I live in the U.S. and use the 500mcg prefilled syringes of Besremi. I know the instructions say to never reuse a syringe, but I'm unsure if I will continue to receive more after the first four. I'm on the Quickstart program and insurance has denied coverage twice, and is now reviewing a level 2 appeal. With approval unlikely, I need enough medication to last until the end of the year when I may be able to switch to an insurance plan that covers Besremi.
I would use a new needle for each injection, but my concern is how to safely store a syringe after use. Should I immediately remove the used needle, and if so should the syringe be re-capped? Would leaving it uncapped for 2 weeks until next use be unhygienic? Or should I just attach a new needle after each use and store it until the next usage?
If anyone has experience or thoughts on this subject I would appreciate your input.
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I have been doing multiple injections per syringe from the start per Dr's firm instructions. It's actually part of the Euro instructions to use it twice but they use a different injection device.
You should confirm with your Dr as this is only my procedure, not medical advice.
My procedure is:
-Warm up the syringe only partly, ~10 minutes. I use an ice cube on the skin to reduce discomfort as one member suggested. Warming is only for comfort as I understand it and less extreme temp changes to the future doses should be better.
-Fit the needle, get the bubbles out, and note closely where the plunger stops when it's all drops at the tip.
-Inject the Rx dose. This is tricky since you need to watch the plunger closely as it goes down from its start point. I think this difficult step is one reason for the published wasteful process.
- Continue light pressure on the plunger as the needle pulls out. This ensures nothing goes back into the needle or contents. There is some waste here. This is not official procedure but seems useful way to keep the drug pure.
- Remove needle ASAP and press the plunger till the air is minimized.
-Replace the cap. It might resist from the air pressure, requires a firm twist to prevent unscrewing. I usually press the plunger a bit during this to minimize the air. It took a few tries to figure this out.
From the Euro instructions, section 6.3:"The pre-filled pen may be stored for a maximum of 30 days in the refrigerator (2 °C - 8 °C) when stored with the pen cap on and kept in the outer carton in order to protect from light. The pre-filled pen may be used up to two times within these 30 days." (remember this is for same drug but a different device)
I use the cap vs a new needle as it's the best airtight seal and was designed for storing the med. Also matches the Euro procedure. But I handle the cap carefully, being sure its important areas don't touch anything.
You'll find the total used is more than the actual doses, as there is still some waste, I get about 10-20% loss. More, smaller doses per syringe will have higher % waste since each session loses about the same amount.
I've also found the needles that come with Bes can be dull and painful. The ones I get at Dr are way better (30 gauge, 1/2".)
I believe there is a multi-use device/procedure in Europe that is not in use in the USA. Perhaps someone using it there can make a more meaningful commentary. I believe this may be addressed in paragraph 6.6 in this document.
There are no handling instructions for multi-dose use of the syringes we get in the USA. There is no approval for a different kind of dispensing device in the USA. Perhaps there will be at some point.
You might consider trying to use Pegasys for a while until you can get Besremi approved. Some do not find that much difference between the two forms of interferon.
Regarding your appeal, know that a 2nd level appeal is not always the end. it depends on your plan. It o very important to get a copy of your plan rules to know how they work. It makes a big difference in a successful appeal. I have had to file my own appeals twice for medications, including Besremi. I was successful in both cases.
hunter5582, thanks for your response. I read the Europe document you linked to and it does say in section 6.6 "A new, sterile needle as provided with the pre-filled pen must be carefully attached onto the pre-filled pen before each injection. Needles must be discarded immediately after use." That and section 6.3 that EPguy referred to, which says to cap the syringe for storage answers my question. I definitely will not store with the used needle attached.
It's really simple. After injecting your dose, unscrew the used needle and discard it. Recap the syringe and put in refrigerator. Two weeks later uncap the syringe and screw on a new needle.
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Besremi - CBC after the 11th dose kept at 175mcg
