How much water do I mix with tesamorelin? A Guide to Proper Reconstitution

The correct reconstitution of tesamorelin is critical for patient safety and accurate administration. The exact amount of water, or diluent, you must mix with tesamorelin varies depending on the specific product formulation you have been prescribed.

Quick Summary

This guide provides explicit instructions for reconstituting tesamorelin, including specific diluent volumes for different formulations like EGRIFTA SV and Egrifta WR, emphasizing proper technique and safety.

Key Points

• Check Your Product: The amount of water to mix depends on the specific tesamorelin formulation, such as EGRIFTA SV or Egrifta WR.

• Use Only Provided Diluent: Always use the Sterile Water or Bacteriostatic Water included with your medication kit, as specified by the manufacturer.

• Roll, Don't Shake: Mix the powder by gently rolling the vial between your hands for 30 seconds; shaking can damage the peptide.

• Inspect the Solution: Ensure the reconstituted solution is clear, colorless, and free of particles before injection.

• Use as Directed: The reconstituted solution should be used according to the manufacturer's guidelines and any unused portion discarded as instructed.

• Dispose of Sharps Safely: All used needles and syringes should be placed in a designated sharps container to prevent injury and disease transmission.

• Never Share: Sharing syringes or needles, even with a changed needle, can spread infections and is strictly prohibited.

Why the Amount of Water Varies with Tesamorelin

Tesamorelin is a synthetic analog of human growth hormone-releasing factor (GRF) used to treat excess abdominal fat in HIV-infected adults with lipodystrophy. It is supplied as a lyophilized (freeze-dried) powder that must be mixed with a diluent before injection. The amount of diluent needed is not universal; it depends on the specific product and vial strength prescribed. Following the manufacturer's instructions is paramount to ensure the correct concentration and dose are administered.

Reconstituting EGRIFTA SV

For the most currently available U.S. formulation of tesamorelin, EGRIFTA SV (2 mg per vial), the manufacturer provides clear, specific instructions for reconstitution.

• Volume of Diluent: Each 2 mg vial of EGRIFTA SV must be reconstituted with a specific volume of Sterile Water for Injection, which is supplied in the medication kit.
• Mixing Technique: The diluent should be slowly injected into the vial, aiming the stream toward the side to prevent foaming. After injecting, gently roll the vial between your hands for 30 seconds to mix thoroughly. Do not shake the vial.
• Preparing the Dose: From this reconstituted solution, a daily dose requires withdrawing a specific volume for injection as directed by a healthcare professional.

Reconstituting Egrifta WR

A different formulation, Egrifta WR, follows a multi-dose protocol with different dilution instructions.

• Volume of Diluent: A vial of Egrifta WR is reconstituted with a specific volume of bacteriostatic water for injection, also supplied by the manufacturer.
• Mixing Technique: Like EGRIFTA SV, gentle swirling or rolling is required for 30 seconds. Shaking can degrade the medication.
• Preparing the Dose: For Egrifta WR, the daily dose involves withdrawing a specific volume of the reconstituted solution.

Reconstitution for Compounded or Other Forms

Some patients may receive tesamorelin from a compounding pharmacy or a different manufacturer. In these cases, the reconstitution instructions will vary significantly. Always follow the specific instructions from your pharmacy or healthcare provider. Always verify the type of diluent and volume with the prescribing professional.

A Step-by-Step Guide to Reconstituting Tesamorelin

To ensure a safe and effective injection, follow these steps meticulously:

1. Gather Supplies: Before you begin, collect all necessary items: the tesamorelin vial, the specified diluent (e.g., Sterile Water or Bacteriostatic Water), syringes, mixing needles, injection needles, and alcohol swabs.
2. Wash Hands Thoroughly: Clean your hands with soap and water and dry them completely to maintain a sterile environment.
3. Clean Vials: Remove the plastic caps from both the tesamorelin and diluent vials. Wipe the rubber stopper of each vial with a new alcohol swab.
4. Draw Diluent: Attach the mixing needle to a syringe. Insert the needle into the diluent vial and pull back the plunger to draw the exact amount of water specified for your formulation.
5. Inject into Tesamorelin Vial: Insert the needle into the tesamorelin powder vial. Slowly push the plunger to inject the diluent, directing the flow down the side of the vial to minimize foaming.
6. Mix Gently: With the syringe removed, gently roll the vial between your palms for 30 seconds until the powder is fully dissolved. Do not shake.
7. Inspect the Solution: The final solution should be clear and colorless, without any particulate matter. Do not use if it is cloudy, discolored, or contains particles.
8. Withdraw Dose: Insert a new, clean syringe and needle into the reconstituted vial and withdraw the prescribed dose volume.
9. Inject Promptly: The reconstituted solution should be used according to the manufacturer's instructions. Do not save for later use outside of recommended guidelines.

Comparison of Common Tesamorelin Formulations

This table summarizes the differences in reconstitution for the two common US-based products, EGRIFTA SV and Egrifta WR.

Feature	EGRIFTA SV	Egrifta WR
Tesamorelin Vial Strength	2 mg	11.6 mg
Diluent Type	Sterile Water for Injection	Bacteriostatic Water for Injection
Diluent Volume	Specific volume supplied	Specific volume supplied
Single- or Multi-dose	Single-dose vial	Multi-dose vial (7 daily doses)

Important Safety Precautions

Proper handling of tesamorelin injections is crucial for patient safety.

• Never Share Needles: Syringes and needles should never be shared with anyone else, even if the needle is changed. This practice can transmit infectious diseases, including HIV.
• Use the Provided Diluent: Always use the diluent that comes with your specific tesamorelin product. Substituting different types of water can compromise the medication's stability and safety.
• Dispose of Sharps Safely: All used needles and syringes must be disposed of in a puncture-resistant sharps container. Never throw them in the regular trash.
• Monitor the Solution: Before injection, always inspect the reconstituted solution. It should be clear and colorless. If it is cloudy, discolored, or has particles, do not inject it and contact your pharmacy.

Conclusion

The question of how much water do I mix with tesamorelin does not have a single answer; it is entirely dependent on the specific product formulation you are using, such as EGRIFTA SV or Egrifta WR. The correct mixing volume is a critical step in the reconstitution process that ensures the medication's safety and efficacy. Patients should always refer to the manufacturer's provided instructions or consult with their pharmacist or healthcare provider for guidance tailored to their specific prescription. Correct dilution, gentle mixing, and strict adherence to safety protocols are essential for a successful and safe injection regimen.

Disclaimer: This article is for informational purposes only and is not a substitute for medical advice. Always follow the instructions provided by your healthcare professional and the product manufacturer.

Frequently Asked Questions

Can I use any sterile water to mix with tesamorelin?

No, you must use only the specific diluent provided with your tesamorelin product. Substituting different types of water could compromise the medication's stability and efficacy.

What should I do if I accidentally shake the vial instead of rolling it?

Shaking the vial can damage the tesamorelin peptide. If you accidentally shake it vigorously, it is best to discard the vial and reconstitute a new one, as the medication may be compromised.

After mixing, can I store the tesamorelin solution for later?

The storage instructions for the reconstituted solution depend on the specific product. For some, it must be used immediately, while multi-dose vials may have specific storage guidelines. Always follow the manufacturer's instructions.

Why is it important to inject the diluent slowly down the side of the vial?

Injecting the diluent slowly down the inside wall of the vial helps prevent foaming, which can make it difficult to accurately measure and withdraw the correct dose of medication.

What is the difference between Sterile Water and Bacteriostatic Water?

Sterile Water is used for single-dose applications, while Bacteriostatic Water for Injection contains a preservative (like benzyl alcohol) that allows it to be used for multi-dose applications over a period of time, as specified by the manufacturer.

What if the tesamorelin solution is not clear after mixing?

If the solution appears cloudy, discolored, or contains any particles after mixing, do not use it. This could indicate that the medication is compromised. Contact your healthcare provider or pharmacist for guidance.

What should I do if I draw the wrong amount of diluent?

Discard the vial and start over with a new one. Administering the incorrect amount of diluent will result in the wrong concentration and an inaccurate preparation, which could be ineffective or unsafe.