Medication and Injection Instructions - Sublingual Troche

Overview: A medication dosage form dating back to the 1800s, troches have regained tremendous popularity for the absorption of medications, especially hormones and ED medications. They are effective because the lining of the mouth is thin and rich in blood supply.

How to take: Troches are small lozenges that dissolve between the cheek and gum over a period of about 10-20 minutes. As it dissolves, the medication is gradually absorbed into the blood stream so that it can be absorbed more efficiently and in some cases faster than if the same medication was taken orally.

Storage: To prevent melting, troches should be stored at 70 degrees or lower. We suggest storing them in the refrigerator in warmer climates.

Customization: We can flavor your troches depending on the medication. If a flavor is not indicated the pharmacy usually defaults to watermelon or mint. If you have specific flavors in mind please let us know and we will see if it is possible. Troches can also be compounded using a combination of medications, allowing for custom dosages and formulas.

Medications that are commonly prescribed as a sublingual troche include:

Tadalafil
Sildenafil
Hormones
Oxytocin

Sermorelin Mixing Directions

Sermorelin Acetate for Injection (GHRH)

Sermorelin Acetate for Injection (GHRH)

Sermorelin Acetate is compounded in the following strength: 15mg (15,000 micrograms).

  • Step1: Mix the Bacteriostatic water provided into the vial of Sermorelin using a large “mixing syringe” with attached needle. This is done by using the mixing syringe to draw the appropriate amount of bacteriostatic water and dispensing it into the vial of Sermorelin. Usually the mixing syringe is between 3ML and 10ML in size (not to be confused with the much smaller syringes used to inject).

    For 15mg vial of Sermorelin: Using the mixing syringe, dilute (mix) 7.5ml of bacteriostatic water.

  • Step 2: Next, Swirl the vial with a gentle rotary motion until contents are dissolved- DO NOT SHAKE

  • Step 3: Now you are ready to administer your Sermorelin. Please note that 10 units on the syringe = 200mcg of Sermorelin when measured on the syringe used to inject, usually an “insulin” syringe. This is indicated in the diagram below. So if your prescribe dose is 1000mcg this means you draw to the 50 unit mark on the syringe.

You may use this mixture for up to 90 days, but remember to keep it refrigerated after mixing. If you accidentally leave your sermorelin out of the fridge don’t worry, sermorelin can be left at room temperature for 72 hours after being mixed.

Be sure to properly dispose of all syringes and needles after use.

Measuring your dose on the syringe:

  • 1000mcg (1mg) = 50 units on the insulin syringe
  • 500mcg (0.5mg) = 25 units on the insulin syringe
  • Mcg=microgram (measurement of the amount of medication)
  • mL= milliliter (measurement of the volume of ‘ liquid’ in the syringe)
  • 1ml = 1cc

This diagram shows a ½ cc Insulin syringe which contains up to 50 units. Please note there are different sizes of syringes, including 1cc (100unit) syringes. The amount you are instructed to draw to will remain consistent no matter the syringe size.

Important Information about Sermorelin

[Sermorelin Acetate for Injection]

15mg (15,000mcg per vial): Individual pharmacies may offer different strengths.
* Always be sure to check the label to confirm that you have received the correct strength

The diluent is Bacteriostatic Water for Injection, USP containing 0.9% Benzyl Alcohol added as an antimicrobial preservative. Do not use any other diluent unless approved by the prescribing physician. Refrigerate after reconstitution.

BEFORE USING THIS MEDICINE:

  • Inform your Doctor or Pharmacist if you are allergic to any prescription or non-prescription medicine; taking other medicines or have other medical problems; pregnant, planning a pregnancy, or breast feeding.
  • Check with your Doctor, Pharmacists, or Nurse if information in this leaflet causes you special concern or if you want additional information about your medicine and its use.

COMMON USES FOR THIS MEDICINE:

For replacement of endogenous growth hormone in adults with growth hormone deficiency who meet either of the following two criteria:

Adult Onset: Patients who have growth hormone deficiency either alone, or associated with multiple hormone deficiencies (hypopituitarism), as a result of pituitary disease, hypothalamic disease, surgery, radiation therapy, or trauma.

Or

Childhood Onset: Patients who were growth hormone deficient during childhood who have growth hormone deficiency confirmed as an adult before replacement therapy is started.

HOW TO USE THIS MEDICINE:

Use this medicine exactly as directed on the label, unless instructed differently by your doctor
* DO NOT inject if solution is cloudy or contains particles. Contact your doctor or pharmacy

WHAT TO DO IF YOU MISS A DOSE:
Take when remembered unless time for next dose. No double doses.

HOW TO STORE THIS MEDICINE:
Refrigerate in original container away from children. Do not freeze. Discard unneeded medicine.

ADVERSE REACTIONS:

The following adverse reaction, in decreasing order of frequency, have been reported following sermorelin administration:

  • Transient warmth and/or flushing of the face
  • Injection site pain
  • Redness and/or swelling at injection site
  • Nausea
  • Headache
  • Vomiting
  • Strange taste in the mouth
  • Paleness
  • Tightness in the chest

Approximately one in four patients given repeated doses of one or more of the three forms of GRH (1-29, 1-40, and 1-44) has developed antibodies to GRH. The clinical significance of these antibodies is unknown. One patient who developed antibodies to GRH (1-44) also experienced an allergic reaction described as severe redness, swelling, and urticaria at the injection sites. No long-lasting effects from this reaction were reported. No symptomatic allergic reactions to GRH (1-29) have been reported.

Related-

Introduction to Sermorelin
Sermorelin Safely Increases Growth Hormone in Patients
Improving your Mind with Sermorelin

Types of Injectable Testosterone:

  • Testosterone Cypionate
  • Testosterone Enanthate
  • Testosterone Propionate

All testosterone types are suspended in USP oil

How To Fill the syringe:

  • Remove safety seal (plastic cap) and wipe rubber-top with alcohol. Wipe rubber-top before every injection to ensure sterility.
  • Taking a 3cc syringe and attached needle; push the needle into the rubber-top and turn the vial upside-down
  • Pull back the plunger and draw out your dose of testosterone (push plunger back and forth to try and remove as much air-bubbles as possible).
  • Remove needle from the vial and pull plunger back to pull testosterone which might be trapped in needle tip.
  • Carefully twist off the needle used to “draw’’ the testosterone and replace it with a 25G 1-inch needle (fresh needle for injection).

You will inject into one of 3 places: Deltoid (shoulder), Glute (butt-cheek), or top of your thigh. Find whichever works best for you, or alternate between them.

How to do a Test Cyp IM (Intramuscular---In the muscle) injection:

Type of needle to use for injecting testosterone intramuscular (IM):

  • 25g 1”- Best to use with testosterone in grapeseed oil
  • 23g 1”- Best to use with testosterone in sesame or cottonseed oil

*the type of oil will be stated on the bottle’s label

  • Determine which site you will be using: Glute- always inject into upper-outer quadrant of the butt-cheek…close to the hip.
  • Clean the site with an alcohol pad
  • Make sure plunger is pushed up which removes all the air-bubbles, leaving only the testosterone (along with whatever else is being injected).
  • Relax the muscle being injected. For Example- if injecting into your glute you may lay down on your front or lean onto a counter-top. Tensed muscle may cause a little pain.
  • Push the needle all the way straight into the muscle, the faster the better!
  • Once the needle is in, pull back very slightly on the plunger to ensure you ARE NOT into a vein. If you are indeed in a vein (which is rare) then you will see blood in the syringe and are to remove the needle and re-inject.
  • If you are not in a vein then simple push the plunger all the way down, injecting the testosterone into the muscle and remove the needle.

How to do a Test Cyp Subcutaneous (SC) injection:

  • Determine which site you will be using: The best areas for a SC injection are at the upper thigh, shoulder, or upper glute (hip).
  • Use only one of the following needles/syringes: 29g ½” needle with 1ml syringe 30g 1/2” needle with 1ml syringe 26g 5/8” needle with 1ml or 3ml syringe
  • Clean the injection site with an alcohol pad
  • Make sure plunger is pushed up which removes all the air-bubbles, leaving only the testosterone (along with whatever else is being injected).
  • Inject the needle directly into the shoulder, thigh, or glute at 90 degrees. If the injection is being administered in the abdomen, use your thumb and forefinger to pinch a fold of skin (hold loosely so the skin is not too taunt) and insert the needle the entire length.
  • Push the needle all the way straight into the injection site
  • Once the needle is in, pull back very slightly on the plunger to ensure you ARE NOT into a vein. If you are in a vein (which is rare) then you will see blood in the syringe and are to remove the needle and re-inject.
  • If you are not in a vein then simple push the plunger all the way down, injecting the testosterone until the syringe is empty then remove the needle.

Combine vitamin B12 and testosterone cypionate in the same syringe

Vitamin B12 is a popular injectable vitamin requested by many patients. Some men and women feel better when taking B12. Even though testosterone is suspended in oil and vitamin B12 is suspended in water, you can combine them into the same syringe to minimize the need for additional injections. Draw your testosterone dose into the syringe first, then draw the B12. If you are taking your testosterone once per week, you can add 0.5ml to 1ml of b12 to your injection. If you are splitting your testosterone injection into twice per week, try adding 0.25ml of b12. B12 can increase red blood cells which Defy Medical will monitor every six months. If you already have elevated hematocrit we recommend speaking with the doctor prior to starting b12 injections.

Click here to learn more about the best type of injectable vitamin b12. Order a 10 week supply of B12 for $25 at Defy Medical.

Additional Information

  • “CC” is the same thing as a “ML” CC=ML
  • 100 units an “insulin” syringe equals 1ML. 100units = 1ML
  • Be sure to keep your injections CLEAN. Always wipe your injection site with alcohol and store your medications in a clean location. Always use a new, unopened needle for each injection. Do not reuse your needle and syringe!
  • Contact Defy Medical if you need syringes, needles, or supplies



VIDEO: How to Inject Testosterone by IM injection



VIDEO: How to Inject Testosterone by SC Injection

More about Injectable Testosterone

Reasons Men Run Out of Testosterone Cyp Too Early
How long does it take to see results
Test Cyp cold weather storage WARNING

TRI-MIX

Intracavernous Injection Therapies (ICP) have changed the lives of many men who previously suffered from severe erectile dysfunction. Many of these men had little or no response to commonly prescribed PDE5 medications like Viagra and Cialis. ICP medications can be used to produce a very strong erection which can last the entire duration of sexual activity.

If you have been prescribed Tri-Mix or any other ICP medication, it is important that you print and read each link below. These medications are very powerful and if not used correctly they can lead to prolonged erection (severe priapism) resulting in permanent damage to the penis. If you follow your doctors instructions and understand the information below than Tri-Mix and ICP medications are very safe to use.

All Defy Medical patients who are prescribed Tri-Mix and similar ICP medications will be given unlimited medical support and assistance with the administration of your medication. Our medical director and team want to ensure safety for every patient under our care. Please do not hesitate to contact the clinic for assistance with your medication.

Start small with your dosage! For Bi-Mix, Tri-Mix, Quad-Mix, and Penta-Mix we recommend starting at 0.05ml (1/20th of a milliliter) and increasing slowly until erection is sustained. It is much better to require an additional injection than to take too much and require medical care for priapism!



*Attention Tri-Mix and ICP Users: IN ORDER TO PREVENT DAMAGE TO YOUR PENIS WE REQUIRE PATIENTS TO USE ONLY A 30G ½” NEEDLE WHEN USING TRI-MIX. USING A SMALLER GAUGED NEEDLE (LESS THAN 30G) INCREASES THE RISK OF BENDING THE NEEDLE DURING INJECTION WHICH WILL DAMAGE TISSUE OVER TIME. A SHORTER NEEDLE WILL NOT DEPOSIT THE MEDICATION DEEP ENOUGH THEREFORE A ½” LENGTH IS RECOMMENDED.


Video: How to Administer a Tri-Mix Injection

NEVER take Tri-Mix or any ICP injection within same 24hr period as Viagra/Cialis/Levitra or other ED meds.

TRI-MIX DRUG INSERT FROM THE PHARMACY

TRI-MIX AND QUAD-MIX: MORE DETAILED INFORMATION

HOW TO INJECT TRI-MIX

HOW TO PREVENT & TREAT PRIAPISM

ALL SALES ARE FINAL

Insurance:

Defy Medical strives to provide both quality medical care along with affordable access to compounded medications, blood tests, and nutritional supplements. In order to accomplish this, Defy Medical does not accept any form of insurance. Many of the formulations we use in our therapies are not covered by insurance, and the cost of overall treatment is often less than when using insurance. On case by case basis, some insurance companies do reimburse for Hormone Replacement Therapy and Testosterone Replacement Therapy. It is each patient's responsibility to contact their own insurance company to confirm reimbursement. Defy Medical will not contact your insurance company nor will take any responsibility for any additional forms your insurance requires. Defy Medical provides claim assistance by completing the standard claim form (CMS-1500) for the patient to submit to their insurance company. If you would like to receive Claim Assistance, please contact patient services at info@defymedical.com.