Steady-state concentrations across dose tiers — January 2024

JennaRN said:

Dead space is the answer to the missing dose.

I am going to disagree with reconstituting low as a general rule. More diluent, more punctures, more in-use days at room temperature, and the stability trade-off is real. Precision is not the only variable being optimised.

Dr.GastroMayo said:

I reconstituted a 10mg vial with 2ml of bacteriostatic water and I want someone to check my unit arithmetic before I draw anything, because I keep…

Regarding dosing arithmetic multi-dose vial contamination prevention: after reconstituting, I wipe the vial stopper with a fresh alcohol swab before EVERY single draw. I also never touch the stopper with my fingers and use a new needle for each draw.

Even with bacteriostatic water preservative, contamination is cumulative. One sloppy draw can introduce bacteria that multiply over days. Aseptic technique isn't optional — it's essential for injectable medications.

Dr.CardioMD said:

I am going to disagree with reconstituting low as a general rule.

Peptide calculator app recommendation for dosing arithmetic: I use PeptideCalc to calculate reconstitution volumes and injection doses. Eliminates math errors completely.

Input: vial size (mg), desired concentration (mg/mL), prescribed dose (mg)
Output: BAC water volume (mL), injection volume (units on insulin syringe)

A math error with injectable medication can mean underdosing or overdosing. Use a calculator every time until the math becomes second nature.

Following on from CanadaChris — and this may be the naive question:

How much material I am losing to dead space, and whether that explains why a 10mg vial gives me nine usable draws rather than ten?

Reporting back.

Follow-up: it was dead space. Switching to a low-dead-space fixed-needle syringe gave me the tenth dose back.