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Comment by kritiko | Hacker News Reader

May be his pharmacy struggling with supply -- I hear lots of folks are titrating outside of the guidelines because they can't get the appropriate dosage.

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I wish more folks would get comfortable crushing tablets and weighing out their own dosage on scales. It’s not that hard to cut tabs in half or crush two and make 3 doses out of those, then put them back into caps. Empty gelatin caps are cheap and easy to work with.

Should anyone have to do this? Of course not, but if the choice is between this or projectile vomit every waking hour, it’s not a hard choice IMO.

Lastly, I just wanted to take a moment to think about how useless pharmacies have become that they can’t actually do this for you anymore and literally just count out pills, or more realistically push a button on a machine that counts out the correct amount.

Ozempic is an injection administered weekly not a pill that can be split.

Even some pills cannot be split really easily. One example I like to give is Vyvanse. It uses extended release balls that are not evenly distributed in terms of what they contain (I’m no expert here, just going off a doctor’s summary). The only way to properly split it is to pour it into a glass of water and let it dissolve, then take the percentage of the dosage that you need and consume that percentage of water before the contents settle and while they still remain in a well mixed suspension. The remainder of the dosage is essentially no longer any good by virtue of being inactivated over time by being in the water and must be discarded.

Letting it dissolve like that will interrupt the time release mechanism. This is not recommended

My understanding of Vyvanse is that it uses metabolic mechanisms in order to time the release of the drug which helps to prevent abuse. I'm far from a doctor however.

I’m not sure about vyvanse specifically but for some medications the time release mechanism is the coating. my comment should have been more clear

vyvanse relies heavily on the second pass effect to activate, which is what makes it resistant to abuse. it also means if you don’t make sure to eat lunch the second half of the dose doesn’t kick in until supper and you end up being awake until 4-5am. ask me how i know…

Ozempic is a pen-style injector, not a pill.

I agree with your general point, although (and it may not be the same everywhere, but is certainly true in the UK) Ozempic is supplied as a pre-filled pen injector that handles the dose for you, and is taken once a week - there are no markings for a half-dose (and the patient info sheet seems to suggest that a partial dose isn't possible)

Having taken it, I can say that attempting a half-dose of Wegovy pens would have wildly varying results. The smaller Ozempic pens can easily titrate down, but Wegovy pens are not at all designed for it.

Yup, and this is mostly to protect profit for the pharma companies so people don't split doses.

don't some medicines have a time delay release mechanism that this would defeat? getting that much of a dose of some medicines all at once wouldn't be ideal I'd think. caveat emptor and all that.

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