing error.
Sharps
Use a proper sharps container, not a household bottle. Most pharmacies and local authorities operate a disposal route, and it is usually free.
Travelling
- Carry-on, never checked luggage. Hold temperatures are uncontrolled and bags get lost, and a lost bag here is a missed dose plus a replacement cost.
- Use an insulated cool pack, and keep the medication from touching ice or a frozen gel pack directly. Freezing it in transit is the common failure.
- Bring the original labelled pharmacy packaging. Travelling internationally, bring a letter from your prescriber as well.
- Medication and needles are permitted through airport security. Declare them at the checkpoint rather than letting them be found.
- Weekly dosing is forgiving about time zones. Keep the same weekday and do not try to correct by hours.
Sources
- Wegovy and Ozempic prescribing information, Novo Nordisk
- Mounjaro and Zepbound prescribing information, Eli Lilly
- TSA guidance on medically necessary liquids and sharps