Combining Reconstituted MOTS-C Vials

Every puncture lets outside air in and raises the risk. The situation differs if everything goes into a pen. When using syringes it is safer to leave the rest in their original vials until needed.

I agree that piercing adds exposure, which is exactly my point. Blending a few vials together is not a problem in the risk sense because most people already use multi-dose vials daily. One extra puncture for mixing changes nothing. To lower risk further, which remains low for subq injections anyway, avoid sharing or reusing needles and always clean skin plus bottle tops.

Drawing from that same vial each time means far more than one puncture. Every draw also pushes unfiltered air from the surroundings into the vial to balance pressure. Pulling larger amounts per use would reduce how often the vial is entered and therefore cut the risk.

Mixing two vials needs only one puncture. For the daily draws a contaminated needle causes the same issue whether the vial was entered once or fifty times. The problem comes from the needle. After thirty years in nursing I know that injecting air is not required. It is done to ease withdrawal from truly pressurized vials, but these are not consistently pressurized so the step can be skipped.