Triumeq 5 mg/60 mg/30 mg dispersible tablets
Spain
Table of Contents
Patient Information Leaflet
Introduction
Patient Information Leaflet
Triumeq 5mg/60mg/30mg dispersible tablets
dolutegravir/abacavir/lamivudina
Read the entire leaflet carefully before you start using this medicine, as it contains important information for you.
- Keep this leaflet as you may need to read it again.
- If you have any questions, ask your doctor or pharmacist.
- This medicine has been prescribed for a child under your care. Do not give it to other people, even if they have the same symptoms as the child under your care, as it may harm them.
- If the child experiences any side effects, consult your doctor or pharmacist, even if they are side effects not listed in this leaflet. See section 4.
Leaflet Contents
- What Triumeq is and what it is used for
- What you need to know before using Triumeq
- How to use Triumeq
- Possible side effects
- How to store Triumeq
- Contents of the pack and other information
- Step-by-step instructions for use
1. What Triumeq is and what it is used for
Triumeq is a medicine that contains three active substances used to treat HIV infection: abacavir, lamivudine, and dolutegravir. Abacavir and lamivudine belong to a group of antiretroviral medicines (medicines used to treat HIV infection) called nucleoside reverse transcriptase inhibitors (NRTIs), and dolutegravir belongs to a group of antiretroviral medicines called integrase inhibitors (INIs).
Triumeq is used to treat HIV (human immunodeficiency virus) infection in children from 3 months of age who weigh at least 6 kg but less than 25 kg.
Before prescribing Triumeq for the child under your care, the doctor will perform a test to determine whether the child carries a specific gene called HLA-B*5701. Triumeq must not be used in patients known to carry the HLA-B*5701 gene. Patients with this gene have a high risk of developing a severe hypersensitivity (allergic) reaction if they take Triumeq (see "Hypersensitivity reactions" in section 4).
Triumeq does not cure HIV infection; it reduces the amount of virus in the body and keeps it at a low level. It also increases the number of CD4 cells in the blood. CD4 cells are a type of white blood cell important in helping the body fight infections.
Not all people respond to treatment with Triumeq in the same way. Your doctor will monitor the treatment's effectiveness in the child.
2. What you need to know before starting Triumeq
Do not use Triumeq
- if the child under your care is allergic (hypersensitive) to dolutegravir, abacavir (or any other medicine containing abacavir), lamivudine, or to any of the other ingredients of this medicine (listed in section 6).
Read carefully all the information about hypersensitivity reactions in section 4.
- if the child under your care is taking a medicine called fampridine (also known as dalfampridine; used to treat multiple sclerosis).
→ If you think any of these apply to the child, consult your doctor.
Warnings and precautions
IMPORTANT — Hypersensitivity reactions
Triumeq contains abacavir and dolutegravir. These two active substances may cause a serious allergic reaction known as a hypersensitivity reaction. The child under your care must never take abacavir or any medicines containing abacavir again if they have had a hypersensitivity reaction: this could potentially be fatal.
You must read carefully the information on “Hypersensitivity reactions” in section 4.
The Triumeq packaging includes an Information Card to remind you and medical personnel about the risk of a hypersensitivity reaction. You must remove this card and carry it with you at all times.
Take special care with Triumeq
Some people taking Triumeq or other combination treatments for HIV are at higher risk of developing serious adverse effects than others. You should be aware that there is an increased risk:
- if the child under your care has moderate or severe liver disease
- if the child under your care has ever had liver disease, including hepatitis B or C (if the child has hepatitis B, do not stop taking Triumeq without medical advice, as this could worsen the condition)
- if the child under your care has a kidney problem.
→ Consult your doctor before starting Triumeq if any of these situations apply to the child. Additional tests, including blood tests, may be required while taking this medicine. For more information, see section 4.
Hypersensitivity reactions to abacavir
Even patients who do not have the HLA-B*5701 gene may develop a hypersensitivity reaction (serious allergic reaction).
→ Read carefully all the information on hypersensitivity reactions in section 4 of this leaflet.
Risk of cardiovascular events
It cannot be ruled out that abacavir may increase the risk of cardiovascular events.
→ Inform your doctor if the child under your care has cardiovascular problems, smokes, or has any condition that may increase their risk of cardiovascular disease, such as high blood pressure or diabetes. Do not stop administering Triumeq unless advised by your doctor.
Be alert to important symptoms
Some people taking medicines for HIV infection develop other disorders, which may be serious. These include:
- symptoms of infections and inflammation
- joint pain, stiffness, and bone problems.
You need to know which important signs and symptoms to watch for while administering Triumeq.
→ Read the information on “Other possible adverse effects of combination HIV treatment” in section 4 of this leaflet.
Children
Triumeq must not be used in children under 3 months of age or weighing less than 6 kg, as it has not been evaluated below this threshold in these groups.
Children must attend scheduled medical appointments (see section 3, How to use Triumeq, for more information).
Other medicines and Triumeq
Inform your doctor if the child under your care is taking, has recently taken, or might need to take any other medicine.
Some medicines may affect how Triumeq works, or increase the likelihood of adverse effects. Triumeq may also affect how other medicines work.
Inform your doctor if the child under your care is taking any of the following medicines:
- metformin, to treat diabetes
- medicines called antacids, to treat indigestion and heartburn. The child under your care must not take an antacid within 6 hours before taking Triumeq, or at least 2 hours after taking it (see also section 3)
- supplements or multivitamins containing calcium, iron, or magnesium. If the child takes Triumeq with food, they may take supplements or multivitamins containing calcium, iron, or magnesium at the same time as Triumeq. If Triumeq is not taken with food, do not take supplements or multivitamins containing calcium, iron, or magnesium within 6 hours before taking Triumeq, or at least 2 hours after taking it (see also section 3)
- emtricitabine, etravirine, efavirenz, nevirapine, or tipranavir/ritonavir, to treat HIV infection
- medicines (usually liquids) containing sorbitol and other polyols (such as xylitol, mannitol, lactitol, or maltitol), if taken regularly
- other medicines containing lamivudine, used to treat HIV infection or hepatitis B
- cladribine, used to treat hairy cell leukemia
- rifampicin, to treat tuberculosis (TB) and other bacterial infections
- trimethoprim/sulfamethoxazole, an antibiotic to treat bacterial infections
- phenytoin and phenobarbital, to treat epilepsy
- oxcarbazepine and carbamazepine, to treat epilepsy or bipolar disorder
- St. John’s wort (Hypericum perforatum), a herbal remedy used to treat depression
- methadone, used as a heroin substitute. Abacavir increases the rate at which methadone is eliminated from the body. If the child is taking methadone, they should be monitored for symptoms of withdrawal. Their methadone dose may need to be adjusted.
- Riociguat, to treat high blood pressure in the blood vessels (pulmonary arteries) carrying blood from the heart to the lungs. Your doctor may need to reduce the dose of riociguat, as abacavir may increase blood levels of riociguat.
→ Inform your doctor or pharmacist if the child under your care is taking any of these medicines. Your doctor may decide to adjust the child’s dose or order additional tests.
Pregnancy
If the patient is pregnant, thinks she might be pregnant, or plans to become pregnant:
→ Consult your doctor about the risks and benefits of taking Triumeq.
Inform your doctor immediately if you become pregnant or plan to become pregnant. Your doctor will review your treatment. Do not stop treatment with Triumeq without consulting your doctor, as this could harm both you and your fetus.
Breast-feeding
Breast-feeding is not recommended for women living with HIV, because HIV infection can be transmitted to the baby through breast milk.
A small amount of the components of Triumeq may also pass into breast milk.
If you are breast-feeding or considering breast-feeding, you must consult your doctor as soon as possible.
Driving and use of machines
Triumeq may cause dizziness and may cause other adverse effects that reduce your attention.
→ Do not drive or operate machinery unless you are certain that your reflexes are not affected.
Triumeq contains sodium.
This medicine contains less than 1 mmol of sodium (23 mg) per dispersible tablet; essentially, it is “sodium-free”.
3. How to use Triumeq
Follow exactly the instructions given by your doctor for administering this medicine. If you are unsure, consult your doctor or pharmacist again.
Your doctor will decide the correct dose of Triumeq for the child under your care based on their weight.
If the child under your care is less than 3 months old or weighs less than 6 kg, Triumeq is not suitable, as it is unknown whether Triumeq is safe and effective in such cases. Your doctor should prescribe the individual components separately for the child.
Triumeq can be taken with or without food.
Dispersible tablets must be dispersed in drinking water. The tablets should be dispersed completely in the dosing cup provided before administration. Do not chew, cut, or crush the tablets. If the child under your care cannot use the dosing cup provided, you may also need an oral syringe to administer the medicine. Speak with your doctor for advice.
The dose for children must be adjusted as their weight increases.
→ Therefore, it is important that children attend their scheduled medical appointments.
Triumeq is available as film-coated tablets and dispersible tablets. Film-coated tablets and dispersible tablets are not interchangeable. Therefore, do not switch between film-coated and dispersible tablets without first speaking to your doctor.
Do not give an antacid within 6 hours before taking Triumeq, or at least 2 hours after taking it. Other medicines that reduce acidity, such as ranitidine and omeprazole, may be taken at the same time as Triumeq.
→ Consult your doctor for advice on which acid-reducing medicines may be used with Triumeq.
If you give Triumeq with food, you may take supplements or multivitamins containing calcium, iron, or magnesium at the same time as Triumeq. If you do not give Triumeq with food, do not take any supplement or multivitamin containing calcium, iron, or magnesium within 6 hours before taking Triumeq, or at least 2 hours after taking it.
→ Consult your doctor for advice on how to use supplements or multivitamins containing calcium, iron, or magnesium with Triumeq.
If you give more Triumeq than you should
If you exceed the prescribed number of dispersible Triumeq tablets, contact your doctor or pharmacist for advice. If possible, show them the Triumeq packaging.
If you forget to give Triumeq
If you forget to give a dose, give it as soon as you remember. However, if less than 4 hours remain before the next dose, skip the missed dose and give the next dose at the usual time. Then continue the child's treatment as before.
→ Do not give a double dose to make up for missed doses.
If you have stopped treatment with Triumeq
If, for any reason, you have stopped giving Triumeq to the child—especially because you think they are experiencing adverse effects or have another illness:
→ Consult your doctor before restarting treatment. Your doctor will assess whether the child's symptoms were related to a hypersensitivity reaction. If your doctor considers that they may have been related to a hypersensitivity reaction, they will instruct you never to give Triumeq or any other medicine containing abacavir or dolutegravir again. It is important to follow this warning.
If your doctor advises that the child should restart treatment with Triumeq, they may ask you to give the first doses in a place where the child has easy access to medical assistance, if needed.
4. Possible adverse effects
Like all medicines, this medicine can cause adverse effects, although not everyone experiences them.
While the child is receiving treatment for HIV, it may be difficult to determine whether a symptom is an adverse effect of Triumeq or of other medicines the child is taking, or whether it is due to the HIV disease itself. Therefore, it is very important that you inform your doctor about any changes in the child's health.
Abacavir may cause a hypersensitivity reaction (a serious allergic reaction), particularly in people who have a specific gene type called HLA-B*5701. Even patients who do not have the HLA-B*5701 gene may develop a hypersensitivity reaction, as described under the heading "Hypersensitivity reactions." It is very important that you read and understand the information about this serious reaction.
In addition to the adverse effects listed below for Triumeq, other disorders may develop during combination antiretroviral therapy for HIV.
- It is important that you read the information under the heading “Other possible adverse effects of combination antiretroviral therapy for HIV” in this section.
Hypersensitivity reactions
Triumeq contains abacavir and dolutegravir. These two active substances may cause a serious allergic reaction known as a hypersensitivity reaction.
Such hypersensitivity reactions have occurred more frequently in people taking medicines containing abacavir.
Who experiences these reactions?
Any person taking Triumeq could develop a hypersensitivity reaction, which could potentially be fatal if treatment with Triumeq is continued.
The child is more likely to develop this reaction if they have a gene called HLA-B*5701 (but the reaction may still occur even if they do not have this gene). Before starting treatment with Triumeq, the child should have been tested for this gene. If you know the child has this gene, inform your doctor.
What are the symptoms?
The most common symptoms are:
fever (high temperature) and rash.
Other common symptoms include:
nausea (feeling unwell), vomiting, diarrhoea, abdominal (stomach) pain, and excessive tiredness.
Other possible symptoms include:
joint or muscle pain, swelling of the neck, difficulty breathing, sore throat, cough, occasional headaches, eye inflammation (conjunctivitis), mouth ulcers, low blood pressure, tingling or numbness in the hands or feet.
When do these reactions occur?
Hypersensitivity reactions may occur at any time during treatment with Triumeq, but are most likely to occur within the first 6 weeks of treatment.
Contact your doctor immediately:
1if the child develops a rash, OR
2if the child has symptoms from at least 2 of the following groups:
- fever
- difficulty breathing, sore throat, or cough
- nausea or vomiting, diarrhoea, or abdominal pain
- excessive tiredness or aches and pains, or general malaise.
Your doctor may advise you to stop giving Triumeq.
If you have stopped giving Triumeq
If you have stopped giving Triumeq due to a hypersensitivity reaction, NEVER restart Triumeq or any other medicine containing abacavir. If you do, within hours the child may experience a drop in blood pressure that could potentially be fatal or cause death. You must also never restart medicines containing dolutegravir.
If, for any reason, the child has interrupted treatment with Triumeq—especially because you think they are experiencing adverse effects or due to another illness:
Consult your doctor before restarting treatment. Your doctor will assess whether the child's symptoms were related to a hypersensitivity reaction. If your doctor suspects such a link, they will instruct you never to give Triumeq or any other medicine containing abacavir again. You must also never give medicines containing dolutegravir again. It is important to follow this warning.
Occasionally, hypersensitivity reactions have occurred in people who restart abacavir-containing medicines after having experienced only one symptom listed on the Alert Card before stopping.
Very rarely, patients who previously took abacavir-containing medicines without any signs of hypersensitivity have developed a hypersensitivity reaction when restarting these medicines.
If your doctor advises restarting Triumeq, they may ask you to administer the first doses in a setting where the child has immediate access to medical care, should it become necessary.
If the child is hypersensitive to Triumeq, you must return all unused Triumeq tablets for safe disposal. Consult your doctor or pharmacist.
The Triumeq packaging includes an Alert Card to remind you and medical personnel of the risk of a hypersensitivity reaction. You must remove the card and carry it with you at all times.
Very common adverse effects
These may affect more than 1 in 10 people:
- headache
- diarrhoea
- nausea
- difficulty sleeping (insomnia)
- lack of energy (fatigue).
Common adverse effects
These may affect up to 1 in 10 people:
- hypersensitivity reaction (see "Hypersensitivity reactions" earlier in this section )
- loss of appetite
- rash
- itching (pruritus )
- vomiting
- stomach pain (abdominal pain )
- discomfort in the stomach (abdomen )
- weight gain
- indigestion
- gas (flatulence )
- dizziness
- abnormal dreams
- nightmares
- depression (feeling deeply sad and lacking self-worth)
- anxiety
- tiredness
- drowsiness
- fever (high temperature )
- cough
- irritated or runny nose
- hair loss
- muscle pain and discomfort
- joint pain
- feeling weak
- feeling generally unwell.
Common adverse effects that may appear in blood tests include:
- increased levels of liver enzymes.
- increased levels of muscle enzymes (creatine phosphokinase).
Uncommon adverse effects
These may affect up to 1 in 100 people:
- liver inflammation (hepatitis )
- suicidal thoughts and behaviour (especially in patients who previously had depression or mental health problems)
- panic attacks.
Uncommon adverse effects that may appear in blood tests include:
- decreased number of cells involved in blood clotting (thrombocytopenia )
- low red blood cell count (anaemia) or low white blood cell count (neutropenia)
- increased blood sugar (glucose) levels
- increased blood triglyceride (a type of fat) levels.
Rare adverse effects
These may affect up to 1 in 1,000 people:
-
inflammation of the pancreas (pancreatitis)
-
muscle tissue rupture
-
liver failure (signs may include yellowing of the skin and whites of the eyes, or unusually dark urine)
-
suicide (especially in patients who previously had depression or mental health problems).
-
Inform your doctor immediately if any mental health problems occur (see also other mental health problems listed above).
Rare adverse effects that may appear in blood tests include:
- increased bilirubin (liver function test)
- increased levels of an enzyme called amylase.
Very rare adverse effects
These may affect up to 1 in 10,000 people:
-
numbness, skin tingling (pins and needles)
-
weakness in the limbs
-
skin rash, which may form blisters resembling small targets (dark central spot surrounded by a paler area, with a dark ring around the edge) (erythema multiforme )
-
widespread blistering and peeling of the skin, especially around the mouth, nose, eyes, and genitals (Stevens-Johnson syndrome), and a more severe form causing skin peeling over more than 30% of the body surface (toxic epidermal necrolysis )
-
lactic acidosis (excess lactic acid in the blood).
Very rare adverse effects that may appear in blood tests include:
- failure of the bone marrow to produce new red blood cells (pure red cell aplasia).
Frequency not known Cannot be estimated from available data:
- a condition in which red blood cells do not form properly (sideroblastic anaemia).
If the child in your care experiences any adverse effect
- Consult your doctor. This includes any possible adverse effect not mentioned in this leaflet.
Other possible adverse effects of combination antiretroviral therapy for HIV
Combination therapies, such as Triumeq, may cause other disorders to develop during antiretroviral treatment for HIV.
Symptoms of infection and inflammation
People with advanced HIV infection or AIDS have weakened immune systems and are more likely to develop serious infections (opportunistic infections). Such infections may have developed "silently," undetected by the weakened immune system before treatment began. After starting treatment, the immune system becomes stronger and may begin to fight these infections, causing symptoms of infection or inflammation. Symptoms usually include fever, along with some of the following:
- headache
- stomach pain
- difficulty breathing.
Rarely, as the immune system becomes stronger, it may also attack healthy tissues (autoimmune disorders). Symptoms of autoimmune disorders may appear many months after the child starts taking medicines for HIV infection. Symptoms may include:
- palpitations (irregular or rapid heartbeat) or tremors
- hyperactivity (excessive restlessness and movement)
- weakness starting in the hands and feet and moving upward toward the body trunk.
If the child has any symptoms of infection and inflammation or notices any of the symptoms listed above:
- Consult your doctor immediately. Do not give any other medicines for infection without first consulting your doctor.
Joint pain, stiffness, and bone problems
Some people receiving combination antiretroviral therapy develop osteonecrosis. In this condition, parts of the bone tissue die due to reduced blood supply to the bones. People may be more likely to develop this condition if:
- they have been on combination antiretroviral therapy for a long time
- they are also taking anti-inflammatory medicines called corticosteroids
- they drink alcohol
- their immune system is severely weakened
- they are overweight.
Signs of osteonecrosis include:
- stiffness in the joints
- discomfort and pain (especially in the hip, knee, or shoulder)
- difficulty moving.
If you notice any of these symptoms:
- Inform your doctor.
Effects on weight, lipids, and blood glucose
During antiretroviral treatment for HIV, there may be an increase in weight and in blood lipid and glucose levels. This is partly related to improved health, lifestyle, and sometimes to the antiretroviral medicines themselves. Your doctor will evaluate these changes.
Reporting of adverse effects
If you experience any adverse effect, talk to your doctor or pharmacist, even if it is a possible adverse effect not listed in this leaflet. You can also report them directly through the national reporting system detailed in Appendix V. By reporting adverse effects, you can help provide more information on the safety of this medicine.
5. Storage of Triumeq
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date stated on the carton and on the label of the bottle after EXP. The expiry date is the last day of the month indicated.
Store in the original packaging to protect it from moisture. Keep the bottle tightly closed. Do not remove the desiccant. Do not ingest the desiccant.
This medicine does not require any special storage temperature.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines and containers you no longer need. This will help protect the environment.
6. Contents of the pack and other information
Composition of Triumeq
- The active substances are dolutegravir, abacavir and lamivudine. Each tablet contains dolutegravir sodium equivalent to 5 mg of dolutegravir, 60 mg of abacavir (as sulfate) and 30 mg of lamivudina.
- The other components are potassium acesulfame, crospovidone, mannitol (E421), microcrystalline cellulose, povidone, silicified microcrystalline cellulose (microcrystalline cellulose; colloidal anhydrous silica), sodium starch glycolate, sodium stearyl fumarate, strawberry cream flavour, sucralose, partially hydrolysed polyvinyl alcohol, macrogol, talc, titanium dioxide (E171) and yellow iron oxide (E172).
- This medicine contains less than 1 mmol of sodium (23 mg) per dispersible tablet, i.e. essentially "sodium-free".
Nature and contents of the container
Triumeq dispersible tablets are yellow, biconvex, capsule-shaped tablets, with "SV WTU" engraved on one side.
Bottles contain 90 dispersible tablets.
The bottle contains a desiccant to reduce moisture. After opening, keep the desiccant in the bottle; do not discard it.
The pack includes a dosing cup.
Marketing Authorisation Holder
ViiV Healthcare BV, Van Asch van Wijckstraat 55H, 3811 LP Amersfoort, The Netherlands
Manufacturer
Glaxo Wellcome, S.A., Avda. Extremadura 3, 09400 Aranda de Duero (Burgos), Spain.
For further information about this medicine, please contact the local representative of the Marketing Authorisation Holder:
Belgium/Belgium/Belgium ViiV Healthcare srl/bv Tel/Tel: + 32 (0) 10 85 65 00 | Lithuania ViiV Healthcare BV Tel: + 370 80000334 |
| Luxembourg/Luxembourg ViiV Healthcare srl/bv Belgium/Belgium Tel/Tel: + 32 (0) 10 85 65 00 |
Czech Republic GlaxoSmithKline, s.r.o. Tel: + 420 222 001 111 | Hungary ViiV Healthcare BV Tel.: + 36 80088309 |
Denmark GlaxoSmithKline Pharma A/S Tlf.: + 45 36 35 91 00 | Malta ViiV Healthcare BV Tel: + 356 80065004 |
Germany ViiV Healthcare GmbH Tel.: + 49 (0)89 203 0038-10 | Netherlands ViiV Healthcare BV Tel: + 31 (0) 33 2081199 |
Estonia ViiV Healthcare BV Tel: + 372 8002640 | Norway GlaxoSmithKline AS Tlf: + 47 22 70 20 00 |
Greece GlaxoSmithKline Monoprosopi A.E.B.E. Tel: + 30 210 68 82 100 | Austria GlaxoSmithKline Pharma GmbH Tel: + 43 (0)1 97075 0 |
Spain Laboratorios ViiV Healthcare, S.L. Tel: + 34 900 923 501 | Poland GSK Services Sp. z o.o. Tel.: + 48 (0)22 576 9000 |
France ViiV Healthcare SAS Tél.: + 33 (0)1 39 17 69 69 | Portugal VIIVHIV HEALTHCARE, UNIPESSOAL, LDA Tel: + 351 21 094 08 01 |
Croatia ViiV Healthcare BV Tel: + 385 800787089 | Romania ViiV Healthcare BV Tel: + 40800672524 |
Ireland GlaxoSmithKline (Ireland) Limited Tel: + 353 (0)1 4955000 | Slovenia ViiV Healthcare BV Tel: + 386 80688869 |
Iceland Vistor ehf. Sími: +354 535 7000 | Slovakia ViiV Healthcare BV Tel: + 421 800500589 |
Italy ViiV Healthcare S.r.l Tel: + 39 (0)45 7741600 | Finland GlaxoSmithKline Oy Puh/Tel: + 358 (0)10 30 30 30 |
Cyprus ViiV Healthcare BV Tel: + 357 80070017 | Sweden GlaxoSmithKline AB Tel: + 46 (0)8 638 93 00 |
Latvia ViiV Healthcare BV Tel: + 371 80205045 |
Date of the most recent review of this leaflet: {Month YYYY}.
Other sources of information
Detailed information on this medicine is available on the website of the European Medicines Agency: https://www.ema.europa.eu.
Step-by-step instructions for use
Read these instructions for use before administering a dose of medication. Follow the steps, using clean drinking water to prepare and administer a dose to a child. Important information Always administer this medicine exactly as your doctor has instructed. Speak with your doctor if you are unsure. Do not chew, cut, or crush the tablets. If you forget to give a dose, administer it as soon as you remember. However, if there are less than 4 hours until the next dose, skip the missed dose and give the next one at the usual time. Then continue treatment as before. Do not administer two doses at the same time or more than prescribed by your doctor. Speak with your doctor if your child cannot take the full dose. If you administer too much medication, go to the emergency room immediately for medical help.
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Use only drinking water.
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If any medication is spilled, clean it up. Discard the remaining prepared medication and prepare a new dose. |
The dose should be taken within 30 minutes of preparation. If more than 30 minutes have passed, discard the dose and prepare a new dose of medication. |
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