Hi
ET Jak2, just been moved from HU to Pegasus 45mcg, due in HU being intolerable. Looking for advice on how not waste the drug (especially considering shortage, and it might not be available next month), and split the vial for more than one use. I think I have previously read about using new syringes each time, being very careful with hygiene. I know its not ideal, but with the shortage, its better than going back on HU, as no other drug is accessible in NZ. Thanks 
Hi Zephyr
I have been taking 45mcg Pegasys once a week for 9 months (ET Jak2). This meant wasting half the syringe every time I injected. Due to the shortages in the UK my MPN team have changed my dose to 90mcg every three weeks as they are happy with my blood results. When I asked about saving the 45mcg I wasted each week the MPN nurse said a definite no as contamination may occur - once the syringe seal is broken it is for one use only, whatever the dose.
I imagine your team will probably say the same. Perhaps a chat with them to see if your dose can be tweaked?
Gill
There is precedent for authorized multi use of an IFN. From the Euro label for Bes
"The pre-filled pen may be used up to two times within these 30 days."
ema.europa.eu/en/documents/...
They provide two needles per syringe for this purpose.
While on the point, this is not PEG and it's a syringe rather than a vial.
Fascinating. My medical team always denied it was safe to use a vial more than once, and I certainly never heard of the two needle application. I am currently wasting 4/5 of this enormously expensive stuff every month. This is costing Medicare plenty, even tho I am getting a grant right now. My congressperson said to contact the FDA here in the States, but their answer was not helpful. It was "translated" by office staff as: The FDA is basically asking you to complain to the distributor so the distributor decides to change the packaging options. If the FDA gets enough complaints they may intervene, especially in times of shortage.
Besremi pens are specifically designed to be used twice within a 30 day period, so are safe for that.
Pegasys syringes aren’t designed for reuse, hence the concern about contamination once they are opened - I’ve been told I can’t reuse mine, so have moved from 45mcg every four weeks to 90mcg every eight weeks.
I'm not familiar with a vial, but it would seem to be more steps than just pushing the pre-filled pen/syringe twice with fresh needles as the Euro instructions. Is your PEG not avail by syringe/pen?
Many reports cover advice against one vial for more than one pt, which does seem quite valid.
A search of insulin practice I find multi uses of various types seems common.
Hi Zephyr,
I use the vial and split each 180mg vial into two 90mg doses. There are two ways I think you can do this with minimal risk of contamination. One is to draw up all of the syringes at one time (using different syringes), labeling them, and place them in refrigerator. The other is to draw up the first dose, then cap the vial with an alcohol wipe and tape, label the vial and put back into refrigerator. If you use sterile technique I think there is minimal risk of contamination. The vial does not contain a bacteriostatic agent, which is why the drug company cannot legally market it as a multi-use vial.
Personally, I think the risk of contamination is minuscule, and the waste of such an expensive drug is unwise,,especially when there is a shortage.
All this being said, you would need to assume responsibility for using it as a multi-use vial. I’m comfortable with that decision for myself.
I am on 45 mg Pegasus every 14 days. My consultant gave me some extra needles and I have been splitting dose from pre filled 90mg syringe for 3 months with no problem. Just be very careful with aseptic technique
Consultant moved me from 45 weekly to 90 fortnightly to avoid wastage. Seems to going OK so far.
I get a 180 mcg (0.5 ml) single use pre filled syringe with the needle not attached. It depends what packaging you have your peg in and this seems to vary country to country. My current dosing is 45 mcg one week and 90 mcg the next.
My clinical nurse showed me how to use a syringe to draw up the amount I needed.
I use an insulin syringe for my 45mcg week. The ones I get have 0.3ml capacity and divided into 30 units. So for my 45mcg week I draw up 12.5 units or 0.125ml. I recommend getting insulin syringes with 8mm needle as the really short needles make it dang near impossible to do the draw.
The technique is very fiddly and recommend lots of practice using an used peg syringe and water.
With the pre filled peg syringe I remove the rubber cap, draw back peg and remove any bubbles. Insert needle of insulin syringe in top of peg syringe and slowly push up the peg while sucking it up through the insulin syringe. It's a two handed technique pushing the peg plunger and pulling the insulin plunger.
Once I have drawn up enough, I remove insulin syringe, draw back peg fluid, swab peg syringe with alcohol wipe and put cap back on. Put peg syringe back in box and in in fridge for next week.
Remove bubbles from the insulin syringe and inject using that. Discard in sticks container.
I haven't yet got good enough at drawing up to not lose some of the peg, so I'm only getting 2 weeks per syringe (the second week I just use the provided needle and discard peg to leave a 90mcg dose).
Once you attach the provided needle to the pre loaded single use syringe, I haven't found a way to remove the needle.
Hope this helps but if you have a different presentation of peg, it may not.
Am I being negative or realistic?
Storage of Pegasus interferon 
Hi all
