You can only get this drug through the Natpara REMS Program.

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PATIENT & CAREGIVER EDUCATION Parathyroid Hormone Brand Names: US Natpara Warning This drug has been shown to raise the chance of bone tumors in lab animals. It is not known if there is a higher chance of bone tumors in humans. This drug is only for use in people not controlled on calcium and vitamin D treatment. This drug is also only for use when the benefits are thought to be g reater than the risks. Do not take this drug if you have Paget s disease, high levels of alkaline phosphatase in the blood, radiation therapy of the bones, or if your bones have not finished growing. You can only get this drug through the Natpara REMS Program. What is this drug used for? It is used to control low blood calcium levels in people who have low blood parathyroid hormone levels. What do I need to tell my doctor BEFORE I take this drug? If you have an allergy to this drug or any part of this drug. If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tong ue, or throat; or any other sig ns. If you are taking alendronate. Parathyroid Hormone 1/6

If you are breast-feeding or plan to breast-feed. This is not a list of all drugs or health problems that interact with this drug. Tell your doctor and pharmacist about all of your drug s (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or chang e the dose of any drug without checking with your doctor. What are some things I need to know or do while I take this drug? Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists. Have blood work checked as you have been told by the doctor. Talk with the doctor. Have your urine checked as you have been told by your doctor. Do not use longer than you have been told by the doctor. Take calcium and vitamin D as you were told by your doctor. If you are taking dig oxin, talk with your doctor. You may need to have your blood work checked more closely while you are taking it with this drug. Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this drug while you are preg nant. What are some side effects that I need to call my doctor about right away? WARNING/CAUTION: Even thoug h it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Sig ns of an allerg ic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tig htness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or Parathyroid Hormone 2/6

swelling of the mouth, face, lips, tong ue, or throat. Sig ns of hig h calcium levels like weakness, confusion, feeling tired, headache, upset stomach and throwing up, constipation, or bone pain. A new, tender lump. Lasting pain in 1 spot. Very bad dizziness. Very bad headache. Very low blood calcium levels have happened with this drug. The chance is hig hest when this drug is stopped all of a sudden but can happen at any time. Call your doctor rig ht away if you have any sig ns of low blood calcium levels like chang e in thinking; cramping of feet or hands; depression; memory problems; seizures; ting ling of your lips, tong ue, fing ers, or feet; or twitching of face muscles. What are some other side effects of this drug? All drug s may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or g et medical help if any of these side effects or any other side effects bother you or do not go away: Pain in arms or leg s. Loose stools (diarrhea). Headache. Joint pain. Upset stomach or throwing up. Neck pain. Nose or throat irritation. Belly pain. Tingling, tickling, or burning feeling of the skin. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. Parathyroid Hormone 3/6

You may report side effects to your national health ag ency. How is this drug best taken? Use this drug as ordered by your doctor. Read all information g iven to you. Follow all instructions closely. It is given as a shot into the fatty part of the skin in the thigh. Switch thighs every day. If you will be giving yourself the shot, your doctor or nurse will teach you how to give the shot. Follow how to use as you have been told by the doctor or read the package insert. Do not use if the solution is cloudy, leaking, or has particles. Do not use if solution chang es color. Do not shake. Throw away needles in a needle/sharp disposal box. Do not reuse needles or other items. When the box is full, follow all local rules for getting rid of it. Talk with a doctor or pharmacist if you have any questions. Do not share pen or cartridg e devices with another person even if the needle has been chang ed. Sharing these devices may pass infections from one person to another. This includes infections you may not know you have. To gain the most benefit, do not miss doses. Keep using this drug as you have been told by your doctor or other health care provider, even if you feel well. What do I do if I miss a dose? Use a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not use 2 doses or extra doses. How do I store and/or throw out this drug? Parathyroid Hormone 4/6

Before mixing, store in the refrig erator. Store in orig inal container. After mixing, store the cartridg e in the provided pen in the refrig erator. Do not freeze. Do not use if it has been frozen. Do not use if it has been shaken. Protect from heat. Protect from lig ht. Throw away the cartridge 14 days after mixing, even if it is not empty. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back prog rams in your area. General drug facts If your symptoms or health problems do not g et better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else s drugs. Keep a list of all your drug s (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor. Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins. Some drug s may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider. If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. Parathyroid Hormone 5/6

Consumer Information Use and Disclaimer This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of g eneral information about this medicine. It does NOT include all information about the possible uses, directions, warning s, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. Last Reviewed Date 2017-02-21 Copyright 2018 Wolters Kluwer Clinical Drug Information, Inc. and its affiliates and/or licensors. All rig hts reserved. If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday throug h Friday from 9:00 AM to 5:00 PM at. After 5:00 PM, during the weekend, and on holidays, please call. If there s no number listed, or you re not sure, call 212-639-2000. Parathyroid Hormone 2018 Memorial Sloan Kettering Cancer Center - Generated on October 10, 2018 Parathyroid Hormone 6/6