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        New Message Board Archives >> Jul-Sep 2003 >> Refinement on Imitrex tip
        
(Message started by: jon69 on Jul 31^st, 2003, 7:19am)

Title: Refinement on Imitrex tip
Post by jon69 on Jul 31^st, 2003, 7:19am

I have been suffering from CH (episodic) for the past ten years or so now, and am currently going through another cycle of my ‘visit from the beast’. I’m using Verap, O2 and sumatriptan (imitrex) to try to keep him at bay.

At its worst I get hit about twice a day and once at night time. If I catch the attacks early enough then the oxygen works a treat, which is fine when I’m at home and can just rush upstairs at the first sign of a shadow, but if I’m out and about the only thing I can do is take a shot of trex.

As most of you know, you are only allowed up to two shots per 24hrs, and this is sometimes not enough for me so I was interested to read about the ‘imitrex tip’.

I was getting hit pretty bad yesterday, and when I felt the shadows coming early in the morning I knew I would be in for a rough day so I decided to try it, as the oxygen didn’t seem to be working.

I was in a lot of pain as I fumbled with my jabs, took the syringe from the applicator, got the label off etc., but I finally managed to stick the needle in my arm and push the plunger down manually with a Q-tip. I used about half of the 6ml dose.

I don’t think I put the needle in deep enough though, and it left a nasty welt on my arm (I usually auto inject in my arse cheek!) and I was worried it wouldn’t work. About five minutes later though I felt the trex kick in and the beast was slowly losing his grip on the pliers he was squashing my eyeball with!! SUCCESS!

Although I was relieved the pain had gone, I didn’t like manually injecting myself as I’ve always been very squeamish about injections, so with a bit of fiddling about with my injector I managed to get the remaining trex back into the box so I could use it with the auto injector for another attack.

Anyway, I was hit again in the afternoon (caught it early enough to abort it with oxygen), and a third time in the early evening. Tried the oxygen again but it wasn’t helping so I decided to use the other half of the trex from earlier. Again, the 3ml of trex did the trick for me, and just as fast as the full 6ml dose!!

This morning I got to thinking of ways to use this half dose method without having to manually stick the needle in. Looking at the auto injector and how it works, if you take the ‘gun’ out of the box and look down the ‘barrel’ you will see a white plastic cross. This is the plunger that shoots down into the trex vial and releases the magic fluid. If you push back the blue ring on the front of the injector and push the blue button on the top, the plunger will shoot out and you see it sticks out of the injector about half an inch or so. When you put the injector back into the box, this plunger is pushed back ready for the next shot.

I reckon that if you were to cut off a portion of the plunger (makes my eyes water just thinking about it!), it would enable the gun to deliver half the 6ml dose, as the plunger would only reach halfway down into the vial!

For this you would need two injection kits; one with the ‘modified’ plunger for injecting a half dose from a new vial of trex, and another with the plunger intact for injecting the remaining dose.

I’ve been experimenting with this and it is very easy to put the half used vial back into the case after a shot by just pushing the injector down gently and turning it COUNTER clockwise before pulling it out.

So, to sum up, you would have two boxes. One for half used shots with plunger intact, and another for new shots with a modified plunger!

At the moment, I only have one injector kit, but I have just been to docs to get a ‘script for another kit and I will try this method out. Goes without saying I will keep you all informed as to how I get on.

I hope this all makes sense, as I’ve just read this and see that I have waffled a bit. I welcome any other ideas and comments on this post.

My thanks goes to the guy who originally recommended the ‘trex trick’, (and was brave enough to try it)!

PF days to all.

John.

Title: Re: Refinement on Imitrex tip
Post by jmorgan52 on Jul 31^st, 2003, 8:21am

Hey John

I also posted on this idea some time ago, but watch out for how much you cut off the "plunger". Don't just cut it in half. Take out the vial and measure the length of the trex liquid, and half that length is how much you should probably remove to give half a dose.

I got a 2nd kit during my last episode and did this and it seemed to work ok, but I only tried it once at the end of my episode so not much experience with the method myself. Somebody reported that the 1st half dose may not always be accurately delivered using this technique.

Also be careful about bending the needle when replacing it in the kit, and take care to keep it sterile.

You will need to prime the firing plunger using a pencil or similar when it has been cut down.

Let us know how it goes for you.

good luck.

another John

Title: Re: Refinement on Imitrex tip
Post by jon69 on Jul 31^st, 2003, 8:39am

Hi John

Thanx for advice. I had already realised that the amount to cut from the plunger would have to be carefully calculated, (I'll work this out when I get my second kit).

Just had a thought; did you find that the cut off plunger delivered enough force to get the needle in deep enough? With the plunger intact, it reaches to the bottom of the vial and forces the needle right out. I'm wondering if the resistance on the rubber plunger within the vial might stop the needle coming out far enough.

Also, any tips on what to use to keep the needle sterile?

Title: Re: Refinement on Imitrex tip
Post by jmorgan52 on Jul 31^st, 2003, 9:20am

Hi John

I think the force of the plunger on the seal pushes the needle in first as there is very little resistance from the skin, then it injects the fluid when the needle is fully in and the plunger meets resistance from the barrel and the body.

In my very limited experience the needle went in deep enough. When I withdrew the vial there was about half the fluid remaining. I recall cutting 8,5 mm off the plunger.

I wiped the needle with cotton wool dipped in surgical spirits. Don't know if this is the best way though.

An idea might be to experiment by filling a used vial with water if that is possible, as I think the rubber seal can be removed from the vial with care. Then try injecting an orange to see if it injects the right amount.

John

Title: Re: Refinement on Imitrex tip
Post by Bob P on Jul 31^st, 2003, 9:23am

A guy posted on this trick a year or two ago. He had the exact measurement of how much to cut off the plunger. He used it all the time.

I would guess you should wipe the needle with alcohol before replacing it in the kit for the second use.

Title: Re: Refinement on Imitrex tip
Post by Ree on Jul 31^st, 2003, 6:35pm

I am always so nervous about you guys fooling around with the sterile needles and stuff...Bob it was tough at the convention... syringes everywhere etc... Arent you afraid you will infect yourselfs or shoot yourself up with air.............. jeesh you guys be careful out there... ree

Title: Re: Refinement on Imitrex tip
Post by jonny on Jul 31^st, 2003, 6:47pm

on 07/31/03 at 18:35:34, Ree wrote:

When your brain is about to explode and you think you will die........the needle is your last worry.

............................................jonny

Title: Re: Refinement on Imitrex tip
Post by Mark C on Jul 31^st, 2003, 7:26pm

Imitrex Injection (http://us.gsk.com/products/assets/us_imitrex_injection.pdf) is the nectar of the God's! The first thing to REALLY work.
I use the vials, much easier to control the dose.

"The maximum recommended dose that may be given in 24 hours is two 6-mg injections
separated by at least 1 hour. Although the recommended dose is 6 mg, if side effects are dose
limiting, then lower doses may be used (see CLINICAL PHARMACOLOGY). In patients
receiving MAO inhibitors, decreased doses of sumatriptan should be considered (see
WARNINGS and CLINICAL PHARMACOLOGY). In patients receiving doses lower than
6 mg, only the single-dose vial dosage form should be used. An autoinjection device is available
for use with 6-mg prefilled syringe cartridges to facilitate self-administration in patients in whom
this dose is deemed necessary. With this device, the needle penetrates approximately 1/4 inch (5
to 6 mm). Since the injection is intended to be given subcutaneously, intramuscular or
intravascular delivery should be avoided. Patients should be directed to use injection sites with an
adequate skin and subcutaneous thickness to accommodate the length of the needle.
Parenteral drug products should be inspected visually for particulate matter and discoloration
before administration whenever solution and container permit.
HOW SUPPLIED
IMITREX Injection 6 mg (12 mg/mL) containing sumatriptan (base) as the succinate salt is
supplied as a clear, colorless to pale yellow, sterile, nonpyrogenic solution as follows:
(NDC 0173-0479-00) IMITREX STATdose System ® containing 2 prefilled single-dose syringe
cartridges, 1 IMITREX STATdose Pen ® , and instructions for use.
(NDC 0173-0478-00) IMITREX Injection cartridge pack containing 2 prefilled syringe
cartridges for refill of IMITREX STATdose System only.
(NDC 0173-0449-02) 6-mg Single-dose vials (0.5 mL in 2 mL) in cartons of 5 vials.
Store between 2° and 30°C (36° and 86°F). Protect from light."

Can anyone tell me what "nonpyrogenic" means? Webster don't know. ???

PFDAN's
Mark

Title: Re: Refinement on Imitrex tip
Post by Drk^Angel on Jul 31^st, 2003, 9:09pm

I don't think there's too terribly bad of a risk from injecting air with a subcutaneous injection.

PFDAN....................................... Drk^Angel

Title: Re: Refinement on Imitrex tip
Post by jmorgan52 on Aug 1^st, 2003, 1:40am

Hi Ree

I reckon the cut-down auto injector method looks safer than holding a vial in one hand after stabbing youself with the needle and poking a qtip down the vial.

I tried the qtip method and ended up with a very sore bruise after several attempts to get it right. Practise may improve this method, but when I saw the cut-down injector idea posted in the archives I eventually tried it and it worked ok for me the one and only time I did it. If/when my next cycle comes I am fully prepared to try it again to save meds.

Neither way is ideal, but we don't have the luxury of the prefilled syringe available in South Africa, we only get the autoinjector cartridge. I have to pay cash for mine as my medical insurance don't pay for it, and at about US$60 for a two injection pack it is pretty steep for me. Even though I pay cash myself I can still only get limited prescriptions filled. 2 packs a month is the most they seem willing to supply me, and I can use that up in 4 days or less, and so I always get edgy when the meds are low. I save them up over the year for the next hit.

As Jonny says "When your brain is about to explode and you think you will die........the needle is your last worry. "

John

Title: Re: Refinement on Imitrex tip
Post by Patrick_A on Aug 1^st, 2003, 5:16am

I hope somebody looks into this.
I busted open a nasal spray after i had used it because i was curious as to how it worked, and was also curious if i could somehow make 2 sprays out of 1. Its a pretty cool mechanism. In fact ya can see where a lot of the cost is kicked in!
I don't think it is possible to make 2 sprays but it got me to wondering. A spray is 20mg and a shot is 6mg. Now the magical question ( please dont beat me Don)
Is the medicine inside the spray the exact same formulation as is in the injector? For all you that get unlimited imitrex, this question aint for you! But wouldnt it work better if you could take the medicine out of the spray and use it for the injector. I guess what i am saying is this.... You are cheating the injector to get an extra shot. (3mgs instead) If you could somehow get the medicine out of the spray, you'd have about 7 doses for your injector!
Just trying to find a way to conserve my meds!

Patrick

Title: Re: Refinement on Imitrex tip
Post by jmorgan52 on Aug 1^st, 2003, 7:39am

Partrick

PLEASE DON"T TRY THIS.

The delivery medium of the nasal spray is totally different and my guess is that injecting it could be harmfull.

John

Title: Re: Refinement on Imitrex tip
Post by GlendaB on Aug 1^st, 2003, 7:58am

Main Entry: py·ro·gen·ic
Pronunciation: "pI-rO-'jen-ik
Function: adjective
: producing or produced by fever

Here is one medical dictionary that you can look medical terms up. Hope this helps!

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9276/9276.html

Title: Re: Refinement on Imitrex tip
Post by Hound_Dogg on Aug 1^st, 2003, 8:10am

Mark,

Nonpyrogenic- means free of toxic substances which will produce fever or feverous reaction.

Jim

Title: Re: Refinement on Imitrex tip
Post by River_Rat on Aug 1^st, 2003, 6:50pm

GREAT IDEA-----But it doesn't work I just sat here for two hours trying to do it here's what I found::

1-I cut off 8,5 mm to start Then I filled up a used needle with the same amount of water (same amount as trex in a new needle)

2-I injected it into a sponge and it took almost all of the water leaving a very small amount, maybe a half mg

3-Refilled the old needle with water and cut off a little more of the plunger, then tryed to inject the sponge again, this time it used exactly half (perfect so I thought) However, Now there isn't enough pressure to push the needle in. Most of the water I shot into the sponge just sat on top of it. DAMN-IT

LEE

Title: Re: Refinement on Imitrex tip
Post by Mastifflvr28 on Aug 1^st, 2003, 10:55pm

OMG...get some VIALS!!!!

Mast

Title: hmmm
Post by rumplestiltskin on Aug 1^st, 2003, 11:10pm

i'm listening to you

i have never done the famous trex injection....my condition and/or collapse of present "pain management" systems has me _ALLMOST ready to "do the needle"

BTW...I've checked...my insurance does not cover the "vials"...just every other method.

tracks of my tears
den

Title: Re: Refinement on Imitrex tip
Post by J.ten_Dam on Aug 2^nd, 2003, 1:30am

sorry to say I tryd this 3 years ago . when you use it on annew file it still injects the whole quantety. I have made dosage plunger stiks out of wooden chopstiks so I dont nead to look how much I am injecting. I offerd up one file for this and trid it out by filling it up with water for triels. The auto injector has such a strength that it still releases the whole dosage if you shorten the plunger. You could mark a file fild with water toto the same level as theorigenal and make 3 shots out of it. the chopstik you push to the first line and mark the edge of the file and then you file off the wood so that it is as thin a the origenel plunger but make sure that you dont shave above the line this prevents it from going deeper.
suxsess Joke tendam.

Title: Re: Refinement on Imitrex tip
Post by jmorgan52 on Aug 2^nd, 2003, 1:33am

hey river rat

experimenting by injecting into a sponge is hardly the same as injecting into a "hard" object like a firm orange which is close in texture to the human leg or arm. A piece of sponge offers no resistance to the plunger.

experiment with an orange and see if you get the same results before you write this idea off.

Title: Re: Refinement on Imitrex tip
Post by jmorgan52 on Aug 2^nd, 2003, 1:36am

ps Mastiff

the whole point is that many of us are not able to get trex in vials. It may be available in the USA in this form but not in my country and apparently many others. anyh other suggestions?

Title: Re: Refinement on Imitrex tip
Post by don on Aug 2^nd, 2003, 8:13am

It is a fallacy that injecting an air bubble will harm you. You need to inject a whole syringe full of air to cause harm.

Title: Re: Refinement on Imitrex tip
Post by River_Rat on Aug 2^nd, 2003, 12:05pm

Orange vs. Sponge

My whole point is that the needle wouldn't even push into the sponge, so it sure wouldn't push into an orange not to mention your skin.

The needle is pushed into your skin with the plunger, I found that if you shorten the plunger enough to only inject half (3mg) there is not enough power to push the needle in.

LEE

Title: Re: Refinement on Imitrex tip
Post by Mastifflvr28 on Aug 2^nd, 2003, 12:29pm

Understood Jmorgan,
I'm so sorry you can't get vials.

What is the issue here? Are we afraid of the needle?
What is wrong with taking the vial out...injecting half...use a golf T, or chopstick, and marking it at the half level...then on the next FULL vial, just inject the first half to that level marked on the stick?

The bruising your getting is pretty normal, I bruise my legs up with just the insulin syringes I use with my vials of trex.

But, do whatcha gotta do to help yourselves, I do wish you the best of luck!!
Mast

Title: Re: Refinement on Imitrex tip
Post by River_Rat on Aug 2^nd, 2003, 12:39pm

Mast,

I can't stick myself with that thing, without using the injector, I even have a hard time with that.

But, if I do get the balls to try it, how far do I stick the needle in. aww forget it, I don't think there is anyway I can do it without the injector so I guess I'll just take the 6mg

Note: I gave my wife shots for IVF for months but do ya think I can stick myself---NOT

Even when dancing with the beast!

Lee

Title: Re: Refinement on Imitrex tip
Post by Mikey on Aug 2^nd, 2003, 1:19pm

Hey Michelle,
you took the words right out of my mouth , with the insulin syringes, because that is what i do too ahead of time, is make up half doses with the insulin syringes because they are the same gauge as the Imitrex syringes and i usually stick myself in the lower part of my stomach.......i have plenty of fat there lol.....and don't have to worry about going in to far because the insulin syringes are a little bit longer than the Imitrex ones, but not by much at all just a couple mm.

Guys, if you try this, the whole key to doing this is to be as sterile as you can possibly be when removing the Trex fluid from the original syringes to the insulin syringes.........This is EXTREMELY important!!!!!!!

At least this way, you don't have to peel off the label and try to guess as to how much is half during the throughs of an attack. It's hard enough to think, let alone try to do all of that when your eye's popping out of it's socket and half of your brains on fire, and somebody is driving 16 penny red hot nails into your temple, just for good measure!

Mikey, ;D

Title: Re: Refinement on Imitrex tip
Post by jon69 on Aug 2^nd, 2003, 1:20pm

I've been using this method for a couple of days now (haven't got my new kit yet so have not had chance to look into modifying the kit) and each time I've used it, the half dose has worked.

The reason I like this idea is not for fear of the needle, or even saving on the trex, but it allows me to spread four injections over a 24hr period without going over the recommended dose. Luckily for me, this cycle I'm only getting hit once or twice a day but there have been times in the past where I've done the two jabs in a single night and gone through agony the next day when I get hit again. This method allows me the peace of mind to have the 'extra ammo up my sleeve'.

RiverRat, I think you've confirmed what I already suspected in that the cut down plunger would meet too much resistance from the rubber stopper within the vial.

Like I said, I'll give it a go when I get my next kit, but if all else fails I'll definately be using the half dose method in future.

Thanks for all the comments and advice, been interesting readin'

PS Ree - you're right, you'll never stop us guys fiddling with our plungers!!

Title: Re: Refinement on Imitrex tip
Post by jon69 on Aug 5^th, 2003, 4:31am

Ah well, got my second kit yesterday and I've been spending this morning experimenting with it. Managed to fill a used up vail with water up to original level, and cut off about 8 mil from plunger. Injected into an orange but like River_Rat and J.ten_Dam have already said, the injector is so powerful the whole dose is released, and when you withdraw the needle, liquid is spraying all over the place, so the force is not enough to penetrate the orange at all. Tried this 3 times before I got bored with it. By now, I'm used to manualy injecting anyway so not a prob. Only thing is, I'm still not sure what to use to clean the needle with?

Title: Re: Refinement on Imitrex tip
Post by catlind on Aug 5^th, 2003, 6:33am

jon, get and use some alcohol wipes.

Word of warning, the alcohol will cause the injection to sting if you use it right before you inject.

I am 'supposed' to use alcohol wipes on the skin for each injection, but I'll be damned if I'm gonna fiddle with little square packets when I'm dancin.

Cat