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It introduces foam, increases shear stress, and makes a borderline reconstitution worse
And right now, the vial is telling the more important story.
The oral-contraceptive interaction is a separate study (GPGR), reported in the FDA Mounjaro NDA 215866 summary review: a single 5 mg tirzepatide dose with a combination oral contraceptive (0.035 mg ethinyl estradiol / 0.25 mg norgestimate) reduced the Cmax of norelgestromin and ethinyl estradiol by 55% to 59% a range spanning both analytes, not a separate figure for each with AUC lowered 28.8% (norelgestromin) and 27% (ethinyl estradiol), and tmax delayed 2.5 to 4.5 hours
Use a new sterile needle for each vial access
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