Sema/L-Carnitine SC Injection with E-Visit DESIGNER DRUGS RX PHARMACY

THIS ITEM REQUIRES A PRESCRIPTION FROM DR.K. NEW PATIENTS MUST PAY THE NEW PATIENT FEE AND BE SENT AN *APPROVAL MESSAGE* PRIOR TO ORDERING. DO NOT ORDER PRIOR TO THIS OR YOUR ORDER WILL BE CANCELLED MINUS A 5% PROCESSING FEE. RETURNING PATIENTS MAY PLACE AN ORDER WHEN READY AND DO NOT NEED PERMISSION PRIOR TO PLACING A NEW ORDER.

**AVAILABLE TO ALL PATIENTS EXCEPT MS AND WV**

I CAN NO LONGER PRESCRIBE SEMAGLUTIDE TO PATIENTS IN MISSISSIPPI OR WEST VIRGINIA DUE TO STATE MEDICAL BOARD REGULATIONS. YOU WOULD NEED TO ORDER TIRZEPATIDE HERE.

PLEASE READ THROUGH ALL INFORMATION ABOUT THE DIFFERENT VIAL SIZES AND STRENGTHS BEFORE PLACING AN ORDER.

This product ships to you from DESIGNER DRUGS RX PHARMACY. Please refer to your vial for accurate dosing, as these are multi-dose vials. The medication will need to be refrigerated after arrival, so please place it in the refrigerator when you receive it.

*SHIPPING DISCLAIMER: Please allow 7-10 days for shipping. This pharmacy ships via UPS, but DOES NOT send tracking information to you. However, you may visit www.ups.com and create a profile there with your shipping address; you should then receive shipping notifications anytime UPS is delivering you a package from any source. Please ship to an address that you have easy access to and plan to check daily, such as your home address. We can not be held responsible if you do not receive a delivery notification of your item. If you absolutely require a delivery notification, please consider ordering from another pharmacy.*

**Patients that take medication for hypothyroidism always need have thyroid hormone levels checked often with their primary care physician. While some studies indicate that carnitine can help with the fatigue symptoms associated with hypothyroidism, other studies indicate that it can interfere with your thyroid medication and make them not as effective. However, the pharmacist feels there is not enough carnitine in this medication to affect your thyroid medications.

With this formulation, there is 12.5mg of L-carnitine in 100 units. Injections range from 25-50 units a week on the lower doses, and from 15-30 units a week with the higher doses (these vials are more concentrated) so the maximum amount you would receive is 6.25mg a week. Many people use anywhere from 1-4mg a day for supplementation, so the injections have a relatively low dose of L-Carnitine.

***A syringe kit will be included (10 insulin syringes and 10 alcohol swabs)***

DOSING

*New patients that have never been on tirzepatide or semaglutide will start with the 0.25mg dose for 4 weeks, then move up to the next dose every 4 weeks. The doses are 0.25mg, 0.5mg, 1mg, 1.7mg, and 2.5mg. You may also stay at your current dose if you'd like and only move up when you feel you have stalled on the current dose.

To avoid any confusion on dosage, you will choose one of 8 options when ordering, and these will be the exact instructions on your vial. As long as you complete at least 4 weeks of a dose, you may move up after that. Also, even though your instructions may tell you to move up, you may stay on a dose as long as you'd like and not move up. This pharmacy ships vials with BUDs (beyond use dates) around 6-8 weeks from the time they are compounded, so you should only order one package at a time.

ORDERING OPTIONS:

DD RX has FOUR different vials sizes which each contain a different TOTAL amount of semaglutide. They also have two different concentrations for their vials, so it is very important to follow the dosing directions on your vial.

In the dropdown box, simply choose one of the dosing options. These will be the instructions printed on your vial. Each vial will have enough medication to provide the exact dosing regimen you order.

**PLEASE NOTE THAT 1MG, 2.5MG, 5MG, OR 12.5MG WILL NOT APPEAR ANYWHERE ON YOUR VIAL, ONLY THE CONCENTRATION AND THE VOLUME (1ML OR 2.5ML). THIS IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY.

1MG VIAL: 1mg total semaglutide $200 (USE FOR 0.25 AND 0.5MG DOSES ONLY)

2.5MG VIAL: 2.5mg total semaglutide $300 (USE FOR 0.25 AND 0.5MG DOSES ONLY)

5MG VIAL: 5mg total semaglutide $375 (USE FOR 0.5MG AND 1MG DOSES ONLY)

12.5mg VIAL: 12.5mg total semaglutide $500 (USE FOR 1.75MG AND 2.5MG DOSES ONLY)

1MG VIAL: 1mg total $200: This is a lower concentration vial. It contains a total of 1mg of semaglutide.

1) You would use this vial to deliver 0.25mg X 4 weeks.

2.5MG VIAL: 2.5mg total $300: This is a lower concentration vial. It contains a total of 2.5mg of semaglutide.

2) You would use this vial for 0.25mg X 4 weeks PLUS 0.5mg dose X 3 weeks (7 week starter package).

.Because of the dosing with this vial, patients may skip the 4th week of the 0.5mg dose and start with the 1mg dose after completing this vial (as long as they are having minimal side effects).

3) You could also use this vial for 0.5mg X 5 weeks.

DOSING FOR THESE TWO 1MG AND 2.5MG LOWER CONCENTRATION VIALS ONLY. YOUR WEEKS MAY VARY, BUT THIS SHOWS HOW MANY UNITS TO INJECT FOR EACH DOSE. SPECIFIC DOSING INSTRUCTIONS EXACTLY THE WAY YOU ORDER IT HERE WILL BE ON YOUR VIAL.

0.25mg (25 units/0.25ml) SC once a week

0.5mg (50 units/0.50ml) SC once a week

If you need higher dosing, it's best to order the 5mg or 12.5mg vial.

5MG VIAL: 5mg total vial $375: This is a higher concentration vial. It contains a total of 5mg of semaglutide. It is a great starter vial for those that want to order several weeks up front and save a little money. It can be used for several options.

4) 0.5mg X 4 weeks PLUS 1mg X 3 weeks

Because of the dosing with this vial, patients may skip the 4th week of the 1mg dose and start with the 1.75mg dose after completing this vial (as long as they are having minimal side effects)

5) 1mg X 5 weeks

12.5MG VIAL: 12.5mg total vial $500: This is higher concentration vial. It contains a total of 12.5mg of semaglutide. You may only order this vial after completing

6) 1.75mg X 4 weeks PLUS 2.5mg X 2 weeks

7) 1.75mg X 7 weeks

8) 2.5mg X 5 weeks*
*You may ONLY order this package once you have reached the 2.4mg maximum dose and have completed 4 weeks of the 1.75mg dose plus all lower doses.

DOSING FOR THE 5MG AND 12.5MG HIGHER CONCENTRATION VIALS ONLY. YOUR WEEKS MAY VARY, BUT THIS SHOWS HOW MANY UNITS TO INJECT FOR EACH DOSE. SPECIFIC DOSING INSTRUCTIONS EXACTLY THE WAY YOU ORDER IT HERE WILL BE ON YOUR VIAL.

0.5mg (10 units/0.1ml) SC once a week

1mg (20 units/0.2ml) SC once a week

1.75mg (35 units/0.35ml) SC once a week

2.5mg (50 units/0.5ml) SC once a week

*If you have reached the maximum dose of 2.5mg, you may order TWO of the 12.5mg vials. Otherwise, you may only order one vial.

For patients that have been on tirzepatide and want to switch to semaglutide either temporarily or permanently:

If you have completed:

2.5mg tirzepatide, start with 0.5mg of semaglutide.

5mg of tirzepatide, start with 1mg semaglutide

7.5mg of tirzepatide, start with 1.75mg semaglutide

10mg and above of tirzepatide, use the max dose of 2.5mg semaglutide.

*Please remember that although these medications act on similar receptors in your body, they are still different medications. Therefore, the side effect profile can be different for each medication. The above recommendations are just general guidelines. It can sometimes be difficult to ascertain the exact dose a patient should start with when switching from tirzepatide because of the variations in the way the medications affect different people. If you find that the dose of semaglutide that you start on after switching from tirzepatide is too strong or causes too many side effects, please drop down to a lower dose for a few weeks.

On the other hand, if you start on a particular dose and after 2 weeks of that dose you find that it does not seem to be suppressing your appetite as well as the tirzepatide, you may go ahead and move up ONE dose.

For example, if you have completed the 7.5 mg dose or tirzepatide, you would start with the 1.75 mg dose of semaglutide:

*If you experience side effects that are hard to tolerate, please drop down to the 1 mg dose for your next injection and stay on that dose for a few weeks. Once those side effects have subsided, you may move back up to the 1.75 mg dose for 4 weeks.

**If you use the 1.75 mg dose of semaglutide for 2 weeks and do not feel that your appetite is being suppressed and you are not having a lot of side effects, you may go ahead and increase to the 2.5 mg dose for your third injection.