Infection Risk of Adding Bacteriostatic Benzyl Alcohol to a Single-dose Vial to Make it a Multi-dose Vial

[infoRPH]

TL;DR: How much of an infection risk is it for me to mix single-dose vial Mounjaro with bacteriostatic water or bacteriostatic saline at home outside a clean room so that I can use it as a refrigerated multi-dose vial subcutaneously within a month?

Long Read: Informatics RPH here with previous inpatient experience background SEVERAL years ago looking for advice from other pharmacists with more recent sterile compounding experience. As you may know, the GLP-1 drugs like tirzepatide (Mounjaro/Zepbound) and semaglutide (Ozempic/Wegovy) are typically not covered for weight loss without a diabetes diagnosis. So, I’m paying out of pocket about $500 a month in the USA with the coupon already factored in. I’m currently on a 5 mg weekly dose of Zepbound/Mounjaro, which is already working well to bring my weight out of the clinically obese range. A Mounjaro 5 mg vial (in Canada) or a pen (in the USA) costs around the same as the 15 mg dosage form. Several people in the Mounjaro subreddit recommend combining the 15 mg single-use dosage form with bacteriostatic (benzyl alcohol) NS or bacteriostatic water so they can continue using it as a refrigerated multi-dose vial. There are even videos on how to open the USA pen to withdraw the drug solution easier. If I stay on the 5 mg weekly dose long-term, this hack can save me $4000 a year but I’m worried if that’s worth the infection risk. How much of an infection risk is it for me to do this at home outside a clean room?

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[RXDOC1986]

Clinical Pharmacist/IV pharmacist for 38 years, I wouldn't even begin to assess infection risk in IV compounding in such an environment. USP 797 gives us a BUD of 24hrs for emergency, "table top" compounding. Bacteriostatic, as named, is not bactericidal, so limited in scope.
Now, these being SubQ injections, kind of limit the systemic bacteremia risk. You could have fungal or viral organisms to deal with.
On one hand, you have IV drug abusers, that seem to do OK, under the most contaminated environments. Then you have hospital inpatients, with over 60-65% chance of developing serious infections.
Everything we do, is risk vs. reward. Maybe there is a study out there to cover this, but then who would be the control group?

 

[gwarm01]

At that point I'd just find a weight loss clinic an get an Rx for compounded semaglutide + B vitamins. Pretty sure you'll save money if you shop around.

 

[sunnyandseventytwo]

On one hand, you have IV drug abusers, that seem to do OK, under the most contaminated environments. Then you have hospital inpatients, with over 60-65% chance of developing serious infections.

I came here to write this. I predict you can get by doing this for about 4 years, then you'll end up losing a leg to necrotizing fasciitis.

Note: this is not medical advice and your results may vary by +/- 4 years and +/- 3 limbs.

 

[sunnyandseventytwo]

I came here to write this. I predict you can get by doing this for about 4 years, then you'll end up losing a leg to necrotizing fasciitis.

Note: this is not medical advice and your results may vary by +/- 4 years and +/- 3 limbs.

Just a thought, and I'm not recommending this either, but have you considered finding a couple other people on your same dose and all injecting at the same time? Plenty of IV drug addicts do that, too. Maybe don't share needles and inject into a sterile vial, or something. I have no idea how these things are supplied. I don't work outpatient and have remained at my IBW for the last 30 years.