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Cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, discuss the recent release of Eli Lilly's Zepbound as an injectable with the KwikPen.
Welcome back to Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives!
In this episode, cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, provide a detailed update on evolving incretin-based therapies, with a primary focus on a significant formulation change for tirzepatide.
00:00:01 Intro
00:00:11 Zepbound in the KwikPen
00:01:25 Vials versus pens
00:02:55 Environmental benefits
00:03:53 Pen needles sold separately
00:06:30 LillyDirect availability
00:07:20 Europe approves 7.2 mg injectable semaglutide
00:09:08 Reusable pen concerns
00:10:55 Outro
The discussion highlights the launch of Zepbound in a multi-dose KwikPen device, now available through LillyDirect. Previously dispensed as four single-use pens per month, the new format consolidates therapy into one multi-dose pen designed for four weekly injections. Isaacs and Bellini emphasize several clinical and practical advantages. While micro-titration remains off-label, the device design aligns more closely with real-world practice patterns.
They contrast the new pen with prior vial formulations available through direct programs, noting that vials lacked preservatives and were not intended for repeated punctures, limiting safe dose adjustments. The pen format addresses infection concerns while simplifying administration. Additional benefits include improved patient convenience—particularly for travel—as a single pen replaces the need to transport multiple disposable devices. The hosts also underscore environmental implications, pointing out the reduction in medical waste from four discarded pens per month to one.
From a prescribing perspective, they caution that pen needles are not packaged with the new tirzepatide device and must be ordered separately. They recommend 4–5 mm pen needles for most individuals and remind clinicians to counsel patients on proper technique. Unlike Ozempic, which requires priming only upon initial use, the tirzepatide KwikPen requires priming before each injection—an important distinction to prevent dosing errors.
The conversation broadens to global regulatory developments, including European approval of a higher 7.2 mg dose of Wegovy for obesity management. The hosts note that the submission is under FDA review, with potential availability in the United States later this year. They contextualize this higher-dose approval within the growing need for more effective obesity treatments and the incremental weight-loss benefits observed at higher semaglutide doses.
Finally, Isaacs and Bellini address off-label cost-saving strategies, such as extending the use of higher-dose pens for smaller weekly doses. They caution against prolonged use beyond labeled storage timelines, citing concerns regarding stability, sterility, and maintained efficacy, particularly when pens are kept at room temperature beyond recommended durations.
Overall, the episode provides a clinically grounded discussion of device innovation, prescribing logistics, environmental considerations, and regulatory expansion within the incretin therapeutic landscape, emphasizing practical implications for diabetes and obesity management in real-world practice.
