Is the ‘golden dose’ hack safe with leftover GLP-1s?

• Over the previous few years, the curiosity in GLP-1 medication for weight reduction has skyrocketed.
• At present, the commonest supply system for GLP-1 medicines is thru pre-filled injection pens designed to offer 4 weeks of medicine.
• Many GLP-1 customers have observed that after their 4 anticipated doses, there’s nonetheless medicine leftover of their injection pen, which has been dubbed the “golden dose” by GLP-1 customers.
• Nonetheless, consultants agree that utilizing this “golden dose” is dangerous and as an alternative needs to be discarded correctly.

Whereas some GLP-1 medicines, like Ozempic and Mounjaro are designed to deal with diabetes and have been prescribed off-label to assist folks with out diabetes shed extra pounds, others like Zepbound and Wegovy are prescribed for weight reduction.

As of 2024, researchers estimated that about 12% — or one in every eight adult Individuals — had ever taken a GLP-1 medicine. And from 2019 to 2024, the proportion of adults prescribed a GLP-1 to deal with weight problems rose from 0.30% in 2019 to 2.05% in 2024, an increase of 586.7%.

At present, the commonest supply system for GLP-1 medicines are by means of pre-filled injection pens used for 4 weeks.

“The way in which these meds are delivered is thru a pen that delivers a certain quantity of medicine every week — it’s a single pen that delivers a number of doses,” Mir Ali, MD, a board licensed normal surgeon, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Heart at Orange Coast Medical Heart in Fountain Valley, CA, defined to Medical Information Right this moment. “So every time they use the pen, it offers them the dose that’s required.”

Nonetheless, many GLP-1 customers have observed that after their 4 anticipated doses, there’s nonetheless medicine of their injection pen, offering them with probably a fifth dose, or what’s been coined the “golden dose” by GLP-1 customers.

However is that this fifth dose protected to make use of? If not, then why is there additional medicine within the pen to start with? And the way do you have to eliminate any medicine left within the pen?

MNT spoke with 4 consultants to get the proper solutions to those questions.

Earim Chaudry, MBBS, chief medical officer at U.Okay.-based digital well being supplier Voy, says the “golden dose” refers to a small quantity of liquid left within the injector pen after taking the 4 prescribed doses.

“Every Mounjaro pen accommodates 2.4ml formally with a small additional overfill for priming,” Chaudry gave for example to MNT. “Every dose makes use of 0.6ml — simply sufficient for 4, correct, pre-measured doses of Mounjaro. That leaves a small quantity of liquid behind.”

“The leftover liquid isn’t a bonus dose — it’s a deliberate overfill — a typical medical apply constructed into the pen to make sure full supply of every injection and account for any small variances in supply,” he stated.

When requested if it’s protected for GLP-1 customers to take the potential remaining fifth dose in an injection pen, Chaudry stated the quick reply is not any as it could actually include critical dangers.

“This leftover quantity is a built-in buffer, not a usable dose,” he continued. “The related dangers embrace underdosing — the leftover liquid isn’t a full, measurable dose which might cut back the effectiveness of remedy. (Or) overdosing — with out dose management, sufferers might inject an excessive amount of, rising the chance of unwanted effects like nausea, vomiting, diarrhea, or constipation.”

Hans J. Schmidt, MD, chief of bariatric surgical procedure and director of the Heart for Weight Loss and Metabolic Well being at Hackensack College Medical Heart in New Jersey, agreed about it not being protected to make use of the “golden dose.”

“Medical consultants don’t advocate this and the (Mounjaro) drug maker has warned that the method of ‘breaking into the pens’ isn’t clear and will put customers ‘susceptible to hurt together with’ an infection attributable to potential micro organism, an abscess, (and) if an abscess is left untreated, it may progress to sepsis.”

And Ali stated because the GLP-1 injector pens are usually designed to remain sterile for less than 4 weeks.

“[I]f you’re going to make use of a further dose every week later, you might not have the identical sterility as the primary 4 doses. There’s some threat of introducing micro organism into your system utilizing a pen that’s been out longer than really helpful.”
— Mir Ali, MD

In response to news reports, the potential dangers related to utilizing the remaining medicine within the pen as a fifth dose has reportedly spurred Eli Lilly, the maker of Mounjaro, to revamp its injector pen to remove the additional liquid.

“All medicines, whatever the class or subtype, have been standardized primarily based on respective dose titration and its software associated to the protection, efficacy and supposed mechanism of motion as they have been researched and investigated,” added Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist and proprietor of Vitamin-In-Sight. “In different phrases, manipulating a prescription outdoors of the supposed use or extending it could trigger security issues and penalties unaccounted for in analysis research.”

If it’s unsafe to make use of any leftover medicine within the pen after 4 weeks of injections, GLP-1 customers might marvel what’s the most secure method to eliminate it.

“It’s a pen with a needle, so it’s presupposed to be disposed of in a sharps container,” Ali stated. “However the medicine itself, so long as it’s within the pen, it’s not going to trigger an issue. It’s simply if persons are utilizing it, there’s potential hazards to utilizing that extra medicine in there.”

“As soon as the 4 pre-measured doses have been administered, used pens, together with any remaining liquid, needs to be disposed of safely,” Chaudry detailed “Unscrew and discard the needle right into a sharps disposal container. The needle must not ever go into family waste. After eradicating the needle, discard the empty pen in a sharps container or family waste. Get rid of the needles in a sharps container.”

“In response to the producer (of Mounjaro), the KwikPen accommodates an additional resolution to permit for the ‘vital priming earlier than every injection’ along with delivering the 4 full doses. The producer’s directions say to discard the pen after 4 doses or 30 days after its first use, no matter any remaining liquid.”
— Hans J. Schmidt, MD

If there’s extra medicine in a GLP-1 injector pen than what you want for 4 doses, some customers might imagine rising their dosage will assist them shed extra pounds sooner.

“The way in which the meds are designed, you begin at a decrease dose and step by step work your means up,” he detailed. “And the explanation for that’s the unwanted effects appear to be extra dose-related and that provides your physique time to adapt to the unwanted effects. So sufferers who advance too shortly to a better dose usually have extra extreme unwanted effects and should not be capable of tolerate the medicine.”

There isn’t any ‘secret’ additional dose

“The thought of a ‘golden dose’ could also be tempting for sufferers, however security should come first. The leftover liquid within the pen isn’t a secret fifth dose, and attempting to make use of it could actually result in inaccurate dosing, contamination and critical unwanted effects. If sufferers really feel uncertain about their present dose, or discover that it isn’t working as anticipated, they need to communicate to a clinician. Self-adjusting can result in underdosing, overdosing or unwanted effects, and the well being dangers related to these.”
— Earim Chaudry, MBBS

And Richard emphasised the significance of individuals utilizing GLP-1 medicines to work intently with their healthcare workforce, together with a registered dietitian nutritionist (RDN), and absolutely observe directions to be used associated to any prescription medicine.

“When a person goes rogue it may be an actual security concern — so additionally understanding why could also be vital,” she continued. “Are they financially restricted and attempting to make it last more? Do they perceive the dosing directions? Are they well being literate with the potential unwanted effects, dangers or outcomes of this extra dose?”

“I might encourage our readers to assume: Let’s be sensible, strategic, and savvy when utilizing a few of these instruments, however prioritize security,” Richard added.