Meet the many faces of pain

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Meet the many faces of pain WWW.PRIALT.COM N O W M E E T Ziconotide is a synthetic equivalent of a naturally occurring conopeptide. Distributed by Elan Pharmaceuticals, Inc. (EPI). PRIALT is a registered trademark and is a trademark of EPI. SynchroMed is a registered trademark of Medtronic, Inc. 2008 Elan Pharmaceuticals, Inc. Printed in USA. PRT4871108 www.elan.com

Severe chronic pain is challenging, but there is another option If you are living with severe chronic pain, you are certainly not alone. Millions of people live with some form of severe chronic pain every day. 1 It may be difficult for you and your family, especially if you have tried many therapies, each with a varying level of success and possibly some side effects. The good news is that if you or someone you know is living with severe chronic pain, there is another option available. PRIALT is not a narcotic and works in a different way from other medications you may have tried in the past. Read on to learn more about PRIALT and how therapy with it may be right for you. After reading this information, if you have any questions about PRIALT or your pain management therapy, please be sure to ask your healthcare provider. PRIALT is different PRIALT is a prescription medication that is given directly into the spinal fluid. The spine is where the major nerves that carry pain sensations are located. A special device injects PRIALT into the spinal column near these nerves. PRIALT is used to treat severe chronic pain in adults who cannot take other treatments or when other treatments have not worked. 2 Other treatments include systemic pain medicines, treatments used in combination with pain medicines, or morphine injected into the spinal fluid. PRIALT is not a narcotic 2 It works in a different way PRIALT has a defined safety profile 2 Risks and side effects have been evaluated in over 1200 patients If you experience side effects, PRIALT may be stopped abruptly without withdrawal effects PRIALT has been studied in multiple clinical trials 2 Clinical trials included patients with many types of severe chronic pain PRIALT has real-world experience It has been approved by the FDA and has been on the market since 2004 Most important safety information I should know about PRIALT PRIALT may cause serious mental symptoms and neurological problems You should not receive PRIALT if you have or had a mental condition called psychosis You or a caregiver should call your doctor right away if you: o Are confused o Are less alert o See or feel things that are not real (hallucinations) o Have changes in mood or consciousness If you have mental symptoms or neurological problems, PRIALT treatment can be interrupted or stopped suddenly without experiencing withdrawal effects PRIALT is for use only in the Medtronic SynchroMed EL, SynchroMed II Infusion System and the CADD-Micro ambulatory infusion pump. 2 3

What should I expect from treatment with PRIALT? In clinical trials, patients pain responses varied, with some patients having experienced a reduction in their severe chronic pain while on PRIALT. 2 Treatment with PRIALT has ranged from as little as one hour to more than 7.5 years. 2 Finding pain relief may take time Remember the story of the tortoise and the hare? The same approach lies at the heart of therapy with PRIALT. Dosages are started low and gradually increased in order to reduce the risk of side effects. Safety considerations It is important to know that everyone responds differently to prescription medications, including whether or not they develop side effects. If side effects do occur, PRIALT can be interrupted or stopped suddenly without causing withdrawal effects. 2 A slow dosing approach can help minimize the occurrence of side effects. Talk to your doctor about any concerns you may have about PRIALT safety. The right dose is different for every patient, and finding that right dose may take as little as a few weeks or as long as a few months. Finding relief with PRIALT may take patience, but for some patients, the reward could be pain reduction. Ask your healthcare provider about what you should expect from treatment with PRIALT. Retired teacher, Loving grandmother, In uncontrolled pain 4 5

Important Safety Information Most important safety information I should know about PRIALT PRIALT may cause serious mental symptoms and neurological problems You should not receive PRIALT if you have or had a mental condition called psychosis You or a caregiver should call your doctor right away if you: o Are confused o Are less alert o See or feel things that are not real (hallucinations) o Have changes in mood or consciousness If you have mental symptoms or neurological problems, PRIALT treatment can be interrupted or stopped suddenly without experiencing withdrawal effects You should not be given PRIALT if you: Are allergic to PRIALT or any ingredient in it Have a condition or are receiving a treatment that would cause an injection in your spinal fluid to be unsafe Have or had a mental illness called psychosis Have an infection at the device injection site, uncontrolled bleeding problems, or a blockage in your spinal cord area PRIALT can cause serious problems that you should tell your doctor or healthcare professional about immediately, such as: Severe Psychiatric Symptoms or Neurological Impairment including changes in mood or perception (hallucinations, including unusual sensations in the mouth and throat), changes and slowing in thinking, depression or suicidal thoughts, confusion, memory impairment, speech disorder, or inability to eat. Unconsciousness or Reduced Mental Alertness indicated by changes in mental status (tiredness, confusion, disorientation, or decreased alertness). Some people have lost consciousness while being treated with Prialt. It may not be safe for you to engage in hazardous activity requiring complete mental alertness or motor coordination such as operating machinery or driving a motor vehicle during treatment. Construction worker, Avid fisherman, Experiencing intolerable side effects on current IT therapy Please see accompanying full prescribing information. 6 7

Meningitis or Other Infections indicated by signs and symptoms that include but are not limited to fever, headache, stiff neck, altered mental status (tiredness, confusion, disorientation or decreased alertness), nausea or vomiting, and sometimes seizures. Serious Muscle Damage. Your doctor should regularly monitor you for muscle damage by doing a blood test to check for an increase in Serum Creatine Kinase (CK). Increased CK levels in the blood may mean there is damage to your muscles. High levels of CK in the blood can damage your kidneys. Call your doctor right away if you have new muscle pain, soreness, weakness, or your urine is dark in color. The most common side effects with PRIALT are dizziness, nausea, confusion, headache, sleepiness, problems with vision, weakness, and pain. What should I tell my healthcare professional? Before you receive PRIALT, tell your healthcare provider if you: Have or had a mental illness called psychosis Are taking narcotic pain medicines called opiates. PRIALT is not an opiate medicine and cannot replace your opiate pain medicines Are taking other medicines that can affect your nervous system such as antidepressant medicines, anti-anxiety medicines, seizure medicines, antipsychotic medicines, or sleeping pills Are pregnant, trying to become pregnant, or are breast-feeding Can I take other pain relief drugs? Be sure to tell your doctor or healthcare provider about other medications you may be taking to treat pain. You and your healthcare provider will decide the best treatment plan for you. Are there any interactions with medicines or foods? PRIALT and certain other medicines can interact and cause serious side effects. Tell your doctor or healthcare provider about all medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Your doctor may have to adjust your dose of PRIALT or watch you more closely if you take other medicines that affect your nervous system. 8 9

Medical assistance programs The medical assistance programs are designed to assist patients that are both uninsured and underinsured with limited financial resources. All patients are required to meet specific criteria including diagnosis, residency, and income level requirements. The Patient Assistance Program (PAP) for PRIALT helps patients with insurance and income limitations NORD makes independent decisions on eligibility. To discuss enrollment in this program, contact NORD at 1-800-459-7599 or www.rarediseases.org/programs/medication. For more information on both of these programs, call the Elan Pain Information Center TM at 1-888-PRIALT-1 (1-888-774-2581) Monday Friday, 8 AM to 7 PM EST. Eligible patients receive PRIALT at no cost for one year through their healthcare provider Patients may reapply for continuing coverage after their one year of assistance has ended The National Organization for Rare Disorders (NORD) provides a co-payment assistance program For patients who have no health insurance or patients with health insurance but: o Are not reimbursed for prescription drugs o Have low annual caps on prescription drugs through their insurance plan o Cannot afford to pay for PRIALT because their income is too high to qualify for Medicaid or they are unable to pay for the co-payment required by their insurance provider Decorated veteran, Community leader, Being weaned off opioids due to dependency 10 11

The Elan Pain Information Center TM (EPIC) EPIC is a one-call information center dedicated to providing the information you need about PRIALT. It is staffed with program specialists who are trained to answer questions or assist with the following services: Information and support for PRIALT Access to medical professionals for drug- or pump-related inquiries Reporting of side effects Reimbursement assistance, insurance benefits investigations for PRIALT coverage, and insurance claims denials and appeals assistance To speak with an EPIC Reimbursement Case Advocate, call 1-888-PRIALT-1 (1-888-774-2581) Monday Friday, 8 AM to 7 PM EST Civil engineer, Father of three, Now living with less pain 12 13