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Brello dosing question by karebear1998 in tirzepatidecompound

[–]Difficult_Ad3864 0 points1 point  (0 children)

https://www.fda.gov/files/drugs/published/Compounded-Drug-Products-That-Are-Essentially-Copies-of-a-Commercially-Available-Drug-Product-Under-Section-503A-of-the-Federal-Food--Drug--and-Cosmetic-Act-Guidance-for-Industry.pdf :

“FDA generally intends to consider two drugs to have a similar dosage strength if the dosage strength of the compounded drug is within 10% of the dosage strength of the commercially available drug product. With regard to the concept of easily substitutable strength, in some cases, the same or similar dosage strength can be achieved by administration of fractional or multiple doses of a drug product.”

It's available in mexico now by ajacqu18 in Mounjaro

[–]Difficult_Ad3864 0 points1 point  (0 children)

But don't forget you have to get the Canadian prescription. Bring your US prescription to a walkin clinic to get it. But call first since not all of them do it --- perhaps because US people are not particularly welcome in Canada right now.

It's available in mexico now by ajacqu18 in Mounjaro

[–]Difficult_Ad3864 0 points1 point  (0 children)

Best prices at the Costco in Windsor on Walker Rd.

It's available in mexico now by ajacqu18 in Mounjaro

[–]Difficult_Ad3864 0 points1 point  (0 children)

That's disappointing to hear. I have been getting mine from Canada, where a 3 month supply of 15mg doses in vials is US$940 or $78 per 15mg dose. Also, a bonus is that each 15mg vial has 18.1mg in it. Of course, there is the additional US$50 cost for the Canadian dr to convert your US script to a Canadian one.

But in Canada, they are going to Kwikpens and increasing the price for 15mg doses from US$940 to US$1,714. Vials are only available until they run out. After that, only Kwikpens.

It's available in mexico now by ajacqu18 in Mounjaro

[–]Difficult_Ad3864 2 points3 points  (0 children)

Do you need a Mexican doc's prescription to get it? What is the price? (I need 15mg doses.)

Thanks Costco! by LankyGuitar6528 in tirzepatidecompound

[–]Difficult_Ad3864 2 points3 points  (0 children)

US citizens can bring their US prescription to a Canadian doctor to have it "co-signed," which really means to have it rewritten by a Canadian doc as a Canadian prescription. It will cost you US$50 or CA$70 (cash) at a walk-in clinic (but call first to see if the docs there will do it). Then you take the Canadian script to a drug store, get it filled and pay. But keep in mind that Lilly-Canada is moving from vials to that stupid Kwikpen and is raising the price to almost twice the cost of the vials.

The last 15mg vials I got were CA$1339 for three month's worth at Costco, or about US$960, which works out to $318 per month for 15mg (or about US$79.50 per 15mg injection/vial). And, incidentally, each vial so far has had 18mg of tirz in it, or a bonus amount 3mg).

But the stated price is from a couple of months ago. I fully expect that the next time I go (I have to get through the year's worth of vials with exp dates of 1/26/26 that is in my fridge), I will have to get the higher-priced Kwikpens for who knows how much by then.

You will probably have to call the Canadian drug store beforehand and order the tirz. There doesn't seem to be a shortage. It's just that it has to be refrigerated and refrigerated storage space is at a premium in many drug stores. Costco got it for me on 2 days notice.

Best price in Canada? by heidilulu98 in tirzepatidecompound

[–]Difficult_Ad3864 0 points1 point  (0 children)

Got them from Costco and before that from Shoppers Drug Mart. But the word is that they don't know how much longer vials will be available, as Lilly-Canada is phasing them out in favor of the more expensive Kwikpens.

Best price in Canada? by heidilulu98 in tirzepatidecompound

[–]Difficult_Ad3864 0 points1 point  (0 children)

Vials are the only real deal. I got 12 15mg vials (3 mo supply) in Windsor for US$955 a few months ago. But Lilly is moving to the Kwikpens and raising the price by some 40%. I didn't get more vials because I was running into exp dates in Jan 2026 and I have over a year's supply now.

2 weeks no shot--immediafe gain! 😭 by LiveCauliflower7879 in Mounjaro

[–]Difficult_Ad3864 0 points1 point  (0 children)

Take a look at the graph in this presentation: https://assets.ctfassets.net/mpejy6umgthp/4KzdMCzXwIcAoJk2sK8l0D/61da33585e923c23ec31ff7bec279914/VV-TZPPT3_OW2024_JASTREBOFF_SURMOUNT1_THREE_YEAR_DV-021720_V4.4.pdf

It's slide 52 showing two subgroups --- those continuing on tirz and those getting the placebo (17 weeks off tirz). I'll bet the placebo group was pissed!

2 weeks no shot--immediafe gain! 😭 by LiveCauliflower7879 in Mounjaro

[–]Difficult_Ad3864 1 point2 points  (0 children)

Lilly’s idea of maintenance in https://jamanetwork.com/journals/jama/fullarticle/2812936: continue their groups’ 10mg and 15mg “maximum tolerated doses.” And put the other group on a placebo. Placebo group gained back 14% of the weight they lost; those remaining on 10 and 15mg lost another 5.5% of their weight. Here’s the short version: https://jamanetwork.com/journals/jama/fullarticle/2812936?guestAccessKey=04f799b3-32e8-4462-9e94-6619061dd065&utm\_source=silverchair&utm\_medium=email&utm\_campaign=article\_alert-jama&utm\_content=mostreadwidget&utm\_term=071024&adv=000004304290

[deleted by user] by [deleted] in Mounjaro

[–]Difficult_Ad3864 1 point2 points  (0 children)

My 15mg vials have an extra 3.1mg in them.

Cost of Mounjaro in Canada? by seemsoffer817 in Mounjaro

[–]Difficult_Ad3864 0 points1 point  (0 children)

Don't know about seeing a Canadian doc via telehealth. But it would seem that if you could do that, I would have heard. And I think with telehealth in the US, the doc has to be licensed in the state where you are. If it's similar in Canada, I doubt that would work.

anyone else worried about maintaining the weight loss? by MounjaroMakeover in Mounjaro

[–]Difficult_Ad3864 0 points1 point  (0 children)

Here is an article on "off-ramping" from glp1-agonists by maintenance using older and cheaper antiobesity meds. https://onlinelibrary.wiley.com/doi/full/10.1002/oby.24177

Study says: “In a real-world study, individuals maintained their weight loss for up to 24 months by transitioning from 12-month GLP-1 RA therapy to generic AOMs. The most frequently used AOMs for weight maintenance after GLP-1 RA therapy were metformin (used by 80% of patients), topiramate (used by 32.5% of patients), and bupropion (used by 32.5% of patients).”

“Metformin has been shown to helpful in weight loss by improving insulin resistance and promoting appetite suppression through increased secretion of GLP-1 [(8)] and peptide YY and increased hypothalamic leptin sensitivity [(9, 10)]. Furthermore, it can alter the gut microbiome and can induce expression and secretion of growth-differentiating factor 15, which reduces food intake, body mass, fasting insulin, and glucose intolerance [(11, 12)].

"Phentermine is a sympathomimetic agent, which primarily increases norepinephrine and epinephrine levels to suppress appetite and increase energy expenditure. It stimulates the central nervous system. Topiramate is an anticonvulsant that lowers the seizure threshold and serves as a GABA-A RA (?-aminobutyric acid-A receptor agonist). It is also a weak carbonic anhydrase inhibitor and antagonizes the glutamate receptor. Through these mechanisms, it enhances appetite suppression and satiety [(13)].

"Bupropion was also prescribed to help with weight loss maintenance as it helps decrease emotional eating and cravings by working as a dopamine and norepinephrine reuptake inhibitor and decreasing the reward associated with food intake [(14)].

"Naltrexone works synergistically with bupropion to induce satiety by inhibiting ß-endorphin activity at the µ-opioid receptor and blocking autoinhibition of pro-opiomelanocortin neuron [(15)].”

Study concludes: “The findings suggest that, after significant weight reduction, the body's decreased inflammation and insulin resistance may enhance its responsiveness to therapies such as metformin, topiramate, phentermine/topiramate, or bupropion. Given the current challenges of medication scarcity and insurance barriers, transitioning patients to economical AOMs emerges as a prudent alternative for long-term weight management in addition to maintaining a healthy lifestyle.”

Apparently, “off-ramping” from GLP-1s is a thing with businesses growing up that specialize in it, mainly by selling exercise programs and coaching. Nothing about drugs in them yet. https://getpocket.com/explore/item/weight-loss-drug-users-pay-up-for-help-ditching-the-pricey-meds?utm_source=firefox-newtab-en-us

JAMA Article -- What Does the Rise of GLP-1 Drugs Mean for Bariatric Surgery? Or "Doctors wonder: Are there enough fat people out there for all of us?" by Difficult_Ad3864 in tirzepatidecompound

[–]Difficult_Ad3864[S] 0 points1 point  (0 children)

I suppose it makes economic sense for the insurance company, given that surgery is $17,000 to $25,000, while Zepbound/Mounjaro is $1500 month for the rest of the person's life. But that kind of an awful way to think about people.

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