Denepra

Package leaflet: Information for the user

Denepra, 25 mg, prolonged-release injectable suspension in pre-filled syringe
Denepra, 50 mg, prolonged-release injectable suspension in pre-filled syringe
Denepra, 75 mg, prolonged-release injectable suspension in pre-filled syringe
Denepra, 100 mg, prolonged-release injectable suspension in pre-filled syringe
Denepra, 150 mg, prolonged-release injectable suspension in pre-filled syringe
Denepra, 150 mg and 100 mg, prolonged-release injectable suspension in pre-filled syringe
Paliperidone
Please read carefully the entire leaflet before using this medicine, as it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist, or nurse.
• If you experience any side effects, including any not listed in this leaflet, tell your doctor, pharmacist, or nurse. See section 4.

Leaflet contents

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

1. What Denepra is and what it is used for

Denepra contains the active substance paliperidone, which belongs to a group of medicines called antipsychotics. It is used for the maintenance treatment of symptoms of schizophrenia in stable adult patients previously treated with paliperidone or risperidone.
For patients who previously responded to oral paliperidone or risperidone and whose psychotic symptoms are mild to moderate, the doctor may initiate treatment with Denepra without prior stabilisation with paliperidone or risperidone.
Schizophrenia is a disorder characterised by "positive" and "negative" symptoms. Positive symptoms refer to the presence of abnormal experiences that are not usually present. For example, a person with schizophrenia may hear voices or see things that are not there (hallucinations), believe things that are not true (delusions), or be excessively suspicious of others. Negative symptoms refer to the absence or reduction of normal behaviours or emotions. A person with schizophrenia may appear withdrawn, emotionally flat, or have difficulty speaking clearly and logically. People with this condition may also experience depression, anxiety, feelings of guilt, or tension.
Denepra helps to reduce the symptoms of the illness and helps prevent their recurrence.

2. Important information before using Denepra

When not to use Denepra

• If the patient is allergic to paliperidone or any of the other ingredients of this medicine (listed in section 6).
• If the patient is allergic to another antipsychotic medicine, including the substance risperidone.

Warnings and precautions
Before starting treatment with Denepra, discuss this with your doctor, pharmacist, or nurse.
The use of this medicine in elderly patients with dementia has not been studied. However, in such patients treated with other similar medicines, there may be an increased risk of stroke or death (see section 4, "Possible side effects").
All medicines have side effects. Some of the side effects of this medicine may worsen symptoms of other medical conditions. For this reason, during treatment with this medicine, discuss with your doctor if any of the following conditions apply:

• if the patient has Parkinson's disease
• if the patient has ever been diagnosed with a condition characterised by symptoms such as high fever and muscle stiffness (also known as neuroleptic malignant syndrome)
• if the patient has ever experienced abnormal movements of the tongue or facial muscles (tardive dyskinesia)
• if the patient has previously had a low white blood cell count (which may or may not have been caused by other medicines)
• if the patient has diabetes or is predisposed to developing diabetes
• if the patient has breast cancer or a pituitary gland tumour
• if the patient has heart disease or is being treated for heart conditions that predispose to hypotension
• if the patient has low blood pressure upon sudden change to an upright or sitting position
• if the patient has epilepsy
• if the patient has impaired kidney function
• if the patient has impaired liver function
• if the patient experiences prolonged and/or painful erection
• if the patient has problems with body temperature regulation or overheating
• if the patient has abnormally increased levels of prolactin hormone in the blood or suspected prolactin-dependent tumour
• if the patient or their family has a history of blood clots in blood vessels, as antipsychotic medicines are associated with their occurrence.

If the patient meets any of the above criteria, they should consult their doctor, who may adjust the dose or monitor the patient periodically.
The treating doctor may order a white blood cell count test, as very rarely, dangerously low levels of certain types of white blood cells necessary to fight infections have been observed in patients taking this medicine.
Even if the patient previously tolerated oral paliperidone or risperidone well, allergic reactions may rarely occur after Denepra injections. Seek immediate medical help if the patient develops rash, throat swelling, itching, or breathing difficulties, as these may be symptoms of a severe allergic reaction.
This medicine may cause weight gain. Significant weight gain may negatively affect the patient's health. The treating doctor will regularly monitor the patient's body weight.
The treating doctor will monitor for symptoms of elevated blood sugar levels, as new-onset diabetes or worsening of pre-existing diabetes has been observed in patients taking this medicine. In patients with pre-existing diabetes, blood glucose levels should be monitored regularly.
Since this medicine may suppress vomiting, it may mask the body's normal response to ingestion of toxic substances or other medical conditions.
During cataract surgery, the pupil may not dilate sufficiently.
Also, the iris of the eye may be flaccid during surgery, which may result in eye damage.
If the patient has planned eye surgery, inform the ophthalmologist about taking this medicine.

Children and adolescents
This medicine is not intended for use in individuals under 18 years of age.

Denepra and other medicines
Inform your doctor about all medicines currently or recently taken, as well as any medicines the patient plans to take.
Taking this medicine together with carbamazepine (an antiepileptic and mood-stabilizing medicine) may require adjustment of the dose of this medicine.
Since this medicine acts primarily in the brain, interactions with other medicines acting on the brain, such as other psychotropic medicines, opioids, antihistamines, and sedatives, may increase side effects such as drowsiness or other central nervous system effects.
This medicine may lower blood pressure; therefore, caution is advised when using it concurrently with other medicines that lower blood pressure.
This medicine may reduce the effectiveness of medicines used in Parkinson's disease and restless legs syndrome (e.g. levodopa).
This medicine may cause electrocardiogram (ECG) abnormalities, manifested by prolongation of the time it takes for an electrical impulse to pass through a specific part of the heart (known as "QT interval prolongation"). Other medicines with such effects include those used to regulate heart rhythm or treat infections, as well as other antipsychotic medicines.
If the patient is prone to seizures, this medicine may increase the risk of their occurrence. Other medicines with such effects include certain antidepressants or antimicrobials, as well as other antipsychotic medicines.
Caution is advised when using Denepra together with medicines that increase central nervous system activity (psychostimulants such as methylphenidate).

Denepra and alcohol
Alcohol consumption should be avoided.

Pregnancy and breastfeeding
If the patient is pregnant or breastfeeding, suspects she may be pregnant, or is planning to have a child, she should consult her doctor or pharmacist before using this medicine.
This medicine should not be used during pregnancy unless discussed with a doctor.
Newborns whose mothers used paliperidone during the third trimester (last three months of pregnancy) may experience the following symptoms: tremors, muscle stiffness and/or weakness, drowsiness, agitation, breathing difficulties, and feeding problems. If such symptoms are observed in the newborn, contact a doctor.
This medicine may pass from the mother's body into breast milk and harm the infant. Therefore, breastfeeding should not be undertaken during treatment with this medicine.

Driving and operating machinery
During treatment with this medicine, dizziness, extreme tiredness, and vision disturbances may occur (see section 4). These effects should be taken into account in situations requiring full alertness, such as driving or operating machinery.

Denepra contains sodium and polisorbate
This medicine contains less than 1 mmol of sodium (23 mg) per dose, meaning the medicine is considered "sodium-free".
This medicine contains 12.0 mg of polisorbate 20 in each mL of paliperidone injection.
Polisorbates may cause allergic reactions. Inform your doctor of any known allergies.

3. How to use Denepra

The medicine is administered by a doctor or other healthcare professional. Your doctor will inform you when the next injection is due. It is important not to miss a scheduled dose. If you are unable to keep the scheduled appointment, you should contact your doctor immediately to arrange a new appointment as soon as possible.

The first (150 mg) and second (100 mg) injections of this medicine will be given into the upper arm, approximately one week apart. Afterwards, an injection (in a dose ranging from 25 mg to 150 mg) will be administered into the upper arm or buttock once a month.

If your doctor decides to switch you from long-acting risperidone injections to this medicine, the first injection of this medicine (in a dose ranging from 25 mg to 150 mg) will be given into the upper arm or buttock on the day the next scheduled risperidone injection was due. Afterwards, an injection (in a dose ranging from 25 mg to 150 mg) will be administered into the upper arm or buttock once a month.

Depending on your symptoms, your doctor may increase or decrease the dose by one level during your scheduled monthly injection.

Patients with kidney function impairment

Your doctor will adjust the dose of the medicine based on kidney function. If you have mild kidney impairment, your doctor may reduce the dose. This medicine should not be used in cases of moderate or severe kidney impairment.

Elderly patients

Your doctor may reduce the dose if you have impaired kidney function.

Use of a higher than recommended dose of Denepra

This medicine will be administered under medical supervision, so an overdose is unlikely.

In patients who have received an excessive dose of paliperidone, the following symptoms may occur: drowsiness and sedation, increased heart rate, low blood pressure, abnormal ECG (electrocardiogram) findings, or slowed or abnormal muscle movements of the face, body, arms, or legs.

Stopping treatment with Denepra

If you stop receiving the injections, the medicine will no longer work. Do not discontinue treatment unless instructed by your doctor, as symptoms of the illness may return.

If you have any further questions about the use of this medicine, please consult your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody will get them.
You should immediately inform your doctor if:

• the patient develops blood clots in the veins, especially in the legs (symptoms include swelling, pain and redness of the leg), which may travel through blood vessels to the lungs, causing chest pain and difficulty breathing. If such symptoms occur, seek immediate medical help.
• the patient with dementia experiences a sudden change in mental state or sudden weakness or numbness of the face, arms or legs, particularly on one side, or speech disturbances, even if brief. These symptoms may indicate a stroke.
• the patient develops fever, muscle stiffness, sweating or reduced level of consciousness (a condition called neuroleptic malignant syndrome). Immediate treatment may be necessary.
• the male patient experiences prolonged or painful erection. This condition is known as priapism. Immediate treatment may be required.
• involuntary rhythmic movements of the tongue, mouth or face occur. Discontinuation of paliperidone treatment may be necessary.
• the patient develops a severe allergic reaction characterized by: fever, swelling of the lips, face, tongue or mouth, shortness of breath, itching, skin rash, and sometimes low blood pressure (known as "anaphylactic reaction"). Even if the patient previously tolerated risperidone or oral paliperidone, allergic reactions may rarely occur after paliperidone injections.
• the patient has planned eye surgery. Inform the ophthalmologist that the patient is taking this medicine. During cataract removal, floppy iris syndrome may occur, which could lead to eye damage.
• the patient has dangerously low levels of certain white blood cells essential for fighting infections.

The following side effects may occur:
Very common side effects (may occur in more than 1 in 10 patients)

• difficulty falling asleep or waking up

Common side effects (may occur in less than 1 in 10 patients)

• cold-like symptoms, urinary tract infection, flu-like symptoms
• the medicine Denepra may increase the level of prolactin hormone in the blood (this may, but does not necessarily, cause symptoms). If symptoms of increased prolactin occur, they may include in men: breast swelling, difficulty achieving or maintaining erection, or other sexual disturbances. In women, they may include breast discomfort, milk discharge from the breasts, absence of menstrual bleeding or other menstrual cycle disturbances
• high blood sugar levels, weight gain, weight loss, decreased appetite
• irritability, depression, anxiety
• parkinsonism: this condition may involve slow or abnormal movements, feelings of stiffness or muscle tension (causing uneven, jerky movements), and sometimes even a sensation of "freezing" of movements followed by sudden release. Other symptoms of parkinsonism include: slow shuffling gait, resting tremor, increased salivation/drooling, and expressionless face
• psychomotor restlessness, feeling sleepy or drowsy
• dystonia: this condition involves slow or sustained involuntary muscle contractions. Although it may affect any part of the body (possibly resulting in abnormal body posture), dystonia most commonly affects facial muscles, including abnormal eye, mouth, tongue or jaw movements
• dizziness
• dyskinesia: this condition involves involuntary muscle movements and may present as repetitive, spasmodic or twisting movements or jerks
• tremor
• headache
• rapid heartbeat
• high blood pressure
• cough, stuffy nose
• abdominal pain, vomiting, nausea, constipation, diarrhoea, indigestion, toothache
• increased liver enzyme activity in blood
• bone or muscle pain, back pain, joint pain
• absence of menstruation
• fever, weakness, fatigue
• injection site reaction, including itching, pain or swelling

Uncommon side effects (may occur in less than 1 in 100 patients)

• pneumonia, bronchitis, respiratory tract infections, sinus infection, bladder infection, ear infection, fungal nail infection, tonsillitis, skin infection
• decreased number of white blood cells, decreased number of certain white blood cells protecting against infections, anaemia
• allergic reaction
• onset of diabetes or worsening of pre-existing diabetes, increased blood insulin levels (hormone regulating blood sugar levels)
• increased appetite
• loss of appetite leading to malnutrition and low body weight
• high blood triglyceride (fats) levels, increased blood cholesterol levels
• sleep disturbances, elevated mood (mania), decreased libido, nervousness, nightmares
• tardive dyskinesia (involuntary twitching or jerking movements of the face, tongue or other body parts). Inform your doctor immediately if involuntary rhythmic movements of the tongue, mouth or face occur. Discontinuation of this medicine may be necessary
• fainting, need to move body parts, dizziness upon standing, difficulty concentrating, speech difficulties, loss or altered sense of taste, reduced sensation to pain and touch on the skin, tingling, pricking or numbness of the skin
• blurred vision, eye infection or conjunctivitis, dry eyes
• sensation of dizziness, ringing in the ears, ear pain
• conduction block of impulses between heart chambers, abnormal conduction of electrical impulses in the heart, QT interval prolongation in the heart, rapid heartbeat upon standing, slow heartbeat, abnormal electrocardiogram (ECG), sensation of heart palpitations
• low blood pressure, low blood pressure upon standing (as a result of which some patients taking this medicine may faint, feel dizzy or lose consciousness when standing up suddenly)
• shortness of breath, sore throat, nosebleed
• abdominal discomfort, stomach or intestinal infection, difficulty swallowing, dry mouth
• excessive passing of gas
• increased activity of the enzyme GGTP (liver enzyme - gamma-glutamyl transferase) in blood, increased liver enzyme activity in blood
• hives, itching, rash, hair loss, skin eruption, dry skin, skin redness, acne, subcutaneous abscess
• increased activity of CPK (creatine phosphokinase) in blood, an enzyme sometimes released from damaged muscles
• muscle cramps, joint stiffness, muscle weakness
• urinary incontinence, frequent urination, painful urination
• erectile dysfunction, ejaculation disorders, absence of menstruation and other menstrual cycle disturbances (in women), breast enlargement in men, sexual disturbances, breast pain, galactorrhoea
• swelling of the face, lips, eyes or mouth, body swelling, swelling of upper or lower limbs
• increased body temperature
• change in gait
• chest pain, chest discomfort, malaise
• skin hardening
• fall

Rare side effects (may occur in less than 1 in 1,000 patients)

• eye infection
• skin inflammation caused by mites, scaly and itchy scalp or other body parts
• increased number of eosinophils (a type of white blood cells) in blood
• decreased number of platelets (blood cells responsible for stopping bleeding)
• head tremors
• abnormal secretion of the hormone regulating urine output
• glucose in urine
• life-threatening complications of untreated diabetes
• low blood sugar levels
• excessive water drinking
• lack of movement and response to stimuli in a patient who is not asleep (catatonia)
• disorientation
• sleepwalking
• lack of emotion
• inability to achieve orgasm
• neuroleptic malignant syndrome (disorientation, reduced or loss of consciousness, high fever and severe muscle rigidity), cerebrovascular disorders including sudden interruption of blood flow to the brain (stroke or "mini" stroke), lack of response to stimuli, loss of consciousness, reduced level of consciousness, seizures, balance disturbances
• abnormal motor coordination
• glaucoma (increased pressure in the eyeball)
• eye movement disorders, rotary eye movements, light sensitivity, increased tearing, red eyes
• atrial fibrillation (irregular heartbeat), irregular heartbeat
• blood clot in the lungs causing chest pain and difficulty breathing. If such symptoms occur, seek immediate medical help
• blood clots in veins, particularly in the lower limbs (symptoms include swelling, pain and redness of the lower limbs). If such symptoms occur, seek immediate medical help
• flushing attacks
• breathing disturbances during sleep (sleep apnoea)
• blood congestion in the lungs, congestion of the airways
• crackling sounds in the lungs, wheezing
• pancreatitis, tongue swelling, faecal incontinence, very hard stool
• intestinal obstruction
• chapped lips
• drug-related skin rash, skin thickening, seborrhoea
• breakdown of muscle fibres and muscle pain (rhabdomyolysis)
• joint swelling
• inability to urinate
• breast discomfort, enlargement of mammary glands, breast enlargement
• vaginal discharge
• priapism (prolonged erection which may require surgical intervention)
• very low body temperature, chills, feeling of thirst
• withdrawal symptoms
• abscess due to infection at injection site, deep skin infection, cyst at injection site, bruising at injection site

Side effects of unknown frequency (frequency cannot be estimated from available data)

• dangerously low number of certain white blood cells responsible for fighting infections;
• severe allergic reaction characterized by fever, swelling of lips, face, mouth or tongue, shallow breathing, itching, skin rash, and sometimes low blood pressure
• dangerously excessive water drinking - water intoxication
• eating disorders related to sleep
• coma due to uncontrolled diabetes
• reduced oxygenation of various body parts (due to reduced blood flow)
• rapid, shallow breathing, pneumonia caused by food aspiration, voice disturbances
• lack of intestinal peristalsis leading to obstruction
• yellowing of the skin and eyes (jaundice)
• severe or life-threatening blistering rash with skin peeling, which may appear in the mouth, nose, eyes, genital organs and around these areas and may also spread to other parts of the body (Stevens-Johnson syndrome or toxic epidermal necrolysis)
• severe allergic reaction with swelling which may involve the larynx and lead to breathing difficulties
• skin depigmentation
• abnormal body posture
• in newborns whose mothers used Denepra during pregnancy, adverse drug reactions and (or) withdrawal symptoms may occur, such as: irritability, slow or sustained muscle contractions, tremor, drowsiness, breathing difficulties and feeding problems
• decreased body temperature
• necrosis at injection site and ulceration at injection site

Reporting of side effects
If any side effects occur, including any side effects not listed in this leaflet,
you should inform your doctor or pharmacist. Side effects can be reported directly to the Department of Monitoring of Adverse Drug Reactions at the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products:
Al. Jerozolimskie 181C, 02-222 Warsaw
tel.: +48 22 49 21 301, fax: +48 22 49 21 309,
website: https://smz.ezdrowie.gov.pl
Side effects can also be reported to the marketing authorization holder.
Reporting side effects helps provide more information on the safety of this medicine.

5. How to store Denepra

Keep this medicine out of sight and reach of children.
Do not use this medicine after the expiry date stated on the carton
and on the pre-filled syringe.
The expiry date refers to the last day of the stated month.
Do not freeze.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. This will help protect
the environment.

6. Contents of the pack and other information

What Denepra contains
25 mg: Each pre-filled syringe contains 39 mg of paliperidone palmitate in 0.25 mL of suspension,
equivalent to 25 mg of paliperidone.
50 mg: Each pre-filled syringe contains 78 mg of paliperidone palmitate in 0.5 mL of suspension,
equivalent to 50 mg of paliperidone.
75 mg: Each pre-filled syringe contains 117 mg of paliperidone palmitate in 0.75 mL of suspension,
equivalent to 75 mg of paliperidone.
100 mg: Each pre-filled syringe contains 156 mg of paliperidone palmitate in 1 mL of suspension,
equivalent to 100 mg of paliperidone.
150 mg: Each pre-filled syringe contains 234 mg of paliperidone palmitate in 1.5 mL of suspension,
equivalent to 150 mg of paliperidone.
Initiating treatment pack
Each 100 mg pre-filled syringe: contains 156 mg of paliperidone palmitate in 1 mL of suspension,
equivalent to 100 mg of paliperidone.
Each 150 mg pre-filled syringe: contains 234 mg of paliperidone palmitate in 1.5 mL of suspension,
equivalent to 150 mg of paliperidone.
Other ingredients:
polysorbate 20, macrogol 4000, citric acid monohydrate, disodium phosphate, monosodium phosphate monohydrate, sodium hydroxide (for pH adjustment), water for injections.

What Denepra looks like and contents of the pack
Denepra is a white to off-white extended-release suspension for injection in a pre-filled syringe.
The pre-filled syringe (colourless type I glass) is fitted with a bromobutyl rubber plunger stopper, a lock, and a "tip-cap" made of bromobutyl rubber, and comes with two needles: 22G 1½ inch (35.5–39.5 mm) and 23G 1 inch (22.5–26.5 mm).
Outer packaging: PET blister packed in a cardboard carton.
Each pack contains 1 pre-filled syringe and 2 needles.
Each treatment initiation pack contains:

• 1 pack of Denepra 150 mg, 1 pre-filled syringe and 2 needles (for administration on day 1 of treatment)
• 1 pack of Denepra 100 mg, 1 pre-filled syringe and 2 needles (for administration on day 8 of treatment).

Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Sandoz Polska Sp. z o.o.
ul. Domaniewska 50C
02-672 Warszawa
Poland
tel. 22 209 70 00

Manufacturer/Importer
Pharmascience International Limited
1st Floor Jacovides Tower
81-83 Griva Digeni Avenue
1090 Nicosia
Cyprus
Lek Pharmaceuticals d.d.
Verovskova Ulica 57
1526 Ljubljana
Slovenia

This medicinal product is authorised for marketing in the European Economic Area under the following names:
Austria Denepra 25 mg - Depot-Injektionssuspension
Denepra 50 mg - Depot-Injektionssuspension
Denepra 75 mg - Depot-Injektionssuspension
Denepra 100 mg - Depot-Injektionssuspension
Denepra 150 mg - Depot-Injektionssuspension
Denepra Starterpackung 100 mg + 150 mg - Depot-Injektionssuspension
Czech Republic Denepra
Spain Denepra 50 mg suspensión inyectable de liberación prolongada EFG
Denepra 75 mg suspensión inyectable de liberación prolongada EFG
Denepra 100 mg suspensión inyectable de liberación prolongada EFG
Denepra 150 mg suspensión inyectable de liberación prolongada EFG
Denepra 100 mg + Denepra 150 mg suspensión inyectable de liberación prolongada EFG (starterpack)
Croatia Denepra 50 mg suspenzija za injekciju s produljenim oslobađanjem u napunjenoj štrcaljki
Denepra 75 mg suspenzija za injekciju s produljenim oslobađanjem u napunjenoj štrcaljki
Denepra 100 mg suspenzija za injekciju s produljenim oslobađanjem u napunjenoj štrcaljki
Denepra 150 mg suspenzija za injekciju s produljenim oslobađanjem u napunjenoj štrcaljki
Poland Denepra
Sweden Denepra

Information intended exclusively for medical personnel or healthcare professionals and must be read together with the full product information (Summary of Product Characteristics).

The suspension for injection is intended for single use only. Before administration, inspect the suspension for the presence of foreign particles. If foreign particles are visible in the prefilled syringe, do not use the medicinal product.

The package contains one prefilled syringe and two safety needles [22G 1.5 inch (35.5–39.5 mm) and 23G 1 inch (22.5–26.5 mm)] for intramuscular administration. The medicinal product Denepra is also available in a starter pack containing two prefilled syringes (150 mg + 100 mg) and two additional safety needles.

(A) 22 G x 1 inch (gray hub)
(B) 23 G x 1 inch (blue hub)
(C) Prefilled syringe
(D) Hub
(E) Tip cap

1. Shake the prefilled syringe vigorously for at least 10 seconds to ensure homogeneity of the suspension.

2. Select the appropriate needle.

The first initiating dose of the medicinal product Denepra (150 mg) should be administered on
day 1 of treatment into the DELTOID MUSCLE using the DELTOID MUSCLE needle. The second initiating dose of the medicinal product Denepra (100 mg) should be administered one week later (day 8), also into the DELTOID MUSCLE using the DELTOID MUSCLE needle.

If switching from long-acting risperidone injections to the medicinal product Denepra, the first injection of Denepra (at a dose between 25 mg and 150 mg) may be administered either into the DELTOID MUSCLE or the GLUTEAL MUSCLE using the appropriate needle on the day of the next scheduled injection.
Subsequently, monthly maintenance doses may be administered into either the DELTOID MUSCLE or the GLUTEAL MUSCLE using the appropriate needle.

For injections into the DELTOID MUSCLE in patients with body weight <90 kg, use a 1-inch, 23 G (22.5–26.5 mm) needle (blue hub). If the patient's body weight is ≥90 kg, use a 1.5-inch, 22 G (35.5–39.5 mm) needle (gray hub).
For injections into the GLUTEAL MUSCLE, use a 1.5-inch, 22 G needle (gray hub).

3. Hold the syringe vertically with the tip pointing upwards. Remove the rubber tip cap with a gentle twisting motion.

4. Peel off the protective needle cover. Hold the base of the needle, not the protective cover. Attach the safety needle to the syringe’s Luer connector by pressing and turning clockwise.

5. Remove the needle cover with a straight pull. Do not rotate the cover, as this may loosen the needle from the prefilled syringe.

6. Remove air from the prefilled syringe by gently pressing the plunger while holding the syringe in an upright position.

7. Inject the entire contents of the prefilled syringe intramuscularly, slowly and deeply, into the selected muscle of the patient—either the deltoid or gluteal muscle. Do not administer the medicinal product intravenously or subcutaneously.

8. After completing the injection, secure the needle using the thumb or finger of one hand (8a, 8b), or a flat surface (8c). A clicking sound indicates that the needle has been properly secured. Dispose of the prefilled syringe with needle appropriately.

8a

8b

8c

Any unused portions or waste material must be disposed of in accordance with local regulations.