E is on backorder & I need advice!

[frances_larina]

So, I've been injecting Rx estradiol valerate weekly for about 6 years.   

Two weeks ago I was nearing the end of my supply and ordered as soon as it was allowed (our HMO won't allow reordering until they calculate the patient is almost out b/c goddess forbid we have a cushion in case of emergencies).  My last injection was a week ago Sunday.   I only had a half dose left but figured I'd pick up more on Monday or Tuesday.   When I called last Monday they told me it was on backorder.  Yikes!

Today when I went in she said they have no alternate suppliers and both the generic and way-more-expensive-non-generic were  unavailable.  ETA has been pushed back to Dec 8th.  "Oh, cr*p", right?  And to make the visit complete she told me that they no longer can get the smaller gauge needle so I have to use ones that feel like I'm jabbing a ballpoint pen into my leg.  This is from California's largest HMO/hospital chain, btw.  The one with the feel-good and be healthy radio ads.

Bitterness & frustration aside, here's my question:

The pharmacists said that she could get a substitute by tomorrow, maybe Wednesday.  But the concentration is twice that of my usual Rx.  And that concerns me a bit.  She shrugged it off and just figured since it's twice as concentrated (mg/mL) I'd just take half as much and be good for the week.  The fact that I had to help her do the dose conversion math b/c it wasn't whole number mL's kinda lost some of my confidence in her.  I've emailed my Dr. and Endo but they can take a few days to reply.

The way I understand IM, the volume of oil helps the E take a week to get absorbed.  Will this be like getting the whole week's worth of E in 3 or 4 days and then...crash?  Doesn't that double the amount in my blood during those few days and will that raise the risk of say, clotting?  The pharmacist sort of hemmed and hawed and finally admitted she doesn't know. 

Does anyone have any knowledge or advice - however vague or non-specific - please??? 

>>>  Since this thread deals with dosages - although not specific ones - I'm posting rule 8C. to remind myself as much as anyone else not to cross the line:

8. The discussion of hormone replacement therapy(HRT) and it's medications are permitted, with the following limitations:
[...]     C. The discussion of recommended or actual dosages is strongly discouraged to prevent information obtained on this site from being used to self medicate.

[Madeline182]

Boo! Not fun at all.
I've been told on this site before that the e juices will latest up to two weeks.. I wouldn't think it'd be an enjoyable week, but hopefully it doesn't come down to that.
I get my goods from cvs, and when it is back ordered or not in stock, I make them check other locations for me. 

Hope this provides some relief c:

Best of luck!!

[Cynobyte]

hopefully i can say this without challenging the laws of the hormone gods:)  You have 10mg/ml?  they seem to have more 40mg/ml!  I was told there was a batch of estradiol that was bad.  they quietly recalled it and the new dates i can find are in mar 2015!  After scouring nm, w texas, and az, nobody has any.  I accidentally found a 40ml/mg 5mg bottle at a local grocery store.  at my rate i should have enough to last months..  how do you get insurance to pay for it?  I have medicare, and the va!  I live in an area where my endo and psych are working with me as a start to help others.  i ended up paying $300 for that bottle and other tg's in the are say thats good?

now you brought up a subject that brought up a scare.  When i took that first dose, I didnt really see anything bad.  I had been on the pills for the last year.  but going to this site:http://pharmlabs.unc.edu/labs/parenterals/intramuscular.htm

hopefully this answers your question as you have made a new one for me to ask.  i searched more sites, it will dissolve faster into your system, but im going to ask my endo about splitting the dose. that should still keep the blood levels low?  still a big needle for the thick oil to double up on it..  but i had worse in the military:)  hope this answers your question..  if you get more info, please reply too:)  I just wonder if my endo didnt endanger me?  but doubt it..

*mod edit for dosages

[frances_larina]

Boo! Not fun at all.
I've been told on this site before that the e juices will latest up to two weeks.. I wouldn't think it'd be an enjoyable week, but hopefully it doesn't come down to that.
I get my goods from cvs, and when it is back ordered or not in stock, I make them check other locations for me. 

Hope this provides some relief c:

Best of luck!!

Thanks.  Today I went in to the pharmacy and...my endo had cancelled the stop-gap prescription!  She's really nice and was trying to help but apparently she thought the problem was the workaround put in place by the pharmacist.  At this point I guess all I can to is wait quietly.  I *wish* I could use CVS or some outside pharmacy but our plan doesn't allow it.  Thanks again for the support!

[frances_larina]

hopefully i can say this without challenging the laws of the hormone gods:)  You have 10mg/ml?  they seem to have more 40mg/ml!  I was told there was a batch of estradiol that was bad.  they quietly recalled it and the new dates i can find are in mar 2015!  After scouring nm, w texas, and az, nobody has any.  I accidentally found a 40ml/mg 5mg bottle at a local grocery store.   how do you get insurance to pay for it?  I have medicare, and the va!  I live in an area where my endo and psych are working with me as a start to help others.  i ended up paying $300 for that bottle and other tg's in the are say thats good?

now you brought up a subject that brought up a scare.  When i took that first dose, I didnt really see anything bad.  I had been on the pills for the last year.  but going to this site:http://pharmlabs.unc.edu/labs/parenterals/intramuscular.htm

hopefully this answers your question as you have made a new one for me to ask.  i searched more sites, it will dissolve faster into your system, but im going to ask my endo about splitting the dose.  that should still keep the blood levels low?  still a big needle for the thick oil to double up on it..  but i had worse in the military:)  hope this answers your question..  if you get more info, please reply too:)  I just wonder if my endo didnt endanger me?  but doubt it..

You are sooo lucky...I wish my grocery store carried estrogen!
"Let's see...I need milk, sugar, yogurt and....oh! That Nestle Injectable Estrogen on aisle 4 !"   
Glad you found a supply, hope this doesn't turn out to be a more widespread problem. I have a mental picture of 3 women getting in a tussle over the last vial at Safeway...

[Cynobyte]

I see it being; (  maybe find supplies where not sold much?  Talked to my endo nurse today about the 10mg/ml compared to the 40.  She said she's been dealing with injections w oils and never hear about oil as being the time release.  She said she will talk to dr, and I haven't heard any news yet..  I do my own injections just in case.  I had some sort of rush last week, but I thought it had todo more with my other meds.  I dropped off them for almost a month due to kidney problems..  btw, if ya wanna experience labor, have a kidney stone, followed by surgery where they give you an epidural like a real pregnancy and stick a laser up you bladder all the way to your kidneys somehow and blow up the stones.  I peed sand 4 3 weeks..  but no, I don't want no baby:)  my son is in college and that's enough..  he was sweet, and took some classes on gender after he found out about me..  I could go on but I'm too stoned;)  legally in nm!  Been a while, didn't get out of bed today with killer pain after tons of oxy and fentynol; (
As for that fight in the grocery store, I called everywhere for a week freaking out.  After they said they had it, I got my script transfered there then drive over a little later.  I walked over to the pharmacy to find it was empty!  Lights out, shelves empty?  I broke down and started crying for no reason.  Felt like an idiot or going crazy.  I had stopped e pills a week earlier..  before I made a scene, I sat down and called them again and the lady answered and verified she was in the store.  I was going nuts swearing I was there but they are closed til she apologized that she forgot to tell me they temporarily moved to other side for renovations!  She came and got me because I was comming down from this panic that has never happened before!  I admit these drugs are bringing emotions out of me.  My wife loves it.  I feel embarrassed since it's so new..    but to me this is a new start.  I'll post more info on the meds as I find it..  my opinion now is the oil slows down absorbtion, but rather hours instead of days..  which can be overcome if true..  I'm just looking for more info on other meds.  If anyone has one of those papers that goes with the bottle and has a chart of absorbtion rates, I'd love a pic of it.. tnx

*mod edit for dosages

[Eva]

Thats scary 

I just refilled mine today (not telling where sorry) its not in my hands yet though... They said they had to order it and usually its right away

They say call tomorrow and it should be there after 2...

10mg/ml 5 ml Delestrogen...

I do keep emergency supplies on hand though just in case

Good Luck!!!

[Cynobyte]

I think it's good luck to you!  Do share if you find a source.  After you get you product will be fine;)

[Newgirl Dani]

Hi Frances, I have posted a number of EV injection post questions.  There is one here on hrt page 8 called "The Rationale of Halve" that may hold an answer, at least to ease concerns about losing ground from a gap in injections.  Serum levels reach a peak in 24 hours after injection, although previous injection cycles add together so to speak due to prior dosages not fully used before the next one occurs (at reasonably short cycles)

The next concern which involves dealing with mg/ml change is really very simple if using math viewpoint, a volume reduction 'or' increase depending on rise 'or' lowering of the mg portion of the mg/ml.

$ indicator can be had, using google search   "estradiol valerate"  goodrx    (put these first two within quotes and then tag on goodrx all in one search)

Thankfully I have not had a backorder problem with my EV (generic) here in WA state.  Wsh you a speedy recovery of supply.   Dani

[missymay]

I am having the same problem thru my regular pharmacy, so I found a compounding pharmacy in my area, and they were able to fill my prescription. I plan to switch back to my regular pharmacy when they begin stocking the generic estradiol valerate again, as my insurance will not cover the brand name, since it's so much more expensive.

[mrs izzy]

Just a reminder.

Seems some get so wrapped up into their posts that they have been adding dosages.

Please re-read your post and self edit out dosages before we catch them.

Thank you.
Mrs Izzy

[frances_larina]

It looks like that the volume injected may indeed alter absorption rates.  Not that it matters much, as now I can't get either concentration until the pharmacy and doctor can work together.  That's what i get for questioning authority...again.    

For the curious, the results of a quick, shallow query:

"There is evidence that using smaller volumes aids absorption"  (John and Stevenson, 1995)

and,

Effect of dosing volume on intramuscular absorption rate of aminoglycosides.
Pfeffer M, Van Harken DR.
J Pharm Sci. 1981 Apr;70(4):449-52.
Abstract
The Loo-Riegelman method was applied to serum amikacin level data after intravenous and intramuscular administration. Intramuscular amikacin absorption can be described by first-order kinetics, but the absorption rate constant decreased from 1.95 hr-1 at a 125-mg dose to 1.00 hr-1 at a 750-mg dose. This rate change apparently is a physical phenomenon due to differing dosing volumes at different doses and attendant changes in the surface area to volume ratio at the injection site. Amikacin absorption rates on intramuscular injection can be maximized by giving several smaller injections rather than a single larger injection. This phenomenon should be generally observed with aminoglycoside antibiotics and could be partly responsible for reported variations in the absorption rate and the poor predictability of serum concentrations.
(from http://www.ncbi.nlm.nih.gov/pubmed/722996 )

also:

Tanaka et al 1974 and Hirano et al. 1981 indicate "the absorption rate is not dependent on the initial drug concentration.  In contrast a significant decrease of the absorption rate is observed with the increase of the injection volume [...] The absorption rate of a drug from an oily depot is only minimally affected by the viscosity of the vehicle.
(from:  Neglected Factors in Pharmacology and Neuroscience Research: Biopharmaceutics, Animal Characteristics, Maintenance, Testing Conditions
by V. Claassen, J.P. Huston -Editor)

[Eva]

Well it turned out they didn't get it yesterday, "its unavailable from the manufacturer" 

They said they "should" have it from another source today, I hope!!! Its my local Target pharmacy

[Eva]

It looks like that the volume injected may indeed alter absorption rates.  Not that it matters much, as now I can't get either concentration until the pharmacy and doctor can work together.  That's what i get for questioning authority...again.    

For the curious, the results of a quick, shallow query:

"There is evidence that using smaller volumes aids absorption"  (John and Stevenson, 1995)

and,

Effect of dosing volume on intramuscular absorption rate of aminoglycosides.
Pfeffer M, Van Harken DR.
J Pharm Sci. 1981 Apr;70(4):449-52.
Abstract
The Loo-Riegelman method was applied to serum amikacin level data after intravenous and intramuscular administration. Intramuscular amikacin absorption can be described by first-order kinetics, but the absorption rate constant decreased from 1.95 hr-1 at a 125-mg dose to 1.00 hr-1 at a 750-mg dose. This rate change apparently is a physical phenomenon due to differing dosing volumes at different doses and attendant changes in the surface area to volume ratio at the injection site. Amikacin absorption rates on intramuscular injection can be maximized by giving several smaller injections rather than a single larger injection. This phenomenon should be generally observed with aminoglycoside antibiotics and could be partly responsible for reported variations in the absorption rate and the poor predictability of serum concentrations.
(from http://www.ncbi.nlm.nih.gov/pubmed/722996 )

also:

Tanaka et al 1974 and Hirano et al. 1981 indicate "the absorption rate is not dependent on the initial drug concentration.  In contrast a significant decrease of the absorption rate is observed with the increase of the injection volume [...] The absorption rate of a drug from an oily depot is only minimally affected by the viscosity of the vehicle.
(from:  Neglected Factors in Pharmacology and Neuroscience Research: Biopharmaceutics, Animal Characteristics, Maintenance, Testing Conditions
by V. Claassen, J.P. Huston -Editor)

Interesting, thanks So Im better off doing injections every 5 days than every week or two weeks at the same monthly dosage to get the most bang for my buck.... I knew that but this supports my experience

[KayXo]

Serum levels reach a peak in 24 hours after injection

I read from a paper that looked at pharmacokinetics of different esters including valerate, that EV's peak was at approximately 2 days. And that the average durating of elevated levels was 7-8 days.

Also very interesting about the frequency of injections...I do them every 5 days, YAY!

[Eva]

SO turns out they couldnt get Delestrogen ANYWHERE in 10 mg/ml, 5ml vial...

The only place I could get any Delestrogen was at the local hospitals outpatient pharmacy but its 20mg/ml 5mg vial... It is a little cheaper and I have it anyway

SUCKS and its scary they just CANT get it and they say "the manufacturer has discontinued it", WHAT

I donno Im thinking someone will keep making it....

[Newgirl Dani]

SO turns out they couldnt get Delestrogen ANYWHERE in 10 mg/ml, 5ml vial...

The only place I could get any Delestrogen was at the local hospitals outpatient pharmacy but its 20mg/ml 5mg vial... It is a little cheaper and I have it anyway

SUCKS and its scary they just CANT get it and they say "the manufacturer has discontinued it", WHAT

I donno Im thinking someone will keep making it....

Just curious, is there any particular need for it to be the original brand name: Delestrogen?  I know for myself, I did not know or understand the whole brand/generic thing until researching prior to hrt.
When the time period is up on for a patent name, usually if I remember correctly 15 to 20 years, then its sort of open season for other pharmaceutical companies to manufacture the drug (unless a patent renewal takes place.)
Here was the big and most important part for me, I believed that along with the patent, the restrictions on standards would be lifted as well.  This is NOT true, all companies that begin making a generic version has to follow ALL standards of purity and testing.

Maybe doing the google search:     "estradiol valerate"  goodrx    will yeild some good results for finding a generic source.   Dani

[frances_larina]

After way too much time on the phone with my plan's pharmacy I've learned that:

  Neither Delestrogen nor Estradiol Valerate will be available until at least March 2015.  I don't know if it is just their authorized supplier or if there is only one or if most people will even be affected.

   There is now a 'shortage alert' that the pharmacist found.  Again, I don't know how widespread and they wouldn't say.  Apparently all of that is top secret information.

   I asked what they would do if this were insulin or an anti-depressant that shouldn't be abruptly stopped and Kaiser apparently classifies estrogen for trans women the same as say, motrin.  Or as the rep said, "It's not classed the same as drugs that are medically necessary" so they can't authorize me to get it elsewhere.

And now I'm going to go cry for a bit.   This is just the latest in a chain of transition roadblocks that I can't seem to go under, over or around.   

[Cynobyte]

I posted the delay date a page back;)  it was a contamination found in the bottle.  I think it was some red stuff floating in it found to be inert..  they quietly recalled it from that mfg and the others had to pick up the shortfall causing a shortage until 2015 when the fda will clear the next production batch..  hope this helps..  buy the 20 or 40 mg/ml and cut back on dosage and possibly split to once a week until next year?  Good luck. 
Also, I have medicare w my va insurance, what part d drug insurance will pay for estradiol shots?  Tnx

[Eva]

So anyone else know what the difference is between 10mg/ml, 20mg/ml, or 40mg/ml as far as the speed of absorption???  Could the higher mg/ml result in a higher peak and crash due to less oil???

I was started on the 10mg/ml every 5 days and I was doing just fine thanks... Then I couldn't get that anymore and Ive been on 20mg/ml and I guess Im doing OK on 1/2 the volume of oil to get my script every five days... Maybe its all in my head but I do feel like it peaks faster and I dont feel as good the day or two before my shot... I never had a problem with the 10/mg ml solution at my scripts dosage every five days...

I still have 3-4 shots of 20mg/ml solution left so I figured Id try to refill early and I cant get either the 10mg/ml or 20/mg/ml... I was told "discontinued and nobody knows when or if it will be available again" WTF

My doc just tested me and my level was 637pg/ml 3 days after my shot... He says try the 40mg/ml solution, thats gonna be a TINY shot... Im wondering if my insurance will cover so many months supply at once too

I cant see how they can just "discontinue" such a vital med