Injecting Dupixent at home

Key points

• 01The warm-up wait is the step that changes the experience. The leaflet asks you to let the device reach room temperature before injecting, with a wait that depends on your device and strength. People who inject straight from the fridge describe far more stinging, and that is the whole explanation in most cases.
• 02There is a 14-day room-temperature clock. The prescribing information allows storage at room temperature for a limited period, up to 14 days, after which an unused device is discarded. Write the date you take it out of the fridge on the carton, because there is no other way to know.
• 03That is a much longer window than a GLP-1 pen. If you have injected a weekly GLP-1 before, do not carry over its storage rules. The out-of-fridge allowances are different for every product, and our post on medication left out of the fridge explains why the number always comes from the label.
• 04Two devices, two techniques. The prefilled pen presses flat against the skin and signals with clicks. The prefilled syringe uses a pinched fold and a plunger. Read the leaflet for the device you actually have, since the steps are not interchangeable.
• 05The pen tells you when it is finished. The first click starts the injection and the second signals the end, with an indicator that stops moving when delivery is complete. Lifting between the two clicks is the way people end up with a partial dose, and it is silent when it happens.
• 06The sites are thigh and abdomen for self-injection. The instructions use the thigh or the abdomen, avoiding about 5 cm around the navel. The upper arm is reserved for when a caregiver gives the injection, because you cannot reliably control the device on your own arm.
• 07Rotate, and skip skin that is not healthy. Change the site with each injection, and avoid skin that is tender, bruised, scarred or in the middle of a flare. Our rotating injection sites guide covers a pattern that keeps you moving without having to think about it.
• 08A loading dose can mean two injections. When a dose requires two devices, they go in two different places rather than one after another in the same spot. Confirm with your prescriber whether your first dose is a loading dose, because the number of devices changes.
• 09Air bubbles in the window are expected. You may see bubbles in the device, and the instructions do not ask you to remove them. This is a prefilled device, not a syringe you filled, so the rule about clearing air does not apply. Our air bubbles post covers the distinction.
• 10Injection-site reactions are the common complaint. Redness, swelling, itching or soreness at the site are among the most frequently reported reactions with this medication. Our injection site reaction post covers what is ordinary, what settles, and what should be reported instead of tolerated.
• 11Eye symptoms are worth reporting, not ignoring. The prescribing information describes eye problems including conjunctivitis and keratitis in patients treated for atopic dermatitis. New or worsening eye redness, pain or vision change is a call to your prescriber rather than something to wait out.
• 12Tell your prescriber before any vaccination. The labelling advises against live vaccines during treatment, so any planned travel or routine vaccination is a conversation to have first. The same applies before starting treatment if you have a parasitic infection or are travelling somewhere they are common.

Pre-injection checklist

• ✓Keep the instructions for use that came with your device. The pen and the prefilled syringe are handled differently, and the leaflet for the one in your hand is the governing source.
• ✓Take the device out of the fridge and let it reach room temperature before injecting. The leaflet gives a specific wait that depends on your strength and device, commonly 30 or 45 minutes. Do not warm it any other way.
• ✓Do not remove the cap until you are ready to inject, and never put the cap back on. Do not shake the device at any point.
• ✓Look at the liquid through the window. It should be clear to slightly opalescent and colourless to pale yellow. Do not use a device that is cloudy, discoloured, contains particles, or has been dropped on a hard surface.
• ✓This is a technique reference, not medical advice. Your dose, your schedule and whether you self-inject at all are set by your prescriber.

Step-by-step guide

1. 1

   Take the device out of the fridge and wait

   Remove the pen or syringe from the carton and let it sit at room temperature for the time your instructions for use specifies. This is the step most often shortened, and a cold injection is the most common reason people describe this one as stinging.

   Pro tip

   Always check the fluid is clear and colourless before injection.
2. 2

   Do not warm it any other way

   No microwave, no hot water, no radiator, no sitting on it. The leaflet is explicit about this. Heat outside the intended range can affect the medication, and the wait is short enough to plan around rather than hurry.

   Pro tip

   Always check the fluid is clear and colourless before injection.
3. 3

   Wash your hands and set up

   Wash with soap and water for at least 20 seconds. Lay out the device, an alcohol pad and gauze on a clean surface, and open the sharps container before you start so the used device has somewhere to go the moment you are done.

   Pro tip

   Always check the fluid is clear and colourless before injection.
4. 4

   Check the label and the liquid

   Confirm the name and the strength, check the expiry date, and look through the window. Clear to slightly opalescent, colourless to pale yellow is expected. Air bubbles may be visible and are normal. Cloudiness, discolouration or particles are not.

   Pro tip

   Always check the fluid is clear and colourless before injection.
5. 5

   Choose a site and clean it

   The instructions use the thigh or the abdomen, staying about 5 cm clear of the navel. The upper arm is used only if someone else gives the injection. Wipe the spot and let it air-dry for at least ten to fifteen seconds.

   Pro tip

   Always check the fluid is clear and colourless before injection.
6. 6

   Avoid skin that is not intact

   Do not inject into skin that is tender, damaged, bruised, scarred or affected by a flare. Move to a different area rather than a slightly different centimetre. Our post on where not to inject on the skin covers the reasoning.

   Pro tip

   Always check the fluid is clear and colourless before injection.
7. 7

   Pull the cap straight off

   Remove the cap in a straight pull and put it in the bin, not back on the device. Do not touch the needle end after the cap is off, and do not press the plunger or the button until the device is against your skin.

   Pro tip

   Always check the fluid is clear and colourless before injection.
8. 8

   For the pen: press flat and listen for two clicks

   Place the pen flat against the skin at a right angle, with the window facing you, and press down. The first click means the injection has started. Keep pressing until the second click and until the indicator has stopped moving, then hold as your leaflet directs.

   Pro tip

   Always check the fluid is clear and colourless before injection.
9. 9

   For the syringe: pinch, insert, inject slowly

   Lift a fold of skin, insert the needle at the angle your instructions specify, and push the plunger slowly until the syringe is empty. Keep the fold held throughout. Our guide to pinching skin for injection covers the grip.

   Pro tip

   Always check the fluid is clear and colourless before injection.
10. 10

    Lift away and dispose immediately

    Lift the device straight off the skin. On the pen the yellow safety shield covers the needle automatically. Press with gauze if it bleeds, without rubbing. Put the whole device in the sharps container and write down the date and the site.

    Pro tip

    Always check the fluid is clear and colourless before injection.

After the injection

• Press a gauze square on the site for a few seconds without rubbing.
• Put the whole device in the sharps container immediately. Never recap it and never bin it loose.
• Record the date and the site, so the next injection goes somewhere else.
• Write the date on the carton if you have moved a device from the fridge to room temperature, so the 14-day limit is visible.

Common mistakes

Frequently asked questions

Sources

1. Regeneron and Sanofi. DUPIXENT (dupilumab) injection, full prescribing information.
2. DailyMed. DUPIXENT (dupilumab) injection, solution.
3. European Medicines Agency. Dupixent (dupilumab) EPAR and product information.
4. MedlinePlus. Giving a subcutaneous injection (patient instructions).
5. Frid AH et al. 2016. New Insulin Delivery Recommendations. Mayo Clinic Proceedings 91(9):1231-1255.