Understanding the click method
PDL has become aware of a number of adverse events and health consequences from the popularised method of OZEMPIC® (semaglutide) administration known as “counting clicks”.
OZEMPIC solution is available in pre-filled multidose pens in 1.5mL and 3mL sizes for subcutaneous administration. Both pens contain semaglutide 1.34mg/mL. OZEMPIC dosing is once weekly, starting at 0.25mg, increasing to 0.5mg after 4 weeks, and to 1mg weekly as prescribed. OZEMPIC dosing is achieved by turning the dose selector on the device until the counter displays either 0.25mg or 0.5mg on the 1.5mL pen, or 1mg on the 3mL pen. A “click” sound is audible each time the dose selector on the pen is turned.
As OZEMPIC stock shortages continue to affect supply to Australian patients, the PDL Professional Officers have received reports from pharmacists that patients are seeking information about “counting clicks” as an alternative method of dosing OZEMPIC, when they are being advised that the 3mL size pen is the only available option. The “click method” is the method by which audible clicks are used to count doses to achieve the prescribed dose of OZEMPIC (e.g. using a 1mg pen and counting 18 clicks for a 0.25 mg dose).
Manufacturer’s comments
Novo Nordisk, the manufacturer of OZEMPIC, has not evaluated the dosing of OZEMPIC by number of clicks. As the dose received by counting clicks cannot be guaranteed, only marked doses of 0.25mg and 0.5mg may be selected for the 1.5mL volume pen. Novo Nordisk states:
“Using unmarked doses could result in product waste as well as inaccurate or inconsistent dosing. Additionally, because Novo Nordisk does not recommend dosing by number of clicks, we cannot provide the exact dosage and volume of OZEMPIC® provided with each audible click of the pen.”
In addition, the Australian Diabetes Educators Association (ADEA) released a statement in May 2024 warning of risk and potential dose errors associated with counting clicks. ADEA does not recommend this method of administration as it does not follow manufacturer guidelines.
The importance of patient education
Reports of prescribers providing instructions to patients to implement click counting as a method of dose measurement is a cause for concern. This would be considered off-label prescribing and the Professional Officers recommend discussing the risks of potential dose inconsistencies with patients if this method is suggested. Providing printed Consumer Medication Information to a patient and highlighting the manufacturer’s advice not to count clicks may assist with an explanation.
The patient may still choose to use the click counting method for OZEMPIC dose measurement; however, they should only do so with a clear understanding and acknowledgement that they accept greater responsibility for any consequences if they use a method of administration that is outside the guidance in the approved product information.
The Professional Officers do not endorse a pharmacist independently offering the click method as a dosing option to a patient.
Documentation
The Professional Officers strongly advise pharmacists to document all communication with prescribers and any counselling or education provided to the patient including discussions about counting clicks as an alternate method of OZEMPIC dosing.
Resources
- Novo Nordisk | Ozempic 2024 Product Information
- ADEA | Reminder for CDEs: advice about ‘counting clicks’ as a method of dose calculation for the 1mg OZEMPIC® pen
Pharmacists may also wish to refer to the Practice Alert Mounjaro® (tirzepatide) from November 2023, which is a timely reminder of other important obligations and liabilities when it comes to the dispensing of GLP-1 analogues.
For immediate advice and incident support, call PDL on 1300 854 838 to speak with one of our Professional Officers. We are here to support our pharmacist members 24/7, Australia-wide.
