u/karim_ilunga

Compounded supply arrangements have changed materially in recent years. Advice predating that change describes a situation that no longer applies.

reconstituting at a round concentration makes every later dose easy

Provincial plan, employer plan, or paying cash?

Shook the first vial because nobody told me not to. It was fine, but I have swirled every one since.

reconstituting at a round concentration makes every later dose easy

Have you seen the special authorization criteria for your province?

Research-use-only material is not approved for human use, so treat everything in this thread as arithmetic about solutions rather than instructions for a person.

Small fix — a U-100 syringe is 100 units per mL. If yours is marked differently it is not U-100 and the whole calculation changes.

The dead space question sent me down a rabbit hole for a week. It is a fraction of a unit and it is the same every draw.

What concentration did you actually reconstitute at, rather than what did you intend to?

If your calculation produces a fraction of a unit, the concentration is wrong for your dose. Change the water volume until the numbers land on whole units.

Asked GL Biochem what volume they reconstitute to for their own stability testing and they answered in one line. Useful thing to know.

Correcting myself: the compounded position changed and my earlier comment was describing the old one.

Read the special authorization criteria and wrote the application against them line by line.

Adding the fastest step — ask the pharmacist. They can usually check in minutes.

employer plans have their own criteria and their own appeals

Same. I got this wrong once, caught it because the units looked absurd, and have written on every vial since.

Criteria changed at plan renewal and the denial that had been immovable simply did not apply any more.

Bacteriostatic or plain sterile water?

Same. I got this wrong once, caught it because the units looked absurd, and have written on every vial since.

Agreed — units are volume. Once that lands, the rest of the arithmetic is one division.

Left up and flaired Explainer — the numbers in this one check out.

Adding one thing — put the date on the label too. Concentration plus date and you can never mix two vials up.

Careful, that criterion was updated at renewal and the version you are quoting is superseded.

the shortage listing has an expected resolution date on it

swirl, never shake

compounded supply arrangements changed and the threads have not caught up

Same. I got this wrong once, caught it because the units looked absurd, and have written on every vial since.

write the concentration on the vial in marker, that is the whole post

A rejected claim at the pharmacy counter and a denied authorization are different events with different remedies. The first can be an administrative or quantity issue; the second is a determination you can appeal.

Did the maths give you a whole number of units, or a fraction?

do not import US advice into an Australian thread

the number you write down is the number you will trust at 6am

Bacteriostatic water contains benzyl alcohol as a preservative, which is what makes repeated entry into the same vial reasonable. Plain sterile water has no preservative.

PBS criteria are published and searchable

Quantity limits restrict how much may be dispensed in a period even where coverage exists. They are a distinct barrier and require a distinct request.

the price you pay depends on the listing status of your indication

label the vial with the date as well as the concentration

Careful — that arithmetic is wrong. 30mg in 3mL is 10mg/mL, so 2.5mg draws to 25 units, not what you wrote.

Employer-sponsored plans have their own criteria and appeal processes, independent of the provincial formulary. Which one applies determines everything about the route.