TZ/B12 Multidose Packages with E-Visit TX PATIENTS ONLY STONEGATE

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.

***This medication is only available to patients in TX.***

This ships from Stonegate Pharmacy. In the past, Stonegate was running 3-4 weeks on shipping. Currently, their shipping time is much better, about 2 weeks.

Your medication may have a pink or red tint due to the B12 in the vial. This is normal. I love it because it helps me see the medication better when drawing it up!

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. If approved, your order will be placed with the pharmacy and shipped to your home or office. Please allow 3-4 weeks for the pharmacy to ship your order. New patients that have not been on a prior weight-loss medication must start at the 2.5 mg dose.

Please store your medication in the refrigerator after arrival.

IMPORTANT INFO:

There are two different vial strengths, depending on your order. You will receive the number of vials indicated beside the option. 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.

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.

***You MUST use the dosage that you plan to use. Each package must be used within 90 days from receiving it! Please discard after 90 days! If you order PACKAGE 4 or PACKAGE 8 (which both have escalating doses over 12 weeks), you will waste medication if you are not able to escalate the dose and inject weekly. For this reason, I recommend package 4 only if you have been on tirzepatide in the past (and need to restart at the lowest dose for whatever reason) and know 100% that you will be able to escalate to the 7.5mg dose. You MUST discard any remaining medication after 90 days.***

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STANDARD PROTOCOL FOR TZ (SEE BELOW FOR CHARTS):

Month 1: Inject 2.5 weekly X 4 weeks

Month 2: Inject 5mg weekly X 4 weeks

Month 3: Inject 7.5mg weekly X 4 weeks

Month 4: Inject 10mg weekly X 4 weeks

Month 5: Inject 12.5mg weekly X 4 weeks

Month 6+: Inject 15mg weekly

**If you are having a lot of side effects with a particular dose, I would recommend not moving up until the side effects lessen. You may also try going back down a dose for a few weeks, then try moving back up again in a few weeks.

***Although many people like to stick to the same pharmacy when they reorder, you may order from any pharmacy available for your state. However, please note that the formulations are different across pharmacies, and the units you use for a particular dose may change drastically with a new pharmacy. Please pay careful attention to your vial and refer here for correct dosing.

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VIAL OPTIONS:

There are two vial types from Stonegate Pharmacy:

1) 30 mg vial: This vial contains 30mg total of tirzepatide. The concentration reads TZ/HB12 10/0.4mg/ml. This means there is 10mg of TZ in each ml of fluid. The vial contains 3ml of fluid, so therefore 10 X 3= 30mg total in the vial. Having 3ml of fluid means there are 300units in the vial. So, there is a total of 30mg of tirzepatide in the 300 units in your vial. PACKAGE 1-3 WILL USE THIS VIAL.

2) 60 mg vial: This vial contains 60mg total of TZ. The concentration reads TZ/HB12 20/0.4mg/ml. This means there is 20mg of TZ in each ml of fluid. The vial contains 3ml of fluid, so therefore 20 X 3= 60mg total in the vial. Having 3ml of fluid means there are 300units in the vial. So, there is a total of 60mg of tirzepatide in the 300 units in your vial. PACKAGE 4-12 WILL USE THIS VIAL.

DOSAGE (mg)	UNITS TO INJECT 10/0.4mg/ml 30mg vial PACKAGE 1-3	UNITS TO INJECT 20/0.4mg/ml 60mg vial PACKAGE 4-12
2.5mg	25 units	12.5 units
5mg	50 units	25 units
7.5mg	75 units	37.5 units
10mg	100 units	50 units
12.5mg	125 units	62.5 units
15mg	150 units	75 units

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ORDERING OPTIONS:

In the dropdown box, simply choose a package. This is the dosing that will be written on your prescription. If you choose to alter from these directions, please use the correct dosing chart for your vial. As long as you use each dose for 4 weeks, you may move up to the next dose. The BUD dates on each vial is usually 12 weeks so please use your medication within this time frame.

*PACKAGE 1 (30mg vial): 2.5mg X 4 weeks PLUS 5mg X 4 weeks*, $475

*PACKAGE 2 (30mg vial): 2.5mg X 12 weeks*, $475

*Great for 2.5mg maintenance dosing if you are injecting WEEKLY. YOU MUST DISCARD THIS VIAL 90 DAYS AFTER RECEIVING IT EVEN IF YOU HAVE NOT USED ALL OF THE MEDICATION.

*PACKAGE 3 (30mg vial): 5mg X 6 weeks, $475

Please note the vial concentration change with these next packages if switching from one of the above. The number of units you inject for a particular dose changes.

*PACKAGE 4 (60mg vial): 2.5mg X 4 weeks PLUS 5mg X 4 weeks PLUS 7.5mg X 4weeks*, $800

*12 Weeks Starter Package (BEST VALUE). YOU MUST DISCARD THIS VIAL 90 DAYS AFTER RECEIVING IT EVEN IF YOU HAVE NOT USED ALL OF THE MEDICATION.

*PACKAGE 5 (60mg vial): 5mg X 12 weeks*, $800

*Great for 5mg maintenance dosing if you are injecting WEEKLY. YOU MUST DISCARD THIS VIAL 90 DAYS AFTER RECEIVING IT EVEN IF YOU HAVE NOT USED ALL OF THE MEDICATION.

*PACKAGE 6 (60mg vial): 7.5mg X 8 weeks $800

*PACKAGE 7 (60mg vial X 2): 7.5mg X 4 weeks PLUS 10mg X 4 weeks PLUS 12.5mg X 4 weeks*, $1200

*Great value for package deal on these higher doses. YOU MUST DISCARD THESE VIALS 90 DAYS AFTER RECEIVING THEM EVEN IF YOU HAVE NOT USED ALL OF THE MEDICATION.

*PACKAGE 8 (60mg vial X 2): 10mg X 4 weeks PLUS 12.5mg X 4 weeks PLUS 15mg X 2 weeks*, $1100

*PACKAGE 9 (60mg vial X 2): 10mg X 12 weeks*, $1100

This is a great maintenance package for the 10mg dose if you are injecting WEEKLY. YOU MUST DISCARD THESE VIALS 90 DAYS AFTER RECEIVING THEM EVEN IF YOU HAVE NOT USED ALL OF THE MEDICATION.

*PACKAGE 10 (60mg vial X 2): 12.5mg X 4 weeks PLUS 15mg X 4 weeks*, $1100

*You will have one 10mg dose left over with this package. You can also use this package for 12.5mg X 9 weeks with 7.5mg left over.

*PACKAGE 11 (60mg vial X 3): 15mg X 12 weeks, $1400** YOU MUST MESSAGE US FOR SPECIAL PERMISSION TO ORDER THIS PACKAGE PRIOR TO ORDERING.

**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. Repeated misuse may result in dismissal from the program and a referral back to your primary care physician for further care.

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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.