# Gonal F vials - they say 450 IU but seem to be 600? Confused!



## SarahPooh

Dear Pharmacist, 

Please can you help, I am really worried - I have always used Gonal F pens before but decided to try the vials to try and save some money (this is my 4th cycle of treatment and I need 450IU per day of stimming) - I am really confused because the box says "One multidose vial of powder contains follitropin alfa 600 IU/ml.  Net content per vial 450 IU."  It also says (on the front of the box) 450 IU/0.75ml, and it says elsewhere on the box that the pre-filled syringe of solvent contains 1ml of water.  When I went to inject my dose of 450IU I got in a panic because I the box was sold to me as a dose of 450 IU and I was worried that if I didn't inject the whole thing I wouldn't get the full dose so I injected the whole lot (it said 550 on the syringe, I lost some when transferring it - so the upshot is I think I have injected about 550 IU instead of 450 today and I am terrified that the overdose will have a bad effect on my precious follicles (this is day 3 of stimming and I have 11 follicles this time which is more than twice as many as I usually get which has given me a ray of hope) and I am worried about what to do tomorrow - my DH said that there must be 150 IU of solution spare in each vial/syringe once it is mixed up - I don't understand this because it sounds like you are getting 150 IU in 0.25ml of solution "free" - could I save up the spare 150 from 3 injections and then use all 3 of them to equal one 450 dose?  I don't understand why the drug company would give an extra amount of such an expensive drug for nothing - also on the box it says "For multiple injections only" - why is this?

Sorry this is so full of questions, I am really in a panic and would be so grateful if you could explain all this to me

Many thanks in anticipation,

Sarah


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## SarahPooh

If someone could help me I would be so grateful, I am really worried and have already posted this on Ask a Pharmacist but am desperate for some wisdom ASAP so just posting on here too in case anyone knows the answer in the meantime, this is what I posted:

Dear Pharmacist, 

Please can you help, I am really worried - I have always used Gonal F pens before but decided to try the vials to try and save some money (this is my 4th cycle of treatment and I need 450IU per day of stimming) - I am really confused because the box says "One multidose vial of powder contains follitropin alfa 600 IU/ml.  Net content per vial 450 IU.  It also says (on the front of the box) 450 IU/0.75ml, and it says elsewhere on the box that the pre-filled syringe of solvent contains 1ml of water.  When I went to inject my dose of 450IU I got in a panic because I the box was sold to me as a dose of 450 IU and I was worried that if I didn't inject the whole thing I wouldn't get the full dose so I injected the whole lot (it said 550 on the syringe, I lost some when transferring it - so the upshot is I think I have injected about 550 IU instead of 450 today and I am terrified that the overdose will have a bad effect on my precious follicles (this is day 3 of stimming and I have 11 follicles this time which is more than twice as many as I usually get which has given me a ray of hope) and I am worried about what to do tomorrow - my DH said that there must be 150 IU of solution spare in each vial/syringe once it is mixed up - I don't understand this because it sounds like you are getting 150 IU in 0.25ml of solution "free" - could I save up the spare 150 from 3 injections and then use all 3 of them to equal one 450 dose?  I don't understand why the drug company would give an extra amount of such an expensive drug for nothing - also on the box it says "For multiple injections only" - why is this?

So my questions are really - what will the overdose (if it is an overdose) do to my poor little follies (DH said it might do what the ovitrelle does and make them mature too early - aaaargh!)

and how much drug really is in the vials, is it really 450 IU or is it 600?  And if it's 600, why is there 150 extra and can I use it?

I would be so grateful if anyone can help me,

SarahP


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## ♥JJ1♥

I've pm'd you hun we were cycling together on the last time!!! Best of luck hun


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## SarahPooh

Bless you darlin we have just sort of "crossed in the post"!


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## mazv

Hi Sarah,

The vials are intended to be used for multiple injections for people starting out on treatment taking lower doses of Gonal-F i.e. 75-150iu for anovulation or 150-225iu for IVF (the maximum licensed daily dose is 450iu). This is why you get 6 disposable syringes with it. However there is nothing to stop you using the vial to get 450iu in one dose from it.

The vial actually contains 600iu and you use the 1ml solvent solution to reconstitute the powder, therefore you get 450iu/0.75ml. If you were using it to take multiple injections from the vial you would be going into the vial upto 6 times. Everytime you draw up a new syringe you always 'lose' a tiny bit of liquid in the dead space in the needle and its pretty impossible to get all the liquid out of the vial. So if you think about it in order to guarentee that you can get a total of 450iu using up to 6 syringes (75iu each time) then the company have to overfill the vial with powder and liquid (you only have 0.25ml to play with)

If you are prescribed a dose of 450iu then draw up 0.75ml and inject this every day. If I read your post right then you appear to have used as much liquid as possible and injected 550iu instead? It is more than you needed but not too much so don't worry about it, an extra 100iu over the course of stimms won't make a huge difference. Just make sure you only draw up 0.75ml in future.

If you were to collect the extra left in the vials then you could probably squeeze an extra dose out of 4 vials (in theory there would be 450iu after 3 but as you noted it's difficult to draw up the whole 600iu in one syringe).

Hope this explains things for you? I'd let your clinic know at next scan that you injected a little extra by mistake but I'm sure it will be fine. They are keeping a close eye on you.

Best wishes
Maz x


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## mazv

Sarah I have replied to your post on ask a Pharmacist. I will merge this thread with the other one as multiple posts aren't really allowed.

Maz x


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## SarahPooh

Oh thank you SO much Maz - you have totally put my mind at rest and your reply was so clear and helpful!  You have explained it brilliantly thank you thank you thank you!       

I didn't realise multiple post weren't allowed, so I apologise for that    I wasn't expecting such a speedy reply from you as the "read before posting" thread said don't expect a really quick answer, so I thought if I put it on peer support someone else who knew the answer might just come across it - I was worried I might not know the answer before tonight's injection! 

Thanks again so much, you really have taken a huge weight off my mind.  I will tell the clinic when I go for my next scan on Monday but carry on and just take the 0.75ml injection tonight and tomorrow.  By the way your little Lily is gorgeous, bless her, she looks like a right little giggler!  

With very best wishes,

SarahP x


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## mazv

Hi Sarah,

Glad I could help and you feel more relaxed about it now  I do understand how stressful the whole process is of drawing up the injections and trying to get it right   My last hcG trigger shot I tried 3 times to self inject and just couldn't get the darn thing in ended up having to shout DH to do it and he was terrified   Luckily he managed it but I ended up on the bathroom floor for 5 minutes trying to remain conscious  

No need to apologise about the posts I mod on peer support too so I just merged the threads. Not meaning to offend any other FF members here but I didn't want the possibility of you getting lots of different replies or opinions as I realised you were upset about what had happened. Glad that JJ1 was able to help ease your worries too though   I do check my boards about 2-3 times a day (sad FF addict here   ) but the disclaimer is just incase I'm away for a day or not able to access much.

The issue mainly with multiple posting is that you end up with replies to the same question all over the place and for other members it makes future searches for the same topic easier if they are all under one heading (if you see what I mean) It also makes it easier for the mods and we're all for an easier life   

Thanks for the comments about Lily   she is gorgeous but then I'm rather biased   Hope this cycle will bring you your own little giggler       

All the best for Monday, I'm sure it'll go fine and those 11 follies will be well on their way to 18mm    

Love
Maz x


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## SarahPooh

Dear Maz

Thanks for your lovely reply, you really did help me such a lot.  Your poor DH having to inject you, bless him - my DH is a bit of an old pro having been a type 1 diabetic since he was 4 so injections are no big deal to him!  Your last HCG trigger shot sounds pretty traumatic   but thank goodness you got your lovely Lily in the end.   I understand now about the multiple posting and the searching thing - makes perfect sense and I'm all for making searching as easy as possible, it might help some other poor FF who's in a panic in the future!

Thanks again for your help and your good wishes, 

love Sarah and all 11 Follies   xx


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