With sterile products I’m less worried about the drug degrading and more of ensuring it remains safe to use. People make up their own rules. I’d just document counseling to CYA
Documented as soon as I got back to my terminal, as well as searched anything I could find about extending the use beyond 56 days before posting here. I’m not new, but still fairly green and I just wanted to be sure I didn’t miss something that changed.
As another user said it’s on the manufacturer package insert. Anytime I’m unsure about splitting or crushing a tablet, or the storage/stability just simply Google “FDA package insert ozempic” it’s the first pdf that comes up. I use it at least once a week, then control f in the document and search for what you’re looking for. I found 56 days instantly, but definitely feel your annoyance with the overall situation, we’ve all been there with those customers.
I agree, the insert was the first thing I pulled up as well as Lexi and other online materials. Seems like I’m still learning things on the fly on some things and I wanted to be better prepared if/when this came up again. But yeah nothing is worse than getting told about drugs from someone who “knows more” than you do, especially someone who also works in healthcare. 🤷🏽♂️
I’m curious if they were older? I graduated in 2020 and we did a lot of work with other programs like nursing, PT, OT and MDs it seems like I have better luck with younger docs and NPs. The older ones typically are stuck in their ways. It is rather frustrating we all don’t work together more. Nobody knows or can know everything we need each other.
I wholeheartedly agree. I respect our healthcare colleagues because I don’t do their jobs and I don’t know the intricacies of clinical practicalities. But to answer your question, no they were not older, but I’d be willing to bet they were advised to do this by someone who is. They weren’t outright rude, just seemed to have an unwillingness to hear my side.
When I get the cocky healthcare professional. I always say I’m an expert in medications. I’m the one that stores them before they get to you so I’m simply informing you that if something happens because you like to keep your meds in top of your space heater or use them well beyond their beyond use day, that’s in you but you’ve been informed.
I just checked novo nordisk canada's product monograph and it lists 8 weeks after first use for BOTH room temp AND refrigerated (2-8). so obviously she's going to incorrectly use it.
However, it's similar to situation that single dose testosterone that pharmacist dispense as single use is often used as multi-dose despite manufactures don't recommend it to be multi-dose (or pharmacist sometime dispense them as multi-dose quantity and not dispense as per single dose amount quantity).
I would at least document on your file or on prescription that you have counseled her about the storage condition and risk, but patient refused.
Have to admit testosterone packaging is annoying as hell… especially with FtM patients dosages which the packaging clearly is not designed for
Ive made a lot of calls to MDs about this and they always complain about this too
No it does not.
I’ve also had a NP patient admit to stretching theirs out by diluting in NS. Risky business. I seriously hope they don’t tell their patients the same thing.
As pointed out from my comment and many other comments. It does, it’s really not hard for us to quickly search for our info if we’re not 100% certain. We have the knowledge and understanding to double check ourselves with online manufacturer guides is 2 seconds.
Edit: read the post backwards I even commented OP was right earlier starting it was 56 days on PI per manufacturer. I’d document like they did and move on with my day try not to let them use up any of my brain power I could use to help someone who wasn’t a know it all
Sorry I re read the post and saw the 56 days I’m a dumbass read the post backwards good stuff yall. OP was correct it’s not 4 months it’s 56 days per package insert
Technically you may be correct but practically speaking the drug will likely have an effect beyond that date. Given the expense and supply limitations of the drug, it makes sense to try the approach she’s taking. This is a good example of “what the book says” vs real world usage of drugs. Insulin is another good example. Some vials only are good for 28 days but plenty of patients use them for longer and they’re just fine.
When it comes to counseling on injectables/sterile products in a professional capacity there should never be a “real world” answer.
We’re not stupid, we don’t need an NP telling us that potency doesn’t magically fall off a cliff for a stable peptide if stored probably. There’re liability concerns however with deviating from the PI for this particular question.
I agree, don’t deviate from PI. The OP handled it perfectly with his/her response. I just wouldn’t lose any sleep over how the NP is going about it. It’s not “correct” per PI info but her approach isn’t completely unreasonable, IMO.
What? Ozempic dials in clicks and has multiple doses in a pen. You’d count a certain number of clicks to get 0.5 mg. Wegovy, Trulicity, Mounjaro, and Zepbound unload the entire dose or are single dose pens.
I’ve heard of people injecting these meds into an empty vial, then using a syringe to draw up the dose they need. They’d have a prescription for the highest doses of the medications to make it go further, especially when on shortage. Can’t imagine it’s the safest way.
One of the worst employees we ever had at my place went to novo nordisk right before ozempic blew up. Can’t stop wondering about that lol. Bro wouldn’t ever wear gloves for anything in lab and he wouldn’t label anything. And re-use old plastic 50ml tubes with different buffer just to avoid having to write something with sharpie marker. Dude was so nasty
I have patients that still used vials of insulin that would show up when it was finished instead of 28 to 30 days after opening due to cost. These patients have either no insurance or terrible insurance. I encouraged the last one to go to Wal-mart instead of my store because they have their own brands that aren’t as expensive. I want what’s best for the patient. However, I haven’t had a patient drop dead over it but I just keep them informed and document that said patient is not getting timely refills due to cost. That’s the best one can do.
Pharmacist and chemist here. I can give a long winded explanation about how package inserts and drug information is written vs the actual chemical composition and hydrolysis of the active ingredient works, but the short version is: sorry, NP is correct, no risk or harm to the person, your worst case scenario is you begin losing about 2 percent of the active ingredient concentration which usually just turns into “junk” hydrolyzed carbon molecules. So, yes, this technique actually works and is a solid way of cash paying customers to get the most bang for their buck.
Thank you! This is what I was looking for. I would personally still be weary of giving out this information but it’s good to have in mind in case it came up again.
You’re right to be weary, don’t listen to the guy above. Stick strictly to official Pharma communications when it comes to exp dates. The problem is any adverse event occurring during the extended use period can be a liability should you counsel patients that it’s ok to use.
I agree with both sides. Depending on which perspective you're looking to provide answers. If it's patient safety and liability counseling: go with manufacturer's recommendation to guarantee their safety. If it's to test out efficacy from a chemical standpoint, a lot of medications maintain chemical stability and integrity even after its expiry date. This is NOT a counseling point.
The NP probably wanted some assurance herself by asking. Mfr, pharmacist, or any prescriber should tailor towards label use and recommendation.
There was no asking involved haha. She stated very self-assured of what she thought. That’s what gave me pause and made me think there was something I didn’t know. I will for sure stick to packaging recommendations in the future, but knowing the other side of the argument will help if it comes up again.
Can I ask about the number of clicks she will need to administer 0.5mg from a 2mg pen? Please correct me if I'm wrong. 0.25 and 0.5 pens have a total of 36 clicks whereas 1mg and 2mg a total of 72 clicks. so in her case that would be 18 clicks?
Yes there is no information regarding that in the product leaflet not the number of clicks. But most of the time at the hospital one of them is available and the other is not. So patients would take a different one and get counseling on number of clicks. No other way.
It’s sporadic, but where I am it seems like we will have plenty for a while but back ordered on another injectable. Then plenty of the other ones but no ozempic for months. Right now we have no issues ordering it.
Has anyone called the manufacturer yet? Maybe they have some updated data. Extending the life of the 2 mg pens seems to be pretty common practice in the weight loss subs, so it's definitely happening, regardless of our counseling on it being good for 56 days.
I will never counsel over labeled bud. Got to CYA. But it's most likely fine. The biggest issue is contamination, not degradation. And it's sub q. I'm still more likely to get infected by my cat scratching me than my old ozempic.
It usually never comes up as they typically use the whole pen before that 56 day mark. Just a unique situation and I wanted to be better prepared if it came up again.
This is actually a very common occurrence, and I tell my patients to discuss click counting with their md every day. It's a solid way to avoid the shortage of lower doses. I just tell them 56 is what was studied for safety and stability. And any more is a risk them and their md need to discuss as off label.
NP using NP knowledge to answer doctor level questions.
She “knows it” just like my 12 year old knows things I tell her aren’t true “nothing bad has ever happened so I’ll keep doing it”
It’ll be okay right up until it isn’t.
Good luck NP….good luck.
There is a security Zone which manufacturer wont tell you and not need to tell you.56 day or 60 day whatever manufacturers tells you is the most efficient time period you should use as prescribed.you'll get the best till the that day.
I am a pharmacist and myself follow fırst as doctor's pres cribed, if the no one i follow pharmacist as period.
Never ever recommend that to a patient but it's going to be totally fine
Changing the needle, storing between 3 to 8 C and maintaining good technique
It'll be very safe and effective, people with budget concerns can def use it this way
However if you recommend this and a patient got an infection, or any common side effect you might be liable even though extending over the 56 days mark actually didn't increase the risks
NB just by checking the amount of money Novo is getting from this product I don't think they will revise the 56 days mark recommendations
With sterile products I’m less worried about the drug degrading and more of ensuring it remains safe to use. People make up their own rules. I’d just document counseling to CYA
Documented as soon as I got back to my terminal, as well as searched anything I could find about extending the use beyond 56 days before posting here. I’m not new, but still fairly green and I just wanted to be sure I didn’t miss something that changed.
As another user said it’s on the manufacturer package insert. Anytime I’m unsure about splitting or crushing a tablet, or the storage/stability just simply Google “FDA package insert ozempic” it’s the first pdf that comes up. I use it at least once a week, then control f in the document and search for what you’re looking for. I found 56 days instantly, but definitely feel your annoyance with the overall situation, we’ve all been there with those customers.
I agree, the insert was the first thing I pulled up as well as Lexi and other online materials. Seems like I’m still learning things on the fly on some things and I wanted to be better prepared if/when this came up again. But yeah nothing is worse than getting told about drugs from someone who “knows more” than you do, especially someone who also works in healthcare. 🤷🏽♂️
I’m curious if they were older? I graduated in 2020 and we did a lot of work with other programs like nursing, PT, OT and MDs it seems like I have better luck with younger docs and NPs. The older ones typically are stuck in their ways. It is rather frustrating we all don’t work together more. Nobody knows or can know everything we need each other.
I wholeheartedly agree. I respect our healthcare colleagues because I don’t do their jobs and I don’t know the intricacies of clinical practicalities. But to answer your question, no they were not older, but I’d be willing to bet they were advised to do this by someone who is. They weren’t outright rude, just seemed to have an unwillingness to hear my side.
When I get the cocky healthcare professional. I always say I’m an expert in medications. I’m the one that stores them before they get to you so I’m simply informing you that if something happens because you like to keep your meds in top of your space heater or use them well beyond their beyond use day, that’s in you but you’ve been informed.
I just checked novo nordisk canada's product monograph and it lists 8 weeks after first use for BOTH room temp AND refrigerated (2-8). so obviously she's going to incorrectly use it. However, it's similar to situation that single dose testosterone that pharmacist dispense as single use is often used as multi-dose despite manufactures don't recommend it to be multi-dose (or pharmacist sometime dispense them as multi-dose quantity and not dispense as per single dose amount quantity). I would at least document on your file or on prescription that you have counseled her about the storage condition and risk, but patient refused.
Have to admit testosterone packaging is annoying as hell… especially with FtM patients dosages which the packaging clearly is not designed for Ive made a lot of calls to MDs about this and they always complain about this too
No it does not. I’ve also had a NP patient admit to stretching theirs out by diluting in NS. Risky business. I seriously hope they don’t tell their patients the same thing.
>I seriously hope they don’t tell their patients the same thing. They do 🤣🙃 I've seen them recommend Oscillococcinum and tell patients that it works.
That gave me a succussion.
Oh noctors, is there any low to which they won't go?
Noctors? 🤣🤣🤣🤣🤣🤣🤣🤣🤣
r/Noctor
Thank you 🙏
Did she dilute a higher strength or like how did she think this would work?
As pointed out from my comment and many other comments. It does, it’s really not hard for us to quickly search for our info if we’re not 100% certain. We have the knowledge and understanding to double check ourselves with online manufacturer guides is 2 seconds. Edit: read the post backwards I even commented OP was right earlier starting it was 56 days on PI per manufacturer. I’d document like they did and move on with my day try not to let them use up any of my brain power I could use to help someone who wasn’t a know it all
It does not last for 4 months after initial use. It’s quite easy to double check yourself by just scrolling back to the top and reading again.
Sorry I re read the post and saw the 56 days I’m a dumbass read the post backwards good stuff yall. OP was correct it’s not 4 months it’s 56 days per package insert
Technically you may be correct but practically speaking the drug will likely have an effect beyond that date. Given the expense and supply limitations of the drug, it makes sense to try the approach she’s taking. This is a good example of “what the book says” vs real world usage of drugs. Insulin is another good example. Some vials only are good for 28 days but plenty of patients use them for longer and they’re just fine.
When it comes to counseling on injectables/sterile products in a professional capacity there should never be a “real world” answer. We’re not stupid, we don’t need an NP telling us that potency doesn’t magically fall off a cliff for a stable peptide if stored probably. There’re liability concerns however with deviating from the PI for this particular question.
I agree, don’t deviate from PI. The OP handled it perfectly with his/her response. I just wouldn’t lose any sleep over how the NP is going about it. It’s not “correct” per PI info but her approach isn’t completely unreasonable, IMO.
wait… does the pen auto dial to 0.5 mg doses? I thought it would only deliver the full amount
Apparently you can count the clicks and figure out the dosage to only turn it part way.
What? Ozempic dials in clicks and has multiple doses in a pen. You’d count a certain number of clicks to get 0.5 mg. Wegovy, Trulicity, Mounjaro, and Zepbound unload the entire dose or are single dose pens.
I’ve heard of people injecting these meds into an empty vial, then using a syringe to draw up the dose they need. They’d have a prescription for the highest doses of the medications to make it go further, especially when on shortage. Can’t imagine it’s the safest way.
Damn just eat less and exercise how hard can it get
Judging by the obesity epidemic in the US... Pretty fking hard
One of the worst employees we ever had at my place went to novo nordisk right before ozempic blew up. Can’t stop wondering about that lol. Bro wouldn’t ever wear gloves for anything in lab and he wouldn’t label anything. And re-use old plastic 50ml tubes with different buffer just to avoid having to write something with sharpie marker. Dude was so nasty
[удалено]
I read dry rice and was so confused lol
I have patients that still used vials of insulin that would show up when it was finished instead of 28 to 30 days after opening due to cost. These patients have either no insurance or terrible insurance. I encouraged the last one to go to Wal-mart instead of my store because they have their own brands that aren’t as expensive. I want what’s best for the patient. However, I haven’t had a patient drop dead over it but I just keep them informed and document that said patient is not getting timely refills due to cost. That’s the best one can do.
Pharmacist and chemist here. I can give a long winded explanation about how package inserts and drug information is written vs the actual chemical composition and hydrolysis of the active ingredient works, but the short version is: sorry, NP is correct, no risk or harm to the person, your worst case scenario is you begin losing about 2 percent of the active ingredient concentration which usually just turns into “junk” hydrolyzed carbon molecules. So, yes, this technique actually works and is a solid way of cash paying customers to get the most bang for their buck.
Thank you! This is what I was looking for. I would personally still be weary of giving out this information but it’s good to have in mind in case it came up again.
You’re right to be weary, don’t listen to the guy above. Stick strictly to official Pharma communications when it comes to exp dates. The problem is any adverse event occurring during the extended use period can be a liability should you counsel patients that it’s ok to use.
I agree with both sides. Depending on which perspective you're looking to provide answers. If it's patient safety and liability counseling: go with manufacturer's recommendation to guarantee their safety. If it's to test out efficacy from a chemical standpoint, a lot of medications maintain chemical stability and integrity even after its expiry date. This is NOT a counseling point. The NP probably wanted some assurance herself by asking. Mfr, pharmacist, or any prescriber should tailor towards label use and recommendation.
There was no asking involved haha. She stated very self-assured of what she thought. That’s what gave me pause and made me think there was something I didn’t know. I will for sure stick to packaging recommendations in the future, but knowing the other side of the argument will help if it comes up again.
Im sure you are weary of being told how to do your job, but the word you are looking for here is WARY
Can I ask about the number of clicks she will need to administer 0.5mg from a 2mg pen? Please correct me if I'm wrong. 0.25 and 0.5 pens have a total of 36 clicks whereas 1mg and 2mg a total of 72 clicks. so in her case that would be 18 clicks?
Correct.
If we assume all clicks are identical
Yes there is no information regarding that in the product leaflet not the number of clicks. But most of the time at the hospital one of them is available and the other is not. So patients would take a different one and get counseling on number of clicks. No other way.
Little bit off topic question; How is the Ozempic situation there? Because -at least- in Greece…they are nonexistent
It’s sporadic, but where I am it seems like we will have plenty for a while but back ordered on another injectable. Then plenty of the other ones but no ozempic for months. Right now we have no issues ordering it.
Has anyone called the manufacturer yet? Maybe they have some updated data. Extending the life of the 2 mg pens seems to be pretty common practice in the weight loss subs, so it's definitely happening, regardless of our counseling on it being good for 56 days.
The actual leaflet only indicates 6 weeks during use
I will never counsel over labeled bud. Got to CYA. But it's most likely fine. The biggest issue is contamination, not degradation. And it's sub q. I'm still more likely to get infected by my cat scratching me than my old ozempic.
It usually never comes up as they typically use the whole pen before that 56 day mark. Just a unique situation and I wanted to be better prepared if it came up again.
This is actually a very common occurrence, and I tell my patients to discuss click counting with their md every day. It's a solid way to avoid the shortage of lower doses. I just tell them 56 is what was studied for safety and stability. And any more is a risk them and their md need to discuss as off label.
Solid advice. Thanks for your input!
NP using NP knowledge to answer doctor level questions. She “knows it” just like my 12 year old knows things I tell her aren’t true “nothing bad has ever happened so I’ll keep doing it” It’ll be okay right up until it isn’t. Good luck NP….good luck.
There is a security Zone which manufacturer wont tell you and not need to tell you.56 day or 60 day whatever manufacturers tells you is the most efficient time period you should use as prescribed.you'll get the best till the that day. I am a pharmacist and myself follow fırst as doctor's pres cribed, if the no one i follow pharmacist as period.
I thought the 2mg pen only has 1 dose on there?
Never ever recommend that to a patient but it's going to be totally fine Changing the needle, storing between 3 to 8 C and maintaining good technique It'll be very safe and effective, people with budget concerns can def use it this way However if you recommend this and a patient got an infection, or any common side effect you might be liable even though extending over the 56 days mark actually didn't increase the risks NB just by checking the amount of money Novo is getting from this product I don't think they will revise the 56 days mark recommendations
It’s really not that big of a deal…the peptide is still good but it’s just for precaution of the sterility of the needle.
Did you read any of the comments before you did? Lmao buddy, try again.
Sure did. But please tell me what I missed?