How do I store, handle, and inject MOTS-c?

Store MOTS-c in the refrigerator, away from direct light. Do not freeze it.

Your vials are good for 90 days from the date the pharmacy mixed them, not 90 days from the day they arrived. The date to check is the one on each vial rather than the box. A vial past that date is a reorder — message us and we will get you a fresh one.

If it has been left out, put it back in the refrigerator right away and message us with how long it was out. The safe time depends on which pharmacy filled your order, and we'll check it for you. Do not use any solution that looks cloudy or has particles in it.

When your shipment arrives

Your MOTS-c arrives already mixed and ready to use. Open the package promptly and move the vials to the refrigerator. Each 8-week box has 4 vials of 10 mg (2 mg/mL, 5 mL) and 40 syringes, one for each dose. If your shipment was delayed or arrived warm, contact us before using it. Your instructions for your prescription may be on the vial packaging, or may be an insert in the packaging with the medication. We recommend taking a picture or writing down your instructions, although they will always be available in your Belle Patient portal as well. Inspect all aspects of your package before throwing excess away.

When to take it

MOTS-c is taken 5 times a week, in the morning, before you exercise. Each dose is 1 mg, which is 50 units on your syringe, injected under the skin.

The timing is not arbitrary. MOTS-c acts on the same energy-sensing machinery in your cells that training does, so dosing before a workout is how it is meant to be used. Morning also keeps it well away from bedtime — taken late in the day it can keep you up. If MOTS-c is disturbing your sleep, the first thing to try is moving your dose earlier.

Which days is up to you, as long as each dose lands in the morning. The days off give your receptors a short reset, the same idea as the longer break between cycles.

MOTS-c runs in cycles of 8 weeks on, then 2 weeks off. Your exact dose and schedule are printed on your prescription label, and your label is always the one to follow. If your order was placed before September 30, follow the directions on your own label.

Low blood sugar: know this before your first injection

MOTS-c makes your body more sensitive to insulin, which means your blood sugar can drop too low. This is more likely if you also take a GLP-1, and it is more likely if you skip a meal or after a hard workout.

Signs to watch for: feeling shaky, sweaty or dizzy · a fast heartbeat · sudden hunger · feeling irritable or anxious · a headache · blurry vision · trouble thinking clearly.

If that happens, use the rule of 15:

1. Take about 15 grams of fast sugar right away — four ounces of juice or regular soda, glucose tablets, or a tablespoon of honey.
2. Wait 15 minutes. Do not keep eating in the meantime.
3. Still feeling bad? Another 15 grams, then wait another 15 minutes.
4. Once you feel better, eat a snack with some protein in it. Sugar on its own will let it drop again.

Call 911 if you or someone with you becomes confused, cannot swallow safely, or passes out.

Tell us if this happens more than once. One episode is worth reporting. Two means your plan needs adjusting, and that is a conversation with your provider rather than something to ride out.

Where and how to inject

MOTS-c is injected subcutaneously, just under the skin, not into a muscle or a vein. The most common sites are:

• The abdomen, at least two inches from the belly button
• The outer thigh
• The back of the upper arm, if you have someone to help

Wipe the top of the vial and your skin with an alcohol swab, use a fresh needle every time, and put used needles in a sharps container. Rotate your sites and do not inject the same spot twice in a row.

Starting, stopping and restarting

There is no taper. At the end of a cycle you stop, take your 2 weeks off, and start your next cycle at your normal dose. If you are unwell — an infection or a fever — hold your doses and restart when you are better.