Pegysus Pre-Filled Syringes

[epiphiny]

This segues out of the previous post on Peg needle guards. I have had nothing but grief from the prefilled syringes for the past 42 weeks.  Over here in NZ we use ones with a red plunger and a clear needle guard.  

There is always a significant amount left over after each shot.  And yes, I depress fully, and I leave it in situ for 10 secs before I withdraw the needle to prevent leakage from injection spot.

I brought this up once before and had two conflicting opinions presented to me. 1: There is extra added to compensate for the plunger mechanism. 2. There is exactly the amount you need in each one.  Huh?  Clearly, no one really knows.

I also checked with my NP and she seemed to think there was extra included.

Anyway, since tx has brought the OCD out in me I decided to run an experiment.  I got all my 'left overs' and syringed them back into one syringe.  It took me 16 shots worth of left overs to get a full syringe.  Over the course of 48 weeks, that equals 3 extra 180mcg shots.  Or 3 less shots, depending on which way you look at it.

It equals about 8 drops per syringe but each syringe only 0.5ml.  So approx 8 drops is A LOT!

I would like to think this is extra but who really knows, maybe I'm 3 shots down.  And I wish I had figured this out earlier as I could have saved the extra in the fridge and used it to taper down at EOT.

Any thoughts or experiences?

Thanks,  Epi.

PS:  Sorry folks, accidentally posted this on the other side...

[captainp73]

With any drug, but especially Interferon, you may just ask the questions " Can you feel the medicine doing its job? "   and " Are your bloodwork results indicating you are receiving the medication prescribed ? "     If you are experiencing all the Interferon side-effects and your bloodwork shows the full effects of the  medicine are taking place, then you're not receiving less than the prescribed dosage.   It's easy to get OCD about this kind of thing-- I asked the same question to the nurses-- but any delivery system in such an expensive medication is going to be at the very tip-top quality control level.   Keep obsessing, it's not too bad a thing if it's therapeutic, but do it over some different things like your real side-effects and how to minimize them.

[epiphiny]

If I lose more than one drop getting the air out I consider the event compromised.  Just kidding!  Thanks for the encouragement to ring Roche.  Amazingly simple really, no more confusion, no more fretting...  

[jmjm530]

An overfill of 0.1ml.
___________________

There you go. The cumulative overfill is greater than the leftover residual, so in effect, you're getting too much Peg :) Don't know about you, but I evened it out when I lost a drop or two out the needle end getting the air out of the barrel!!!

--- Jim

[GreatBird]

All you did was put down your marbles and they rolled away. It's the nature of marbles to do that. You're okay. Really. :)

XXOO

[epiphiny]

I give up.  An overfill of 0.1ml.

I need to go and lie down, losing my marbles here, it's Monday after all, never one of my good days.

[epiphiny]

Brain fog?  I got plenty brain fog.

I should have written each prefilled syringe has 0.6ml for 0.5ml of med.  That is an 'overfill' of .01ml to compensate for the mechanics of priming and injecting.

Epi.

[Rockerforlife]

If you dont like seeing the "leftovers"....you wouldnt like the redipen...theres a big glob of liquid sitting around the needle tip after attaching the needle and removing the cap

[geterdone]

LOL! No, no, no, don’t try to save and use any leftovers. I would take a pair of wire cutters after each injection and cut the needle off at the base and then smash the barrel because of the crazy ocd during that time of exploration. But I don’t see how one would reinfect oneself if one did follow through it if one would use a sterile needle. Anyway No! Don’t try to save the leftovers treat’em just like thanksgiving left overs.

Tiny air bubble is ok tho… if you have a steady hand.
Of course this is all hypothetical and in jest. :-)

jasper

[epiphiny]

Yes, I've been doing that too but I still wasn't happy with what was left.  All good now.  I do like Geter's idea tho.  Not that I would do that, of course!  Oh yeah, the Roche guy also warned against trying to reuse the leftovers.

[eureka254]

I noticed the extra in the glass chamber in the pre-fills too after I gave my husband his first shot, and also noticed that I actually had to lose a few additional drops if I pushed the plunger to the correct "180" start line.  My approach has been to simply stop pushing the plunger when the interferon starts coming out the needle (reassuring I'd left no air in the chamber), and fire away, whether or not it was at he "180" line ... thereby compensating for the ~0.5ml if the manufacturer didn't account for it when scoring the lines :D.
~eureka

[Rockerforlife]

Take a deep breath....let it out...again....in...out.
What sthe next experiment?....maybe we can mix the extra meds with our mouth wash...LOL...i am kiddn

[epiphiny]

There are some great things about living in a small country, people answer their phones!

I rang Roche NZ and spoke to a lovely young man in the medical team and asked him about the left over amount after each shot.  

He read me an internal memo that states each prefilled syringe of Pegasys has 1.6ml of fluid to deliver 1.5ml of medicine. This overfill compensates for the syringe mechanism.

Well, that certainly makes me feel better!  It means we are getting our full amount of medicine in each shot despite what appears to be left over.

The other great thing is the guy actually took the time to work it all out with me, didn't think I was a whacko-caller.  He even worked out the amount of the overfill roughly equaled the amount I had estimated was left after 48 syringes.

Love it when things work out.  One more thing that I can't be anxious about!

[geterdone]

Lol correct and If you really wanted to get that last little bit of the juice (not saying anyone should try this ;) but one could conceivably leave a tiny air bubble in the top of the barrel while injecting. This would force all the liquid of the barrel but I would not trust a shaky hand.

jasper

[lalapple]

hi epi *waves at epi* i think we use the same medication, mine has a red plunger too. and there are always leftover liquid at the tip no matter how hard i push it in.  i always try to push it to the end, then wait then pull it out if that helps :)

*screaming*

[Rockerforlife]

I like your investagative technique style...what brain fog?...but rest assured....your getting the full does each time....no worries there...i wouldnt bother fiddlinf around and doing the "extra stuff'....aint worth the hassle

[epiphiny]

Lol, actually, that thought has occurred to me.  I just don't have a small enough measure to be precise about it.  0.5ml is a tiny amount, approx 26 - 32 drops depending on your dropper!

[epiphiny]

Yes, it's in the glass chamber.  In the space between where the chamber ends and the narrow funnel that you put the needle on to.  The plunger goes as far as it can but the 'left over' is trapped between the funnel and the end of the chamber. When I pull the plunger back again and depress it again that's when it comes out and then there is NOTHING left in there...

Interestingly enough, this doesn't happen when I apply more pressure to the plunger straight after I remove the needle.  I have to reprime the plunger so to speak.  It is consistent each and every time.

It's such a lot in there that it really freaks me out. The first time I did it I thought I had completely messed up. I took the syringe into the clinic and they didn't seem concerned about it but that didn't put my mind at ease at all.  

Then I read a post here in which the poster was adamant that there was absolutely no extra built in at all.  I've been quietly fretting away about it since then, and now that I'm approaching EOT I'm starting to get anxiety that I haven't had all my meds...

[meakea]

Epi

I had a bad batch of pre-filled Pegasys syringes and 3 of them leaked from the joint where the syringe met the needle.  That was my FIRST batch of shots so I thought I was doing something wrong.  Well, I wasn't.  I called Pegasys and they asked me to ship the used syringes to them so they could evaluate them in their lab, which I did.  They subsequently sent me a letter about their evaluation but it really didn't tell me much.

While talking to Pegasys about this issue, they told me that there is "extra" built into the shot for the scenario you are talking about.  They told me the exact amount of "extra" that they calculate into each syringe but I don't remember what it is.

By the way, where is this leftover that you are seeing...is it still in the syringe?

[jmjm530]

If your OCD is still working overtime :)  I suppose you could do another experiment. Mark the fill line on a pre-filled. Then after injecting fill with water to the pre-fill line. Now get a measure and see how many ml are actually in the syringe and how many are leftover. It may turn out that you end up with .5ml of fluid in addition to the leftovers. But even if not, that still could have been compensated for by the drug company but they would be the ones to ask on this.

[portann]

Good point and thanks for doing the laboratory work!

It's disconcerting but let's hope it's all sixes.

[jmjm530]

Another perhaps more realistic reason not to re-inject leftovers is the possiblity of bacterial contamination.

[jmjm530]

My guess is that the drug makers compensated for any leftovers. Personally, I would not use the leftovers for tapering or any other reason for the remote chance of re-infecting yourself with the virus. I know the virus is not supposed to live for more than a few days on surfaces but not sure if that's every been tested when refrigerated and in a liquid medium. I couldn't get my used syringes and barells out of the house quick enough and would bring them to my doc's office as soon as the sharp container starting filling up.

-- Jim