TREATMENT PLAN WORKBOOK Keep track of everything related to your diagnosis and treatment Please see accompanying full Prescribing Information and Important Safety Information on page 15.
Please see accompanying full Prescribing Information and Important Safety Information on page 15.
YOUR PERSONAL TREATMENT WORKBOOK Manage all the important information about your advanced prostate cancer diagnosis with the Treatment Plan Workbook. Take notes and record information about the progress of your treatment and management of your medicines, and share information with other members of your healthcare team.
FIRMAGON (degarelix for injection) DOSING SCHEDULE You should receive an injection of FIRMAGON every 28 days (4 weeks) to help keep your testosterone levels low. After each injection, you should schedule your next appointment for 28 days later. If you cannot keep an appointment, talk to your healthcare provider to reschedule as soon as possible. Use the Treatment Tracker on pages 10 and 11 in this workbook to record the date, day of the week, and time of your next appointment. REMEMBER TO MARK YOUR NEXT FIRMAGON APPOINTMENT ON YOUR CALENDAR. Please see accompanying full Prescribing Information and Important Safety Information on page 15. IMPORTANT SAFETY INFORMATION FIRMAGON should not be given to people who are allergic to any of the ingredients in FIRMAGON. Life-threatening allergic reactions have been reported with drugs in this category. It should not be given to women who are pregnant or may become pregnant. FIRMAGON can harm an unborn baby when given to a pregnant woman.
MEDICAL HISTORY Work with your doctor to record your medical history (such as medical conditions), especially if you have any problems with your heart, kidney, or liver. It s important that every member of your healthcare team is aware of your medical history as they develop your treatment plan. Use the space on the following page to list all current medicines. Current & Past Medical Conditions Notes 5
PRESCRIPTION AND OVER-THE-COUNTER MEDICINES Provide a list of all medicines, including over-the-counter medicines you currently take. Name of Medicine Dose How Often You Take It Length of Treatment Please see accompanying full Prescribing Information and Important Safety Information on page 15.
TESTOSTERONE (T) Testosterone is a key tumor-growth factor in prostate cancer. The goal of hormone therapies like FIRMAGON (degarelix for injection) is to lower T levels. Keeping track of your T levels may help your doctor gauge how the treatment is working. IMPORTANT SAFETY INFORMATION Before receiving FIRMAGON, tell your healthcare provider about all your medical conditions, including if you have any heart problems, problems with balance of your body salts or electrolytes (such as sodium, potassium, calcium, and magnesium), or have kidney or liver problems. TRACKING YOUR LEVELS THIS WORKBOOK CONTAINS A TESTOSTERONE AND PROSTATE-SPECIFIC ANTIGEN (PSA) TRACKER FOR YOU TO RECORD THE RESULTS THAT YOUR DOCTOR GIVES TO YOU THROUGHOUT TREATMENT. WHILE THESE LEVELS MAY SHOW HOW YOUR BODY IS REACTING TO FIRMAGON, YOUR DOCTOR IS THE BEST SOURCE OF INFORMATION FOR HOW WELL YOU ARE DOING. 7
PSA Part of your treatment will involve regular measurements of your PSA levels. PSA is a substance produced by the prostate. In prostate cancer, the cells in the prostate are disrupted. This allows more PSA to leak into the bloodstream, resulting in higher PSA levels. This is why PSA levels are used to help diagnose prostate cancer. What s a normal PSA level? There is no particular PSA measurement that is considered normal or abnormal, but some doctors use the ranges outlined below to evaluate PSA levels. Level (ng/ml) Description 0 2.5 Low 2.6 10 Slightly to moderately elevated 10.1 19.9 Moderately elevated 20 or more Elevated IMPORTANT SAFETY INFORMATION The common side effects of FIRMAGON include: hot flashes, injection site pain, redness and swelling (especially with the first dose), weight gain, increase in some liver enzymes, tiredness, hypertension, back and joint pain, chills, urinary tract infection, decreased sex drive, and trouble with erectile dysfunction (impotence).
T AND/OR PSA TRACKER Record your T and/or PSA levels before the first injection and after every injection, or when your doctor thinks it s appropriate. Refer back to these levels to gauge how your body is responding to treatment. Your doctor will determine the appropriate length of treatment. Month Date of Appointment T Test PSA Test Before First Treatment First Treatment Month 2 Month 3 Month 4 Month 5 Month 6 To continue tracking your treatment, ask your nurse for another workbook. Please see accompanying full Prescribing Information and Important Safety Information on page 15. 9
TREATMENT TRACKER Be sure to make your next appointment before you leave the office. If you have to miss an appointment, talk to your healthcare provider to reschedule as soon as possible. First treatment Notes: Time: Date: Day of week: Doctor: Month 2 Notes: Time: Date: Day of week: Doctor: Month 3 Notes: Time: Date: Day of week: Doctor: Month 4 Notes: Time: Date: Day of week: Doctor: Please see accompanying full Prescribing Information and Important Safety Information on page 15.
Month 5 Notes: Time: Date: Day of week: Doctor: Month 6 Notes: Time: Date: Day of week: Doctor: To continue tracking your appointments, ask your nurse for another workbook. 11
WHAT ARE THE POSSIBLE SIDE EFFECTS OF FIRMAGON (degarelix for injection)? The common side effects include: Hot flashes Injection site pain, redness, and swelling, especially with the first dose Weight gain Increase in some liver enzymes Tiredness Hypertension Back and joint pain Chills Urinary tract infection Decreased sex drive and trouble with erectile dysfunction (impotence) These are not all the possible side effects. For more information, ask your healthcare provider or pharmacist. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. Please see accompanying full Prescribing Information and Important Safety Information on page 15.
MY HEALTHCARE TEAM CONTACT INFORMATION Complete the contact information on this sheet, tear it off at the dotted line, and keep it in a place where you and your caregivers can easily find it, like the kitchen refrigerator. Primary Care Physician Doctor s Name: Nurse s Name: Office Phone: Other Phone: E-Mail: Radiation Oncologist Doctor s Name: Nurse s Name: Office Phone: Other Phone: E-Mail: Urologist Doctor s Name: Nurse s Name: Office Phone: Other Phone: E-Mail: Other Doctor Doctor s Name: Nurse s Name: Office Phone: Other Phone: E-Mail: 13
ADDITIONAL NOTES AND/OR QUESTIONS Use this space to write down any questions you may have, or to take notes during your discussion with your doctor. FERRINGPROMISE.COM
FIRMAGON (degarelix for injection) is a prescription medicine used in the treatment of advanced prostate cancer. IMPORTANT SAFETY INFORMATION FIRMAGON should not be given to people who are allergic to any of the ingredients in FIRMAGON. Lifethreatening allergic reactions have been recorded with drugs in this category. It should not be given to women who are pregnant or may become pregnant. FIRMAGON can harm an unborn baby when given to a pregnant woman. Before receiving FIRMAGON, tell your healthcare provider about all your medical conditions, including if you have any heart problems, problems with balance of your body salts or electrolytes (such as sodium, potassium, calcium, and magnesium), or have kidney or liver problems. The common side effects of FIRMAGON include: hot flashes, injection site pain, redness and swelling (especially with the first dose), weight gain, increase in some liver enzymes, tiredness, hypertension, back and joint pain, chills, urinary tract infection, decreased sex drive, and trouble with erectile dysfunction (impotence). You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please see accompanying full Prescribing Information. 15
FOR MORE INFORMATION ABOUT FIRMAGON (degarelix for injection) PROMISE SUPPORT SERVICES, VISIT FERRINGPROMISE.COM. Please see accompanying full Prescribing Information and Important Safety Information on page 15. FIRMAGON is a registered trademark of Ferring B.V. 2015 Ferring B.V. FNPR/1856/2014/US Printed in U.S.A. January 2015