SOMAVERT20mgpowderandsolventforsolutionforinjection

SOMAVERTisusedforthetreatmentofacromegaly,ahormonaldisorderresultingfromtheincreasedsecretionofgrowthhormone(GH)andIGF-I(Insulin-likegrowthfactors),whichischaracterisedbyovergrowthofbone,softtissueswelling,heartdiseaseandrelateddisorders.

SOMAVERTisaproductofbiotechnology.TheactivesubstanceinSOMAVERT,pegvisomantisknownasagrowthhormonereceptorantagonist.ThesesubstancesdecreasetheactionofGHandlevelsofIGF-Icirculatingintheblood.

DonotuseSOMAVERT

If you are allergic hypersensitive to pegvisomant or any of the other ingredients ofSOMAVERT

TakespecialcarewithSOMAVERT

• IfyouexperiencedisturbedvisionorheadacheswhileusingSOMAVERTyoumustcontactyourdoctorimmediately.
• YourdoctorornursewillmonitorthelevelsofIGF-I(Insulin-likegrowthfactors)circulatinginthebloodandadjustthedoseofSOMAVERTifnecessary.
• Yourdoctorshouldalsomonitoryouradenoma(benigntumour).
• Yourdoctorornursewillmonitorthelevelofliverenzymesinthebloodevery4-6weeksforthefirstsixmonthsoftreatmentwithSOMAVERT.AdministrationofSOMAVERTshouldbediscontinuedifsignsofliverdiseasepersist.
• Ifyouarediabetic,yourdoctormayneedtoadjusttheamountofinsulinorothermedicinesyouareusing.
• Femalepatientsshoulduseadequatecontraceptionasfertilitymaybeincreased.SeealsothesectionaboutPregnancybelow.

Usingothermedicines

Youmusttellyourdoctorifyouhavepreviouslyusedothermedicinesforthetreatmentofacromegalyormedicinesforthetreatmentofdiabetes.

Pleasetellyourdoctororpharmacistifyouareusingorhaverecentlyusedanyothermedicines,includingmedicinesobtainedwithoutaprescription.

Aspartofyourtreatmentyoumaybegivenothermedicines.ItisimportanttokeepusingallyourmedicinesaswellasSOMAVERTunlessyouaretoldotherwisebyyourdoctororpharmacist.

Pregnancyandbreast-feeding

TheeffectsofSOMAVERTinpregnantwomenarenotknown,andsotheuseofSOMAVERTinpregnantwomenisnotrecommended.YouareadvisedtonotbecomepregnantwhiletakingSOMAVERTtherapy.Incaseyoubecomepregnant,youmustconsultyourdoctor.Askyourdoctororpharmacistforadvicebeforetakinganymedicine.

ItisnotknownifSOMAVERTpassesintobreastmilk.Youshouldnotbreast-feedwhiletakingSOMAVERTunlessyourdoctorhasdiscussedthiswithyou.

Drivingandusingmachines

Nostudiesontheeffectsontheabilitytodriveandusemachineshavebeenperformed.

ImportantinformationaboutsomeoftheingredientsofSOMAVERT

Thismedicinalproductcontainslessthan1mmolsodium(23mg)per10mgdose,lessthan1mmolsodium(23mg)per15mgdose,orlessthan1mmolsodium(23mg)per20mgdosei.e.essentially?sodium-free?.

AlwaysinjectSOMAVERTexactlyasyourdoctorhastoldyou.Youshouldcheckwithyourdoctororpharmacistifyouarenotsure.

Astartingdoseof80mgofSOMAVERTwillbegivensubcutaneously(justundertheskin)byyourdoctor.Followingthis,theusualdailydoseofSOMAVERTis10mg,whichisgivenbysubcutaneousinjection(justundertheskin).

Everyfourtosixweeksyourdoctorwillmakeappropriatedoseadjustments,madeinincrementsof5mgpegvisomant/day,basedonyourso-calledserumIGF-Ilevelstomaintainanoptimaltherapeuticresponse.

Methodandrouteofadministration

SOMAVERTisinjectedundertheskin.Theinjectioncanbeself-administeredorgivenbyanotherperson,forexampleyourdoctororhis/herassistant.Thedetailedinstructionsoninjectionprocedureprovidedattheendofthisleafletmustbefollowed.YoushouldcontinuetoinjectSOMAVERTforaslongasinstructedbyyourdoctor.

SOMAVERTmustbedissolvedbeforeuse.Theinjectionmustnotbemixedinthesamesyringeorvialasanyothermedicine.

Fattytissueoftheskincanbuild-upatthesiteofinjection.Toavoidthis,useaslightlydifferentplaceforyourinjectioneachtime,asdescribedinStep2ofthe?InstructionsforPreparingandGivinganInjectionofSomavert?sectionofthisleaflet.Thisgivesyourskinandtheareaunderyourskintimetorecoverfromoneinjectionbeforeitreceivesanotheroneinthesameplace.

IfyouhavetheimpressionthattheeffectofSOMAVERTistoostrongortooweak,talktoyourdoctororpharmacist.

IfyouinjectmoreSOMAVERTthanyoushould

IfyouaccidentallyinjectmoreSOMAVERTthantoldtobyyourdoctoritisunlikelytobeserious,butyoushouldcontactyourdoctororpharmacistimmediately.

IfyouforgettouseSOMAVERT

IfyouforgettogiveyourselfaninjectionyoushouldinjectthenextdoseassoonasyourememberandthencontinuetoinjectSOMAVERTasprescribedbyyourdoctor.Donotinjectadoubledosetomakeupforforgottenindividualdoses.

Ifyouhaveanyfurtherquestionsontheuseofthisproduct,askyourdoctororpharmacist.

Likeallmedicines,SOMAVERTcancausesideeffects,althoughnoteverybodygetsthem.

Commonsideeffects(likelytooccurinfewerthan1in10patients)include:

Headache, dizziness, sleepiness, uncontrolled trembling.Diarrhoea, constipation, feeling sick, being sick, feeling bloated, indigestion, gas.Sweating, itching, rash.Joint pain, muscle pain, swelling of the extremities.Increased blood cholesterol, weight gain, increased blood glucose, increased appetite.Increased blood pressure.Bruising or bleeding at injection site, soreness or swelling at injection site, build up of fatbelow the surface of the skin at injection site.Flu-like illness, fatigue.Increased levels of substances that measure the function of the liver. These can be seen in theresults of blood tests.Abnormal dreams, problems sleeping

Uncommonsideeffects(likelytooccurinfewerthan1in100patients)include:

Decreased platelets in the blood, increased or decreased white cells in the blood, tendency tobleed.Decreased sense of touch, abnormal sense of taste, migraine.Eyestrain, eye pain, inner ear problems.Shortness of breath.Dry mouth, increased saliva, tooth problems, hemorrhoids.Blood in the urine, protein in the urine, increased urine, kidney problems

Facial swelling, dry skin, tendency to bruise, night sweats.Arthritis.Increased fatty substances in the blood, decreased blood glucose.Fever, weakness, feeling abnormal, impaired healing.Anger, lack of interest, feeling confused, increased sex drive, panic attack, loss of memory

Ifanyofthesideeffectsgetsserious,orifyounoticeanysideeffectsnotlistedinthisleaflet,pleasetellyourdoctororpharmacist.

About17%ofpatientswilldevelopantibodiestogrowthhormoneduringtreatment.TheantibodiesdonotseemtostopSOMAVERTfromworking.

Keepoutofthereachandsightofchildren

DonotuseSOMAVERTaftertheexpirydatewhichisstatedonthevialandthecartonafterEXP.Theexpirydatereferstothelastdayofthatmonth.

Storeinarefrigerator(2-C?8-C).Donotfreeze.Keepthevialsintheoutercartoninordertoprotectfromlight.

AfterpreparingtheSOMAVERTsolutionitmustbeusedimmediately.CarefullydisposeofanySOMAVERTsolutionthathasnotbeeninjected.

DonotuseSOMAVERTifyounoticethatthesolutioniscloudyorcontainsparticulatematter.

Medicinesshouldnotbedisposedofviawastewaterorhouseholdwaste.Askyourpharmacisthowtodisposeofmedicinesnolongerrequired.Thesemeasureswillhelptoprotecttheenvironment.

WhatSOMAVERTcontains

• Theactivesubstanceispegvisomant.
• Onevialofpowdercontainseither10mg,15mg,or20mg.Afterreconstitutionwith1mlofsolvent,1mloftheclearsolutioncontainseither10mg,15mgor20mgpegvisomant.
• Theotheringredientsareglycine,mannitol(E421),sodiumphosphatedibasicanhydrousandsodiumphosphatemonobasicmonohydrate.
• Thesolventiswaterforinjections.Onevialofsolventcontains8mlwaterforinjections.

WhatSOMAVERTlookslikeandcontentsofthepack

SOMAVERTispresentedasapowderandasolventforinjection,inavial.Powderinavial(either10mg,15mg,or20mgpegvisomant)andsolventinavial(8ml).Packsizesof1and30.Notallpacksizesaremarketed.Thepowderiswhiteandthesolventisclearandcolourless.

MarketingAuthorisationholder:

PfizerLimited
Sandwich
KentCT139NJ
UnitedKingdom

Manufacturer:

PfizerManufacturingBelgiumNV
Rijksweg12
2870Puurs
Belgium

Foranyinformationaboutthismedicine,pleasecontactthelocalrepresentativeoftheMarketingAuthorisationHolder.

BelgiëBelgiqueBelgienPfizer S.A.N.V.TélTel 32 02 554 62 11 LuxembourgLuxemburgPfizer S.A.TélTel 32 02 554 62 1

, . 359 2 970 4333 Magyarország Pfizer Kft.Tel. 36 1 488 37 0

eská republika Pfizer s.r.o.Tel 420 283 004 111 Malta V.J. Salomone Pharma Ltd.Tel 356 21 22 01 7

DanmarkPfizer ApSTlf 45 44 20 11 00 NederlandPfizer bvTel 31 010 406 43 0

DeutschlandPfizer Pharma GmbHTel 49 030 550055 51000 NorgePfizer ASTlf 47 67 52 61 0

EestiPfizer Luxembourg SARL Eesti filiaalTel 372 6 405 328 ÖsterreichPfizer Corporation Austria Ges.m.b.H.Tel 43 01 521 15-

Pfizer Hellas A.E. 30 210 6785800 Polska Pfizer Polska Sp. z o.o.Tel. 48 22 335 61 0

EspañaPfizer S.A.Tel 34 91 490 99 00 PortugalLaboratórios Pfizer, Lda.Tel 351 21 423 550

FrancePfizerTél 33 01 58 07 34 40 RomâniaPfizer România S.R.L.Tel 40 021 207 28 0

IrelandPfizer Healthcare IrelandSlovenijaPfizer Luxembourg SARL, Pfizer, podrunica zasvetovanje s podroja farmacevtske dejavnosti, LjubljanaTel 386 01 52 11 400Tel 1800 633 363 toll free44 01304 61616

ÍslandIcepharma hf. Sími 354 540 8000 Slovenská republikaPfizer Luxembourg SARL, organizaná zlokaTel 421 2 3355 550

ItaliaPfizer Italia S.r.l.Tel 39 06 33 18 21 SuomiFinlandPfizer OyPuhTel 358 09 43 00 4

Geo. Pavlides Araouzos Ltd, 35722818087 Sverige Pfizer ABTel 46 08 55052000

Latvija United KingdomPfizer Luxembourg SARL filile LatvijTel 371 670 35 775 Pfizer LimitedTel 44 01304 61616

Lietuva

PfizerLuxembourgSARLfilialasLietuvoje
Tel.+37052514000

Thisleafletwaslastapprovedin{MM/YYYY}.

DetailedinformationonthismedicineisavailableontheEuropeanMedicinesAgency(EMEA)website:http://www.emea.europa.eu.Therearealsolinkstootherwebsitesaboutrarediseasesandtreatments.

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INSTRUCTIONSFORPREPARINGANDGIVINGANINJECTIONOFSOMAVERT

Introduction

ThefollowinginstructionsexplainhowtoprepareandinjectSOMAVERT.Pleasereadtheinstructionscarefullyandfollowthemstepbystep.Youwillbeinstructedbyyourdoctororhis/herassistantonthetechniqueofself-injection.Donotattempttoself-injectuntilyouaresurethatyouunderstandhowtoprepareandgiveaninjection.
Thepowdermustbedissolvedwiththesolventbeforeuse.
Thisinjectionshouldnotbemixedinthesamesyringeorvialwithanyothermedicine.

STEP1.CHOOSINGTHEMETHODFORPREPARINGTHESOMAVERTSOLUTION

Thereare2methodsforpreparingtheSOMAVERTsolution.Pleasediscusswithyourhealthcareprofessionalwhichmethodisbestforyou:

a)TheVialAdapterMethod(MIXJECT?),

b)TheNon-VialAdapterMethod.

a)VIALADAPTERMETHOD(MIXJECT?)

GETTINGSTARTED

Wash your hands thoroughly.Collect1 vial of powder SOMAVERT,1 vial of solvent Water for Injections,1 luer-lock syringe of 1ml for both reconstituting the SOMAVERT solution and giving theinjection is recommended. However, other sizes and types of syringes can be used for thepreparation and injection of SOMAVERT. Please consult your healthcare professional for furtherinformation.2 MIXJECT vial adapters,1 detachable needle 25 to 30 gauge,Alcohol or antiseptic swabs and a proper disposal container for used needles and syringes.Inspect the expiry dates on both the vial label and the syringe label. They should not be used afterthe month and year shown

Afterreconstitutionwith1mlofsolvent,1mloftheclearsolutioncontainseither10mg,15mg,or20mgpegvisomant.

PREPARINGTHESOMAVERTDOSEFORINJECTION

Figure

1.RemovetheprotectiveplasticcapsfromthetopsofbothvialofsolventandvialofSOMAVERT(Fig.1).Takecarenottotouchtherubbervialstoppers.Atthispoint,thestoppersareclean.Ifthestoppersaretouchedorotherwisecontaminated,youmustcleanthemwithanantisepticoralcoholswabbeforeinsertingavialadapterthroughthestopper.

2.Openonlyoneofthevialadaptersbypeelingbacktheprotectivecover.Leavetheadapterintheplasticpackaginganddonottouchthespikeoftheadapter.

Figure

3.Whileholdingtheplasticadapterpackaging,placetheadapteroverthesolventvialandinsertthepiercingspikeofthevialadapterallthewayinthroughtherubberstopperofthesolventvial,usingapushingmotion.(Fig.2).Removetheplasticpackagingfromthevialadapteranddiscard.

Figure

4.Removethesyringefromtheprotectivepackaging.Pulltheplungerofthesyringeouttothe1mlmark.Holdthesolventvial,placedonaflatsurface,withonehandandconnectthetipofthesyringetothevialadapterbytwistingthesyringeonthevialadapterclockwise(Fig.3).Gentlypushtheplungeruntiltheairisinjectedintothevial.

ADDINGSOLVENT

Figure

5.Securelygraspthesolventvial,adapterandsyringeassembly.Carefullyturnthevial,adapterandsyringeassemblyupsidedown.Bringtoeyelevel(Fig.4).

6.Slideonehandcarefullydownthesolventvialsothatwithyourthumbandforefingeryoucansecurelygrasptheneckofthevial,andwithyourotherfingers,theupperpartofthesyringe.Withtheotherhand,slowlypullthesyringeplungerdowntoslightlypastthe1mlmark.

Examinethesolutioninthesyringeforairbubbles.Ifbubblesarepresent,tapthesyringebarreluntilthebubblesrisetothetopofthesyringe.Carefullypushtheplungeruptoejectonlytheairbubblesbackintothevial.Recheckthat1mlofsolventremainsinthesyringe.

Carefullyturnthesolventvial,adapterandsyringeassemblyandplacethemuprightonacleansurface.Donotremovethesyringefromtheadapteratthispoint.

Figure

7.Asexplainedforthefirstvialadapter,opennowthesecondvialadapterbypeelingbacktheprotectivecover.Donottouchthevialadapter.Donotremovetheadapterfromtheplasticpackaging.Whileholdingtheplasticadapterpackaging,placetheadapterovertheSOMAVERTvialandinsertthepiercingspikeofthevialadapterallthewayinthroughtherubberstopperoftheSOMAVERTvial,usingapushingmotion(Fig.5).Removetheplasticpackagingfromthevialadapteranddiscard.

Figure

8.DisconnectthesyringefromthesolventvialadapterandattachittothevialadapteronthevialofSOMAVERT.TiltthevialofSOMAVERT,adapterandsyringeassemblytothesideandgentlyinjectthesolventdowntheinnersideofthevialofSOMAVERT(Fig6).Discardthesolventvialasdirectedbyyourhealthcareprovider.

Figure

9.HoldthevialofSOMAVERTwiththeadapterandsyringestillattacheduprightbetweenyourhandsandgentlyrollittodissolvethepowder(Fig.7).DONOTSHAKETHEVIAL.Thesolutionshouldbeclearafterthepowderisdissolved.Ifthesolutioniscloudyorhazy,donotinjectit.Notifyyourpharmacyandrequestareplacementvial.Donotthrowthevialawaybecausethepharmacymayrequestthatyoureturnit.

PREPARINGTHEINJECTION

10.SecurelygraspthevialcontainingtheSOMAVERTreconstitutedsolution,vialadapterandsyringeassembly.Carefullyturnthevial,adapterandsyringeassemblyupsidedown.Bringtoeyelevel.

Figure

11.Asbefore,slideonehandcarefullydownthevialsothatwithyourthumbandforefingeryoucansecurelygrasptheneckofthevial,andwithyourotherfingers,theupperportionofthesyringe.Withtheotherhand,slowlypullthesyringeplungerdowntowithdrawthefullcontentsofthevial(1ml).(Fig.8).

Visuallyinspectthesyringeforairbubbles.Ifbubblesarepresent,tapthesyringebarreluntilthebubblesrisetothetopofthesyringe.Carefullypushtheplungeruptoejectonlytheairbubblesbackintothevial.Recheckthat1mlofthesolutionremainsinthesyringe.CarefullyturnthevialcontainingtheSOMAVERTreconstitutedsolution,adapterandsyringeassemblyandplacethemuprightonacleansurface.Donotremovethesyringefromtheadapteratthispoint.

Figure 912. Open the needle packaging so that only the end of the needle to be connected to the syringe isexposed. The needle should be partially left in its protective packaging. Lay the needle with itsprotective packaging on the tabletop. Disconnect the syringe from the vial. Discard theprotective packaging and attach the needle to the syringe. Keep the plastic cap on the needlewhile preparing the site for injection Fig. 9. Once reconstituted, SOMAVERT should be usedimmediately. Please proceed to STEP 2. GIVING THE INJECTION

b)NONVIALADAPTERMETHOD

GettingStarted

Wash your hands thoroughly.Collect one vial of powder SOMAVERT and one vial of solvent Water for Injections, one 3-mlsyringe with a 21-gauge, 1-inch detachable needle, one standard 1 ml insulin syringe, alcohol orantiseptic swabs and a proper disposal container for used needles.Inspect the expiry dates on both the vial label and the syringe label. They should not be used afterthe month and year shown

Afterreconstitutionwith1mlofsolvent,1mloftheclearsolutioncontainseither10mg,15mg,or20mgpegvisomant.

PREPARINGTHESOMAVERTDOSEFORINJECTION

Removetheprotectiveplasticcapsfromthetopsofbothvials.Takecarenottotouchtherubbervialstoppers.Atthispoint,thestoppersareclean.Ifthestoppersaretouchedorotherwisecontaminated,youmustcleanthemwithanantisepticoralcoholswabbeforeinsertinganeedlethroughthestopper.

Carefullyremovethecapfromtheneedleofthelargersyringe(3ml)andsetthecapaside.Thisisthesolventsyringe.

Figure

1.Pulltheplungerofthesolventsyringedowntothe1mlmark.Withonehand,securelyholdthevialofsolventand,withtheotherhand,inserttheneedleofthesolventsyringestraightthroughthecenteroftherubberstopperanddeepintothevial.Gentlypushtheplungeruntiltheairisinjectedintothevial.(Fig.1)

ADDINGSOLVENT

Figure

2.Securelygraspthesolventvialandsyringeassembly,withtheneedlestilldeeplyinsertedintothevial.Carefullyturnthevialandsyringeassemblyupsidedown.Bringtoeyelevel.(Fig.2)

Figure

3.Slideonehandcarefullydownthesolventvialsothatwithyourthumbandforefingeryoucansecurelygrasptheneckofthevial,andwithyourotherfingers,theupperpartofthesyringe.Withtheotherhand,slowlypullthesyringeplungerdowntoslightlypastthe1mlmark.

Examinethesolutioninthesyringeforairbubbles.Ifbubblesarepresent,tapthesyringebarreluntilthebubblesrisetothetopofthesyringe.Carefullypushtheplungeruptoejectonlytheairbubblesbackintothevial.Recheckthat1mlofsolventremainsinthesyringe,thenwithdrawtheneedlefromthevial.(Fig3)

Figure

4.Inserttheneedleofthesolventsyringestraightthroughthestopperofthevialwiththepowder(SOMAVERT).TiltthesyringetothesideandgentlyinjectthesolventdowntheinnersideofthevialofSOMAVERT.Whenthesolventsyringeisempty,withdrawitfromthevial.Discardthesolventvial,syringe,andneedleasdirectedbyyourhealthcareprovider.Tominimiseaccidentalinjury,recaptheneedleonlyifinstructedtodosobyyourhealthcareprovider,andinthemannerdemonstratedtoyoubyyourhealthcareprovider.(Fig4)

Figure

5.HoldthevialofSOMAVERTuprightbetweenyourhandsandgentlyrollittodissolvethepowder. DONOTSHAKETHEVIAL.Thesolutionshouldbeclearafterthepowderisdissolved.Ifthesolutioniscloudyorhazy,donotinjectit.Notifyyourpharmacyandrequestareplacementvial.Donotthrowthevialawaybecausethepharmacymayrequestthatyoureturnit. InjectSOMAVERTimmediately.(Fig.5)

PREPARINGTHEINJECTION

Figure

6.CleantherubberstopperofthevialofSOMAVERTwithanantisepticoralcoholswab.Removethecapfromthesyringe(1ml).Pullthesyringeplungerdowntothe1-mlmark.Withonehand,securelyholdthevial.Withtheotherhand,inserttheneedlestraightthroughthecenteroftherubberstopperanddeepintothevial.Gentlypushtheplungeruntiltheairisinjectedintothevial.Securelygraspthevialandsyringeassembly,withtheneedlestilldeeplyinsertedintothevial.Carefullyturnthevialandsyringeassemblyupsidedown.Bringtoeyelevel.(Fig.6)

Figure

7.Asbefore,slideonehandcarefullydownthevialsothatwithyourthumbandforefingeryoucansecurelygrasptheneckofthevial,andwithyourotherfingers,theupperportionofthesyringe.Withtheotherhand,slowlypullthesyringeplungerdowntowithdrawthefullcontentsofthevial(1ml).Tokeeptheneedletipwithintheliquid,youmayhavetoslowlybackitoutofthestopperasyoudrawouttheliquid.

Visuallyinspectthesyringeforairbubbles.Ifbubblesarepresent,tapthesyringebarreluntilthebubblesrisetothetopofthesyringe.Carefullypushtheplungeruptoejectonlytheairbubblesbackintothevial.Recheckthat1mlofthesolutionremainsinthesyringe,thenwithdrawtheneedlefromthevial.

Recaptheneedleasdirectedbyyourhealthcareprovidertominimiseaccidentalinjurywhilepreparingthesiteforinjection.(Fig.7)

STEP2.GIVINGTHEINJECTION

Chooseaninjectionsiteontheupperarm,upperthigh,abdomenorbuttocks.Alwaysmoveontoadifferentareawitheachday?sinjection.Itmaybehelpfultokeeparecordofeachday?sinjectionsiteasyoutakeyourdailydoseofSOMAVERT.Donotuseanareathathasarashorbrokenskin,orisbruisedorlumpy.

Cleanthesitewithanantisepticoralcoholswab,lettheskindrybeforeinjectingtheproduct.Uncaptheneedleifpreviouslyrecapped.

Figure

a.With one hand, gently pinch up the skin at the site of injection. Hold the syringe with the otherhand, and in a single, smooth motion, push the needle completely into the skin straight down ata 90-degree angle. Fig. A

Figure

b.Be sure to keep the needle all the way into the skin while you slowly push the syringe plungerdown until the barrel is empty

Releasethepinchedskinandpulltheneedlestraightout.(Fig.B)

Figure

c.Do not rub the injection area. A small amount of bleeding may occur. If necessary, apply aclean, dry cotton swab over the area and press gently for 1 or 2 minutes, or until the bleeding hasstopped. Fig. C

DisposingofSupplies

Thesyringeandneedleshould NEVERbereused.Disposeoftheneedleandsyringeasinstructedbyyourdoctor,nurseorpharmacist.

Allquestionsshouldbehandledbyadoctor,nurseorpharmacistfamiliarwithSOMAVERT.