TZ/B12 Multidose Packages Service Fee STONEGT PHARMACY

***DISCLAIMER***

You are requesting a service from Dr. K, which includes a chart review for eligibility. If approved, the listed item above will be shipped to the specified address on the order. Because this requires a prescription, you must be a registered patient under Dr. K on Push Health. If you have not registered, please click HERE to get started. Unless otherwise approved, new patients must request a 2.5mg dose package or lower of TZ.

This service request will not be completed until all enrollment steps have been taken. New patients will receive an “Approval Message” through your Push Health account when you are approved for the program and another message once your service has been competed. Returning patients may return and place a new order request when ready and do not need prior approval. Please message us through your Push Health account with any questions before requesting a service.

***This is only available to patients in CO and TX.***

1. You will receive 1, 2, or 3 multidose vials (depending on your order) plus insulin syringes to draw up and self-administer your dose once a week.
2. Please store your medication in the refrigerator after arrival.
3. Please allow 5-7 business days for shipping. This pharmacy ships via UPS and FedEx, but DOES NOT send tracking information to you. However, you may visit www.ups.com plus www.fedex.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.
4. Make sure you carefully follow the instructions on your vial because one of the vials this pharmacy uses is double the strength of the other vial. To make sure you inject the correct amount, carefully follow directions on the vial you receive. Depending on where you are in your weight loss journey and what you order, you may receive different strength vials. For instance, 2.5mg in the 8-week starter dose bundles is 25 units, but in the 12-week starter bundle it's only 12.5 units because a more concentrated vial is used for the latter.
5. You MUST use the dosage that you plan to use.
6. Please order 12-week packages only if injecting weekly.
7. You will receive either 1 or 2 vials for packages 1-3 depending on the volume of each vial. You will receive 2 vials for PACKAGES 7-10 and 3 vials for PACKAGE 11. Sometimes the pharmacy will send one vial at a time depending on the current BUD of the vials, so if you do not receive both/all of your vials initially, please let the pharmacy know when you are ready for your next vial.
8. STARTING PATIENTS: I recommend PACKAGE 4 ONLY if you have been on TZ in the past (and need to restart at the lowest dose) and know 100% that you will be able to escalate to the 7.5mg dose over the 3-month period. Many patients are able to lose weight staying at the two lower doses and may not need to move up for several months. You MUST discard any remaining medication after 90 days.***
9. Before ordering PACKAGE 11 (15mg X 12 weeks), please message us for special permission to do so.
   
   This large volume package is restricted and ONLY to be used for patients that are injecting 15mg WEEKLY. YOU MUST DISCARD YOUR VIALS 90 DAYS AFTER RECEIVING IT EVEN IF YOU HAVE NOT USED ALL OF THE MEDICATION. Your ordering patterns will indicate whether you are following this schedule. Patients that attempt to stretch this package beyond 12 weeks by injecting smaller doses will be restricted to ordering 4-week packages with future orders to maintain compliance. Unfortunately, repeated misuse may result in referral back to your primary care physician for further weight loss care.

VIAL OPTIONS:

There are two vial concentrations from SG Pharmacy:

• 30 mg vial: This vial contains 30mg total of TZ. The concentration of TZ is 10mg/ml and it is a 3ml vial. PACKAGES 1-3 WILL USE THIS VIAL.
  
  *PLEASE NOTE THAT SOME ORDERS MAY ALSO BE SHIPPED AS 2x 1.5ML VIALS WITH THE SAME CONCENTRATION.
• 60 mg vial: This vial contains 60mg total of TZ. The concentration of TZ is 20mg/ml and is also a 3ml vial. PACKAGES 4-11 WILL USE THIS VIAL.
  
  *PLEASE NOTE THAT YOU WILL RECEIVE 1, 2, OR 3 VIALS DEPENDING ON YOUR PACKAGE.
  
  

What Is Vitamin B12?

Vitamin B12 is an essential water-soluble B vitamin that is needed for many different functions in your body. It is the most complex of all vitamins when it comes to how your body stores and metabolizes this vital nutrient.

Vitamin B12 is chemically known as cobalamin. B12 is named cobalamin because it contains the mineral cobalt.

Hydroxocobalamin is one main form of B12 that is naturally found in animal proteins. It is an active, bioavailable form of B12 that may also be called hydroxycobalamin or hydroxy B12. Hydroxocobalamin has the longest half-life of any vitamin B12 form in the body.

Hydroxocobalamin is a good alternative for people who react to methylcobalamin or adenosylcobalamin. Hydroxocobalamin is typically the form that is used in intramuscular B12 injections.

While hydroxocobalamin is not already methylated, it is readily converted to this form to support the methylation cycle. It can also convert to adenosylcobalamin to facilitate conversion of fats and amino acids to ATP. The body decides where hydroxocobalamin is needed most and converts it accordingly.

Joint Commission guidelines for proper use of many multi-dose vials include the recommendation to discard the vial 4 weeks after first puncture, even though the Beyond Use Date (BUD) may be longer. These guidelines are generally followed in office and hospital settings, particularly when the vial is used for multiple different patients. However, this same suggestion is made for vials punctured several times a day or only once a week. With certain vial sizes/doses/packages, using all of the medication in the vial without wasting any could result in a patient using the vial for longer than 28 days after first puncture. If you choose to use your vial longer than 28 days after first puncture due to package size or maintenance dosing, you must acknowledge that you understand the Joint Commission recommendations to discard the vial 28 days after first puncture, even if you only puncture the vial once a week. You will be using the vial at your own discretion.

If you have any concerns about this issue and for best safety practices, please choose a 4-week package and discard any medication leftover 28 days after first puncture.