Two 20 mg copaxone shots at one time instead of one 40mg

[DancingOnTheEdge13]

I am in a nursing home. Today was injection day. I am on the 40 mg. Nurse came in with two shots. I asked her why and she said "Have they not been giving you two shots?" No why would they? She said these are 20 mg, so you need two and they should have been giving you two to make it 40mg. She gave me both shots in my right arm. Ten minutes later my arm feel like it is on fire and I found out they have been giving me to 20 mg three times a week ... half a dose, half the week. I asked for an ice pack. They told me kitchen was closed. I said you can make one and was told no, we have nothing to make it with. (There is an ice machine and rubber gloves) Someone finally made me one.

But what angers me is the nurse said that to 20mg has been being used since June 1.

Anyone taking two 20 in a single site at a time. Would it not be better to go back to daily injections until they get the 40 mg in?



Thanks for any feedback

[artteacher]

I think I would be asking a whole lot of questions about this. I would talk to the medical director/head nurse and possibly an administrator. There should not be any problems for you to be getting the 40 mg shots. It is not protocal to have two 20 mg shots.

What color was the plunger on the shot? The 40 mg shots have blue plungers. The 20 mg shots have a different color.

I hope you can get some answers.

[jreagan70]

Hi Dancing:

OUCH! Do you have a call in to your neurologist to get this straightened out?

Two 20 mg shots in the same place is fine for the glatiramer (Copaxone drug) part, but it's giving you a double dose of mannitol, which can be really irritating, and probably why your arm hurt so much. (The 40 mg shot and the 20 mg shot each have the same amount of mannitol, so two 20 mg shots is double that amount.)

Based on that, it might be better to go back to daily injections of 20 mg, with proper injection site rotation. If for some reason that isn't possible, then it would probably be helpful to get the two injections widely separated, like one arm and one leg, so the mannitol doesn't concentrate and irritate one place.

I hope your neuro can get this straightened out for you soon.

[Mamabug]

...

Anyone taking two 20 in a single site at a time. Would it not be better to go back to daily injections until they get the 40 mg in?

...

Yes! Would be way better. I'd be mad about two shots at the same time. If they have to use two C20 shots, could they find a needle to inject them into together, so that they can just give you a single injection?

You'll probably be OK, though, even with the lower dose since June 1. There are studies out there, prior to C40, that indicate that 20 mg every other day is just as effective as daily.

[DougW]

Hello DancingOnThe Edge :-)

Have a large fish to smack them across the head with the next time they come at you with two injections. How absurd. Obviously, someone does not know what they are doing. There is no doubt your arm was burning and hurting after that, you received twice the amount of filler product in the injection. Get in touch with your neurologist ASAP and tell them what is going on. Personally, I would take one injection of the 20mg each day until I had the 40mg injections on-site for use.

Artteacher (below) did give an easy way to tell what they have brought to administer to you. The 40mg sryringes have a blue rubber plunger tip and the 20mg syringes have black tips.

I hope you get this straightened out quickly, so you are on the daily schedule, with the proper dosage, that your neurologist wants you to have. You asked a very good question for a very good reason!

I hope you stay safe and well.

[Bo Perkins]

Copaxone 20mg instead of 40mg

If they only have 20mg you can't have a shot for 2 days then you have to have one shot of 20mg a day. 2 vials of 20mg does not equal 1 of 40mg. They obviously don't know Copaxone. The 40mg needle is smaller than the 20mg.

Call your Neuro and let him/her know what is going on please. This has to be reported and fast. Shared Solutions will even want to know about this.

[MarkLavelle]

Yes, 2 x 20 does not equal 40 in this case...

The 40mg needle is smaller than the 20mg.

Really? Any idea why?

[Jules A]

OP, are you still RRMS?

[Imagine]

Be Careful

My understanding is that the make up of the 20 & 40 are different; hence, that is why 7 injections = 140 mg, while 3 injections = 120. The amount of medication is the same. I absolutely agree with the advise of speaking with your Neuro about this. I would also contact Shared Solutions; I have found them to be a valuable resource. Good Luck Shalom, Suzanne

[Jules A]

My understanding is that the make up of the 20 & 40 are different; hence, that is why 7 injections = 140 mg, while 3 injections = 120. The amount of medication is the same. I absolutely agree with the advise of speaking with your Neuro about this. I would also contact Shared Solutions; I have found them to be a valuable resource. Good Luck Shalom, Suzanne

While I would not think its appropriate to give two 20mg at the same time in the same limb I'd disagree that the amount of medication in the daily vs 3xs week are equal. 120mg is not equal to 140mg. My best guess is this was the largest amount that would be tolerated at once and due to the long 1/2 life a therapeutic steady state is achieved and maintained despite the lower total amount injected. I continue to have have concerns about recently changing because I'm worried about the reduced dose.

[Ikaika]

Ummmm NO! I used to be a Wellness Director in a retirement community and know the nurses have strict, state and federal, guidelines to follow when administering medication!! I was also an EMT for 16 years.
(Been on C for almost ten years now.)

If your prescription is 40mg, that is the ONLY medication you should be receiving and at it's proper, prescribed dosage. Which is one injection 3x a week- 48 hours apart.

Please get in contact with your neuro asap, or your legal guardian to call for you, and the Nurse Administrator as well as Executive Director at the nursing home immediately. Wow, both NA and ED know better and what a lawsuit this is for them!! (As well as the RN's know they only administer what is prescribed!)

Shared Solutions also has RN's available, if you are able to call, or your guardian can call, please contact them and the nurse will take the appropriate steps for you.

20mg can be given once a day, daily, with proper rotations sites- this is wrong on so many levels.

I'm praying for you to keep good health and this nonsense to stop NOW at the nursing home!!!

[Ikaika]

While I would not think its appropriate to give two 20mg at the same time in the same limb I'd disagree that the amount of medication in the daily vs 3xs week are equal. 120mg is not equal to 140mg. My best guess is this was the largest amount that would be tolerated at once and due to the long 1/2 life a therapeutic steady state is achieved and maintained despite the lower total amount injected. I continue to have have concerns about recently changing because I'm worried about the reduced dose.

I actually just spoke to a Shared Somution nurse about this.. I was thinking it was like taking an extra strength Tylenol versus a regular strength, that 140mg total a week would be better than 120mg a week...but it is not.

The nurse explained, and I followed up with a lot of research and attended a Copaxone seminar with a neurologist teaching it, that the weekly measurements are not measured in efficacy the same way as per se a Tylenol. The studies and FDA approvals for the way the dosage of 20mg daily or 40mg 3x a week proved to have the exact same efficacy rates.
So it's just a matter of preference, or insurance, for the patient.

I was nervous because after being on 20mg for so many years with very little growth of new lesions, then upon switching to 40mg- bam numerous, new, active lesions.
It's NOT because of the different dosage (I was in tears but wanting to switch off C!) , it is just how my body is needing a stronger DMT now- a new sheriff in town for the MS. Gileyna but that's a diff story.

Hope this helps clarify! SS nurse and the Dr were so helpful explaining this too!

[Jules A]

I actually just spoke to a Shared Somution nurse about this.. I was thinking it was like taking an extra strength Tylenol versus a regular strength, that 140mg total a week would be better than 120mg a week...but it is not.

The nurse explained, and I followed up with a lot of research and attended a Copaxone seminar with a neurologist teaching it, that the weekly measurements are not measured in efficacy the same way as per se a Tylenol. The studies and FDA approvals for the way the dosage of 20mg daily or 40mg 3x a week proved to have the exact same efficacy rates.
So it's just a matter of preference, or insurance, for the patient.

I was nervous because after being on 20mg for so many years with very little growth of new lesions, then upon switching to 40mg- bam numerous, new, active lesions.
It's NOT because of the different dosage (I was in tears but wanting to switch off C!) , it is just how my body is needing a stronger DMT now- a new sheriff in town for the MS. Gileyna but that's a diff story.

Hope this helps clarify! SS nurse and the Dr were so helpful explaining this too!

Thanks for the response! I understand, although I'm not so certain the size or longevity of these studies give me as of a comfort level as I'd like, supports that 120mg and 140mg at a therapeutic level are comparable.

I continue to disagree with the poster who said #2 of the 20mg injection is not equal to #1 of the 40mg injections. It is the exact same medication and mg=mg.

[Jules A]

If your prescription is 40mg, that is the ONLY medication you should be receiving and at it's proper, prescribed dosage. Which is one injection 3x a week- 48 hours apart.

Please get in contact with your neuro asap, or your legal guardian to call for you, and the Nurse Administrator as well as Executive Director at the nursing home immediately. Wow, both NA and ED know better and what a lawsuit this is for them!! (As well as the RN's know they only administer what is prescribed!)

Again while I agree taking 2 separate injections especially in one limb doesn't sound ideal you are incorrect that if the prescribed amount was 40mg that 2xs 20mg couldn't likely be substituted depending on how the actual order was written. Although worth reporting to admin because no one wants two injections instead of one especially on a regular basis I don't see any reason that would indicate a lawsuit especially if there isn't proof of harm.

[Ikaika]

Thanks for the response! I understand, although I'm not so certain the size or longevity of these studies give me as of a comfort level as I'd like, supports that 120mg and 140mg at a therapeutic level are comparable.

I continue to disagree with the poster who said #2 of the 20mg injection is not equal to #1 of the 40mg injections. It is the exact same medication and mg=mg.

I hear you! We are really in a trial of many choices with MS, and studies take so much time and nothing is certain. You know yourself best and we are blessed to have options and still it takes learning, Faith and making the best choice- ahhh!

Also, in my original post I noticed a typo- correction is, I was in tears NOT wanting to switch off Copaxone!
I'm more accepting now and am in the process of getting stated with Gileyna...our bodies change and dosages, meds and even the slightest variable can affect us in such a big way. The nurse was just reminding me of that today, and MS is ever so changing and research is ongoing hence info can be inconclusive. Keep the Faith!! Yay!