Yorvipath 420 micrograms/1.4 ml solution for injection in pre-filled pen

Spain
Brand name Yorvipath 420 micrograms/1.4 ml solution for injection in pre-filled pen
Form solution for injection in pre-filled pen
Active substance / Dosage
Prescription type Hospital Diagnosis
Registration number 1231766003

Patient Information Leaflet

Introduction

Package leaflet: Information for the patient

Yorvipath 168 micrograms/0.56 ml solution for injection in pre-filled pen
Yorvipath 294 micrograms/0.98 ml solution for injection in pre-filled pen
Yorvipath 420 micrograms/1.4 ml solution for injection in pre-filled pen

palopegteriparatide

This medicinal product is subject to additional monitoring, which will allow for faster detection of new safety information. You can help by reporting any side effects you may experience. Information on how to report side effects is included at the end of section 4.

Read this entire leaflet carefully before you start using this medicine, as it contains important information for you.

  • Keep this leaflet, as you may need to refer to it again.
  • If you have any questions, consult your doctor or pharmacist.
  • This medicine has been prescribed for you only, and you should not give it to others, even if they have the same symptoms as you, because it may harm them.
  • If you experience any side effects, consult your doctor or pharmacist, even if they are side effects not listed in this leaflet. See section 4.

Contents of this leaflet

  1. What Yorvipath is and what it is used for
  2. What you need to know before using Yorvipath
  3. How to use Yorvipath
  4. Possible side effects
  5. How to store Yorvipath
  6. Contents of the pack and other information

1. What Yorvipath is and what it is used for

Yorvipath contains the active substance palopegteriparatide. Palopegteriparatide becomes teriparatide, also known as parathyroid hormone (PTH), in the body. PTH is normally produced in the body and is necessary to maintain the levels of calcium and phosphate within normal limits.

Yorvipath is used for the treatment of chronic hypoparathyroidism in adults. In people with hypoparathyroidism, the body produces very little or no PTH. As a result, they cannot maintain calcium and phosphate levels within normal ranges, leading to symptoms of the condition such as muscle spasms, twitching, and tingling sensations in the fingertips, toes, and lips. Yorvipath replaces the missing PTH, thereby helping to control calcium and phosphate levels.

2. What you need to know before using Yorvipath

Do not use Yorvipath

  • if you are allergic to palopegteriparatide or to any of the other ingredients of this medicine (listed in section 6)
  • if you have pseudohypoparathyroidism, a condition in which the body does not respond properly to the parathyroid hormone produced by the body

Warnings and precautions

Talk to your doctor, pharmacist, or nurse before you start using Yorvipath.

If you are being treated with Yorvipath, you may experience adverse effects related to low and high levels of calcium in the blood (see section 4 for more information). These effects are more likely to occur when starting treatment or when changing the dose. Your doctor will monitor your calcium levels (see “Tests and monitoring” in section 3). You may be given medications to treat or help prevent these adverse effects, or your doctor may adjust your dose.

High levels of calcium in the blood may cause problems if you are taking medicines containing cardiac glycosides (such as digoxin or digitoxin) (see Other medicines and Yorvipath). Your doctor will monitor your calcium levels (see “Tests and monitoring” in section 3) and cardiac glycoside levels, and will monitor you for signs and symptoms.

If you take Yorvipath and have severe liver or kidney impairment, your doctor will monitor your calcium levels more frequently (see “Tests and monitoring” in section 3).

Tell your doctor if you are at increased risk of a type of bone cancer called osteosarcoma. This is especially important:

  • if you are receiving or have received radiation therapy to the bones
  • if you have bone cancer or another type of cancer that has spread to the bones
  • if you have a bone disease that increases the risk of developing osteosarcoma (for example, if you have Paget's disease)
  • if a blood test shows unexplained increases in bone alkaline phosphatase

If you are at risk of bone fractures, your doctor will monitor you for osteoporosis.

Children and adolescents

Yorvipath must not be used in children and adolescents under 18 years of age, as it has not been studied in this age group.

Other medicines and Yorvipath

Tell your doctor, pharmacist, or nurse if you are taking, have recently taken, or might need to take any other medicines. In particular, tell your doctor if you are taking or have recently taken any of the following medicines:

  • Heart medications containing cardiac glycosides (such as digoxin or digotoxine)
  • Medications for the treatment of osteoporosis such as bisphosphonates, denosumab, or romosozumab
  • Medications that may affect calcium levels in the blood, such as diuretics ("water tablets", such as hydrochlorothiazide or furosemide), systemic corticosteroids (medications used to treat inflammation), and lithium (a medication used to treat mood disorders)

Your doctor may need to adjust the dose of these medicines or the dose of Yorvipath.

Pregnancy, breast-feeding, and fertility

If you are pregnant or breast-feeding, think you may be pregnant, or plan to become pregnant, talk to your doctor or pharmacist before using this medicine.

Pregnancy

If you think you may be pregnant or plan to become pregnant, talk to your doctor. If you become pregnant during treatment, contact your doctor immediately.

Information on the safety of Yorvipath in pregnant women is limited. Your doctor will decide whether you should be treated with Yorvipath during pregnancy. If you are pregnant or plan to become pregnant, your doctor will monitor your calcium levels.

Breast-feeding

If you are breast-feeding or plan to breast-feed, talk to your doctor before using Yorvipath. Your doctor will decide whether you should be treated with Yorvipath during breast-feeding. If you are breast-feeding, your doctor will monitor your calcium levels.

Fertility

It is unknown whether Yorvipath has effects on fertility.

Driving and using machines

The effect of Yorvipath on the ability to drive and use machines is negligible or minor. However, if you experience dizziness or fainting upon standing, do not drive or operate machinery until you feel better.

Yorvipath contains sodium

This medicine contains less than 1 mmol of sodium (23 mg) per dose; this means it is essentially "sodium-free".

3. How to use Yorvipath

Follow exactly the administration instructions for this medicine given by your doctor or nurse. If in doubt, consult your doctor again.

Yorvipath is administered as an injection under the skin (subcutaneous injection). This means it is injected with a short needle into the fatty tissue beneath the skin. The medicine should be injected into the abdomen or the front of the thigh. It is important to inject it each day into a different area to avoid damaging the skin. You may alternate between the right and left side of the abdomen and the left and right front areas of the thigh.

Before you start using the pen for the first time, your doctor, pharmacist, or nurse will show you how to inject Yorvipath. Additional help on how to use Yorvipath can be found in the instructions for use at the end of this leaflet.

Always use the pen exactly as described in the instructions for use.

Initiation, dose adjustment, and maintenance of Yorvipath

Your doctor will perform a blood test to monitor your calcium and vitamin D levels before starting treatment with Yorvipath.

The recommended starting dose of Yorvipath is 18 micrograms once daily. Your doctor will instruct you to gradually adjust the dose according to your response to the medicine, until you reach a dose that maintains calcium levels in your body within normal limits without requiring active vitamin D or therapeutic doses of calcium. Your doctor may advise you to continue taking daily calcium supplements to meet dietary requirements. Your dose may be increased if at least 7 days have passed since the last dose adjustment. Your dose may be decreased no more than once every 3 days if calcium levels in your body are too high.

Tests and monitoring

Your doctor will monitor your response to treatment:

  • 7 days after starting treatment, and
  • 7 to 14 days after any dose adjustment.

This will be done through tests measuring calcium levels in blood or urine. Your doctor may instruct you to adjust the amount of calcium or vitamin D you take (in any form, including calcium-rich foods).

Instructions for use

If your dose is higher than 30 micrograms per day:

  • Administer two injections, one after the other, in different injection sites.
  • It is recommended to use a different Yorvipath pen for the second daily injection, even if both pens have the same color plunger (same concentration).
  • The table below explains how to administer the dose. If in doubt, consult your doctor again.
Medical chart with daily dosages of Yorvipath and instructions on which injectable pens to use with orange or maroon button

Yorvipath 294 microgram/0.98 ml pen delivers doses of 15, 18, or 21 micrograms (with orange plunger)
Yorvipath 420 microgram/1.4 ml pen delivers doses of 24, 27, or 30 micrograms (with burgundy plunger)

If you use more Yorvipath than you should

Contact your doctor or nurse immediately and report your symptoms.

An overdose may lead to high levels of calcium in the blood. Symptoms may include, among others, feeling unwell (nausea, vomiting), dizziness, increased thirst, confusion, muscle weakness, and irregular heartbeat. For further information, see section 4.

If you forget to use Yorvipath

If you forget to inject a dose of Yorvipath, you may take the medicine as soon as you remember, provided that less than 12 hours have passed. For example, if you normally inject the medicine at 08:00, you may inject the missed dose before 20:00.

If you only remember within 12 hours of your next scheduled dose, skip the missed dose and continue injecting your next dose as usual. For example, if you remember at 22:00 that you missed your Yorvipath injection and your next dose is scheduled for 08:00, you should not inject the missed dose.

Never take a second dose to make up for a missed dose.

If you stop using Yorvipath

Do not stop using Yorvipath without speaking to your doctor. If you interrupt treatment with Yorvipath, calcium levels in the blood may decrease and you may develop the symptoms described below (see section 4).

If you have any further questions about the use of Yorvipath, ask your doctor or nurse.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everybody gets them.

Some adverse effects may be considered serious

Frequent serious adverse effects (may affect up to 1 in 10 people):

  • High levels of calcium in the blood (hypercalcemia)

    • Symptoms may include, among others, feeling unwell (vomiting), dizziness, feeling thirsty, confusion, muscle weakness, and irregular heartbeat.
    • Hypercalcemia is more likely to occur during the first 3 months after starting treatment or if your dose of Yorvipath changes.
  • Low levels of calcium in the blood (hypocalcemia)

    • Symptoms may include, among others, tingling sensation in the fingertips, toes, and lips (paraesthesia), muscle spasms and cramps, oral numbness, and seizures.
    • Hypocalcemia is more likely to occur if you stop taking Yorvipath for a short period of time or completely, or if your dose of Yorvipath changes.

Inform your doctor immediately if you experience any of the symptoms mentioned above that could indicate these adverse effects. Your doctor will monitor your calcium levels. You may need to adjust the dose of Yorvipath or temporarily interrupt the injections. You may be given medications to treat or help prevent these adverse effects, or you may be asked to stop taking some of your current medications. These medications may include calcium or vitamin D. You may also be asked to undergo certain laboratory tests.

Other adverse effects include:

Very common adverse effects (may affect more than 1 in 10 people)

  • Headache
  • Tingling sensation in the fingertips, toes, and lips (paraesthesia)
  • Feeling unwell (nausea)
  • Feeling tired (fatigue)
  • Redness, bruising, pain, bleeding, rash, or swelling at the injection site (injection site reactions)

Common adverse effects (may affect up to 1 in 10 people)

  • Sensation of fluttering or very fast heartbeat (palpitations)
  • Dizziness
  • Feeling faint (presyncope)
  • Fainting (syncope)
  • Dizziness, lightheadedness, or fainting when sitting or standing up (orthostatic hypotension)
  • Dizziness, lightheadedness, or fainting with increased heart rate when sitting or standing up (postural orthostatic tachycardia syndrome)
  • Painful mouth or sore throat (oropharyngeal pain)
  • Diarrhoea
  • Constipation
  • Feeling unwell (vomiting)
  • Abdominal pain
  • Abdominal discomfort
  • Joint pain (arthralgia)
  • Muscle pain (myalgia)
  • Weakness (asthenia)
  • Thirst
  • Rash
  • Skin reaction to sunlight (photosensitivity reaction)
  • Need to urinate at night (nocturia)
  • Muscle twitches
  • Pain in the bones and muscles (musculoskeletal pain)

Uncommon adverse effects (may affect up to 1 in 100 people)

  • Chest pain
  • Chest discomfort
  • High blood pressure (hypertension)

Frequency not known (cannot be estimated from available data)

  • Need to urinate frequently (polyuria)
  • Decreased bone density

If you experience any adverse effect or symptoms that concern you, inform your doctor or nurse.

Reporting of adverse effects

If you experience any adverse effect, talk to your doctor, pharmacist, or nurse, even if it is a possible adverse effect not listed in this leaflet. You can also report them directly through the national reporting system listed in Appendix V. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Yorvipath Storage

Keep this medicine out of sight and reach of children.

Do not use this medicine after the expiry date stated on the carton after EXP. The expiry date is the last day of the month indicated.

Before first use:

Store in a refrigerator (between 2 °C and 8 °C). Do not freeze.

Keep in the original packaging with the pen cap attached to protect it from light.

After first use:

Store below 30 °C.

Keep the pen cap on the pre-filled pen to protect it from light.

Dispose of pens 14 days after first use.

Do not use this medicine if the solution appears cloudy, discolored, or contains visible particles.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to properly dispose of any unused medicines and their packaging. This helps protect the environment.

6. Contents of the pack and other information

Composition of Yorvipath

  • The active substance is palopegteriparatide.
  • The other excipients are succinic acid, mannitol, metacresol, sodium hydroxide (see section 2, “Yorvipath contains sodium”), hydrochloric acid (for pH adjustment), and water for injections.

Yorvipath is a solution for subcutaneous injections in a pre-filled pen available in three presentations:

Yorvipath 168 micrograms/0.56 ml

Each pre-filled pen contains palopegteriparatide equivalent to 168 micrograms of PTH(1-34) in 0.56 ml of solvent. The concentration based on PTH(1-34) is 0.3 mg/ml.

Yorvipath 294 micrograms/0.98 ml

Each pre-filled pen contains palopegteriparatide equivalent to 294 micrograms of PTH(1-34) in 0.98 ml of solvent. The concentration based on PTH(1-34) is 0.3 mg/ml.

Yorvipath 420 micrograms/1.4 ml

Each pre-filled pen contains palopegteriparatide equivalent to 420 micrograms of PTH(1-34) in 1.4 ml of solvent. The concentration based on PTH(1-34) is 0.3 mg/ml.

Nature and contents of the container

Yorvipath is a clear, colourless, injectable solution free from particles in a pre-filled pen.

Yorvipath is available in packs containing 2 pre-filled pens (with 30 disposable needles or without needles) for 28 days of treatment. Each pre-filled pen is for 14 days of treatment.

Only certain pack sizes may be marketed.

The concentration colours are indicated on the outer and inner cartons, on the label and on the push-button of the pre-filled pen as follows:

Color

Strength

Blue

Yorvipath 168 micrograms/0.56 ml

Orange

Yorvipath 294 micrograms/0.98 ml

Garnet

Yorvipath 420 micrograms/1.4 ml

Marketing Authorization Holder

Ascendis Pharma Bone Diseases A/S

Tuborg Boulevard 12

DK-2900 Hellerup

Denmark

Manufacturer Responsible

Ascendis Pharma A/S

Tuborg Boulevard 12

DK-2900 Hellerup

Denmark

For further information regarding this medicinal product, please contact the local representative of the Marketing Authorization Holder:

Belgium/Belgium/Belgium

Ascendis Pharma Bone Diseases A/S

Tel/Tel: +32 2 790 6340

Lithuania

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Text in Cyrillic script showing the word Bulgaria, the name Ascendis Pharma Bone Diseases A/S, and the phone number +45 70 22 22 44

Luxembourg/Luxembourg

Ascendis Pharma Bone Diseases A/S

Tel/Tel: +45 70 22 22 44

Czech Republic

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Hungary

Ascendis Pharma Bone Diseases A/S

Tel.: +45 70 22 22 44

Denmark

Ascendis Pharma Bone Diseases A/S

Tlf.: +45 88 74 22 67

Malta

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Germany

Ascendis Pharma Bone Diseases A/S

Tlf.: +45 88 74 22 67

Netherlands

Ascendis Pharma Bone Diseases A/S

Tel: +31 20 259 2731

Estonia

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Norway

Ascendis Pharma Bone Diseases A/S

Tlf: +47 23 50 24 80

Greece

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Austria

Ascendis Pharma Bone Diseases A/S

Tel: +43 1 205 636 7700

Spain

Ascendis Pharma Iberia, S.L.

Tel: +34 910 798 364

Poland

Ascendis Pharma Bone Diseases A/S

Tel.: +45 70 22 22 44

France

Ascendis Pharma France SAS

Tel: +33 1 72 35 02 00

Portugal

Ascendis Pharma Bone Diseases A/S

Tel: +351 21 124 8316

Croatia

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Romania

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Ireland

Ascendis Pharma Bone Diseases A/S

Tel: +44 20 4570 1942

Slovenia

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Iceland

Ascendis Pharma Bone Diseases A/S

Sími: +45 70 22 22 44

Slovakia

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Italy

Ascendis Pharma Bone Diseases A/S

Tel: +39 02 8128 1581

Finland

Ascendis Pharma Bone Diseases A/S

Puh/Tel: +358 64 60 41 367

Cyprus

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Sweden

Ascendis Pharma Bone Diseases A/S

Tel: +46 8 502 414 23

Latvia

Ascendis Pharma Bone Diseases A/S

Tel: +45 70 22 22 44

Date of last review of this leaflet:

Other sources of information

Detailed information on this medicine is available on the website of the European Medicines Agency: https://www.ema.europa.eu. There are also links to other websites about rare diseases and orphan medicines.

This leaflet is available on the website of the European Medicines Agency in all languages of the European Union/European Economic Area.

On the reverse of this leaflet, instructions for use are shown, containing information on how to inject Yorvipath.


INSTRUCTIONS FOR USE

Yorvipath

168 micrograms/0.56 ml

For doses of 6, 9 or 12 micrograms only

Injectable solution in a pre-filled pen

palopegteriparatide

Subcutaneous route

The instructions for use contain information on how to inject Yorvipath.

Additional information

If you do not understand or are unable to complete any of the steps described in the instructions for use, consult your doctor or nurse.

Important information you need to know before starting to use your Yorvipath pen

Read and follow the package leaflet and these instructions for use carefully to ensure you inject Yorvipath properly.

Make sure you have been trained by your doctor or nurse before administering the injection. This is important to ensure you receive the correct treatment.

For proper use

  • If you do not follow these instructions, you may not receive the correct dose and therefore may not get the full effect of your medicine.
  • If you are blind or have visual impairment, or lack concentration, do not use your pen without assistance. Instead, ask someone who has been trained in the use of the Yorvipath pen for help.
  • Keep out of sight and reach of children.
  • The pen and needles are for use by a single patient only.
  • Do not share your pen or needles with other people. This could cause infection (cross-contamination).
  • Always dispose of your pen after 14 days, even if there is still medicine left. This is important to ensure you receive the correct effect of the medicine.
  • Always use the needles provided with the Yorvipath pen for your injections.
  • Remove the needle after each use. Do not store the pen with the needle attached.
  • Avoid bending or breaking the pen needle.
  • Do not change the injection angle after inserting the needle into the skin. Changing the angle may cause the needle to bend or break. A bent or broken needle could become stuck in the body or remain completely under the skin. If a broken needle becomes stuck in the body or under the skin, seek medical attention immediately.
  • Do not use needles if the needle cap or needle shield is damaged.

Caring for the pen

  • Handle the pen with care.
  • Keep the pen dry.
  • Use a damp cloth to clean the pen.
  • Do not drop your pen or hit it against hard surfaces. If this happens, retest the pen flow (Section 2, Steps A–C) before the next use.
  • Do not apply extra force to your pen. It may be empty, damaged, or no longer functioning correctly.
  • Do not attempt to repair a damaged pen yourself.
  • Never use a damaged pen.

Troubleshooting

  1. How often should I test the pen flow?

You should only test the pen flow (Section 2) the first time you use a new pen (or if you suspect it may be damaged) to avoid wasting medication. Testing ensures that the medicine flows through the pen so you can receive the correct dose.

  1. I do not see drops after testing the pen flow 5 times. What should I do?

If you do not see drops at the needle tip after 5 attempts, it may be because there is no flow through the pen or needle.

Change the needle (see Section 5, Step 13) and retest the pen flow (see Section 2, Steps A–C). You can confirm proper flow if you see a drop of medicine. If it still does not work, dispose of the pen and consult your healthcare professional.

  1. How do I know when the injection is complete?

The injection is only complete when you press the button fully down, the dose selector has rotated back to the “?” and you have kept the pen on the skin for 5 seconds.

  1. Why must I continue pressing the pen against the skin for 5 seconds?

Some of the medicine may flow back into the pen or leak from the injection site onto the skin. Pressing the pen against the skin for 5 seconds helps ensure the full dose has been injected.

  1. I cannot set the dose selector to the required dose. What should I do?

The pen does not allow you to set a dose larger than the remaining amount.

If your required dose is greater than the amount of medicine left in the pen, you will not be able to set the full dose. You must dispose of your pen and take the full dose using a new pen.

  1. The red cap covers the needle before starting the injection. What should I do?

Unscrew and dispose of the used needle (see Section 5, Step 13). Take a new needle from the box and restart from Step 1. All boxes contain one extra needle.

Overview of the parts

Figure A

Technical diagram of an injectable pen with Spanish labels indicating components such as needle, grip, dosage, and viewing windows

Note: There is no medication inside the needle.

You will also need

White sharps disposal container with an alcohol prep wipe beside it on a white background

1 Preparing the pen and needle

Step 1

Take your Yorvipath pen. Make sure it is the correct concentration and check the expiry date. Take a needle and check the expiry date on the needle (Figure C).
Note: Remove your pen from the refrigerator 20 minutes before first use.

Figure C

Pre-filled Yorvipath syringe with yellow cap and green text reading Fecha de caducidad ¿Correcto? on a white background

Step 2

Remove the pen cap and check the inspection window to make sure the medicine inside the pen is clear and colourless (Figure D).
Important: If the medicine has visible particles, do not use the pen. Use a new pen instead.

Figure D

Two hands holding a pen-like medical device with a green arrow indicating comparison between two versions of the product

Step 3

Remove the needle tab (Figure E).
This needle can only be used once and locks after use.
Always use a new needle for each injection.

Figure E

A hand holds a medical device while the

Step 4

Attach the needle straight onto your pen, then screw the needle onto the pen until secure (it will not tighten completely) (Figure F).

Figure F

Two hands holding an injectable pen to snap and rotate the upper part, with green arrows indicating the insertion movement

Step 5

Remove the needle shield (Figure G) and dispose of it.
Important: Do not touch the blue cap as it may block the needle.

Figure G

Two hands show the

  1. If the pen is new, test its flow

Stylized calendar icon with the text Día 1 in the center on a white background with black border and three top rings

Horizontal yellow rectangle with thin brown border containing the word CUIDADO in dark uppercase letters centered

Test the pen flow (steps A–C) only the first time you use

a new pen.

If your pen is already in use, go to section 3 "Prepare the injection and

select the dose".

Step A

Turn the dose selector to the right by 2 clicks until you see the drop symbol “” in the dose window (Figure H).

Note: You can always correct the selection by turning the dose selector.

Figure H

A hand holds a Varsipath medical device with a magnified inset showing a green arrow pointing toward the

Step B

Bring air bubbles to the top of the pen by tapping the inspection window (Figure I). Hold the pen with the needle tip pointing upward.

Note: Small air bubbles are acceptable.

Figure I

A hand touches the side of a medical injector pen with the index finger, indicating the

Step C

Press the push button and observe droplets of medication coming out from the needle tip.

While pressing, ensure that the dose selector rotates back to the symbol

(Figure J).

Important: If you do not see medication droplets, repeat this test (steps A–C) up to 5 times.

If droplets still do not appear, change the needle and

repeat the test.

Figure J

A hand holds a medical injector pen with a green arrow pointing toward the

3 Prepare the injection and select the dose

Step 6

Choose the injection site. There are two areas on your body where you can administer the injection (Figure K).

Avoid injecting into areas of red, swollen, or scarred skin.

Choose a different injection site each time you give an injection.

Diagram of a human body shown from the front indicating injection sites on the

Step 7

Wash your hands and clean the injection site with an alcohol wipe

(Figure L).

Figure L

A hand uses an alcohol wipe to clean the skin of the arm following a motion toward the

Step 8

Select your dose as prescribed by your doctor (6, 9, or 12 micrograms) by turning the dose selector clockwise

(Figure M).

Important: Make sure not to press the button when selecting the dose to avoid wasting the medication.

Note: Always discard your pen and use a new one if you are unable to set a full dose.

Figure M

A hand holds a medical device with a green arrow indicating a movement toward the

4 Inject the dose

Yellow rectangle with rounded corners and dark outline containing the word CUIDADO in black uppercase letters centered

Use the injection technique recommended by your

doctor or nurse.

Read this entire section (Steps 9–12) before beginning to inject.

Step 9

Hold the pen so that the blue cap is placed over the injection site. Make sure you can see the dose window (Figure N).

Figure N

A hand holds a transparent autoinjector placed against the thigh with a magnified inset showing the blue tip in contact with the skin

Step 10

Push the pen straight against the skin until you hear a click and the blue cap is no longer visible (Figure O).

Figure O

Medical illustration showing a hand pressing an autoinjector device against the upper part of the

Step 11

Press the button down fully and hold it firmly for 5 seconds. Make sure the dose selector rotates back to the symbol. This indicates that the full dose has been delivered

(Figure P).

Figure P

A hand presses an injectable pen against the thigh with a green arrow indicating to wait 5 seconds after pressing

Step 12

Slowly remove the pen from the injection site. The blue cap will automatically lock over the needle, and a red lockout indicator will appear (Figure Q).

Figure Q

A hand holds an injectable pen next to an arm with a magnified detail showing a closed red lock symbol

5 Dispose of the used needle

Step 13

Unscrew the needle and dispose of it safely according to local regulations (Figure R). Do not attempt to recap the needle, as you may get a needlestick injury from the back end.

Figure R

Two hands hold a white injectable pen with green arrows indicating a rotation or sliding motion along the device

Step 14

Firmly attach the pen cap onto the pen to protect it between injections and to protect the medication from light (Figure S).

Figure S

Two hands joining two parts of a white medical device with a green arrow indicating the snapping motion between components

6 Dispose of the used pen

Black calendar icon with the text Día and number 14 in the center on a white background

Important: Always dispose of the

pen 14 days after first use according to local regulations. To keep track of when 14 days have passed, it is recommended to cover the field "?Date of opening″ on the inner packaging.

Always dispose of your pen and extra needles after 14 days of use, even if there is still medication left (Figure T). This is important to ensure you receive the full effect of the medicine.

Figure T

A white injectable pen with red and blue text is moved via a green arrow toward a sharps waste container

INSTRUCTIONS FOR USE

Yorvipath

294 micrograms/0.98 mL

For 15, 18, or 21 microgram doses only

Injectable solution in a pre-filled pen

palopegteriparatide

Subcutaneous route

The instructions for use contain information on how to inject Yorvipath.

Additional information

If you do not understand or are unable to complete any of the steps described in the instructions for use, consult your doctor or nurse.

Important information you must know before starting to use your Yorvipath pen

Read and follow the package leaflet and these instructions for use carefully to ensure you inject Yorvipath properly.

Make sure you have been trained by your doctor or nurse before administering the injection. This is important to ensure you receive the correct treatment.

For correct use

  • If you do not follow these instructions, you may not receive the correct dose and therefore may not get the full effect of your medicine.
  • If you are blind or have visual impairment, or lack concentration, do not use your pen without help. Instead, ask someone who has been trained in the use of the Yorvipath pen to assist you.
  • Keep out of sight and reach of children.
  • The pen and needles are for use by a single patient only.
  • Do not share your pen or needles with other people. This could cause an infection (cross-contamination).
  • Always dispose of your pen after 14 days, even if there is still medicine remaining. This is important to ensure you receive the correct effect from the medicine.
  • Always use the needles provided with the Yorvipath pen for your injections.
  • Remove the needle after each use. Do not store the pen with the needle attached.
  • Avoid bending or breaking the pen needle.
  • Do not change the injection angle after inserting the needle into the skin. Changing the angle may cause the needle to bend or break. A bent or broken needle could become lodged in the body or remain completely under the skin. If a broken needle becomes lodged in the body or under the skin, seek immediate medical attention.
  • Do not use needles if the needle cap or needle shield is damaged.

Special instructions for doses greater than 30 micrograms

If your dose is greater than 30 micrograms/day:

  • Administer two injections, one after the other, in different injection sites (see the recommended schedule table in section 3 of the Package Leaflet).
  • It is recommended to use a different Yorvipath pen for the second daily injection, even if both pens have the same color plunger (same concentration).
  • Follow the steps in the instructions for use for each injection.

Care of the pen

  • Handle the pen carefully.
  • Keep the pen dry.
  • Use a damp cloth to clean the pen.
  • Do not drop your pen or hit it against hard surfaces. If this happens, retest the pen flow (section 2, steps A–C) before the next use.
  • Do not apply extra force to your pen. It may be empty, damaged, or no longer functioning correctly.
  • Do not attempt to repair a damaged pen yourself.
  • Never use a damaged pen.

Troubleshooting

  1. How often should I test the pen flow?

You should only test the pen flow (section 2) the first time you use a new pen (or if you suspect it may be damaged) to avoid wasting medication. The test checks that the medicine flows properly through the pen so you can receive the correct dose.

  1. I do not see drops after testing the pen flow 5 times. What should I do?

If you do not see drops at the needle tip after 5 attempts, it may be because there is no flow through the pen or needle.

Change the needle (see section 5, step 13) and retest the pen flow (see section 2, steps A–C). You can confirm proper flow if you see a drop of medicine.

If it still does not work, dispose of the pen and consult your healthcare professional.

  1. How do I know when my injection is complete?

The injection is only complete when you press the plunger fully down, the dose selector has rotated back to the “?” mark, and you have kept the pen pressed against the skin for 5 seconds.

  1. Why must I continue pressing the pen against the skin for 5 seconds?

Some of the medicine may flow back into the pen or leak from the injection site onto the skin. Pressing the pen against the skin for 5 seconds helps ensure that the full dose has been injected.

  1. I cannot set the dose selector to the required dose. What should I do?

The pen does not allow you to set a dose higher than the amount remaining.

If your dose is greater than the amount of medicine left in the pen, you will not be able to set the full dose. You must dispose of the pen and take the full dose using a new pen.

  1. The red cap covers the needle before starting the injection. What should I do?

Unscrew and dispose of the used needle (see section 5, step 13). Take a new needle from the box and restart from step 1. Each box contains one additional needle.

Overview of the parts

Medical diagram of an injectable pen with yellow label, components such as view window, button, dosage, and details on needle and protection

You will also need

White sharps disposal container next to an alcohol wipe pouch on a white background with text in Spanish and Italian

1 Preparation of the pen and needle

Step 1

Take your Yorvipath pen. Make sure it is the correct concentration and check the expiration date. Take a needle and check the expiration date on the needle (

Figure C).

Note: Remove your pen from the refrigerator 20 minutes before first use.

Figure C

Pre-filled Yorvipath syringe with yellow cap and green text asking if the expiration date is correct

Step 2

Remove the closure cap from the pen and check the inspection window to ensure that the medication inside the pen is clear and

colorless (Figure D).

Important: If the medication has visible particles, do not use the pen. Use a new pen.

Figure D

Two hands hold a pen-like medical device with a circular magnifier showing a close-up of the top part of the drug

Step 3

Remove the tab from the needle (Figure E).

This needle can only be used once and will lock after use.

Always use a new needle for each injection.

Figure E

Two hands rotate a yellow protective cap on a blue and white cylindrical medical device indicated by a curved green arrow

Step 4

Attach the needle directly onto your pen, then screw the needle onto the pen until secure (it will not tighten completely) (Figure F).

Figure F

Two hands holding an injectable pen to snap and rotate the upper part with green arrows indicating the insertion movement

Step 5

Remove the needle shield (Figure G) and discard it.

Important: Do not touch the blue cap as it may block the needle.

Figure G

Two hands separate a green cartridge from a white medical device via a green arrow pointing to the left

  1. If the pen is new, test its flow

Black calendar icon with three top rings and the text Día 1 in the center on a white background

Horizontal yellow rectangle with thin brown border containing the word CUIDADO in black uppercase serif letters

Test the pen flow (steps A–C) only the first time you use a new pen.

If your pen is already in use, go to section 3 "Prepare the injection and select the dose".

Step A

Turn the dose selector clockwise 2 clicks until you see the drop symbol “” in the dose window (Figure H).

Note: You can always correct the selection by turning the dose selector.

Figure H

A hand holds a Varsipath medical device with a magnified inset showing a green arrow pointing toward the

Step B

Move air bubbles to the top of the pen by gently tapping the inspection window (Figure I). Hold the pen with the needle tip pointing upward.

Note: Small air bubbles are acceptable.

Figure I

A hand touches with the

Step C

Press the injection button and watch for drops of medication to appear at the needle tip. When pressing, ensure that the dose selector rotates back to the symbol (Figure J).

Important: If you do not see drops of medication, repeat this test (steps A–C) up to 5 times. If no drops appear, replace the needle and repeat the test.

Figure J

A hand holds a medical injector pen with a green arrow pointing toward the

3 Prepare the injection and select the dose

Step 6

Choose the injection site. There are two areas on

your body where you can administer the injection (Figure K).

Do not inject into areas of red, swollen, or scarred skin.

Choose a different injection site each time you give an injection.

Stylized diagram of a human body indicating injection sites on the

Step 7

Wash your hands and clean the injection site

with an alcohol wipe (Figure L).

Figure L

A hand cleans the skin with an alcohol wipe following a motion toward the

Step 8

Select your dose as prescribed by your doctor (15, 18, or 21 micrograms) by turning

the dose selector clockwise (Figure M).

Important: Make sure not to press the button when selecting the dose to avoid wasting the medication.

Note: Always discard your pen and use a new one if you cannot set a complete dose.

Figure M

A hand holds a white medical device with a magnified inset showing a curved green arrow indicating a rotation movement

4 Inject the dose

Yellow rectangle with dark brown border containing the word CUIDADO in uppercase brown letters

Use the injection administration technique recommended by your

doctor or nurse.

Read this entire section (Steps 9–12) before beginning to inject.

Step 9

Hold the pen so that the blue cap is positioned

over the injection site. Make sure you can see

the dose window (Figure N).

Figure N

A hand holds a transparent medical device and presses it against a person's thigh with a magnified detail of the contact point

Step 10

Push the pen directly against the skin until

you hear a click and the blue cap is no longer visible (Figure O).

Figure O

A hand grips an injector pen toward the

Step 11

Press and hold the button down firmly for 5 seconds.

Ensure that the dose selector rotates back to the symbol. This means

that the full dose has been administered (Figure P).

Figure P

A hand holds an injector pen against the thigh with a green arrow indicating to wait 5 seconds with a

Step 12

Slowly remove the pen from the injection site. The blue cap will automatically lock over the needle and a red cover will appear (Figure Q).

Figure Q

A hand holds an injectable pen next to an arm with a magnified detail showing a closed red lock symbol

5 Dispose of the used needle

Step 13

Unscrew the needle and dispose of it safely according to local regulations (Figure R).

Do not attempt to recap the needle, as you may get a needle stick injury from the back end.

Figure R

Two hands hold a white injectable pen with green arrows indicating a rotation or sliding motion along the device

Step 14

Firmly attach the pen cap onto the pen to protect it between injections and to protect the medication from light (Figure S).

Figure S

Two hands joining two parts of a white medical device with green edges and blue text following the direction of a green arrow

6 Dispose of the used pen

Black calendar icon with the text Día and number 14 in the center on a white background

Important: Always dispose of the

pen 14 days after first use,

according to local regulations. To keep track of

when 14 days have passed, it is recommended

to cover the “Date of opening” field on the

inner packaging.

Always dispose of your pen and any extra

needles after 14 days of use, even if there is

still medication remaining (Figure T).

This is important to ensure you receive

the full effect of the medicine.

Figure T

A Yonipath injector pen is inserted into a gray disposal container via a curved green arrow

INSTRUCTIONS FOR USE

Yorvipath

420 micrograms/1.4 ml

For doses of 24, 27, or 30 micrograms only

Injectable solution in a pre-filled pen

palopegteriparatide

Subcutaneous use

The instructions for use contain information on how to inject Yorvipath.

Additional information

If you do not understand or are unable to complete any of the steps described in the instructions for use, consult your doctor or nurse.

Important information you must know before starting to use your Yorvipath pen

Read and follow the package leaflet and these instructions for use carefully to ensure you inject Yorvipath properly.

Make sure you have received training from your doctor or nurse before administering the injection. This is important to ensure you receive the correct treatment.

For correct use

  • If you do not follow these instructions, you may not receive the correct dose and therefore may not get the full effect of your medicine.
  • If you are blind or have visual impairment, or lack concentration, do not use your pen without help. Instead, ask someone who has been trained in the use of the Yorvipath pen for assistance.
  • Keep out of sight and reach of children.
  • The pen and needles are for use by a single patient only.
  • Do not share your pen or needles with other people. This could cause infection (cross-contamination).
  • Always dispose of your pen after 14 days, even if there is still medicine remaining. This is important to ensure you receive the correct effect of the medicine.
  • Always use the needles provided with the Yorvipath pen for your injections.
  • Remove the needle after each use. Do not store the pen with the needle attached.
  • Avoid bending or breaking the pen needle.
  • Do not change the injection angle after inserting the needle into the skin. Changing the angle may cause the needle to bend or break. A bent or broken needle could become stuck in the body or remain completely under the skin. If a broken needle becomes stuck in the body or under the skin, seek medical attention immediately.
  • Do not use needles if the needle cap or needle shield is damaged.

Special instructions for doses greater than 30 micrograms/day

If your dose is greater than 30 micrograms/day:

  • Administer two injections, one after the other, in different injection sites (see the recommended schedule table in section 3 of the Package Leaflet).
  • It is recommended to use a different Yorvipath pen for the second daily injection, even if both pens have the same color dose button (same concentration).
  • Follow the steps in the instructions for use for each injection.

Care of the pen

  • Handle the pen carefully.
  • Keep the pen dry.
  • Use a damp cloth to clean the pen.
  • Do not drop your pen or hit it against hard surfaces. If this happens, retest the pen flow (section 2, steps A–C) before the next use.
  • Do not apply extra force to your pen. It may be empty, damaged, or no longer functioning correctly.
  • Do not attempt to repair a damaged pen yourself.
  • Never use a damaged pen.

Troubleshooting

  1. How often should I test the pen flow?

You should only test the pen flow (section 2) the first time you use a new pen (or if you suspect it may be damaged) to avoid wasting medication. The test checks that the medicine flows through the pen so you can receive the correct doses.

  1. I do not see drops after testing the pen flow 5 times. What should I do?

If you do not see drops at the needle tip after 5 attempts, it may be because there is no flow through the pen and needle.

Change the needle (see section 5, step 13) and retest the pen flow (see section 2, steps A–C). You can confirm proper flow if you see a drop of medicine.

If it still does not work, dispose of the pen and consult your healthcare professional.

  1. How do I know when the injection is complete?

The injection is only complete when you have pressed the dose button fully down, the dose selector has rotated back to the “?” and you have kept the needle in the skin for 5 seconds.

  1. Why must I continue pressing the pen against the skin for 5 seconds?

Some of the medicine may flow back into the pen or leak back from the injection site onto the skin. Pressing the pen against the skin for 5 seconds helps ensure that the full dose of medicine has been injected.

  1. I cannot set the dose selector to the required dose. What should I do?

The pen does not allow you to set a dose higher than the amount remaining.

If your dose is greater than the amount of medicine left in the pen, you will not be able to set the full dose. You must dispose of your pen and take your full dose using a new pen.

  1. The red cap covers the needle before starting the injection. What should I do?

Unscrew and dispose of the used needle (see section 5, step 13). Take a new needle from the box and restart from step 1. All boxes contain an extra needle.

Overview of the parts

Figure A

Medical diagram illustrating parts of a Yorvipath injectable pen including label, dosage, button, needle, and protective components

Note: There is no medication inside the needle.

You will also need

Sharps disposal container and an alcohol wipe on a white background with descriptive text in Spanish

1 Preparing the pen and needle

Step 1

Take your Yorvipath pen. Make sure it is the correct concentration and check the

expiration date. Take a needle and check

the expiration date on the needle

(Figure C).

Note: Remove your pen from

the refrigerator 20 minutes before first use.

Figure C

Pre-filled Yorvipath syringe with yellow cap and green text asking if the expiration date is correct

Step 2

Remove the closure cap from the pen and check the inspection window to ensure that the medicine inside the pen is clear and

colorless (Figure D).

Important: If the medicine contains

visible particles, do not use the pen. Use a

new pen.

Figure D

Two hands hold an injectable pen to compare the top part of the device with a circular magnifier on a white background

Step 3

Remove the tab from the needle (Figure E).

This needle can only be used once and will lock after use.

Always use a new needle for each injection.

Figure E

Two hands rotating a yellow cap on a medical device with a curved green arrow indicating the rotation movement toward the

Step 4

Attach the needle directly onto your pen, and

then screw the needle onto the

pen until secure (it will not tighten completely) (Figure F).

Figure F

Two hands snapping and rotating the top part of an injectable pen onto a cylindrical body with directional green arrows

Step 5

Remove the needle cap (Figure G) and discard it.

Important: Do not touch the blue cap

as it may block the needle.

Figure G

Two hands show the

  1. If the pen is new, test its flow

Stylized white calendar icon with black border and three top rings displaying the text Día 1 in black characters

Horizontal yellow rectangle with dark border containing the word CUIDADO in black uppercase serif letters

Test the pen flow (steps A – C) only the first time you use

a new pen.

If your pen is already in use, go to section 3 "Prepare the injection and

select the dose".

Step A

Turn the dose selector to the right by 2 clicks until you see the drop symbol “” in the dose window (Figure H).

Note: You can always correct the selection by turning the dose selector.

Figure H

A hand holds a medical device with a magnified inset showing a green arrow pointing toward the

Step B

Move air bubbles to the top of the pen by tapping the inspection window (Figure I). Hold the pen with the needle tip pointing upward.

Note: Small air bubbles are acceptable.

Figure I

A hand touches the side of a medical injector pen with the index finger while green graphic symbols appear indicating contact

Step C

Press the push button and observe the medication drops coming out from the needle tip. While pressing, ensure that the dose selector returns to the symbol (Figure J).

Important: If you do not see medication drops, repeat this test (steps A – C) up to 5 times. If no drops appear, replace the needle and repeat the test.

Figure J

A hand holds an injectable pen with a green arrow pointing toward the

3 Prepare the injection and select the dose

Step 6

Choose the injection site. There are two areas on your body where you can administer the injection (Figure K).

Avoid injecting into areas of red, swollen, or scarred skin.

Choose a different injection site each time you give an injection.

Stylized diagram of a human body indicating injection sites on the

Step 7

Wash your hands and clean the injection site with an alcohol wipe

(Figure L).

Figure L

A hand cleans the arm skin with an alcohol wipe using a circular motion indicated by green arrows

Step 8

Select your dose as directed by your doctor (24, 27, or 30 micrograms) by rotating

the dose selector to the right

(Figure M).

Important: Make sure not to press the button when selecting the dose to avoid wasting the medication.

Note: Always discard your pen and use a new one if you are unable to set a full dose.

Figure M

A hand holds a white and red medical device with a magnified inset showing a green arrow indicating a vertical movement toward the

4 Inject the dose

Yellow rectangle with brown border containing the word CUIDADO in uppercase dark brown letters

Use the injection administration technique recommended by your

doctor or nurse.

Read this entire section (Steps 9–12) before starting to inject.

Step 9

Hold the pen so that the blue cap is positioned over the injection site. Make sure you can see the dose window (Figure N).

Figure N

A hand holds a transparent autoinjector placed against the thigh with a magnified inset showing the blue tip in contact with the skin

Step 10

Push the pen directly against the skin until you hear a click and the blue cap is no longer visible (Figure O).

Figure O

Illustration of a hand holding an injectable pen to apply it to the upper part of the

Step 11

Press the button fully down and hold it firmly for 5 seconds. Ensure that the dose selector rotates back to the symbol . This means

that the full dose has been delivered

(Figure P).

Figure P

A hand holds an injector pen against the thigh and a green arrow indicates to wait 5 seconds with a

Step 12

Slowly remove the pen from the injection site. The blue cap automatically locks over the needle, and a

red lockout is visible (Figure Q).

Figure Q

A hand holds an injectable pen next to an arm with a red lock symbol and a magnified view of the locking mechanism

5 Dispose of the used needle

Step 13

Unscrew the needle and dispose of it safely according to local regulations (Figure R).

Do not attempt to recap the needle, as you may get a needlestick injury from the back end.

Figure R

Two hands hold a white injectable pen with green arrows indicating a rotation or sliding motion along the device

Step 14

Firmly attach the pen cap onto the pen to protect it between injections and to protect the medication from light (Figure S).

Figure S

Two hands joining two parts of a white medical device with green border and blue text following the direction of a green arrow

6 Dispose of the used pen

Black calendar icon with the text Día and number 14 in the center on a white background

Important: Always discard the

pen 14 days after first use, according to local regulations. To keep track of when 14 days have passed, it is recommended to cover the “Date of opening” field on the inner packaging.

Always discard your pen and any unused needles after 14 days of use,

even if there is still medication remaining (Figure T). This is important to ensure you receive the full therapeutic effect of the medication.

Figure T

A white medical device with red and blue text is inserted into a gray disposal container via a green arrow

INSTRUCTIONS FOR USE

Yorvipath

168 micrograms/0.56 ml

For doses of 6, 9, or 12 micrograms only

Injectable solution in a pre-filled pen

palopegteriparatide

Subcutaneous use

The instructions for use contain information on how to inject Yorvipath.

Additional information

If you do not understand or are unable to complete any of the steps described in the instructions for use, consult your doctor or nurse.

Important information you must know before starting to use your Yorvipath pen

Read and follow the package leaflet and these instructions for use carefully to ensure you inject Yorvipath properly.

Make sure you have been trained by your doctor or nurse before administering the injection. This is important to ensure you receive the correct treatment.

For correct use

  • If you do not follow these instructions, you may not receive the correct dose and therefore may not get the full effect of your medicine.
  • If you are blind or have visual impairment, or lack concentration, do not use your pen without help. Instead, ask someone who has been trained in the use of the Yorvipath pen to assist you.
  • Keep out of the sight and reach of children.
  • The pen and needles are for use by a single patient only.
  • Do not share your pen or needles with other people. This could cause an infection (cross-contamination).
  • Always dispose of your pen after 14 days, even if there is still medicine left. This is important to ensure you receive the correct effect of the medicine.
  • Always use the needles provided with the Yorvipath pen for your injections.
  • Remove the needle after each use. Do not store the pen with the needle attached.
  • Avoid bending or breaking the pen needle.
  • Do not change the injection angle after inserting the needle into the skin. Changing the angle may cause the needle to bend or break. A bent or broken needle could become lodged in the body or remain completely under the skin. If a broken needle becomes lodged in the body or under the skin, seek medical attention immediately.
  • Do not use needles if the needle cap or needle shield is damaged.

Caring for the pen

  • Handle the pen carefully.
  • Keep the pen dry.
  • Use a damp cloth to clean the pen.
  • Do not drop your pen or hit it against hard surfaces. If this happens, retest the pen flow (Section 2, Steps A–C) before the next use.
  • Do not apply extra force to your pen. It may be empty, damaged, or no longer functioning correctly.
  • Do not attempt to repair a damaged pen yourself.
  • Never use a damaged pen.

Troubleshooting

  1. How often should I test the pen flow?

You should only test the pen flow (Section 2) the first time you use a new pen (or if you suspect it may be damaged) to avoid wasting medication. The test checks that the medicine flows through the pen so you can receive the correct doses.

  1. I do not see drops after testing the pen flow 5 times. What should I do?

If you do not see drops at the needle tip after 5 attempts, it may be because there is no flow through the pen and needle.

Change the needle (see Section 5, Step 12) and retest the pen flow (see Section 2, Steps A–C). You can confirm proper flow if you see a drop of medicine. If it still does not work, dispose of the pen and consult your healthcare professional.

  1. How do I know when the injection is complete?

The injection is complete only when you press the button fully down and the dose selector has rotated back to the “?” and you have kept the needle in the skin for 5 seconds.

  1. Why must I continue pressing the pen against the skin for 5 seconds?

Some of the medicine may flow back into the pen or leak out from the injection site onto the skin. Pressing the pen against the skin for 5 seconds helps ensure that all the medicine has been injected.

  1. I cannot set the dose selector to the required dose. What should I do?

The pen does not allow you to set a dose larger than the amount remaining.

If your dose is greater than the amount of medicine left in the pen, you will not be able to set a full dose. You must discard your pen and take the full dose of medicine with a new one.

Overview of the parts

Figure A

Diagram of a Yorvipath injectable pen showing droplets, dosage options of 6, 9, or 12 micrograms, button, selector, and dosage window

You will also need

Figure B

Medical diagram with needle, alcohol wipe, sharps disposal container, protection, inner cap, tip, and blade of the

1 Preparing the pen and needle

Step 1

Take your Yorvipath pen. Make sure

it is the correct concentration and

check the expiration date. Take a

needle and check the expiration date on

the needle (Figure C).

Note: Remove your pen from the

refrigerator 20 minutes before first use.

Figure C

Diagram of a Yorvipath injectable pen with arrows indicating the cap and expiration date check window on a white background

Step 2

Remove the pen cap and check the inspection window to ensure the medicine inside the pen is clear and colorless (Figure D).

Important: If the medicine has visible particles, do not use the pen. Use

a new pen.

Figure D

Two hands hold a pen-like medical device with a circular magnifier showing a close-up of the top part of the drug

Step 3

Remove the tab from the needle (Figure E).

This needle can only be used once.

Always use a new needle for each injection.

Figure E

A hand holds a medical device while the

Step 4

Attach the needle straight onto your

pen, then screw the needle onto the

pen until secure (Figure F).

Figure F

Two hands hold an injectable pen while a green arrow indicates rotating the top part of the device for preparation

Step 5

Remove the needle protector and the

inner needle cover (Figure G).

Important: Do not touch the blue cap as it may block the needle.

Figure G

Two hands holding a medical device to attach a green protective cap onto the tip of a transparent injectable pen

  1. If the pen is new, test its flow

Stylized white calendar icon with black border and three top rings displaying the text Día and number 1 in the center

Horizontal yellow rectangle with thin brown border containing the word CUIDADO in black uppercase serif letters

Test the pen flow (steps A – C) only the first time you use a new pen.

If your pen is already in use, go to section 3 "Prepare the injection and select the dose".

Step A

Turn the dose selector to the right by 2 clicks until you see the drop symbol “” in the dose window (Figure H).

Note: You can always correct the selection by turning the dose selector.

Figure H

A hand holds a Varsipath medical device with a magnified inset showing a green arrow pointing toward the

Step B

Move air bubbles to the top of the pen by tapping the inspection window (Figure I). Hold the pen with the needle tip pointing upward.

Note: Small air bubbles are acceptable.

Figure I

A hand touches the side of a white medical injector pen with blue and red text, surrounded by green symbols indicating touch

Step C

Press the push button and observe drops of medication coming out from the needle tip. While pressing, ensure that the dose selector rotates back toward the symbol (Figure J).

Important: If you do not see medication drops, repeat this test (steps A – C) up to 5 times. If no drops appear, replace the needle and repeat the test.

Figure J

Medical illustration showing a hand holding a pre-filled syringe with three magnified views of the device and the

3 Prepare the injection and select the dose

Step 6

Choose the injection site. There are two

areas on your body where you can administer

the injection (Figure K).

Avoid injecting into red, swollen, or scarred

skin areas.

Choose a different injection site each

time you give the injection.

Stylized diagram of a human body indicating injection sites on the

Step 7

Wash your hands and clean the injection site with an alcohol wipe

(Figure L).

Figure L

A hand uses an alcohol wipe to clean the skin of an arm with motions toward the

Step 8

Select your dose as directed by your doctor (6, 9, or 12 micrograms) by turning the dose selector to the right

(Figure M).

Important: Make sure not to press the button when selecting the dose

to avoid wasting the medication.

Note: Always discard your pen and use

a new one if you cannot set a full dose.

Figure M

A hand holds a medical device with a green arrow indicating a movement toward the

4 Inject the dose

Yellow rectangle with dark brown border containing the word CUIDADO in uppercase brown letters

Use the injection administration technique recommended by your

doctor or nurse.

Read all of this section (Steps 9–11) before starting to inject.

Step 9

Make sure you can see the dose window. Insert the needle into the

skin (Figure N).

Figure N

A hand holds an injector pen to apply it to the arm skin with a green arrow indicating the movement toward the

Step 10

Press the button fully and hold it firmly

for 5 seconds. Ensure that the dose selector rotates back to the symbol . This indicates that the full dose has been delivered

(Figure O).

Figure O

A hand presses a medical device against the thigh and a green arrow indicates to wait 5 seconds with a

Step 11

Slowly remove the pen from the injection site (Figure P).

Figure P

A hand holds an injector pen horizontally to bring it closer to the upper part of a light-colored leg or thigh

5 Dispose of the used needle

Step 12

Replace the needle cap to carefully remove the needle.

Insert the needle tip into the

cap and secure the cap onto the

needle (Figure Q).

Important: Always recap the needle before removing it to reduce the risk of needlestick injury

and cross-contamination.

Figure Q

A hand holds a syringe with dark liquid and the tip pointing toward an open small green container on a white surface

Step 13

Unscrew the needle and dispose of it

safely according to local regulations

(Figure R).

Figure R

Two hands hold an injectable pen with green arrows indicating a back-and-forth oscillating motion for the

Step 14

Firmly attach the pen cap onto the pen to protect it

between injections and to protect the

medication from light (Figure S).

Figure S

Two hands inserting a white medical device into another component with a green arrow and the text ¡encaja!

6 Dispose of the used pen

Stylized calendar icon with the text Día and number 14 in the center on a white background with black border

Important: Always dispose of the

pen 14 days after first use, according to local regulations. To keep track of

when 14 days have passed, it is recommended to cover the

“Date of Opening” field on the inner packaging.

Always discard your pen after

14 days of use, even if there is

medication remaining (Figure T). This is

important to ensure you receive

the full therapeutic effect of the medication.

Note: If the pen package includes

needles, remember to discard any remaining

needles when disposing of the pen.

Figure T

A white injectable pen with red and blue text is moved via a green arrow toward a sharps waste container

USER INSTRUCTIONS

Yorvipath

294 micrograms/0.98 ml

For doses of 15, 18, or 21 micrograms only

Prefilled pen injection solution

palopegteriparatide

Subcutaneous use

The user instructions contain

information on how to inject

Yorvipath

Additional information

If you do not understand or are unable to complete any of the steps described in the user instructions, consult your doctor or nurse.

Important information you must know before starting to use your Yorvipath pen

Read and follow the package leaflet and these instructions for use carefully to ensure you inject Yorvipath properly.

Make sure you have received training from your doctor or nurse before administering the injection. This is important to ensure you receive the correct treatment.

For proper use

  • If you do not follow these instructions, you may not receive the correct dose and therefore may not get the full effect of your medicine.
  • If you are blind or have visual impairment, or difficulty concentrating, do not use your pen without help. Instead, ask someone who has been trained in the use of the Yorvipath pen to assist you.
  • Keep out of sight and reach of children.
  • The pen and needles are for use by a single patient only.
  • Do not share your pen or needles with other people. This could cause infection (cross-contamination).
  • Always dispose of your pen after 14 days, even if there is still medicine remaining. This is important to ensure you receive the correct effect of the medicine.
  • Always use the needles provided with the Yorvipath pen for your injections.
  • Remove the needle after each use. Do not store the pen with the needle attached.
  • Avoid bending or breaking the pen needle.
  • Do not change the injection angle after inserting the needle into the skin. Changing the angle may cause the needle to bend or break. A bent or broken needle could become lodged in the body or remain completely under the skin. If a broken needle becomes lodged in the body or under the skin, seek immediate medical attention.
  • Do not use needles if the needle cap or needle shield is damaged.

Special instructions for doses greater than 30 micrograms/day

If your dose is greater than 30 micrograms/day:

  • Administer two injections, one after the other, in different injection sites (see the recommended schedule table in section 3 of the Package Leaflet).
  • It is recommended to use a different Yorvipath pen for the second daily injection, even if both pens have the same color-coded dose button (same concentration).
  • Follow the steps in the instructions for use for each injection.

Care of the pen

  • Handle the pen carefully.
  • Keep the pen dry.
  • Use a damp cloth to clean the pen.
  • Do not drop your pen or hit it against hard surfaces. If this happens, test the pen flow again (section 2, steps A–C) before the next use.
  • Do not apply extra force to your pen. It may be empty, damaged, or no longer functioning correctly.
  • Do not attempt to repair a damaged pen yourself.
  • Never use a damaged pen.

Troubleshooting

  1. How often should I test the pen flow?

You should only test the pen flow (section 2) the first time you use a new pen (or if you suspect it may be damaged) to avoid wasting medication. The test checks that medicine flows through the pen so you can receive the correct dose.

  1. I do not see drops after testing the pen flow 5 times. What should I do?

If you do not see drops at the needle tip after 5 attempts, it may be because there is no flow through the pen and needle.

Change the needle (see section 5, step 12) and test the pen flow again (see section 2, steps A–C). You can confirm proper flow if you see a drop of medicine. If it still does not work, dispose of the pen and consult your healthcare professional.

  1. How do I know when the injection is complete?

The injection is only complete when you press the dose button fully down and the dose selector has rotated back, and you have kept the needle in the skin for 5 seconds.

  1. Why must I continue pressing the pen against the skin for 5 seconds?

Some of the medicine may flow back into the pen or leak out from the injection site onto the skin. Holding the pen against the skin for 5 seconds helps ensure that the full dose of medicine has been injected.

  1. I cannot set the dose selector to the required dose. What should I do?

The pen does not allow you to set a dose greater than the amount remaining.

If your dose is greater than the amount of medicine left in the pen, you will not be able to set a full dose. You must dispose of your pen and take the full dose using a new pen.

Overview of parts

Technical diagram of an injectable pen with labels indicating closure cap, inspection window, dose, button, selector, and window

You will also need

Figure B

Medical diagram with illustrations of needle, alcohol wipe, sharps disposal container, protection, and tip of the

1 Preparation of the pen and needle

Step 1

Take your Yorvipath pen. Make sure it is the correct concentration and check the expiration date. Take a needle and check the expiration date on the needle (Figure C).

Note: Remove your pen from the

refrigerator 20 minutes before first use.

Figure C

Medical diagram of a Yorvipath injectable pen with a close-up detail of the cap and a question in Spanish about the expiration date

Step 2

Remove the closure cap from the pen and check the inspection window to ensure that the medicine inside the pen is clear and colorless (Figure D).

Important: If visible particles are present in the medicine, do not use the pen. Use a new pen.

Figure D

Two hands hold an injectable pen to compare the

Step 3

Remove the needle tab (Figure E).

This needle can only be used once.

Always use a new needle for each injection.

Figure E

Two hands rotating a yellow protective cap on a blue cylindrical medical device to open it, following a curved green arrow

Step 4

Place the needle directly onto your pen, then screw the needle onto the pen until it is securely attached (Figure F).

Figure F

Two hands hold a white and orange injectable pen with green arrows indicating rotation movement for drug preparation

Step 5

Remove the needle protector and the inner needle cap (Figure G).

Immediately discard the inner needle cap and keep the needle protector for later use.

Figure G

Diagram showing how to attach the green cap to the tip of a medical injector pen using green directional arrows

  1. If the pen is new, test its flow

Stylized white calendar icon with black border and three top rings displaying the text Día 1 in black characters

Horizontal yellow rectangle with thin brown border containing the word CUIDADO in black uppercase serif font

Test the pen flow (steps A – C) only the first time you use

a new pen.

If your pen is already in use, go to section 3 "Prepare the injection and

select the dose".

Step A

Turn the dose selector to the right 2 clicks until you see the drop symbol “” in the dose window (figure H).

Note: You can always correct the selection by turning the dose selector.

Figure H

A hand holds a Varsipath medical device with a magnified inset showing a green arrow pointing toward the

Step B

Move air bubbles to the top of the pen by tapping the inspection window (figure I). Hold the pen with the needle tip pointing upward.

Note: Small air bubbles are acceptable.

Figure I

A hand touches the side of a medical injector pen with the index finger, indicating the

Step C

Press the injection button and observe drops of medication coming out from the needle tip. While pressing, make sure the dose selector rotates back to the symbol (figure J).

Important: If you do not see drops of medication, repeat this test (steps A – C) up to 5 times. If no drops appear, change the needle and repeat the test.

Figure J

A hand holds a pre-filled syringe with magnified details on the base and tip of the

3 Prepare the injection and select the dose

Step 6

Choose the injection site. There are two

areas on your body where you can administer

the injection (Figure K).

Avoid injecting into red, swollen, or scarred skin.

Choose a different injection site each time you give an injection.

Diagram of a human body indicating injection sites on the

Step 7

Wash your hands and clean the injection site with an alcohol wipe (

Figure L).

Figure L

A hand uses an alcohol wipe to clean the skin of an arm with motions toward the

Step 8

Select your dose as directed by your doctor (15, 18, or 21 micrograms)

by turning the dose selector to the

right

(Figure M).

Important: Make sure not to press

the push-button when selecting the dose

to avoid wasting the medication.

Note: Always discard your pen and use

a new one if you cannot set a full dose.

Figure M

A hand holds a Yorvipath medical device with a magnified inset showing a digital screen and a green arrow pointing toward the

4 Inject the dose

Yellow rectangle with dark brown border containing the word CUIDADO in black uppercase serif font

Use the injection administration technique recommended by your

doctor or nurse.

Read the entire section (Steps 9–11) before starting to inject.

Step 9

Make sure you can see the dose window. Insert the needle into the

skin (Figure N).

Figure N

Medical illustration showing a hand pushing an autoinjector device toward the thigh with a green arrow indicating the movement

Step 10

Press the push-button fully down and

hold it firmly

for 5 seconds. Ensure that the

dose selector rotates back to the

symbol . This indicates that the full

dose has been administered

(Figure O).

Figure O

A hand holds an autoinjector pressed against the thigh with a green arrow and a timer indicating to wait 5 seconds

Step 11

Slowly remove the pen from the injection site. (Figure P)

Figure P

A hand holds an injector pen horizontally to bring it closer to the upper part of a light-colored arm

5 Dispose of the used needle

Step 12

Replace the needle cap to carefully remove the needle.

Place the needle tip into the cap and secure the cap onto the needle (Figure Q).

Important: Always replace the needle cap before removing the needle to reduce the risk of needlestick injury and cross-contamination.

Figure Q

A hand holds a syringe tilted to draw green liquid from a glass vial on a white surface

Step 13

Unscrew the needle and dispose of it

safely according to local regulations (Figure R).

Figure R

Two hands hold a white injectable pen with wavy green arrows indicating rotation or pressing motion for the

Step 14

Firmly attach the pen cap back onto the pen to protect it between injections and to shield the medication from light (Figure S).

Figure S

Two hands joining two parts of a white medical device with a green arrow indicating the snapping motion between components

6 Dispose of the used pen

Stylized calendar icon with the text Día and number 14 in the center on a white background with black border and three top rings

Important: Always dispose of the

pen 14 days after first use, in accordance with local regulations. To keep track of when 14 days have passed, it is recommended to cover the “Date of opening” field on the packaging.

Always discard your pen after

14 days of use, even if there is still medication remaining (Figure T). This is

important to ensure you receive

the full therapeutic effect of the medication.

Figure T

A white injectable pen is inserted into a medical waste disposal container via a curved green arrow

INSTRUCTIONS FOR USE

Yorvipath

420 micrograms/1.4 ml

For 24, 27, or 30 microgram doses only

Injectable solution in a pre-filled pen

palopegteriparatide

Subcutaneous route

The instructions for use contain
information on how to inject
Yorvipath

Additional information

If you do not understand or are unable to complete any of the steps described in the instructions for use, consult your doctor or nurse.

Important information you must know before starting to use your Yorvipath pen

Read and follow the package leaflet and these instructions for use carefully to ensure you inject Yorvipath properly.

Make sure you have received training from your doctor or nurse before administering the injection. This is important to ensure you receive the correct treatment.

For correct use

  • If you do not follow these instructions, you may not receive the correct dose and therefore may not get the full effect of your medicine.
  • If you are blind or have visual impairment, or difficulty concentrating, do not use your pen without help. Instead, ask someone who has been trained in the use of the Yorvipath pen to assist you.
  • Keep out of the sight and reach of children.
  • The pen and needles are for use by a single patient only.
  • Do not share your pen or needles with other people. This could cause an infection (cross-contamination).
  • Always dispose of your pen after 14 days, even if there is still medicine remaining. This is important to ensure you receive the correct effect of the medicine.
  • Always use the needles provided with the Yorvipath pen for your injections.
  • Remove the needle after each use. Do not store the pen with the needle attached.
  • Avoid bending or breaking the pen needle.
  • Do not change the injection angle after inserting the needle into the skin. Changing the angle may cause the needle to bend or break. A bent or broken needle may become lodged in the body or remain completely under the skin. If a broken needle becomes lodged in the body or under the skin, seek medical attention immediately.
  • Do not use needles if the needle cap or needle shield is damaged.

Special instructions for doses greater than 30 micrograms/day

If your dose is greater than 30 micrograms/day:

  • Administer two injections, one after the other, in different injection sites (refer to the recommended schedule table in section 3 of the Package Leaflet).
  • It is recommended to use a different Yorvipath pen for the second daily injection, even if both pens have the same color dose button (same concentration).
  • Follow the steps in the instructions for use for each injection.

Caring for the pen

  • Handle the pen carefully.
  • Keep the pen dry.
  • Use a damp cloth to clean the pen.
  • Do not drop your pen or hit it against hard surfaces. If this happens, test the pen flow again (section 2, steps A–C) before the next use.
  • Do not apply excessive force to your pen. It may be empty, damaged, or no longer functioning correctly.
  • Do not attempt to repair a damaged pen yourself.
  • Never use a damaged pen.

Troubleshooting

  1. How often should I test the pen flow?

You should only test the pen flow (section 2) the first time you use a new pen (or if you suspect it may be damaged) to avoid wasting medication. The test checks that the medicine flows through the pen so you can receive the correct dose.

  1. I do not see drops after testing the pen flow 5 times. What should I do?

If you do not see drops at the needle tip after 5 attempts, this may be because there is no flow through the pen and needle.

Change the needle (see section 5, step 12) and test the pen flow again (see section 2, steps A–C). You can confirm proper flow if you see a drop of medicine.

If it still does not work, discard the pen and consult your healthcare professional.

  1. How do I know when the injection is complete?

The injection is only complete when you press the dose button fully down, the dose selector has rotated back to , and you have kept the needle in the skin for 5 seconds.

  1. Why must I continue pressing the pen against the skin for 5 seconds?

Some of the medicine may flow back into the pen or leak out from the injection site onto the skin. Pressing the pen against the skin for 5 seconds helps ensure the full dose has been injected.

  1. I cannot set the dose selector to the required dose. What should I do?

The pen does not allow you to set a dose greater than the amount remaining.

If your dose is greater than the amount of medicine left in the pen, you will not be able to set the full dose. You must discard your pen and take the full dose using a new pen.

Overview of the parts

Technical diagram of a Yorvipath injectable pen showing droplets, dosages of 24, 27, or 30 micrograms, button, and dosage window

You will also need

Figure B

Medical diagram with needle, alcohol wipe, sharps disposal container, and details of the parts of the

1 Preparation of the pen and needle

Step 1

Take your Yorvipath pen. Make sure

it is the correct concentration and

check the expiration date. Take a

needle and check the expiration date on

the needle (Figure C).

Note: Remove your pen from the

refrigerator 20 minutes before first use.

Figure C

Diagram showing a Yorvipath medical device with a separated cap and a green question about whether the expiration date is correct

Step 2

Remove the pen cap and check the inspection window to ensure the medication inside

the pen is clear and colorless (Figure D).

Important: If the medication contains

visible particles, do not use the pen. Use

a new pen.

Figure D

Two hands hold an injectable pen to compare the top part of the device with a circular magnifier on a white background

Step 3

Remove the tab from the needle (Figure E).

This needle can only be used once.

Always use a new needle for each injection.

Figure E

A hand holds a medical device while the

Step 4

Place the needle straight onto your

pen, then screw the needle onto the

pen until secure (Figure F).

Figure F

Two hands hold an injectable pen while a green arrow indicates rotating and pressing motion for the

Step 5

Remove the needle cap and the inner

needle cover (Figure G).

Immediately discard the inner needle

cover and keep the outer needle cap

for later use.

Figure G

Two hands holding a pen-like medical device to attach a green protective cap onto the tip of the

  1. If the pen is new, perform a flow test

Stylized calendar icon with the text Día 1 in the center on a white background with black border and three holes in the top part

Horizontal yellow rectangle with thin brown border containing the word CUIDADO in black uppercase serif font

Perform the flow test (steps A–C) only the first time you use a

new pen.

If your pen is already in use, go to section 3 "Prepare the injection and

select the dose".

Step A

Turn the dose selector clockwise 2 clicks

until you see the drop symbol “” in the

dose window (Figure H).

Note: You can always correct the

selection by turning the dose selector.

Figure H

A hand holds a horizontal medical device with a magnified inset showing a green arrow pointing toward the

Step B

Bring air bubbles to the top of the pen by tapping the inspection window (Figure I). Hold

the pen with the needle tip pointing

upward.

Note: Small air bubbles are acceptable.

Figure I

A hand touches with the

Step C

Press the injection button and observe

medication drops coming out from the

needle tip. While pressing, ensure the

dose selector returns to the drop symbol

(Figure J).

Important: If you do not see medication

drops, repeat this test (steps A–C) up to

5 times. If no drops appear, replace the

needle and repeat the test.

Figure J

Medical illustration showing a hand holding a pre-filled syringe with magnified details of the mechanism and the

3 Prepare the injection and select the dose

Step 6

Choose the injection site. There are two

areas on your body where you can administer

the injection (Figure K).

Avoid injecting into red, swollen, or scarred

skin.

Choose a different injection site each

time you give an injection.

Stylized diagram of a human body indicating injection sites on the

Step 7

Wash your hands and clean the injection site with an alcohol swab

(Figure L).

Figure L

A hand cleans the skin with an alcohol wipe following a motion toward the

Step 8

Select your dose as directed by your doctor (24, 27, or 30 micrograms)

by turning the dose selector to the

right

(Figure M).

Important: Make sure not to press the button when selecting the dose

to avoid wasting the medication.

Note: Always discard your pen and use

a new one if you cannot set a full dose.

Figure M

A hand holds a Vorvypath medical device with a magnified inset showing a digital display and a double-pointed green arrow

4 Inject the dose

Yellow rectangle with dark brown border containing the word CUIDADO in uppercase brown letters

Use the injection administration technique recommended by your

doctor or nurse.

Read this entire section (Steps 9–11) before starting to inject.

Step 9

Make sure you can see the dose window. Insert the needle into the

skin (Figure N).

Figure N

A hand holds an injector pen to apply it to the arm skin with a green arrow indicating the movement toward the

Step 10

Press the button fully and hold it down firmly

for 5 seconds. Ensure that the dose selector rotates back to the symbol . This indicates that the full dose has been delivered

(Figure O).

Figure O

A hand presses a medical device applied to the thigh with a green arrow and the text '5 seconds' next to a timer

Step 11

Slowly remove the pen from the injection

site (Figure P).

Figure P

A hand holds an injectable pen horizontally to bring it closer to the upper part of the thigh or arm

5 Dispose of the used needle

Step 12

Replace the needle cap to carefully remove the needle.

Place the needle tip into the cap and secure the cap onto the

needle (Figure Q).

Important: Always replace the needle cap before removing the

needle to reduce the risk of needlestick injury

and cross-contamination.

Figure Q

A hand holds a syringe with dark liquid and removes the green protective cap from the tip of the

Step 13

Unscrew the needle and dispose of it safely according to local regulations

(Figure R).

Figure R

Two hands hold an injectable pen with green arrows indicating an up-and-down oscillating motion for the

Step 14

Firmly attach the pen cap onto the pen to protect it

between injections and to protect the

medication from light (Figure S).

Figure S

Two hands inserting a white cylindrical device into another component with a green arrow and the text ¡encaja!

6 Dispose of the used pen

Black calendar icon with the text Día and number 14 in the center on a white background

Important: Always dispose of the

pen 14 days after first use, in accordance with local regulations. To keep track of when

14 days have passed, it is recommended to cover the

“Date of opening” field on the inner packaging.

Always discard your pen after

14 days of use, even if there is

medication remaining (Figure T). This is

important to ensure you receive

the full effect of the medication.

Note: If the pen package includes

needles, remember to dispose of any additional

needles when discarding the pen.

Figure T

A white and purple injectable pen with a green arrow indicating its insertion into a gray waste disposal container