Getting Started with PEGASYS Therapy

Pre-filled Syringes - Before You Inject

Keep it cool

• PEGASYS must be kept in the refrigerator (36^oF-46^oF/2^oC-8^oC), but never frozen. Avoid exposing PEGASYS to direct sunlight

Choose a setting

• Find a clean, comfortable area
• Have all medical supplies within reach

Make sure your PEGASYS Pre-filled Syringes Monthly Convenience Pack contains the following items:

• 4 syringes filled with medicine
• 4 needles
• Alcohol pads

Before you begin, you'll need (see visual A)

• 1 PEGASYS Pre-filled Syringe
• 1 needle with needle guard
• A puncture-resistant container (sharps container)
• Alcohol pad

Always inspect the syringe and the contents inside the syringe. DO NOT use PEGASYS if:

• The syringe is cracked or broken
• Medicine is cloudy
• Medicine has particles floating in it
• Medicine is any color besides colorless or light yellow
• Expiration date has passed

If you notice any of these things, call your doctor or pharmacist to let them know and to obtain a replacement. Note: These instructions are the patient self-injection procedure for PEGASYS. They are not meant to offer instruction for the administration of any other type of medication. Perform this procedure only after consultation with your doctor on the use of PEGASYS.

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Pre-filled Syringes - Injecting PEGASYS

To ensure maximum safety and comfort, please follow these steps during the self-injection process.

Step 1: Warm the refrigerated medicine by gently rolling the syringe in your hands for 1 minute. DO NOT SHAKE

Step 2: Wash hands with soap and warm water to prevent infection

• Dry your hands with a paper towel and use the towel to turn off the faucet so you don't contaminate your hands

Step 3: Attach needle to syringe

• Remove needle from package (DO NOT remove the plastic cap from the needle. Keep needle covered until the time of injection)
• Remove and throw away the rubber cap on the tip of syringe
• Put needle on the end of syringe barrel so that it fits tightly (see visual B)

CHECKPOINT: If you need to put down the syringe, make sure the plastic cap covers the needle. NEVER let the needle touch any surface.

Step 4: Decide where to self-inject

• Pick a place on stomach or thigh. Avoid the navel and any place where you cannot get a good pinch of flesh
• Pick a different spot each time you give yourself an injection

Step 5: Prepare skin for injection

• To avoid any discomfort, gently tap the area you plan to give yourself the injection
• Clean the area with an alcohol pad
• Let the skin dry for approximately 10 seconds

Step 6: Uncover the needle

• Remove the plastic cap from the shield

CHECKPOINT: DO NOT REMOVE the needle guard attached to the syringe above the needle. It is a safety device that is intended to help protect you and others from accidental needlesticks.

Step 7: Remove air bubbles from syringe

• Hold syringe with needle pointed toward the ceiling
• Using the thumb and finger, tap syringe to bring air bubbles to the top
• Press plunger in slightly to push air bubbles out of the syringe

CHECKPOINT: Depending on the dose your doctor has prescribed, you may have to drain off some of the medicine prior to injection. The syringe has markings for 180 mcg, 135 mcg, and 90 mcg (see visual C). Your doctor will tell you which mark to use.

• Once you know which mark to use, slowly and carefully push down on the red plunger rod of the syringe to push out excess medicine. Keep pushing down until the edge of the plunger stopper reaches the right mark on the side of the syringe
• DO NOT decrease your PEGASYS dose unless your doctor tells you to
• DO NOT save or reuse any medication discharged from the syringe

Step 8: Perform the self-injection

• Position the point of the needle (the bevel) so it's facing up (see visual D)
• Pinch a fold of skin on the stomach or thigh firmly with your thumb and forefinger (see visuals E, F)
• 
  Hold the syringe like a pencil at a 45^o to 90^o angle over your skin, and in a quick motion, insert the needle as far as it will go into the pinched area of skin
  
  
  
  
  
  
  
  
  
  
  

CHECKPOINT: Pull the plunger of the syringe back very slightly. If blood comes into the syringe, the needle has entered a blood vessel. DO NOT INJECT. Withdraw needle and discard syringe as outlined in "Cleaning up" above. Repeat the steps in "Injecting PEGASYS" with a new pre-filled syringe.

• If no blood appears, release your skin and slowly push the plunger all the way down so that you get all of your medicine
• Pull out the needle at the same angle you inserted it. Wipe the area clean with an alcohol pad

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Pre-filled Syringes - Cleaning up

Before you throw out the syringe and needle, place the end of the needle guard on a flat surface and push down on it until it clicks and covers the needle (see visual G). ALWAYS put used syringes and needles in a sharps container immediately after use (see visual H).

NEVER REUSE SYRINGES AND NEEDLES.

             

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Vials - Before You Begin

Here are a few things to remember:

Keep it cool

• PEGASYS must be kept in the refrigerator (36^oF-46^oF/2^oC-8^oC), but never frozen. Avoid exposing PEGASYS to direct sunlight

Keep it fresh

• Do not use past the expiration date

Keep it clean

• Be sure to wash hands thoroughly before beginning the injection process
• Use alcohol swabs to clean the injection site, top of vial, etc., as directed in the video and this guide

Keep it consistent

• Be sure to inject the amount of medication your doctor has prescribed
• Take PEGASYS at the same time every week — pick a time that will be practical for you consistently from week to week.

Keep in contact

• If you have any discomfort following injection (such as redness, irritation or swelling) or experience any other side effects, please contact your doctor.

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Vials - Preparing to Self-inject

Note: This guide contains the patient self-injection procedure for PEGASYS^®(Peginterferon alfa-2a). It is not meant to offer instruction for the administration of any other type of medication. Perform this procedure only after consultation with your doctor on the use of PEGASYS.

Choose a setting

• Find a clean, comfortable area
• Have all medical supplies within reach

Before you begin, you'll need the following:

• One vial of PEGASYS (taken out of the refrigerator)
• An unused syringe and needle
  • Your needle may or may not have a needleguard
  • Needleguard use will be explained later in these instructions
• Two alcohol swabs
• Plastic container for disposing of used needles (sharps container)

Warming the Vial

• Remove the vial from its package and look at the medicine
  • Do not use if the medicine is cloudy, has particles in it, or is any color besides colorless or light yellow
• Gently warm the vial by rolling in the palms of your hands for about 1 minute
  • Be careful not to SHAKE up the medicine

Avoiding germs and infection

• Wash your hands with soap and warm water to help avoid infection
• Be sure to give them a good rinse, and then dry them with a clean paper towel
• Use the towel to turn off the water, so you don't contaminate your hands

Preparing the vial

• Use your thumb to flip off the plastic top covering the vial opening
• Clean the rubber stopper in the vial with a new alcohol swab; leave on top of vial when finished

Preparing the needle

• Make sure the needle and syringe are sterile
  • If you see any tears or damage to the packaging, do not use
  • Always throw out needles by placing them in a sharps container
• Remove the needle and the syringe from their packaging
  • You may need to attach the needle to the end of the syringe; do not remove the plastic cap from the needle
• If you need to set the syringe down, make sure the plastic shield covers the needle. Never let the needle touch any surface

Preparing the syringe

• Remove the plastic cap from the needle
• Pull back on the syringe plunger to the mark directed to you by your doctor, which will put air into the syringe
  • If you are unsure of what mark to use, contact your doctor immediately
• Remove the alcohol swab from the top of the vial and push the needle through the center of the stopper on the medicine vial

Removing air from the syringe

• Slowly inject all the air from the syringe into the air space above the medication
  • Do not inject air into the medication

Drawing medication into the syringe

• While keeping needle in vial, turn both upside down
• Hold vial and syringe straight up
• Make sure the needle is now in the liquid to avoid formation of bubbles in the syringe
• Slowly pull medicine into the syringe by pulling plunger back to the mark specified by your doctor. If there are no bubbles in the syringe, then pull the needle out of the vial
  • If you do see bubbles in the syringe, lightly tap the syringe to bring air bubbles to the top
  • Gently press the plunger in slightly to push air out of the syringe

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Vials - Taking Your PEGASYS Injection

Choosing and preparing the injection site

• PEGASYS^® (Peginterferon alfa-2a) should be injected in your stomach area or the tops of your thighs.
  • Avoid your navel and waistline
• NEVER inject PEGASYS into a vein; if you see veins near the surface, be sure to avoid them
• Rotate injection sites to prevent soreness in one spot
• Clean the injection area with an alcohol swab and let the skin dry

Preparing the skin

• Grab the skin at the injection site firmly between your thumb and forefinger to elevate your skin

Positioning the needle

• Make sure the bevel (flat edge) or the needle is facing up

Injecting the medication

• Hold the syringe at a 45^o angle to your skin
• Insert the needle as far as it will go in one quick motion
• Gently pull back the plunger and check to see if any blood appears in the syringe, indicating you are in a vein
• If blood appears in the syringe, discard the syringe in the sharps container and start over. Do not attempt to recap the needle
• If no blood appears in the syringe, release your skin and slowly push the plunger all the way down to make sure you get all of your medication
• Pull out the needle at the same angle you put it in
• Wipe the injection area with an alcohol swab

Closing the needleguard (if present)

• If your needle has a needleguard attached, engage the needleguard by pressing it against a hard object until it snaps into place
• If there is no needleguard, do not attempt to recap the needle

Cleaning up

• Once you have finished injecting, place the syringe and needle in a puncture-resistant sharps container immediately
  • When full, these containers must be thrown away following the directions given to you by your doctor

NEVER REUSE SYRINGES AND NEEDLES.

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