What to Know About Injecting Increlex^®

Overcoming injection anxiety

Because Increlex involves twice-daily injections, your child may be anxious about getting them, which can make you anxious, too. Fortunately, there are ways you can reduce this anxiety:

Develop a routine. Give Increlex injections around the same time each day, and choose a quiet and calm place, separate from where your child plays and eats, and away from the hustle and bustle of the house. Because Increlex is injected in the morning and evening, your child doesn't have to worry about needing injections while at school. This should ease fears he might have about other kids finding out.

Relax. Create a soothing atmosphere. Play your child's favorite music or videos as a distraction, or tell stories and jokes to distract him. Also teach your child breathing techniques, which can help to calm the emotions your child may be feeling.

Engage in positive thinking. Work with your child to think of ways he can mentally “escape” during the injection. Have your child practice visualizing a place or activity that makes him happy and concentrating hard on that mental picture instead of on the shot.

Choose timing wisely. Try to schedule the injection immediately before an activity that your child really enjoys, such as bath time or a favorite TV show. That way, your child can look ahead to the treat instead of focusing on the injection. Also, be sure your child eats shortly before or shortly after getting his injection. This will help to avoid hypoglycemia (low blood sugar).

Project the right attitude. Be careful that you don't contribute to anxiety by making a big deal out of the injection. Don't be dramatic, apologetic or overly sympathetic about it. Remain matter-of-fact and business-like during the few minutes you spend giving the injection, and then always give your child a big hug and words of praise afterward.

Talk it out. It is helpful to pick a time when you're not giving injections to talk with your child about his anxiety. What goes through your child's mind when it's time to get the shot? Are there particular words or phrases your child tends to think about when feeling anxious? Try to come up with a sort of mantra—a positive and helpful phrase or sentence your child can repeat to himself whenever anxious thoughts start to creep in.

The injection process

What should you know about injecting Increlex? View the video.

Safety information

Increlex may cause some side effects, which can be serious.¹ These side effects include low blood sugar or hypoglycemia; enlarged tonsils; increased pressure in the brain (intracranial hypertension); a bone problem called slipped capital femoral epiphysis; worsened scoliosis (caused by rapid growth); allergic reactions; and injection-site reactions.

Your child may have a mild or serious allergic reaction with Increlex. Call your child's doctor right away if your child gets a rash or hives. Get medical help immediately if your child has trouble breathing or goes into shock.

Increlex may cause reactions at the injection site including loss of fat; increase of fat; or pain, redness, or bruising. Injection site reactions can be avoided by changing the injection site at each injection.

Call your child's doctor if your child has side effects that are bothersome or that do not go away. For more information about Increlex side effects, download the Patient Information.

Preparing the dose

1. Wash your hands before preparing Increlex for your child's injection.
2. Use a new disposable needle and syringe every time you give a dose. Use syringes and needles only once. Dispose of them properly. Never share needles and syringes.
3. Check the liquid to make sure it is clear and colorless. Do not use after the expiration date or if it is cloudy or if you see particles.
4. If you are using a new vial, remove the protective cap. Do not remove the rubber stopper.
5. Wipe the rubber stopper of the vial with an alcohol swab to prevent contamination of the vial by germs that may be introduced by repeated needle insertions (see Figure 1).
   
   
   
   
6. Before putting the needle into the vial, pull back on plunger to draw air into the syringe equal to the Increlex dose. Put the needle through the rubber top of the vial and push the plunger to inject air into the vial (see Figure 2).
   
   
   
   
7. Leave the syringe in the vial and turn both upside down. Hold the syringe and vial firmly (see Figure 3).
   
   
   
   
8. Make sure the tip of the needle is in the liquid (see Figure 4). Pull the plunger to withdraw the correct dose into the syringe (see Figure 5).
   
        
   
   
9. Before you take the needle out of the vial, check the syringe for air bubbles. If bubbles are in the syringe, hold the vial and syringe with the needle straight up and tap the side of the syringe until the bubbles float to the top. Push the bubbles out with the plunger and draw liquid back in until you have the correct dose (see Figure 6).
   
   
   
   
10. Remove the needle from the vial. Do not let the needle touch anything. You are now ready to inject the medicine (see Figure 7).
    
    
    
    

Injecting Increlex

Inject Increlex as instructed by your child's doctor.

Do not give the Increlex injection if your child is unable to eat within 20 minutes before or after the injection.

1. Decide on an injection area - upper arm, thigh, buttocks, or abdomen (see below). The injection site should be changed for each injection (“rotate the injection site”).
   
   
   
   
2. Use alcohol or soap and water to clean the skin where you are going to inject your child. The injection site should be dry before you inject.
3. Lightly pinch the skin. Stick the needle in the way your child's doctor showed you. Release the skin (see Figure A).
   
   
   
   Slowly push in the plunger of the syringe all the way, making sure you have injected all the liquid. Pull the needle straight out and gently press on the injection site with gauze or a cotton ball for a few seconds. Do not rub the area (see Figure B).
   
   
   
   Follow the doctor's instructions for throwing away the needle and syringe. Do not recap the syringe. The used needle and syringe should be placed in a sharps container (such as a red biohazard container), hard plastic container (such as a detergent bottle), or metal container (such as an empty coffee can). Containers should be sealed and disposed of properly. Your doctor's office or a PACE^SM representative can tell you who to contact to arrange pickups for biohazardous waste collection.

Indication and Important Safety Information

WHO IS INCRELEX^® FOR?
INCRELEX is used to treat children who are very short for their age because their bodies do not make enough IGF-1. This condition is called severe Primary IGF-1 deficiency. INCRELEX should not be used instead of growth hormone.

WHO SHOULD NOT USE INCRELEX?
Your child should not take INCRELEX if your child: has finished growing (the growth plates at the end of the bones are closed); has cancer; has other causes of growth failure; OR is allergic to mecasermin or any of the inactive ingredients in INCRELEX. INCRELEX has not been studied in children under 2 years of age and should never be used in newborns. Your child should never receive INCRELEX through a vein.

BEFORE YOUR CHILD TAKES INCRELEX, YOU SHOULD TELL YOUR CHILD'S DOCTOR ABOUT:

• All of your child's health conditions, including: diabetes, kidney problems, liver problems, allergies, scoliosis (curved spine), pregnancy or breast-feeding.
• All the medicines (prescription and nonprescription), vitamins, and herbal supplements your child takes, especially insulin or other anti-diabetes medicines, which may require dose adjustment of these medicines.

WHAT ARE POSSIBLE SIDE EFFECTS OF INCRELEX (SOME WHICH CAN BE SERIOUS)?

• Low blood sugar (hypoglycemia). Only give your child INCRELEX right before or right after (20 minutes on either side of) a snack or meal to reduce the chances of hypoglycemia. Signs include dizziness, tiredness, restlessness, hunger, irritability, trouble concentrating, sweating, nausea, and fast or irregular heartbeat. Do not give your child INCRELEX if your child is sick or cannot eat. Severe hypoglycemia may cause unconsciousness, seizures, or death. People taking INCRELEX should avoid participating in high risk activities (such as driving) within 2 to 3 hours after an INCRELEX injection.
• Enlarged tonsils. Signs include: snoring, difficulty breathing or swallowing, sleep apnea (a condition where breathing stops briefly during sleep), or fluid in the middle-ear.
• Increased pressure in the brain (intracranial hypertension). INCRELEX, like growth hormone, can sometimes cause a temporary increase in pressure within the brain. Symptoms include persistent headache, blurred vision and nausea with vomiting.
• A bone problem called slipped capital femoral epiphysis. This happens when the top of the upper leg (femur) slips apart from the rest of the bone. Seek immediate medical attention if your child develops a limp or has hip or knee pain.
• Worsened scoliosis (caused by rapid growth).
• Allergic reactions. Call your child’s doctor right away if your child shows signs of an allergic reaction, such as rash or hives. Seek immediate medical attention if your child has trouble breathing or goes into shock (becomes unconscious).
• Injection site reactions including: swelling, loss of fat; increase of fat; pain, redness, or bruising. This can be avoided by changing/rotating the injection site at each injection.

Your child's doctor is your primary source of information about treatment. For more information, please talk to your doctor and see the full Patient Prescribing Information.