Any top tips for managing localised reaction at interferon injection sites please? (raised red circles, about 4cm wide and itchy). Will dig out baggier clothes and inject higher next time but any other tips about how to minimise local reaction?
Also - I'm taking 45mcg from a 90mcg syringe. I use half and discard the remainder still in the syringe. Is this right or do you eject half before injecting? (does this go in the bin?!)
Thank you.
I also had the red itchy spots when first starting injections. Took couple months of weekly injections to stop reacting. Until then I tried cooling the area first with ice cubes and applying aquaphor healing ointment after. That gel is over the counter and was recommended by my hematologist. As for the vial, I draw the amount first to ensure no screw up of syringe, the needle, my action, etc. so I have a second chance if needed with drug left in vial. Truth be told I had some problems getting refills so had saved vial for reuse if needed, using alcohol to clean it after use and before storage in frig for possible future use. Switched pharmacy to local hospital and have not experienced refill issues since.
Thanks v much Mishie - I’ll have a look for the gel and try the cooling beforehand.
My syringe is pre-filled to 90mcg (I’d forgotten some people have vials) so I suspect what I’m doing is the best option for me as the leftovers go into the sharps bin rather than general waste.
Have a good evening (here - could be earlier there)!
Not sure about the injection site resection. Not sure if a Benadryl topical would help. Suggest you talk to the MPN Specialist.
When using the prefilled syringes, you are supposed to waste the portion not to be used first. I waste it into a paper towel to avoid having any medication end up in the water supply.
Hope you get it sorted ASAP.
Thanks Hunter - will do the same re. the dosage then.
Hopefully seeing the MPN specialist soon so will add this to the list of questions! (Hope he’s not too overstretched that day 
)
Hi Hunter and RoundThe World,
While oral Benadryl might help, we routinely steer patients way from the topical kind- it seems to foster more problems/reactions than it helps.
I also recommend Zyrtec/Cetirizine for patients that do not have any contraindications to taking it. I have been to many conferences and lectures about treating allergic reactions, and Zyrtec has been the most universally recommended treatment for any reaction the might be caused by or have a histamine component.
The original parent company who marketed Zyrtec put out a newer prescription antihistamine called Xyzal, qhich thy marketed as more effective with less side-effects.
Unfortunately, the evidence is that it's not really an improvement over Zyrtec at all, and that the only reason they marketed it was because Zyrtec went off-patent so cheap generics abounded and cut into their sales.
Additionally, Zyrtec is generally safe at up to 4 times the routinely recommended dosage of 10 mg per day, as long as your liver and kidney functions are close to normal.
This is not a recommendation to take that much, not matter what my B-I-L thought I said, I recommended it to him for his severe poison ivy reactions as up to 2 tabs daily, but he decided to take it 4 times a day, and found that it was more effective than taking prednisone with less side-effects.
Speaking of side-effects, its main one is sedation which is still significantly less than is experienced with Benadryl.
I do also recommend icing before and after the injection, as well as being sure to let the alcohol used to swab the site fully evaporate before injecting. As alcohol is a nonpolar solvent, you would not know what else could be getting carried into the sub-Q space when the needle passes through it.
That said, I have never had any local reactions to my Besremi injections, and I am a very allergic fellow.
Thanks PhysAssist. Sounds like I shouldn’t use the alcohol wipe to remove spill off the needle (from having to waste a bit) - will stop doing that!
If injecting in thigh how do you avoid any blood vessels?
Well, it's a tiny needle, and superficial injection, so I just grab some skin with sub-Q fat and inject like I do on my abdomen.
I do unfortunately have some thigh fat that is mostly residual from being a lot heavier, that's concentrated in my upper inner thigh, and this provides a decent amount of tissue [which is not very vascular- similarly to the abdominal sub-Q fat] for the injections.
This is what the Google AI response says for searching "Proper subcutaneous injection technique" :
"AI Overview
Here are some tips for performing a subcutaneous injection:
Choose the injection site
Subcutaneous injections are given into fat tissue between the skin and muscle. Some recommended sites include the outer upper arm, top of the thighs, buttocks, and abdomen, excluding the navel and waistline. Avoid areas with inflammation, scars, moles, birthmarks, or other lesions. You can also try gently pressing the skin to find areas with fewer nerve endings, which may be less painful.
Prepare the injection site
Clean the area with an alcohol wipe and let it dry. Check for lumps, swelling, redness, warmth, bruising, or wounds near the injection site.
Pinch the skin
With your nondominant hand, pinch an inch of skin and fatty tissue between your fingers. This will elevate the subcutaneous tissue and reduce the chance of injecting into a muscle.
Insert the needle
Hold the syringe like a dart between your thumb and forefinger. Remove the needle cap and hold the needle at a 45° or 90° angle, depending on the length of the needle and the depth of the subcutaneous layer. Quickly insert the needle into the pinched skin.
Inject the medication
Push the plunger to inject all the medication into the fatty tissue. Hold the skin fold while injecting to ensure the medication doesn't go into the muscle.
Remove the needle
Pull the needle out at the same angle you inserted it.
Apply pressure
Press clean gauze on the injection site for a few seconds to stop any bleeding.
Dispose of supplies
Dispose of contaminated supplies according to your facility's policy"
Also:
If your belly is thin, than better grab the fat and inject with the 45° angle.
Hope it will help
Cheers
Agree with Hunter. Discard the excess into tissue before injecting. This may even help with your injection site issues. I definitely had the same with my first few doses.I was bruising with anti-coag injections and my nurse reminded me to make sure I am not injecting or withdrawing the injection at an angle and this made a difference for me. I think I had just gotten a bit lax as I got used to doing it. So I try to be very mindful and almost exaggerate taking the needle fully out, ensuring it isn't at an angle.
Thank you Saus_I and William_Indo. I could well have withdrawn the needle at an angle. The nurse said to pinch the fat/skin, inject at 90 degrees and leave it a few seconds to ensure the medicine went in - I didn’t even consider that withdrawal angle might make a difference. I also spilled a bit onto my skin the second time and the irritation was worse then so will make sure not to let this happen next week. Lots of good advice, thanks.
hi,
I was always told to waste what I wasn’t using (paper towel or down the sink) and then inject what is left in the syringe.
To reduce the swelling:
- I used to have a bath beforehand, therefore making sure my skin was nice and supple.
- I also get the injection out of the fridge 30mins before I inject.
- take it slowly when injecting (doing it too fast bruises me good and proper!)
I agree with the previous comment that some reaction may be normal for a while, until your body gets used to it.
Good luck
I was taught to grab a roll of skin and fat and inject into that at an angle, not to go deeper. I now do it at a 45 degree angle, and make sure to inject slowly and withdraw slowly otherwise I get a drop left on the skin. Thank you to everyone for the tips on reducing irritation.
Hi, This is a slaw release medication, which means it will be there in your skin for a while. I take this injection every four weeks and it always have that reaction, red then dark skin. I put some arnica cream on and it helps. Wishing you well.
leave the needle in a few seconds after injection completed & pull straight out. Angle the needle in pinched skin of stomach . If you ensure the half you discharge before you inject is shaken off needle it prevents all those symptoms. I experimented 18 months now leg stomach etc & it hardly leaves a mark now . Julia UK
PS. Yes I put it into sink running water before injection with half not needed. Pity they won’t develop 45 injections as such a waste . .
Hi, I have never had a reaction to the injection and I do not have much flesh on me. I was taught to discharge the unwanted amount first (I do not think I would be able to see that well if I did it the other way around), pinch some skin and then put the needle in straight, push the plunger keeping the skin pinched, remove the syringe but keep the skin pinched for a few seconds so none of the fluid squirts back out. I always remove the medication from the fridge at least half an hour before I use it so it is up to room temperature. Hope it all settles down for you.
hello, I started in January of this year on 45 mg using pre-filled 90mg syringe. The nurse was very good but very specific about the excess being squirted into my sharps bin-not the sink or loo! Getting it up to room temperature should help with skin reaction. Doing the injection slowly rather than rushing, keep calm. I do mine before I go to bed. This is really working well for me and I wish I had started on it sooner instead of putting it off for a whole year! Good luck.
Thank you. Good to know re the sharps bin disposal - I wasn’t sure about it going into any general waste.
I also hold pressure in the site with a finger tip after injecting and withdrawing the needle for about 10 seconds to prevent leakage out.
You can also leave a [tiny] air bubble in the syringe and inject that after the medication, which will happen automatically if the plunger is up and the needle is down. The bubble seals the site by staying on top of the fluid bubble.
I have a vague memory that this called "Z-tracking" the shot,
Hi,
I was advised to waste the portion not needed first to ensure I'm taking the correct dose. I was told to do this into my sharps bin to prevent any contamination.
I have 2 red patches on my stomach, where I inject, too. I was told to ensure meds were at room temperature, so take out of the fridge 20-30 mins before and have since been told to use E45 cream on the areas. To be honest, nothing has changed, I still have the patches, so I'm very interested to read the suggestions for this.
I hope all goes well for you. Keep us posted.
Once the syringe is put together, hold upright and tap gently so that the air bubbles go to the top. Then while still upright, slowly push plunger in so that the air comes out. Syringe should now be set for full 95mcg dose. I then point it downwards and expel the unwanted peg on to a paper tissue that goes in the bin. I made the mistake at the beginning of not expelling the air which means I was actually underdosing by injecting myself with part air, not liquid. Good luck
Hi All,
As I was preparing to give myself my Besremi shot this past weekend, I was reminded of something I had learned so long ago that I now do it without ever consciously deciding to...
That automatic action is:
To always draw back on the plunger while holding the business [needle] end upward before pushing it forward.
This may important/helpful for a couple of reasons: 1) Almost all pre-filled syringes have either a small detent or just initial resistance to movement at the location where the plunger rests when they are filled- this includes saline and virtually all others that come pre-filled.
So if you just push the plunger forward, you have to overcome that initial resistance, but all too often you will then find that you have gone too far and perhaps wasted some of the [$$] medication.
Also, by drawing back initially, you suck some air in which you can then use to coalesce any bubbles that are already present in the syringe and expel them more easily.
Finally, by having overcome the initial resistance under vacuum, you will have more control over the rate of injection.
YMMV,
PA
I find it helpful to inject into different sites. I use four spots in each of two rows across my belly, one a couple inches below the other. Each spot gets an injection every eight doses. I hope it helps.
Upper thighs are also good rotation sites, if there's enough sub-Q fat there to pinch
Also, some folks have mentioned waiting for the medication to come to room temperature- which can reduce the stinging sensation.
When I received my first communication from Onco-360 [the mail-order pharmacy] where my Besremi is distributed from, they included a small battery-operated kitchen timer to use and recommended letting the medication rest at room temperature for at least 30 minutes before injecting it.
When I was trained [in my Emergency Medicine days], I was told to put my [capped] Lidocaine syringes in a [secure] pocket to allow the medication to warm to body temp in order to reduce the otherwise considerable burning and stinging upon injection.
So, instead of leaving my Besremi out on a countertop or table to warm up, I tend to keep it in one of my pockets- usually a chest pocket, and that seems to work very well in reducing discomfort.
Best,
PA
My husband started on Besremi (100mcg) 3 months ago every two weeks. He initially injected himself while sitting down & did not experience any local reaction. He administered two subsequent injections standing up & developed large red welts at injection site lasting a few days both times. His last 2 injections were administered sitting down without any reaction at the injection site. All in belly area. Curious - may be worth experimenting with positioning.
Thank you! How curious! It was better for me this week - still a welt but a smaller one, but good to have more ideas.
Hope your husband is getting on well with Besremi.
Hi AiredaleTerrier,
I have to agree with RTW, that is a very curious finding. Please keep us updated as to his ongoing/future experiences as time passes.
He may also benefit from rotating to his upper thighs in addition to the abdominal sites.
Best,
PA
The nurses at the hospital told me to waste the excess into the sharps bin. To keep an eye on the air bubble and slowly expel the excess till the line of the air bubble is at the 45mcg mark. She said for our injections not to tap the air bubble out. Pinch the fat from either side of the abdomen (not above or below the belly button). A different side each week. Make sure the bevelled edge of the needle is facing up to make an easy entry. (When taking the needle from the fridge to place in my palm with my fingers wrapped around it and to very gentle sway the needle back and further for a minute to warm it up. Do not shake it.
Put needle in at a 45 degree angle and slowly expel. Then count to 20 before removing the needle. Put needle in sharps container.
I have two red circles on either side of my abdomen. I’ve had 4 injections. I’m surprised they haven’t gone away. I did read on the information leaflets given to me that one side effect is that the circles remain for some people 🤷♀️
Thanks Pachena. I'm glad to say that my reaction is much minimised these days - the first four were quite alarming (as they were getting bigger and hotter) but the last two have been much better. Not sure whether that is because my body now recognises the interferon or whether I'm better at doing it! (I am very careful now to wipe off any interferon from the needle before injecting so perhaps it was that on my skin that caused the angry reaction previously).
My first couple of circles lasted about a month (faded to bruises) but I can hardly see them now so fingers crossed yours will fade over time too.
Hi RTW,
Please do NOT touch or wipe the needle- in doing so, you are potentially contaminating it- even if you use an alcohol swab to do so.
It's better to expel any excess medication BEFORE attaching the needle assembly.
It's like the tip of the bottle with eyedrops- best it never touches anything at all.
Best,
PA
Ah interesting PA - I'd never thought of expelling excess before attaching the needle. Will investigate. Thanks for the advice.
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