How to Mix Menopur: Steps From the Label
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How do you mix Menopur?

From FDA labels, public health agencies and published studies · Reviewed

Short answer: The Menopur Instructions for Use describe drawing the saline diluent (usually 1 mL) into a syringe through the Q-Cap vial adapter, pushing it into the powder vial, swirling gently until it dissolves, and drawing the liquid back up. If more than one vial is prescribed, the same liquid is used to dissolve the next vial, up to 5 more. Menopur is used right after mixing and any leftover is thrown away.

What comes in the box

Menopur (menotropins) is a powder containing 75 IU of FSH activity and 75 IU of LH activity per vial. The label says each vial comes with a vial of 0.9% sodium chloride (saline) diluent and a Q-Cap, a plastic vial adapter that lets the liquid be moved between vials without a needle. The label lists the other supplies as a sterile syringe and needle chosen by the prescriber, alcohol pads, gauze pads and a sharps container.

Before mixing, the label says to check that the saline is clear with no particles, and that the Q-Cap blister pack is sealed. A Q-Cap that falls out of its pack is thrown away and replaced.

The mixing steps in the label

  1. Take the caps off the Menopur vial(s) and the saline vial.
  2. Peel open the Q-Cap pack without taking the Q-Cap out. Turn the pack over onto the saline vial and push straight down until the spike pierces the stopper and snaps in place, then lift the pack away.
  3. Pull the syringe plunger back to the amount of saline the prescriber gave (the label says this is usually 1 mL). This fills the syringe with air.
  4. Twist the syringe onto the top of the Q-Cap. Turn the vial upside down and pull the plunger to draw up the saline. Lift the syringe and Q-Cap off the vial together.
  5. Push the Q-Cap tip into the Menopur powder vial until it snaps in place, without pressing the plunger. The label notes the powder may start to dissolve at this point.
  6. Slowly push all the saline into the vial. Swirl gently until the powder is fully dissolved. The label says not to shake, because shaking makes bubbles.
  7. Turn the vial upside down and slowly draw all the liquid back into the syringe.

The label then has the syringe twisted off the Q-Cap, the injection needle twisted on, and air bubbles tapped up and pushed out before the injection.

Mixing more than one vial

The prescriber sets how many vials make up each daily dose. The label says to dissolve the first vial, then use the liquid in the syringe to dissolve the next vial, repeating for up to 5 more vials, before injecting. In other words, one 1 mL portion of saline can carry the powder from up to 6 vials. The label also describes mixing Menopur with Bravelle (urofollitropin) in the same syringe the same way.

For context, the label lists a starting dose of 225 IU a day for women in an IVF cycle and says daily doses should not go above 450 IU. Dose changes are based on ultrasound and estradiol monitoring.

Injecting, storage and leftovers

The label describes injecting under the skin of the lower abdomen, 1 to 2 inches below the navel, switching between the left and right side each day. It says to pinch a fold of cleaned skin, insert the needle at a right angle, and push the plunger steadily. If the site is sore or red, it suggests ice for 1 minute on and 3 minutes off, repeated 3 or 4 times if needed.

Before mixing, Menopur powder can be kept in the refrigerator or at room temperature, 37 to 77°F (3 to 25°C), away from light. Once mixed, it is used right away and any unused medicine is thrown away. Used needles and syringes go into a sharps container right after use. FDA advises arranging disposal of the container under local community rules once it is about three-quarters full, and not reusing it.

Dose Track can log each daily injection with the number of vials and the side used, so the stimulation days are easy to read back at monitoring visits.

Read more on Dose Track: Menopur dosing schedule · Menopur side effects · How to store Menopur · Vial adapter · Menopur vs Gonal-f

General education drawn from labels, public health agencies and published studies, not personal medical advice. Your prescriber, pharmacist and the label that came with your medicine are the final word. Questions for other users? Ask in the Dose Track community.
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Frequently asked questions

How much saline do you mix with Menopur?+
The Instructions for Use say the usual amount is 1 mL of the 0.9% sodium chloride diluent that comes with it, and that the prescriber gives the exact amount.
Can you mix several Menopur vials together?+
Yes. The label says to use the liquid from the first mixed vial to dissolve the next one, for up to 5 more vials, then inject the whole amount.
Should you shake Menopur?+
No. The label says to swirl gently until the powder dissolves and not to shake, because shaking causes bubbles.
Can mixed Menopur be saved for later?+
No. The label says to use Menopur right after mixing and to throw away any unused medicine.

Sources

  1. Menopur (menotropins) US prescribing information, DailyMed
  2. FDA: Best way to get rid of used needles and other sharps

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