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If it stays out longer than 21 days, it must be discarded

Epub 2020 Jul 31

The alternative path: if the patient had an inadequate initial response, a repeat injection after 14 days can be considered medically necessary when the provider documents a rationale for a different approach, level, or medication at the subsequent injection

Together, these variants can tilt the system toward stronger or prolonged responses to infections or toxins

Strategies to minimize reactions include rotating injection sites consistently to avoid repeated trauma to the same area, ensuring the solution is at room temperature before injection (cold injections can increase irritation), injecting slowly rather than quickly, and using a smaller gauge needle for less tissue trauma