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

• Over the previous few years, the curiosity in GLP-1 medicine for weight reduction has skyrocketed.
• At present, the most typical supply system for GLP-1 medicines is thru pre-filled injection pens designed to offer 4 weeks of treatment.
• Many GLP-1 customers have seen that after their 4 anticipated doses, there’s nonetheless treatment leftover of their injection pen, which has been dubbed the “golden dose” by GLP-1 customers.
• Nonetheless, specialists agree that utilizing this “golden dose” is dangerous and as a substitute must 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 drop some weight, others like Zepbound and Wegovy are prescribed for weight reduction.

As of 2024, researchers estimated that about 12% — or one in every eight adult People — had ever taken a GLP-1 treatment. 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 most typical supply system for GLP-1 medicines are by means of pre-filled injection pens used for 4 weeks.

“The best way these meds are delivered is thru a pen that delivers a specific amount of treatment every week — it’s a single pen that delivers a number of doses,” Mir Ali, MD, a board licensed common 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 At this time. “So every time they use the pen, it provides them the dose that’s required.”

Nonetheless, many GLP-1 customers have seen that after their 4 anticipated doses, there’s nonetheless treatment 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 secure to make use of? If not, then why is there further treatment within the pen to start with? And the way do you have to get rid of any treatment left within the pen?

MNT spoke with 4 specialists to get the fitting solutions to those questions.

Earim Chaudry, MBBS, chief medical officer at U.Ok.-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 incorporates 2.4ml formally with a small further 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 just isn’t a bonus dose — it’s a deliberate overfill — a typical medical observe constructed into the pen to make sure full supply of every injection and account for any small variances in supply,” he mentioned.

When requested if it’s secure for GLP-1 customers to take the potential remaining fifth dose in an injection pen, Chaudry mentioned the quick reply isn’t any as it may well include severe dangers.

“This leftover quantity is a built-in buffer, not a usable dose,” he continued. “The related dangers embody underdosing — the leftover liquid just isn’t a full, measurable dose which may scale back the effectiveness of remedy. (Or) overdosing — with out dose management, sufferers could inject an excessive amount of, rising the danger of negative 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 secure to make use of the “golden dose.”

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

And Ali mentioned 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, it’s possible you’ll not have the identical sterility as the primary 4 doses. There’s some danger 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 treatment 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 meant mechanism of motion as they have been researched and investigated,” added Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist and proprietor of Diet-In-Sight. “In different phrases, manipulating a prescription exterior of the meant 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 treatment within the pen after 4 weeks of injections, GLP-1 customers could marvel what’s the most secure strategy to get rid of it.

“It’s a pen with a needle, so it’s alleged to be disposed of in a sharps container,” Ali mentioned. “However the treatment 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 treatment in there.”

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

“In response to the producer (of Mounjaro), the KwikPen incorporates an additional answer 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 treatment in a GLP-1 injector pen than what you want for 4 doses, some customers might imagine rising their dosage will assist them drop some weight sooner.

“The best way the meds are designed, you begin at a decrease dose and regularly work your means up,” he detailed. “And the explanation for that’s the negative effects appear to be extra dose-related and that provides your physique time to adapt to the negative effects. So sufferers who advance too rapidly to the next dose usually have extra extreme negative effects and should not have the ability to tolerate the treatment.”

There isn’t a ‘secret’ further dose

“The concept of a ‘golden dose’ could also be tempting for sufferers, however security should come first. The leftover liquid within the pen just isn’t a secret fifth dose, and making an attempt to make use of it may well result in inaccurate dosing, contamination and severe negative 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 negative 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 carefully with their healthcare workforce, together with a registered dietitian nutritionist (RDN), and totally observe directions to be used associated to any prescription treatment.

“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 making an attempt to make it last more? Do they perceive the dosing directions? Are they well being literate with the doable negative effects, dangers or outcomes of this extra dose?”

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