Mounjaro liquid continued efficacy over time

UK Mounjaro Talk
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Hi. Has anyone examined whether the Mounjara substance remains at full strength indefinately once the rubber has been punctured with the 1st needle?
I see recommendations of buying a large dose pen, and ‘clicking’ to the required dose (eg a 15mg pen - 20 clicks to get a 5ml dose) which means 10 doses from one pen and one discard at the end. This saving appeals to me.
But I am concerned that once the pen tip has been punctured, it might start losing its efficacy over time, even when refrigerated.
So, if its meant to last for the 4 week period would it still be viable for the full 10 weeks?

My endocrinologist has given me a script for 15mg for this purpose, but I don’t want to waste my money if it doesn’t.

Thanks
ps wiping the rubber with alcohol before each puncture and a new needle, prevents contamination. Wondering if the preservative wears off etc

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2

Once you start using a Mounjaro KwikPen, Eli Lilly advises that you must throw it away 30 days later. That’s because the medication is a peptide, they are delicate proteins that can break down over time. Plus, once the seal is broken, the pen is no longer sterile, so there’s a risk that bacteria could grow, especially with repeated use. You can keep the pen in the fridge or store it at room temperature (up to 30 °C), but the 30‑day rule still applies once it’s been opened. We don’t have any studies looking at safety or effectiveness after 30 days, so I can’t say whether it’s still safe or works as well beyond that, and I’m not medically qualified to give any advice.

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I have used the 5th dose. Strict hygiene and alcohol swabs are used to prevent any contamination. First month, I made sure to use all medication in pen within the 30 days even using the fifth dose. Next pen is 5mg and double the dose. Apprehensive about doubling the dose so gradually increased each weekly dose 3.75mg, 4mg, then 5mg and used the 5th dose. Used all medication within the pen. Obviously it was not within the 30 days as recommended. I have continued to use all medication within the pens but within less than 40 days perhaps under 37 days. Seems to still work well, had no side effects.

As to your question, there is one gentleman fatclimber on YouTube who has been using higher dose pen but using less for longer. He has been providing videos for about nine months now. Maybe search there, if interested. It’s a Bit extreme for me but he has certainly changed his own life around.

(It is not recommended by the manufacturer).

Welcome to the forum. New myself and just finding my way around the forum.

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So many people misquote the 30 day rule. The exact wording from Lily is…“Store in a refrigerator…Mounjaro KwikPen CAN be stored unrefrigerated not above 30 degrees C for up to 30 days and then the pen MUST be discarded” (emphasis added)

Nowhere does it state that it must be discarded after 30 days if kept refrigerated. Refrigerated injectable medications in hospital are used multiple times as long as within the expiry date period. We (I am a nurse) don’t mark a vial with the date it was first used.

So in theory, as long as it has been refrigerated at all time and you follow strict aseptic procedures you can use the contents until the expiry date. Having said that I would never advise anyone to use medication contrary to the manufacturers guidelines because failure to do so will ensure you have no recourse back to the manufacturer should anything go wrong.

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Definitely not, Mounjaro is a peptide, it has a shelf life, Mounjaro is a type of drug called a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. An agonist is a substance that binds to a receptor and triggers a response in a cell, mimicking the action of a naturally occurring substance like a hormone or neurotransmitter. It needs to be uncontaminated and fully active to effect change in your body.
It is a sensitive peptide that requires specific temperature and time frame to work correctly.
Am I to think that you have began your journey in the correct manner, 25mg, then 5mg etc…because the medication is titrated specifically and you must not guess or tamper with delicate peptides.
Your endocrinologist should know better than to suggest tampering with medication that is temperature and time sensitive. Peptides can degrade if stored incorrectly, they are sensitive molecules, factors like improper temperature, light exposure, moisture, and pH changes can cause them to break down, losing their intended biological activity. Also, you are at risk of introducing bacteria into your pen because it is no longer sealed and therefore, the content, nor container, is sterile.
All endocrinologists know this, they constantly utilise hormones and enzymes to effect changes to their clients bodies. I am shocked that a professional would suggest this to you.
I am not a doctor, I am not offering medical advice, I am a physiologist of many years and I urge you not to try to cut corners.

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Hi Millie. I started on 2.5. After a month started the 5. I have and will continue to stay on the 5 as I am very close to goal weight. Once there, I will probably reduced to 2.5 as a maintenance dose. 1)The pen is refrigerated from point of purchase to its discard. It stays in its box, so not affected by light or fridge contaminants.
2)I use new needles at every administration.
3)I wipe the rubber seal, before and after every use, with a spirit-soaked swab.
As far as most of your comments go, I have those well covered.
Your admission that you are unaware of any science that shows that: 1) the preservative in Mounjaro ‘wears off’ after the 4 weeks; 2) and, if it does, whether this allows degradation of the product, OR reduces efficacy; 3) the peptides(molecules) themselves, naturally lose their abilities after 4 weeks, even when refrigerated…is appreciated.
Eli Lilly, like all pharma, have a bottom line to consider. Users, saving money by doing this practice, would not be appreciated by Eli. But, I also understand that maybe EIi Lilly are not sure of its continued efficacy after 4 weeks and want to avoid customer backlash if Mounjaro does degrade.
What I am trying to see are comments from actual users who are using their weekly standard dose from a stronger’ pen and whether it is still working after the initial 4 week period.
But, thank you for you response Millie.

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Hi Jessie, Thank you for this info. My pens to not allow a 5th click to make use of the residual amount, sadly. I will check this individual on Youtube. Many thanks.

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I use a 5mg and count the clicks to get around 9 2.5mg from it, absolutely no reduction in efficiency and I’m still standing. I’m careful with hygiene and store in the fridge. I was watching a Australian user who does this on her Dr’s advise as it a lot more expensive overseas.

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I appreciate what you are saying, but peptides have a ‘shelf life.’ You are also assuming that people utilise ‘strict aseptic procedures.’
However, spot on, we cannot assume to hand out medical advice contrary to manufacturers guidelines, eg, how old are those peptides by time they reach us!!!

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Lilly’s research is unclear and they don’t publish their research on how they came up with the 30 days deadline. I have written an extensive bit about this on this site but in a nutshell, the formal advice is that pens cannot be used beyond 30 days because each time we insert a needle into the pen there’s always contamination going in, not just from the needle but from us too since there’s a chance of microscopic fluid going from us to inside the pen.

However, the multidose pens we use have tirzepatide with preservatives on it which makes it last up to 30 days if the pen is kept under 30 degrees Celsius.

The problem with the above recommendations is that Lilly doesn’t allow their research to be scrutinized by scientists or to be replicated so in fact no one knows if the pens last longer than 30 days because Lilly either hasn’t done the research and they just use the 30 days under 30 degrees mark because that’s the traditional limit for most insulin formulas, or Lilly has done the research but they don’t want people to be microdosing on pens to make them last longer as this practice affects Lilly’s profit. Either way they are unscrupulous and unclear.

Suggestions are that the tirzepatide lasts longer than 30 days but because Lilly is saying it doesn’t then if we decide to go off licence if anything happens to us using the pen wrong they won’t be liable and it’s on us.

Many people use the pens off licence and they have not been ill but that’s a decision only we can make and advising you is illegal because we aren’t prescribers and even if we were prescribers we wouldn’t be able to go against Lilly advice.

I have this week submitted a freedom of information request from the drugs regulator in the UK for information on the research done by Lilly on the drug longevity and the conditions that the drug must be kept until it starts degrading, but I suspect they don’t have it because Lilly hasn’t done it, and in that case Lilly could be liable for public misinformation and false advertising of the drug. Either way I hope they get fucked.

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I have been using the 5th dose for the last few months. It is actually works out as 28 days from the 1st dose until the 5th dose so all within a 30 day window.

FYI I have been on Mounjaro since February 1st and have now lost 5.5 stone, 27% off starting weight in 8 months. You do need to consciously adjust your diet, so you are working with the medicine, not just letting it dictate how much you eat, so that when I come off it, I have developed some new eating habits and patterns. If that makes sense?

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I have noticed this type of prescription very common in Italy - have friends there. they buy bigger strength pen and do less clicks per injection to make the pen lasting longer.

Personally I wouldn’t do that, it is not how the medication has been designed. if you need a 7.5mg dose, buy the 7.5mg pen.

I always knew that 30 days post opening or room temperature is the rule so even doing the 5th is borderline and I stop there. I would get too worried about it

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Sorry if I am misunderstanding, are you thinking if you alter the amount your inject from a 15mg strength you will mimic the effect of a 5mg or other? If so you are misguided. All pens carry 6ml of liquid containing the appropriate strength of Tirzepatide, the active ingredient. So, a 15mg pen contains a 6ml solution and diluted within that 6ml is a 15mg dose of the active ingredient Tirzepatide. That is the magic solution that activates hormones to tell your brain you are full and signal the pancreas to release the correct dose of insulin to manage blood sugar. However, even if you reduce the amount of solution you inject, you still inject 15ml of the active peptide Tirzepatide. It is a solution, so the active ingredient is the same strength no matter how little you inject. The drug is designed to ‘drip’ feed over 7 days.

Think of when you make squash, you put the actual squash in a glass, then you add water, you mix and what you get is a solution. When you drink it, it all tastes the same, no matter how little you drink, it is the same…….your mounjaro is like that, no matter how little you inject the strength is the same, you inject is the same amount of the active ingredient, either 2.5mg, 5mg…..etc,etc.

It is impossible to inject 5mg of the active ingredient from a pen that is a different strength.

I am assuming that is what you meant. Please do not take offence I am not a know it all! I am a physiologist, I understand the actions of drugs in the body and how they affect organs.

Kind Regards,

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15

Thanks for this explanation.

So are you saying a lesser dose of the 15mg pen (at say 20 clicks eqiv. 20ml = 5mg dose) is in fact a 15mg dose? Why don’t I feel dreadful?What is happening? doesn’t last the week? loses it efficacy after a couple of days?

I was on a 5mg pen for 4 weeks, no side effects. Went up to a 7mg pen and was very unwell and extremely dehydrated so went back to 5mg after a week and am happy at this dose. Now, with the 15mg pen, I administer 20 clicks = 20ml and feel no negative difference to the 5mg pen doses and it lasts the week. If I was so unwell on the 7mg pen, why am I not REALLY unwell on the 15mg pen… if the strength is the same regardless of dose?

Appreciate you fèedback

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16

Hi again Millie…mind working overtime here.

  1. Mounjaro is set strength regardless of pen size

  2. Efficacy is dictated by the amount you inject and your body’s reaction to that dose.

  3. If your body/hormones don’t react to a 2.5mg pen, increase to 5mg pen. If still no reaction increase to 7.5mg pen etc. until you reach an amount that the body does respond to.

  4. I presume that regardless of amount taken, all doses would be effective over the entire week.

  5. So, if having a adverse reaction at 15mg, need to reduce the amount taken by reducing pen size.

  6. Going down a pen size (eg 15mg to 5mg) just means reducing the amount taken. This would be no different to reducing the amount taken from any pen size. (eg from a 15mg pen, a dose equivalent to 5mg pen would be an amount of 20 clicks = 0.20mls.

Please tell me if I’m dreaming here.

Thanks

ps my 15mg pen is 2 months old and the Tirp is still effective, which was a concern when I bought it.

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Firstly, I apologise, each pen contains 3ml of solution…..I accidentally wrote the incorrect amount because I was writing a paper about a different solution at the same time!!!

Anyway, I hope I can clarify things a bit better for you…….please excuse how many times I repeat what I say…..I just want to make it as clear as possible.

1)The pen size…….., ALL pens are the same size and contain 3ml of liquid, it is the concentration of the active drug that is different, not the quantity of liquid in the pen. Every time you inject a dose, no matter how many clicks, the strength of drug that you inject is whatever mg (strength) you are using. It is a solution therefore the active drug is contained at the same strength throughout the whole of the pen!!!

2)Efficacy actually improves when you use the drug correctly because your body is getting used to the drug over a period of time. You should never increase the strength of the product until your body has adjusted to each strength. If you try you will definitely cause side effects and the drug will be less effective and potentially dangerous because you may put pressure on you pancreas and liver before it has adjusted to the drug.

Think smart, you wouldn’t take twice the dosage of any other drug just to get it to work quicker, you know you would damage your health, you must build up a slow tolerance first!!!

You must titrate in line with the manufacturers guidelines. Currently, that is,increase the strength of the drug by 2.5mg every 4 weeks. This is to ensure your body gets used to the drug over time and you experience minimum side effects. Please note….you are increasing the strength, not increasing the volume of liquid injected. All pens contain the same amount of liquid.

You should never decide what strength you use or need, it must be used correctly,this drug is powerful, you must follow the manufacturers guidelines. If someone is supplying the drug without carrying out checks and measures that you are taking it correctly they are not considering your health.

  1. Drug titration is the process of adjusting the dose of a medication for the maximum benefit without adverse effects. Increasing dosage at will can cause severe reactions. You should never attempt to determine the dose you need. The manufacturer will not take responsibility for any mishaps if you have not followed their protocols……. it will be your own fault if you suffer severe side effects.

Your body does react to the 2.5mg strength, but it is not the optimum therapeutic strength, it is a strength that will get your body used to the drug. Some people do not lose weight for the first couple of weeks because their body needs time to adjust.

Please remember, this drug is designed for people with diabetes, people should still be careful what they eat and drink and reduce their calorie intake accordingly. Anyone trying to continue eating how they did before will have side effects, such as nausea, constipation, bloating.

It’s not a miracle drug, you still have to eat sensibly. It just gets easier as your body adjusts and you begin to lose the glycogen stores from around your muscles and liver, when they are exhausted you begin burning the adipose tissue around your organs. Once that begins to happen you begin to feel differently. You begin to feel like you are not so hungry or don’t feel hungry at all, until you need your next injection. I am at that point right now, I have today taken my 2nd 10mg strength!!!

  1. Once you reach the optimum dose for you. you are burning stored fat (adipose fat) that is the stuff around your middle. Then you will find that the dose lasts the entire week because that fat turns into energy and keeps you going, until the next injection is due.

However, if you are constantly eating sugars and high carbohydrate foods you may experience more side effects because spikes in blood sugar causes higher levels of insulin to be release and you may feels sick and possibly hungry!!! Try to cut out sugars and high fat content food.

  1. If you have used the pens correctly and titrated through the correct strengths…which are 4 weeks at 2.5mg, 4 weeks at 5mg, 4 weeks at 7.5mg……etc,etc, you will not need to do anything other than continue up to 15mg, or if any pen allows your steady weightloss, stay on that until you stop losing, then move up to the next strength.

BUT YOU MUST NOT SKIP ANY STRENGTH!!! YOU MUST FOLLOW THESE STEPS. if you don’t you are actually risking your health!!!

  1. You don’t go down a pen size, all pens are the same size, you mean STRENGTH of active drug. All pens contain ml solution of either 5mg,7.5mg,10mg,12.5mg or 15mg of the active drug solute within the 3ml solution. Remember. ALL pens are the same size and contain the same amount of solution, the only difference is the concentration(stength) of the active drug.

So NO, you cannot get a 5mg dose of the active solution from a 15mg pen. No matter how little solution you inject it will contain 15mg strength!!! The only way to inject 5mg strength of the active drug is to use a 5mg pen!

For instance, if you are using a 15mg pen, the whole pen contains a 3ml solution made up of a carrier liquid and the active drug at a strength of 15mg diluted in the liquid.

When you begin clicking your pen from 0 up to 1 (the dose you should inject) however many clicks that takes, when that pen displays 1, you will inject 0.6ml of the total solution from the pen. Anything inbetween, no matter how many clicks, the strength of the solution that is drawn from the pen will be the same!!!

ALL of that solution contained in the pen carries the same strength of the active drug. So, no matter how little you inject……the strength of the drug is 15mg or whatever the strength of the pen should be………….it doesn’t matter if you only click the pen a few times, the strength of the drug is the same………. you cannot change that!!! Nothing can,nothing will!!!

The reason you inject a whole dose…..is so that it is effective for the whole week any time of the night or day. There will be no peaks and troughs in efficacy, but if you do not inject the whole dose you will experience dips in efficacy and your body will not convert food into energy as efficiently. You will feel hungry or not lose weight because the drug that helping signal to your brain that you have eaten will not be there when you need it to be, which is 24/7.

Please remember, the drug helps food pass through the stomach more slowly and it also tells the brain you are still full and the liver and pancreas to work much more efficiently. If it isn’t there at the correct time or in the correct dose, that will not happen.

In a nut shell, you cannot get a 5mg dose of the drug from a 15mg pen…………….WHY, well because the solution contains 15mg strength of the drug no matter how little you inject.

The only way to get a lesser strength of the active drug is to purchase a pen containing the lesser strength.

All pens contain the same amount of solutions = 3ml………….the difference in each pen is the strength of the active ingredient. If you inject only half a dose the strength is the same, it will just get used up in the body quicker and you will not know until you begin to feel the effect wear off. You need the whole dose because you do not know how much your body uses at any given time and that can mean the difference between losing and gaining weight!!!

Cutting down the amount you inject from a pen does not cut down the strength of the active ingredient. You are just cutting down the amount of the solution you inject….. That means you need to inject more often, and you cannot possibly know how much you need to inject later on or when!!!

The drug is purposely designed to last for 7 days at the strength in the pen!!! YOU must use it correctly or it will not be effective and you will experience peaks and troughs of efficacy or no effect at all!!!

You MUST titrate up through the doses for maximum effect or you body will not adjust or use the drug effectively. You risk side effects.

Does that help?

Oh btw, you can’t inject 20ml, each pen only contains 3ml, of which you inject 0,6ml each time you inject.

I hope that helps.

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18

Sorry but you’re being lax with units there, the strength is an amount (in mg) per volume (in ml).

Calling it a “5mg pen” is convenient shorthand for a strength of 5.0/0.6 = 8.333 mg/ml
so a full dose from the 5mg pen gives
(60/60) * 8.333 * 0.6 = 5.0 mg of MJ per injection

Similarly a “15mg pen” is shorthand for a strength of 15.0/0.6 = 25.0 mg/ml
so a 20 click dose from a 15mg pen pen gives
(20/60) * 25.0 * 0.6 = 5.0 mg of MJ per injection

One third of the volume, at three times the strength equals the same amount.

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It is interesting to see the amount of duff/incomplete info that people give out.

You absolutely can change the number of clicks to adjust the dosage that you administer. If you have a “5mg” pen that means that 60 clicks injects 5mg. If you injected 30 clicks it would give a 2.5mg dose. This can be applied to any strength of MJ and any number of clicks as abuk explained (although potential for error increases as the number of clicks decreases). The dose gets distributed from your fatty layer into your body over a day or so before it becomes fully active.

The 4 week rule is also not related to “delicate” peptides…Tirzepatide is actually very stable in the world of peptides and the unopened pens have a stated shelf life of (I think) 2 years at room temp. Putting them in a fridge does not increase degradation. It is to do with the chances of bacterial growth becoming an issue after piercing the solution with the first needle in non sterile conditions (your home). Essentially EL are confident that if you follow their instructions as a non-medically trained person, the solution will be ‘safe’ to use for the month if stored at 30C or below. Bacteria grow much better at 30 than they do at 5C and most people stored pens in a fridge so take from that what you want. Lots of people use higher conc pens and do what you were asking but ensure that they maintain the best possible control of sterility with additional wiping etc. Plenty of info on youtube etc from people who do this. Just because you can do something that EL doesn’t tell you to do, doesn’t mean that I am recommending it. That would be a personal choice.

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No, the strength of the active ingredient cannot be reduced…….you are incorrect. It is a solution!!!

I did not dispute that you can use the pen to administer less volume!!!

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Of course it does….but it’s a solution!!!

Dilutions

The relationship between concentration and volume is inversely proportional. (See Figure 1 for a schematic of the inverse relationship between percent of concentration or ratio strength (decreases), and the total quantity of product (increases)).

Thus, if a solution requires a dilution, the active drug in the solution will remain constant, but the volume will increase.

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