How do I store, handle, and inject my GLP-1 medication?

Keep your GLP-1 vials refrigerated at 36 to 46°F (2 to 8°C). Do not freeze. Store in the original carton or amber vial to protect from light. Before each use, inspect the solution: tirzepatide with B6 should appear clear and/or slightly yellow, standard semaglutide (with B12) will appear pink to reddish, and formulations with L-carnitine or glycine will appear clear or near-colorless. Do not use if it's cloudy or has particles. If the medication appears unusual, you may need to provide photo verification to your pharmacy to assess its usability.

Refrigeration: Store vials between 36 to 46°F (2 to 8°C). Keep away from freezer vents, direct sunlight, and hot cars. Return the vial to the fridge immediately after each dose.

Unpunctured vials: how long an unopened vial can be out of the fridge depends on the pharmacy that filled it and the medication, and the limits differ a lot between pharmacies. See "What if my medication arrives warm?" for each pharmacy's limit. If you're not sure, or it was out longer than the limit, don't inject it yet: keep it in the fridge and message us, and we'll check with your pharmacy.

Once punctured, keep it in the fridge between doses (for travel, see below). If a punctured vial is exposed to adverse conditions, consult your pharmacist to determine if a replacement is necessary.

28 Day Puncture Rule

While manufacturers typically test multi-dose vials for sterility up to 28 days, pharmacies can extend this timeframe based on their own rigorous safety testing for specific medications. When you receive a multi-month supply in one vial, the pharmacy has verified it remains safe and effective for the entire treatment period.

Beyond-Use Date (BUD)

The beyond-use date tells you how long your medication stays safe and effective in the vial. Always check the labeled BUD on your specific vial. It will be clearly printed by the pharmacy that compounded your medication. BUD varies by compounding pharmacy and formulation.

If you're unsure about the BUD on your vial, ask our Patient Success Team and we'll confirm.

What is on your vial. Your vial label shows the beyond-use date and the concentration of your medication. Your dosing instructions, including how many units to draw, are in the prescription paperwork that comes with your order, not on the vial. Always go by the beyond-use date printed on your own vial.

If you think your medication has stopped working. A vial that has been stored in the fridge as described above, and is within its beyond-use date, is unlikely to have lost strength early. Medication from the same batch is third-party tested. Please do not raise your dose on your own. Message your care team and they will review what is going on.

If your delivery arrives when you are not home, put it in the fridge as soon as you can. For how long an unopened vial can be out of the fridge, see "What if my medication arrives warm?" and check the limit for your pharmacy.

My medication arrived warm or frozen

If your medication arrived warm, see "What if my medication arrives warm?" for what to check and what to do.

If your medication arrived frozen, or you can see ice crystals, do not use it. Contact our Patient Success Team. Stability guidance after freezing varies by compounding pharmacy, so we will confirm with yours before you use it.

Safe handling: Clean the rubber stopper with an alcohol swab before each draw. Use a new sterile syringe and needle every time. Write the date you first punctured the vial on the label. Never share vials or needles.

Sharps disposal: Dispose of used needles and syringes in an FDA-cleared sharps container. Do not throw them in regular trash.

Where and how to inject

GLP-1 medications are injected subcutaneously (under the skin) into the abdomen, front of the thigh, or outer upper arm. Rotate your injection site with each dose to protect your skin. Always use a new sterile needle and syringe for every injection.

• Wash your hands and check your medication and dose
• Choose your injection site: abdomen, front of thigh, or outer upper arm (upper arm is easiest with a partner)
• Clean the site with an alcohol swab and let it air dry
• Draw your medication following the instructions from your care team
• Pinch a fold of skin at your chosen site, insert the needle all the way in at a 90° angle (straight in), and inject subcutaneously into the fatty layer under the skin. Do not inject into a vein or muscle
• Remove the needle and apply light pressure with gauze if needed
• Dispose of the needle in a sharps container and return your vial to the fridge

Rotating sites: Use a simple rotation - for example: left abdomen, right abdomen, left thigh, right thigh, then repeat. Keep a note in your phone or medication box. Avoid your belly button, and any scars, moles, bruised or irritated skin.

Thigh: inject on the outer front of the thigh, not the inner thigh.

Left and right: yes, alternating sides from week to week is recommended. The simple rotation above (left abdomen, right abdomen, left thigh, right thigh) does this.

Does the site change how well it works? The medication works the same from any approved site. Some patients feel a difference in side effects, such as nausea or skin irritation, from one area to another, and everyone responds differently. If you would like to try a different area, such as your thigh or the back of your upper arm, you can, and you can go back to your usual spot if it does not help.

Needle tip: If the needle sticks or is hard to insert, let the vial sit out of the fridge for about 15 minutes to warm slightly before drawing. Make sure any replacement needles match the correct unit markings for your syringe.

Questions about syringes, needles, or drawing from more than one vial? See "Which syringe and needle do I use, and what if something goes wrong when I draw or inject?" It covers using a 0.5 mL syringe, what to do if a needle bends or breaks, and whether you can redraw or combine vials.

Redness, itching, or welts at the injection site

Mild redness, itching, or a small raised spot at the injection site is common, especially after a dose increase. Skin sensitivity varies from person to person. Here is what you can try:

• Let the medication warm up. Take the vial out of the fridge 15 to 30 minutes before you draw your dose, then return it to the fridge right after. Injecting very cold medication can add to irritation.
• Rotate your site every week between your approved areas (abdomen, front of thigh, outer upper arm), and avoid injecting near your belly button or into bruised, scarred, or irritated skin.
• Ask your pharmacist or care team about an over-the-counter antihistamine on injection day.
• After you inject, an over-the-counter anti-itch cream such as hydrocortisone (cortisone) or diphenhydramine (Benadryl) cream on the spot can help with itching, and a cold compress can help with redness or swelling. Do not rub the site.

Feeling a little sensitive or tender around the spot, including after your first dose, is reported by some patients. Message your care team if it is severe or getting worse.

When a reaction needs your care team

Message your care team through the portal if:

• the redness, swelling, or itching spreads beyond the injection site, gets worse, or has not settled within a day or two
• the area becomes large, hot, or hard, or the reactions keep getting stronger from one injection to the next
• you get a rash or hives somewhere else on your body, or a rash that shows up days after an injection. Hold your next dose until your care team has reviewed it, especially if you also feel unwell or have breathing symptoms
• reactions started with a new vial or a new pharmacy, even if your dose has not changed

Call 911 or go to the ER for trouble breathing, or swelling of the face, lips, tongue, or throat.

What your care team may review with you. Some patients are sensitive to the medication itself, and others react to something in a particular formulation. If reactions continue, your care team may talk with you about options such as:

• trying a different formulation (for example one made with L-carnitine or glycine instead of B6, or a version with added B6) or a different pharmacy for your next order. Some patients do better with one, some with the other, and results are not guaranteed
• splitting your dose or temporarily lowering it
• whether a different syringe or needle length is appropriate for you

Please do not change your syringe, your dose, or how you split it on your own. Your care team will make that decision with you.

Travelling with your medication

You can bring your medication and syringes in your carry-on bag. Keep them in your carry-on rather than checked luggage, so they stay with you and are not exposed to the temperatures in the hold.

At the security checkpoint in the United States:

• Tell the officer you have medically necessary liquids at the start of screening.
• Liquid medication is allowed in excess of the usual 3.4oz / 100ml limit when it is medically necessary, and it does not need to go in a zip-top bag.
• Take it out of your bag so it can be screened separately.
• Unused syringes are allowed when they are with your injectable medication. Declare them as well.
• Ice packs used to keep medication cold are allowed, including when they have partly melted. Declare them at the checkpoint.
• The final decision on any item rests with the officer at the checkpoint.

Labelling: TSA does not require medication to be in its original labelled container, but a clear label makes screening easier, and some states have their own labelling rules. Travelling with your vial in its pharmacy-labelled packaging is the simplest way to cover both.

Letter of medical necessity: Belle can provide one if you would like documentation for your trip. Message the care team from your patient portal and we will send it to you.

Keeping it cold: pack it in an insulated bag or small cooler with an ice pack. For how long an unopened vial can be out of the fridge, see "What if my medication arrives warm?" (it depends on your pharmacy), and always check the label on your vial.

If your vial has been opened, keep it in an insulated bag with an ice pack for the whole trip. A few hours at room temperature is fine. Put it back in the fridge as soon as you can.

Would you rather not travel with your medication? A one-time change to your injection day is sometimes possible, so that your dose falls before you leave or after you return. Message your care team with your travel dates and they will tell you the right date to inject. Please do not move or double up doses on your own.

Travelling outside the United States: rules vary by country, and Belle cannot advise on the requirements of a specific country. Please research the rules for your destination yourself before you travel. We can still provide a letter of medical necessity on request.

Please note: this guidance is based on TSA's published rules, which can change. Always check the current TSA guidance, and the rules for your destination, yourself before you travel.