Splitting Sumatriptan Injections

Some patients have discovered that 2 or 3 mg of sumatriptan aborts an attack. Given the unrealistic quantity limits imposed by most health insurance companies, some have learned how to split a 6 mg injection, allowing them to treat more attacks without exceeding the safe daily limits. One of our members teaches how this is done.
NOTE: This valuable information was provided by a fellow cluster headache patient, Andi Green. It is based solely on his personal experience and does not constitute medical advice. Please discuss any changes to your prescription medication use with your doctor before making changes.


Sumatriptan works 100% for me. So splitting is a ‘no brainer’ from where I’m sitting.
I worked many years ago in a clean room environment whilst working in drug research and manufacturing. I have adapted this to something that you and I can use at home, to allow the splitting of the sumatriptan Auto-injectors into precise but smaller doses, in as safe a manner as your home environment allows.
Quite simply, the Sumatriptan auto – injection manufacturing process needs to be sterile, so the sumatriptan can survive long term storage until you need to stick in your arm, and is not crawling with ‘bugs’ that could potentially cause you harm if injected.
When splitting them up, we do not need to be quite so scrupulous about sterility, as the intent is to prepare them for use within 36 hours, not store them for months. But we do need to be clean and quick! (I still use week old ‘splits’, but I’m much practiced and very confident of the process. I suggest you keep prepared ‘splits’ for no longer than 36 hours at normal temperatures, and no longer 24hrs in warmer weather). With that in mind make up ONLY what you need. It’s precious stuff!
Cautious speed with common sense is the important point. The actual transfer to say, 3 syringes with 2mg of Suma should take no more than 3 minutes.
When splitting avoid using more than 12mg in any 24 hour period, as per drug dosage maximum for sumatriptan. The Suma dose resets at midnight, when you can use a further 12mg over the next 24 hours, and so on.
I will on occasions top up an injection with a further 1mg for the very rare occasions I can’t clear with the initial 2mg dose I use, but at such a low dose I personally believe it is a low risk. However the general consensus, even in splitting is to avoid a second injection within two hours of the first. But these are issues, along with any topic discussed here, that I leave to you to research, and weigh up the pro’s and con’s yourselves.
You carry out this procedure at your own risk. Not my fault if your arm falls off. Capiche?
To help you in finding the right dose for you, here are the milligram to millilitre conversions for the Sumatriptan in your Auto-injector, either SUN or GSK products…. 6mg in 0.5ml.
0.5mg = 0.41ml
1.0mg = 0.83ml
1.5mg = 0.124ml
2.0mg = 0.16ml
2.5mg = 0.2ml
3.0mg = 0.25ml
I suggest starting with a 3mg split into 2 insulin syringes. If 3mg works, then drop the dose by 0.5mg till you find the dose that doesn’t work. As guide, I can clear most with just 1.5mg but I use 2mg for a margin of safety, effectively giving me 6 injections to tackle ‘la BitCH’, instead of the meagre 2!

So here’s what you need and how to do it:

 
Cooking time: None
Preparation Time: 5 minutes with practice.


Ingredients:
Washing up detergent (still one of the best antibacterial agents)
Medical alcohol or 45-50% Vodka (Jam-jar optional J )
Sumatriptan auto-injector (Sun or GSK).
8mm 0.5ml Insulin Needled syringes (buy them online in boxes of 200+)
Sterile Gloves (optional)
Mask (optional)
Most importantly, you  need a metal Sewing thimble or similar with the same circumference as the Auto-injector needle housing (see photo below and take a used injector shopping with you), so you can push down on the thimble with the Auto- injector to arm it, before firing, and also, so the auto-injector needle doesn’t get bent. {I’m using plastic ones here so you can see the process more clearly}

Method:

Before your start, Wipe down all surfaces, and equipment you are likely to handle with warm water and a spot of detergent. Wash your hands in ‘something’ antibacterial, paying close attention to finger nails etc. for as long as it takes to recite the alphabet from A-Z in your head. You can do it out loud but people will look at you funny.
Lay out what you need to use, and ONLY what you need. Keep your work area clutter free. If you have sterile gloves pop them on. Open up the Syringe packet’s etc before you commence, but leave them resting on their original packets. The idea here is that when you are doing the transfer of Sumatriptan to the syringes, you touch things as infrequently as possible. Get everything ready now, so you not ‘fiddling about with lids etc. later. Get the auto-injector assembled and ready to fire.
The thimble and a slightly larger and taller container should be pre-soaked in medical alcohol or Strong vodka for at least 20mins (the higher the proof the better). I keep a few thimbles in a Jam-Jar half filled with vodka with an old tea spoon left in to help get the ‘thimbles’ out when I need them. Give the thimble a quick shake upside down to remove any residue alcohol. Here, the thimble on the left is for the Sumatriptan, The larger container on the right (It’s the cover of a small aerosol bottle) is to hold the ‘Suma Thimble’ ……..  which makes things much easier later on……..
By keeping everything stable and giving you something to hold onto later in the process….
So pop one into the other like so.
Ok? With me so far?
With the next photo, all should make sense.
So you have everything ready to go, Syringe packets opened and your Suma-auto injector primed and ready to fire.
Press the auto-injector over the ‘Suma’ thimble, which you carefully measured when buying, to make sure it fits and gives you the support to push the Auto-injector into the firing position 😉 . And you can now fire the completely covered Sumatriptan into the thimble. If you feel safer, hold the outer container around its base for more stability before firing, as it protects the ‘Suma’ Thimble from your fingers. Once fired, keep holding the auto-injector in place for 5-10 seconds to let any drips or aerosols of your ‘Precious juice of relief’ settle into the ‘suma’ thimble.

Now it’s simply a case of filling the syringes with required amount of Suma.

Make sure you ARE NOT BREATHING directly over what you are doing!
Take the cap off the insulin syringe you have waiting and ready, push the Plunger firmly to insure all the air is out of the syringe, then dip the needle only into the Suma solution and slowly draw up what you need.
Once loaded, invert the Syringe, needle up, and inspect for any bubbles and remove by ‘flicking’ the syringe and adjusting the plunger. Just like in the movies. Feel like a Doctor yet?
This will also dislodge and excess drips you may get on the needle and external body of the syringe.
Pop the cap back on, and repeat.
For the last syringe you fill, you will have to pick the Suma up and tip it so you can get at all the ‘juice’ with the Insulin needle.
Again, you can use your fingers at this point as you’ve protected the Suma thimble from your Fingers, and you’re hopefully STILL NOT breathing directly over what you are doing.
Tipping the last one like this lets you get the needle right into the corner and get the last drop out.
Again, invert the syringe once filled, and flick to force the air to the top and adjust the plunger VERY slowly till you see a tiny drop of Suma on the needle tip. Pop the needle cover on and you’re done.
Wash out the suma thimble and thimble container in boiling water. Let them air dry, the pop them back in alcohol ready for the next time. Keep your syringes in a hard covered case to protect them if you’re out and about.
The more time you do it the faster and ‘cleaner’ you will become at ‘splitting’. And make sure you discard any unused splits after 36 hours.
Here endeth the lesson. Enjoy life again.

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