Has anyone dealt with compounded tirzepatide reconstitution?

dan_philly said:

Reconstitution tip for anyone mixing dosing arithmetic from lyophilized powder: use bacteriostatic water, NOT sterile water.

This is exactly what I could not find anywhere else.

Adding the clinical framing, because it changes how the question reads.

Quick syringe math for dosing arithmetic dosing: if your vial is reconstituted at 5mg/2mL, that's 2.5mg/mL. For a 0.25mg dose you need 0.1mL = 10 units on an insulin syringe.

I keep a chart on my fridge:

• 0.25mg = 10 units
• 0.5mg = 20 units
• 1.0mg = 40 units
• 1.25mg = 50 units

Always double-check your concentration before drawing up!

Dr.EM_Chicago said:

Quick syringe math for dosing arithmetic dosing: if your vial is reconstituted at 5mg/2mL, that's 2.5mg/mL.

Can confirm. Same sequence, different timescale. I had assumed I was the exception until I read this.

Dr.EM_Chicago said:

Quick syringe math for dosing arithmetic dosing: if your vial is reconstituted at 5mg/2mL, that's 2.5mg/mL.

There is a second half to this that has not been said yet. They are two different exemptions from the same federal requirements and they buy different things. A 503A pharmacy is regulated primarily by the state board, needs a patient-specific prescription, is exempt from CGMP, and may use a bulk substance that has a USP monograph, is a component of an approved drug, or appears on the 503A bulks list — three independent doorways. A 503B outsourcing facility registers with the FDA, is inspected on a risk basis, must comply with CGMP, may compound for office stock without a patient-specific prescription, and has one doorway to a permitted bulk substance: the 503B bulks list, or the drug shortage list.

Happy to go further on any of that.

Closing the loop on my own question.

The bulks-list asymmetry was the piece I had missed entirely. It explains why one of my two pharmacies is still arguing it can supply and the other simply stopped.