Peg injections - two in one day

[FashionLover]

Hi all, I’m on peginterferon Alfa-2a for ET and a few weeks ago my dose was increased to 180mg. The hospital pharmacy deliver my medication and I can only assume they’ve ran out of 180mg syringes as I’ve been sent about 8 boxes of 90mg pre filled syringes meaning I’m expected to do 2 injections after each other. This fills me with dread, especially as the skin in the areas I can inject on my stomach feels thick and has areas of bruising and damage so it’s hard to find a space for one injection, let alone two. Has anyone else had to do this and if so, can you give me any advice please

[swimswam]

Hi, Last year my dose was increased to alternate weeks 135mcg / 180mcg. I was also unable to get 180mcg syringes from my hospital pharmacy. ( I was told that my area trust no longer purchased the 180mcg) This meant that I had to inject 2x90 mcg every other week. I personally found that if I prepared both syringes at the same time, and injected one after the other in close proximity I still only came up with one bruise. Not ideal but after a few times it wasn’t as bad as I thought it might be. Thankfully the increased dose gave my body the kickstart it needed and I’m now down to 135 mcg weekly.

[FashionLover in reply to swimswam]

Hello, thank you for the advice. I’m glad it wasn’t as bad as you thought and that you were able to eventually reduce the dose. I’ll try to do the second injection as close as I can to the first one, although I also worry about bleeding with being on blood thinners

[hunter5582]

You might want to check and see if the vials of PEG are available. It is very easy to prep a syringe and it gives you options between 90 and 180. It is a bit unusual for a ET patient to be at 180mcg. What is your treatment target? Have you reviewed your treatment plan with a MPN Specialist (not a regular hematologist)?

Hope you get it all sorted to your satisfaction soon.

[FashionLover in reply to hunter5582]

Thank you. My platelets started at over 1000 a year ago when I was diagnosed, they eventually were in the 700s then went back up to the 800s and they’ve been yo yoing pretty much ever since. The plan is to get them into the 600s at least but I may need to try a different treatment if the platelets don’t start coming down more. I have an appointment with a specialist in July. Vials are a good idea, I’ll check if I ever get through to the hospital pharmacy

[hunter5582 in reply to FashionLover]

Wishing you success. Hope the PEG dose is well-tolerated.

[Wyebird]

Hi what a shame regarding 2 jabs. I swear by using ice on the jab site prior to injecting. I use the stomach but I believe you can use the thigh. Maybe it’s worth checking. Also maybe spacing the the jabs out through the week.

[FG251]

Just a thought, could you not leave the needle in after the first injection, carefully remove the syringe and then attach the second syringe to it? This would obviously entail not pushing the first syringe on too tightly and a bit of nimble finger-work, but when I’ve attached my syringe, I’ve noticed it really doesn’t need to be pushed on tightly.

[light in reply to FG251]

Hi there, that could cause air pocket and it is not easy to detach syringe sometimes. Wishing you well.

[FG251 in reply to light]

Ah! Well, I hope you find a good solution 🤗

[light]

I also think that it is better to get in touch with MPN doc for help. Then may come up with the solution.

[NCB1983]

Hi FashionLover, I'm on 180mcg of Peg weekly as well, and I am sorry to hear the troubles you are having. 180mcg syringes are available, I can only assume your pharmacy had run out. Perhaps speak to your care team and they could put a note on your file that you would prefer one injection rather than two in the future. Regarding injecting into your tummy, I too bruise a lot but I do find that a lovely hot bath beforehand not only gets me in a relaxed frame of mind but it makes my skin more supple, it hurts less and I think I bruise less too. I hope this info is of use to you.

[FashionLover]

Thank you all for your advice. When I call haematology they tell me to call the pharmacy but when I call the pharmacy it says they’re very busy and there’s not even an option to leave a message. I’ll keep trying but only have until Monday evening as that’s when I do my injection usually

[light in reply to FashionLover]

I would go back to MPN doc and ask for help again and explain what happen with pharmacy and from my experience MON always help. Wishing you well.