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Nutropin AQ^® [somatropin (rDNA origin) injection] and Nutropin^® [somatropin (rDNA origin) for injection]

Learn what you need to know about your GH therapy with Nutropin, from start to finish:

Getting your prescription

Ask your doctor or nurse about how GH therapy may work for you or your child. It may help to know:

• How other parents and kids deal with GH therapy
• What injection devices are available, how they differ, and which one is right for you
• The basic things you’ll need to know about storing your GH, preparing the dose, and so on
• How treatment really happens, day by day—how other kids and parents cope
• Why the timely filling of your child’s prescription is so important

Everything you’ve done has come into focus. You and your child have identified a challenge, and gone out and gotten the tools to deal with it. In other words, you’ve already accomplished quite a lot! What now?

• The next step is getting your doctor’s office to notify the insurance company and get the paperwork started
• Start with a positive attitude. Don’t let fears fester. Some kids say they don’t mind getting injections; others suffer just thinking about it. You know your child best, but often the direct, supportive approach will help. Your nurse has probably seen similar issues—so ask for advice
• Get the training you need to take Nutropin—injections and all—with confidence
• Ask questions—and keep asking until you get the answers you need

Make sure you and your child understand what you're taking on. Set little and big goals that make daily treatment feel worthwhile, and celebrate the milestones along the way!

The main goal is growth, of course—but smaller goals let you and your child see the progress he or she is making. Depending on your individual situation, those goals might include:

• Moving up a clothing size
• Being “this tall to ride” at the amusement park
• Shopping outside of the kids’ section
• Giving your own injections

Learning to deal with the dose

Because GH is a protein, you have to take it by injection: otherwise, it would be broken down by digestion in the stomach and intestines and would never get to do its job.

The next step is for you or your child to learn how to give GH therapy correctly every day. Here’s how:

• Genentech, the maker of Nutropin, will call you to schedule injection training
• A nurse will train you at the doctor’s office or at your home
• Don’t worry if you're a little squeamish or even a bit nervous at first—sooner or later, it will become part of your daily routine
• If you aren’t sure you’re doing it right or getting the whole dose, call your nurse and ask! And, this is important: keep asking until you feel comfortable
• You can also get your therapy questions answered live by calling the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674)
• Your doctor decided the GH therapy was medically necessary to help your child grow
• Kids are all about routines—and therapy is, in the end, another routine
• If your child doesn’t like the injections but still keeps up with his or her therapy, you should both be proud!

Wouldn’t it be great if everything good could also be easy? Tell your child the truth: It’s going to take a day or two, or even a week or two, to get used to therapy. But, once you do, make it another part of your routine. Eating, brushing your teeth, taking your injection.

Some talking points for both of you:

• You can learn how to do this
• It’s all right to have questions and concerns
• You can get used to it, and then even comfortable with it: many others have!
• Let your child help to set the routine, and help to prepare the injection.
• Your child may feel better knowing he or she has some control over the therapy
• Read the Important Safety Information for Nutropin together, discuss it, and ask your doctor any questions you may have

Remember: every inch gained on GH therapy is something you’ve earned—and that feeling can never be taken away.

Setting realistic goals

It’s important to take every dose of Nutropin, every day, as prescribed by your healthcare professional. A written history of your child’s growth hormone (GH) injections may help your treatment team see how treatment is going.

Be prepared. Bring your injection log along on each doctor visit. If you are having any problems staying with Nutropin therapy, you and your doctor may be able to develop helpful strategies together.

Keep asking questions. Write down any specific questions you have for your child's doctor below, and record the answers on your next phone call or visit. Try some of these:

• How well is my child growing?
• How will you know when it's time for my child to stop GH therapy?
• What other health issues do we need to keep an eye on?
• Are there any additional steps we could take to improve his or her experience with therapy?
• I am concerned about these potential side effects (list):
• Will there be any upcoming lab work or other tests? When?
• How does growth impact my child”s dose over time?
• What changes should we be watching out for (weight gain, growth)?

It may help to think about what goals are: real milestones with a strong connection to the things in your life you care about—and how your GH therapy may help you move toward those goals.

Results may vary. Don’t expect everything to happen overnight, but don't get discouraged—every day may add something. The amazing thing is how much closer a few minutes every day can get you to the next milestone.

Goals are very individual. Some goals might include:

• Moving up a clothing size
• Being “this tall to ride” at the amusement park
• Shopping outside of the kids’ section
• Giving your own injections

Setting up a routine that works

To get the most out of Nutropin treatment, it’s important that your child make it part of his or her routine.

Keep track of your treatment. Use the Daily Tracking tool to create a routine and stick to it, while keeping track of injection times and site rotations. If you have a hard time establishing a routine, ask your healthcare professional’s office for help. If you do miss a dose, don't "double up" or try to "make up" the dose. Just be sure to take the next dose exactly as prescribed.

Get your child involved. Your child has a big stake in his or her growth hormone (GH) therapy. Depending on your child’s age or responsibility level, it might be time to encourage him or her to help set the routine and prepare the injection. By tracking injections day by day, your child can help keep the treatment running smoothly, learn more about his or her treatment, and feel more in control. For an older child who is already handling his or her own injections, the tracking log can show how far he or she has come.

Track your progress. Keep track of how well your child is growing, especially during adolescence, and keep your doctor in the loop. Remember:

• As your child grows, your healthcare professional may decide to increase your child’s dose of growth hormone (GH)
• During puberty, girls and boys may go through a growth spurt, which lasts about two years. During this time, girls generally grow from 2½ to 4½ inches per year, while boys grow 3 to 5 inches a year. This growth spurt comes early in puberty for girls, and later in puberty for boys.

Communicate with your doctor. The goal is to try to help your child reach his or her natural growth potential before the end of puberty, when the growth plates in the bones fuse and your child can grow no taller.

Plan for the transition to adulthood. As a parent, your focus right now is on helping your child reach his or her growth potential. But once overall growth is complete, an endocrinologist must reevaluate your child to see whether he or she may need to continue Nutropin therapy at the reduced dose level recommended for adults.

GH actually has many functions besides helping the body to grow. Adults who lack naturally occurring GH may experience a range of symptoms. Ask your doctor for details.

Doing it day by day

You and your child continue the daily injections. This may be the hardest part: making GH therapy a part of your routine and sticking with it.

Tell your child the truth: It’s going to take a day or two, or even a week or two, to get used to therapy. But, once you do, it’s another part of your routine. Eating, brushing your teeth, taking your injection.

Some talking points for both of you:

• You can learn how to do this
• It’s all right to have questions and concerns
• You can get used to it, and then even comfortable with it: many others have!
• Let your child help to set the routine, and help to prepare the injection.
• Your child may feel better knowing he or she has some control over the therapy

Talk with your doctor to pick a time that works for you every day. If possible, tie the daily injection to a routine that already exists, such as:

• Bedtime
• Just after dinner
• After school

If your child isn’t giving the injections yet, have him or her do as much as possible:

• Help get medicine from the refrigerator
• Open the alcohol wipes
• Set up the injection

Keep checking with your healthcare professional until you get the hang of it.

• Ask your nurse why missed doses have consequences and can’t be “made up”
• If you have any doubts about giving injections or about anything else, check in with your nurse or calling the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674)
• Get help setting realistic treatment goals

Things to keep in mind:

• Remember to fill your prescription right away, so you don’t risk creating a gap in your child’s therapy
• It may be a number of months until you see the results of your Nutropin therapy. The changes may be so gradual at first that they are difficult to notice, but try not to get discouraged
• It is important to remember that missing injections may make your treatment less effective. If you take it as directed, day in, day out, and don’t miss doses, you may increase the likelihood of success (If you do miss a dose, don't “double up” or try to “make up” the dose. Just be sure to take the next dose exactly as prescribed.)
• For pediatric growth hormone deficiency or PGHD, your child may continue taking injections of Nutropin until he or she reaches his or her adult genetic potential height (as determined by the doctor), until the doctor determines that GH therapy should end. At that time, tests will indicate whether or not the growth hormone deficiency may persist into adulthood
• For adults on Nutropin therapy, success may be gauged using measures such as assessments of body fat and muscle mass, spine bone mineral density and ratio of LDL to HDL cholesterol

Nutropin and your safety

Your healthcare professional is your primary source of information. Discuss the potential benefits and risks of GH therapy with your endocrinologist so you are familiar with possible side effects. Be sure to discuss any medications you or your child may be taking.

IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol when using Nutropin reconstituted with Bacteriostatic Water for Injection, USP (benzyl alcohol preserved). For use in newborns, see WARNINGS in full Prescribing Information

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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