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For subsequent injections with the Nutropin AQ Pen 10, attach a new needle, push the white reset button, and dial the dose. If the patient would like to use the dose recall function for subsequent injections, they should wait at least 2 minutes after the previous injection before pressing the white reset button.
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Part II: Storage and maintenance
Follow these tips to ensure proper care of the Nutropin AQ Pen 10:
- Do not immerse the Nutropin AQ Pen 10 in water or expose to moisture.
- If the pen requires cleaning, do not place underwater. Use a damp cloth to wipe away dirt. Do not use alcohol.
- Always keep your Nutropin AQ Pen 10 and 10 mg Cartridge refrigerated and protected from light when not in use.
- Patients may remove the pen and cartridge from the refrigerator up to 45 minutes prior to use.
- Do not let the Nutropin AQ Pen 10 and/or 10 mg Cartridge freeze. Patients are instructed to contact their healthcare professional or distributor for a replacement if either the pen or cartridge malfunctions.
- Avoid excessive temperatures. Cartridge contents are stable for 28 days after first use when stored at 2-8°C/36-46°F.
- When priming a new cartridge, the patient may need to repeat Part I, steps 8 and 9, up to a total of 6 times to remove air bubbles. Small bubbles may remain and will not affect the dose.
- The pen should contain the Nutropin AQ Pen 10 mg Cartridge that is being used. Do not remove cartridge between injections.
- Do not store the Nutropin AQ Pen 10 with needle attached.
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Part III: Needles for the Nutropin AQ Pen 10
Patients are told that their healthcare professional will recommend a needle
that is appropriate for use. The following BD Ultra-Fine™ (Original) needle is
provided by Genentech, Inc. in the patient's Nutropin AQ Pen 10 kit:
| Name |
|
Gauge/Length |
| BD Ultra-Fine™ (Original) |
29 g/ 1/2" |
Needles from other regions or countries may not fit the Nutropin AQ Pen 10. When patients travel outside the United States, make sure that they take enough needles for the duration of their stay.
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Frequently asked questions about Nutropin therapy
What time of day should Nutropin therapy be administered?
It is recommended that the patient establish a consistent routine for the
timing of the injection. For example, every night at bedtime or right before
dinner every night may be easy to remember.
How should the timing of injections be handled with patients on
dialysis?
To optimize therapy for patients who require dialysis, the following
guidelines for injection schedule are recommended:
- Hemodialysis patients should receive their injection at night, just
prior to going to sleep or at least 3 to 4 hours after hemodialysis.
This helps to prevent the GH injection from causing a hematoma due
to heparin exposure during dialysis.
- Continuous cycling peritoneal dialysis (CCPD) patients should receive
their injection in the morning after they have completed dialysis.
- Continuous ambulatory peritoneal dialysis (CAPD) patients should
receive their injection in the evening at the time of the overnight
exchange.
Healthcare professionals should assess the patient's overall treatment plan
to determine the best time of day to habitually administer Nutropin therapy.
What if the patient has a latex allergy?
All Nutropin AQ products are latex-free, including the stopper on the vial and
plunger on the cartridge. However, the stopper in the Nutropin vial is not
latex-free.
Where should families and patients be directed when they have
reimbursement questions?
Patients and families should either call their specialty pharmacy or contact
the Nutropin Access Solutions™ Online Support Center using the contact information below:
Nutropin Access Solutions™
Phone: (800) 545-0498
www.NutropinAccessSolutions.com
Where can healthcare professionals get additional training materials if they need to train more than one household per patient?
To request additional training materials, contact the distributor initiating the
teaching request or call the Nutropin support line toll-free at 1-866-
NUTROPIN (1-866-688-7674).
Frequently Asked Questions About the Nutropin AQ Pen
What if the cartridge window shows an amount that is less than
expected or if it seems that excessive medication was wasted in the
priming step?
The pen is designed to deliver the full 10 mg in 0.1-mg increments.
However, the cartridge window is not exact in its markings. You may be able
to help patients anticipate when, at their current dose, the cartridge will be
completely used. For example—a 0.4-mg dose in the 10-mg cartridge will
deliver 25 doses, while a 2.0-mg dose will exhaust the 10-mg cartridge in 5
doses.
What if the black dose knob cannot be depressed?
A dose must be dialed for the knob to be depressed. The most common
reason the black knob cannot be depressed is that the knob may be between
clicks. Try turning the dosing knob forward until it clicks into dosing position.
If this problem happens when the last dose in the cartridge is dialed, turn
the knob backward until it clicks into dosing position. The dosing knob
cannot be depressed if the needle is not screwed on properly or is bent or
occluded. Inspect the needle and change it, if necessary.
What if medication is leaking from the needle?
If the dose knob is turned past the maximum dose of 4 mg, medication will
come out of the needle. This could also occur if the plunger is not fully
retracted prior to replacing a cartridge.
Does the patient need to change the needle every time the Nutropin
AQ Pen 10 is used?
Yes. It is recommended that a new needle be used for every injection. The
needle is only sterile on the first use.
Where should patients store the Nutropin AQ Pen 10?
The Nutropin AQ Pen 10 should be stored in the case, inside a refrigerator
when a cartridge is inserted. When traveling, place the pen case in a cooler.
DO NOT FREEZE. KEEP DRY.
Why does the medication need to be refrigerated?
Refrigeration helps to maintain the potency of Nutropin AQ.
Can patients store the Nutropin AQ Pen 10 in the freezer?
No. Freezing will damage the pen and drug.
How long can patients keep the Nutropin AQ Pen 10 and 10 mg
Cartridge outside of the refrigerator?
We recommend no longer than one hour per day.
What is the maximum dose the Nutropin AQ Pen 10 can deliver in
one injection?
The maximum dose that may be delivered in one injection is 4.0 mg. If the
patient attempts to dose more than the maximum dose at one time, the
drug will either be forced out of the needle and wasted or excess pressure
will be placed upon the cartridge.
Is it possible to turn the black dose knob back if it is clicked too
many times?
Yes. The black dose knob can be turned backwards until the correct number
appears in the LCD.
What should patients do if there is not enough medication left in the
cartridge to meet dosing requirements?
Patients are encouraged to consult their healthcare professional for
instruction. We recommend administering the partial dose that's left in the
cartridge and then starting a new cartridge to administer the remaining
portion of the medication. Another option is to use the remainder of the
cartridge and give only one injection. Patients may also discard the
incomplete dose and start a new cartridge.
Why must patients rewind the black dose knob on the Nutropin AQ
Pen 10 every time they replace the cartridge?
This ensures that the plunger push rod completely resets itself back to the
starting position. If this is not done, liquid will come out of the needle when
a new cartridge is placed into the pen.
Can patients use the Nutropin AQ Pen 10 without the shields?
Yes. The Nutropin AQ Pen 10 is fully functional without the shields. The
shields are optional to help you administer the injection.
Where is the best place to inject the medication?
The best sites for injection include the abdomen, thighs, buttocks, and upper
arms.
What should patients do if they drop the Nutropin AQ Pen 10?
If the Nutropin AQ Pen 10 is dropped, patients should check to see if the
cartridge is damaged. They should also check the pen to see that the black
dose knob is moving up and down properly and that the LCD counter is
working.
For how long may patients use the Nutropin AQ Pen 10?
A Nutropin AQ Pen 10 is designed to last approximately 24 months from the
time that it is first used.
What does "bt" (blinking or steady) mean in the LCD?
Seeing "bt" in the LCD indicates that the battery in the Nutropin AQ Pen 10
is losing its charge. Batteries typically last 24 months and have 4 weeks of
remaining life from the time the "bt" first appears. Patients are instructed to
contact their healthcare professional or distributor for a replacement pen.
How should patients replace a Nutropin AQ Pen 10?
Patients are instructed to contact their healthcare professional or distributor
if they need a replacement part or if they need to replace an entire pen.
How should patients use the dose recall function?
To use the dose recall function for subsequent injections, patients should
wait at least 2 minutes after their previous injection before pressing the
white reset button.
Is the Nutropin AQ Pen 10 waterproof?
No. Exposure to moisture may cause the Nutropin AQ Pen 10 LCD window to
malfunction. Patients should not immerse the Nutropin AQ Pen 10 in water.
If the Nutropin AQ Pen 10 is accidentally immersed, it should be removed
from the water and dried immediately.
What does it mean when either 3 or 6 bars flash or appear steady on
the digital dose display?
When this occurs, it means that the pen has been used for 2 years and
should be replaced. The pen has 4 weeks of life remaining from the time that
the flashing bars first appear. Patients are instructed to contact their
healthcare provider or distributor for a replacement Nutropin AQ Pen 10.
What other risk and side effect information should I be aware of?
Your healthcare professional is your primary source of information.
Discuss the potential benefits and risks of GH treatment with your
endocrinologist so you are familiar with possible side effects.
If the patient is treated at the hospital for any reason, notify your healthcare
professional, including your endocrinologist, immediately.
It is important to notify the doctor if allergic reactions occur, such as itching,
rash, redness or swelling at the injection site.
Should your child develop a limp or worsened curvature of the spine, or
complain of hip or knee pain, notify your child's doctor.
If the patient has diabetes, consult the treating doctor, as GH may affect the
body's response to insulin.
If the patient has symptoms of headache, visual changes, nausea, and/or
vomiting notify your healthcare professional immediately.
Discuss all medications the patient is taking with the treating doctor,
particularly corticosteroids (like predisone or hydrocortisone), sex steroids
(like estrogens or testosterone), seizure medication or cyclosporine.
If the patient becomes pregnant while on GH therapy, notify your doctor
immediately. If the patient is nursing an infant while on GH therapy, you
should also notify your doctor immediately.
During your treatment with GH your doctor may perform blood tests
periodically (once every few months) in order to be able to make adjustments
to your GH dose. Certain proteins (like IGF-I) will be measured that are
directly influenced by the amount of GH given to you. This is done for safety
reasons, please ask your doctor about the details.
Especially during the first days/weeks of your treatment with growth hormone
you may experience swelling of your hands and feet (edema). Also pain and
swelling of your joints may occur. When you experience these side effects
please bring them to the attention of your HCP right away. Most likely your
doctor has already discussed the possibility of these side effects with you and
told you they are transient and respond well to stopping GH treatment for a
while and then restart at a lower dosage of GH.
Anatomy of the Nutropin AQ Pen 10
Here are a few of the features that make this delivery device so easy to
teach and easy to learn. As you can see, the Nutropin AQ Pen 10 is small in
size and doesn't require a lot of ancillary supplies, making preparation and
injection simple, convenient, and safe. | 
