The Emrani Protocol / Mixing & protocol guide
Mix it right. Measure it right. Stop it on time.
The complete patient guide: how to mix a vial, exactly how many units to draw, how to inject, the FDA label schedules for approved medicines, and the nine-step protocol with labs and stop rules. Written by Dr. Afshine Emrani, MD, FACC.
Read this first
Your dose comes from your prescription. Everything else comes from here.
This guide shows you how to prepare and measure safely. It does not set your dose. The dose belongs on a prescription written for you, after an exam, by a clinician who knows your history.
You have a prescription for a specific patient (you), filled by a state-licensed pharmacy, with a label that shows the drug, the strength, the beyond-use date and your directions.
Your vial says “research use only” or “not for human use,” came without a prescription, is a blend of several peptides, or you can’t tell who made it. No mixing technique makes an unknown product safe. Bring it to your visit instead and we’ll talk about it, without judgment.
FDA-approved medicines such as Wegovy, Zepbound, Ozempic and Mounjaro come in pens or vials with fixed doses. You don’t mix them. Follow the pen’s instructions and the schedules further down this page. Mixing applies to powders (lyophilized vials) that your pharmacy has asked you to reconstitute.
Reconstitution, step by step
How to mix a vial.
Use only the diluent and the volume printed on your pharmacy label, usually bacteriostatic water. If the label and this page ever disagree, the label wins. Call the pharmacy if you’re unsure.
- Check the label before you open anything
Your name, the drug, the strength in mg, the diluent and volume to add, the beyond-use date. Powder should be an intact white cake. A cracked seal or a cloudy, discolored product goes back to the pharmacy.
- Set up a clean space
Wash your hands for 20 seconds. Lay out the powder vial, the diluent, an alcohol pad, a new sterile syringe and a sharps container. Let a refrigerated vial come to room temperature for about 10 minutes.
- Wipe both rubber stoppers
Flip off the plastic caps and scrub each stopper with a fresh alcohol pad. Let them air-dry. Don’t blow on them or touch them.
- Draw the diluent
Pull air into the syringe equal to the volume on your label, push that air into the diluent vial, turn it upside down and draw the exact volume. Tap out bubbles.
- Add it slowly, down the glass wall
Insert the needle into the powder vial at an angle and let the liquid run down the inside wall. Never spray it straight onto the powder. Peptides are fragile.
- Swirl. Don’t shake.
Gently roll the vial between your palms until the powder dissolves, usually 1 to 3 minutes. Shaking can break peptide chains and create foam.
- Inspect it
The solution should be clear and colorless unless your label says otherwise. Particles, cloudiness or color: don’t use it. Call the pharmacy.
- Label the vial
Write the date and time you mixed it and the final concentration from the calculator below (for example, “2 mg/mL, mixed Nov 12”).
- Refrigerate
Store mixed vials at 36–46°F (2–8°C), protected from light. Never freeze. Use by the date on your pharmacy label, then discard what’s left even if the vial isn’t empty.
- Discard the syringe
One syringe, one use. It goes straight into the sharps container. Never recap a used needle.
Precision is the whole point.
A 10-unit error on a 30-unit syringe is a third of your dose. Measure like it matters, because it does.
Model. Image is illustrative.Interactive
Dose calculator: exactly how many units to draw.
Enter what’s in your vial, how much water was added, and the dose on your prescription. The calculator shows the line to fill to on a standard U-100 insulin syringe.
Draw to
= 0.25 mL
Check this against your pharmacy label. If the label lists units, follow the label.
The math: concentration = mg in vial ÷ mL of water. Units to draw = dose (mg) ÷ concentration (mg/mL) × 100. This tool doesn’t choose a dose and doesn’t replace your prescription or your pharmacist.
Subcutaneous injection
How to inject, painlessly and cleanly.
Almost every peptide is given just under the skin, into fat, with a short, thin insulin needle. It takes ten seconds once you’ve done it twice.
- Pick a site and rotate
Belly (at least 2 inches from the navel), front of the thigh, or the back of the upper arm. Move at least an inch from your last spot. Avoid scars, bruises and stretch marks.
- Clean and dry
Wipe the skin with alcohol and let it dry completely. Wet alcohol is what stings.
- Draw your dose
Wipe the stopper, pull to the line the calculator showed you, tap out bubbles, and recheck the line at eye level.
- Pinch, insert, push slowly
Pinch an inch of skin. Insert at 90 degrees (45 if you’re lean). Push the plunger over 5 to 10 seconds. Count to five before you pull out.
- Don’t rub
Press lightly with a cotton ball if needed. Write the date, dose and site in your log.
Grade A medicines
FDA label schedules for the approved weight-loss shots.
These are the manufacturers’ published dose-escalation schedules. Your physician may go slower, hold a step, or stop at a lower dose. That’s normal and often smarter.
| Other approved peptide medicines | How it’s given | Grade | Note |
|---|---|---|---|
| Bremelanotide (Vyleesi) | Autoinjector under the skin, as needed, before sexual activity | A | For low desire in premenopausal women. Label limits how often it can be used. Can raise blood pressure briefly. |
| Tesamorelin (Egrifta) | Daily injection under the skin | A | Approved for excess abdominal fat in HIV. Requires glucose and IGF-1 monitoring. |
| Semaglutide tablet (Wegovy pill, Rybelsus) | Once daily by mouth, on an empty stomach | A | Strict instructions about water and waiting before food. Follow the label exactly. |
Schedules summarized from the U.S. prescribing information as of November 2026. The FDA approved Wegovy HD (7.2 mg) on March 19, 2026. Always follow your own prescription and the current label.
The detailed protocol
Nine steps. Four phases. Three places to stop.
This is how every Emrani Protocol patient starts, whether the answer ends up being a peptide, an FDA-approved medicine, or no prescription at all.
Measure
1. Name one goal, in one sentence.
2. Exam, history, medication review, blood pressure.
3. Baseline labs and up-to-date cancer screening.
Stop point: anyone in a “stop group” (pregnancy, active cancer, tested sport, and others) does not use unapproved peptides.
Foundation
4. Thirty days of sleep, strength training, protein and treating any cause we find (thyroid, apnea, iron, hormones).
Stop point: if the foundation solves the problem, you just saved money and risk.
Decide
5. Choose the highest-grade option for your goal. FDA-approved first.
6. If a compounded peptide: licensed pharmacy, single ingredient, certificate of analysis.
7. Write the dose, the dose tier, a review date and a stop rule.
Stop point: no licensed source or no clear goal means no prescription.
Trial
8. One compound, one goal, one measure. Log every dose.
9. Review at the date we set, usually 8 to 12 weeks. Continue, adjust or stop.
“No change” is a result. It means stop paying for it.
Monitoring
Labs, check-ins and stop rules.
Decide your stop rule before you start. It is much easier to stop a peptide you agreed to stop than one you’ve fallen in love with.
| When | Who | What we check |
|---|---|---|
| Before | Everyone | CBC, metabolic panel, glucose and A1C, lipids, TSH; blood pressure, weight, waist; cancer screening up to date |
| 4–8 weeks | Growth-hormone peptides | IGF-1, fasting glucose |
| 3 months | GH peptides; GLP-1 medicines | IGF-1, A1C, metabolic panel, lipids; strength and lean-mass check on GLP-1s |
| 3–6 months | Anyone continuing | The panel that matters for that drug |
| Any time | Everyone | New symptom: call. Don’t wait for the next check. |
Spreading redness, warmth, pus or fever after an injection · hives, widespread itching or rash · new leg swelling, shortness of breath or rapid fluid weight gain · palpitations or a racing, irregular heartbeat · severe headache or vision changes · a new or changing mole · severe or persistent belly pain, especially on a GLP-1.
Chest pain, trouble breathing, swelling of the face, lips or throat, fainting, confusion, or signs of stroke.
What to expect
Common side effects, and what actually helps.
Most side effects show up in the first weeks or right after a dose increase, and most fade. Tell us early. A slower schedule fixes more problems than any add-on.
| Side effect | Seen with | What helps |
|---|---|---|
| Nausea, fullness | GLP-1 medicines | Smaller meals, stop eating at the first sign of fullness, less fat and alcohol, don’t lie down after eating. We can slow the schedule. |
| Constipation | GLP-1 medicines | Water, fiber, daily walking. Ask before using laxatives regularly. |
| Muscle loss | Any rapid weight loss | Protein at every meal, strength training two to three times a week. We measure strength, not just weight. |
| Redness or a bump at the site | Any injection | Rotate sites, let alcohol dry, inject slowly. Spreading redness, heat or fever: call the same day. |
| Water retention, tingling, higher glucose | Growth-hormone peptides | That’s why we check IGF-1 and glucose. Report swelling or numbness. |
| Flushing, brief rise in blood pressure | Bremelanotide | Usually short. Not for people with uncontrolled blood pressure or heart disease. |
The boring part that keeps you safe
Storage, travel and disposal.
Heat and light break down peptides. Old vials grow bacteria. These rules cost nothing.
Unmixed powder: as the label says, usually refrigerated. Mixed vials: 36–46°F (2–8°C), in the box, away from light, never frozen. Pens: follow the pen leaflet; many can stay at room temperature for a limited number of days. Discard by the beyond-use date.
Carry medicine in your hand luggage with the pharmacy label, in an insulated pouch with a cold pack that doesn’t touch the vial directly. Never leave it in a hot car.
Used needles go into an FDA-cleared sharps container, or a heavy plastic bottle with a screw cap if you’re away from home. Check your city’s drop-off rules. Never throw loose needles in the trash or recycling.
Date, time, dose, units drawn, site, and anything you noticed. Bring it to every visit. It’s how we tell a real effect from a good week.
Questions about your own plan?