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<DIV><FONT face=Arial color=#0000ff size=2>Please note this correction in my
earlier note: Daytrana - toss or flush. the do not flush refers to
the pouch/liner. </FONT>
<DIV><SPAN class=755530314-07112007></SPAN> </DIV>
<DIV><SPAN class=755530314-07112007><FONT face=Arial color=#0000ff><FONT
face="Times New Roman" color=#000000 size=2>How should I store DaytranaTM? - no
flush<BR>• Store DaytranaTM in a safe place at room temperature, 59 to 86° F (15
to 30° C). Keep DaytranaTM patches in<BR>their unopened pouches until ready to
use.<BR>• Once a tray of patches has been opened, use or discard the patches
within 2 months.<BR>• Keep DaytranaTM and all medicines out of the reach of
children.</FONT><FONT face="Times New Roman" color=#000000 size=2> HOW TO
REMOVE AND DISCARD DAYTRANATM<BR>• When you remove the patch, peel it off
slowly.<BR>• Fold the used DaytranaTM patch in half and press firmly so that the
sticky side sticks to<BR>the used patch down the toilet or dispose of it in a
lidded container right away.<BR>• Do not flush the pouches or the protective
liners down the toilet. These items should be<BR>in a lidded container.<BR>• If
any sticky material (adhesive) remains on the child’s skin after removing the
patch, gently<BR>area with oil or lotion to remove the adhesive from the
skin.<BR>• Wash your hands after handling the patch.<BR>• After the patch is
removed and disposed of, record this time on the administration
chart.</FONT></FONT></SPAN></DIV></DIV>
<BLOCKQUOTE>
<DIV class=OutlookMessageHeader dir=ltr align=left><FONT face=Tahoma
size=2>-----Original Message-----<BR><B>From:</B>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us]<B>On Behalf Of
</B>Chickering, Helen (NBC Universal)<BR><B>Sent:</B> Wednesday, November 07,
2007 6:54 AM<BR><B>To:</B> pharmwaste@lists.dep.state.fl.us<BR><B>Subject:</B>
[Pharmwaste] Prescription drug disposal clarification <BR><BR></FONT></DIV>
<DIV><FONT face=Arial><SPAN class=079573711-07112007></SPAN></FONT><FONT
face=Tahoma><FONT size=2></FONT></FONT> </DIV>
<DIV><SPAN class=079573711-07112007><FONT size=4> Hello, I'm a medical
correspondent with NBC News Channel. </FONT></SPAN></DIV>
<DIV><SPAN class=079573711-07112007><FONT size=4></FONT></SPAN> </DIV>
<DIV><SPAN class=079573711-07112007><FONT size=4> I've been working on a
story about Prescription Drug Disposal and came across your list serv during a
simple term search. The information I found there was by far the most
helpful and most insightful. It helped change the focus of my
story. </FONT></SPAN></DIV>
<DIV><SPAN class=079573711-07112007></SPAN><SPAN
class=079573711-07112007><FONT size=4></FONT></SPAN> </DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>I want to say thank you and
to share the clarification stumbling blocks I'm working on as I try to get
this piece on the air. Below is the note to media contacts at the EPA, White
House, and FDA. I also forwarded a link to the list serv thread
that highlights the confusion to some of those contacts. Please know I
am not publishing or quoting any of the thread - just used it as a resource
for my research.</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007></SPAN></FONT> </DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>Here's the latest note.
I'd love to get your feedback and any updates on efforts to get the list
updated.</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007></SPAN></FONT> </DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>Kind
regards,</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>Helen</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>Helen
Chickering</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>Medical
Correspondent</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007>NBC News
Channel</SPAN></FONT></DIV>
<DIV><FONT size=4><SPAN class=079573711-07112007> </SPAN></FONT><SPAN
class=079573711-07112007><FONT face=Arial color=#0000ff size=2>
</FONT></SPAN><SPAN class=504271601-07112007><FONT
size=4></FONT></SPAN></DIV>
<DIV><SPAN class=504271601-07112007></SPAN><FONT size=4> We've delayed
this piece fo<SPAN class=504271601-07112007>r a noon release tomorrow.
</SPAN><SPAN class=504271601-07112007> </SPAN>A few more
questions/clarification issues<SPAN class=504271601-07112007> with an ASAP
deadline. </SPAN></FONT></DIV>
<DIV><FONT size=2><SPAN class=504271601-07112007></SPAN><FONT size=4><SPAN
class=504271601-07112007> I'm sending this message to all parties.
Please answer areas that apply. Thank you!</SPAN></FONT></FONT></DIV>
<DIV><FONT size=2><FONT size=4><SPAN
class=504271601-07112007></SPAN></FONT></FONT> </DIV>
<DIV><FONT size=2><FONT size=4><SPAN
class=504271601-07112007></SPAN></FONT></FONT> </DIV>
<DIV><FONT size=2><FONT size=4><SPAN class=504271601-07112007>Story
angle: As scientists continue to study pharmaceuticals and the
water supply - (science that has uncovered trace amounts - parts per trillion,
suggests an impact on environment/aquatic life - no impact so far on
people) The public is becoming aware of drug disposal concerns -
specifically - flushing isn't environmentally friendly. While we wait
for science to uncover a greener way to dispose of drugs - what's the
consensus about the best way for consumers to dispose of prescription
drugs?</SPAN></FONT></FONT></DIV>
<DIV><FONT size=2><FONT size=4><SPAN
class=504271601-07112007></SPAN></FONT></FONT> </DIV>
<DIV><FONT size=2><FONT size=4><SPAN class=504271601-07112007><FONT face=Arial
size=2>Right now my story is focusing more on the confusion by different
messages a person might find - depending on where they go first.
Jennifer DeVallance with ONDCP - has this comment about the different
guidelines the public may encounter in their search for green disposal
information.</FONT></SPAN></FONT></FONT></DIV>
<DIV><FONT size=2><FONT size=4><SPAN class=504271601-07112007><FONT face=Arial
size=2></FONT></SPAN></FONT></FONT> </DIV>
<DIV><FONT size=2><FONT size=4><SPAN class=504271601-07112007><FONT face=Arial
size=2>" Regardless of the approach - federal state and local entities
are all interested safeguarding legitimate access to prescription medications,
while preventing diversion, abuse and protecting the
environment. All encourage people to monitor and safeguard
prescription drugs and dispose of them when they are expired or no longer
needed. "</FONT></SPAN></DIV>
<DIV><BR><BR></FONT><BR>1. <SPAN class=504271601-07112007><FONT
size=3><STRONG>Consumer Prescription Drug
Disposal Programs</STRONG></FONT> -<FONT size=3>
</FONT></SPAN></FONT><FONT size=3>While I appreciate the information about
past <SPAN class=504271601-07112007>pilot projects</SPAN>, <SPAN
class=504271601-07112007>m</SPAN>y question <SPAN
class=504271601-07112007>is Where are we now? Are the EPA and
other organizations in a research and development phase - gathering
stats, etc. from various pilot projects in an effort to come up with
recommendations or some sort of national standard? <STRONG>Is
there any formal effort to find a reasonable/environmentally friendly drug
disposal option for consumers? IF so what is the plan and
deadline? If not - what is the purpose of these pilot programs - is
there any unified goal - or are they just a collection of efforts by
different organizations? </STRONG></SPAN></FONT></DIV>
<DIV><SPAN class=504271601-07112007><FONT face=Arial
size=2></FONT></SPAN> </DIV>
<DIV><FONT size=2><FONT size=3> Is this more recent project through the
the Substance Abuse and Mental Health Services Administration - which seems to
be an education effort - an effort to take<SPAN
class=504271601-07112007>/study</SPAN> a different<SPAN
class=504271601-07112007> </SPAN>angle to this problem - or just another
groups effort to tackle the drug disposal-environment-abuse
issue?</FONT></FONT></DIV>
<DIV><FONT size=2><FONT size=3></FONT></FONT> </DIV>
<DIV><FONT size=2><SPAN class=504271601-07112007><FONT size=3>2. <STRONG>Where
can consumers go</STRONG> - now - for the most accurate information on
prescription drug disposal? <STRONG>Is the issue of how drugs are disposed -
kitty litter v. flushing - a real risk factor when it comes to drug
abuse/addiction? How do you know - Is there scientific or other
evidence that proves or suggests this? Or is it a drug storage
issue? </STRONG></FONT></SPAN></DIV>
<DIV><FONT face=Arial></FONT><BR></DIV></FONT>
<DIV><BR><FONT size=2><SPAN class=504271601-07112007>3</SPAN> <FONT
size=3><STRONG>The FDA list </STRONG></FONT><SPAN
class=504271601-07112007><FONT size=3><STRONG>of drugs consumers should
flush</STRONG></FONT>. <FONT size=3> Questions - Where did this
list come from? What is the reasoning behind the list? Specific
questions - </FONT></SPAN></FONT><FONT size=3><SPAN
class=504271601-07112007>Oxycodone and other opiates - obviously the abuse
issue here. But where is Hydrocodone? </SPAN><SPAN
class=504271601-07112007>Drug patches are on the list too - are they meant to
be flushed? Daytrana drug info on FDA site recommends not
flushing. </SPAN><SPAN class=504271601-07112007>Xyrem
is a rarely used drug - a narcolepsy drug - Why is this on the
list? Antibiotics -</SPAN><SPAN
class=504271601-07112007>Gatifloxacin/ Fluoroquinolones are
</SPAN></FONT><SPAN class=504271601-07112007>antibiotics - why are they on the
list - especially when even patients who take the drug send concentrated
amounts into the system. </SPAN></DIV>
<DIV><SPAN class=504271601-07112007>Baraclude Tablets (entecavir), Reyataz
Capsules (atazanavir sulfate),Zerit for Oral Solution (stavudine) are all
anti-HIV meds. Why are they on the list?</SPAN></DIV>
<DIV><SPAN class=504271601-07112007><FONT
face=Arial> </FONT></SPAN></DIV>
<DIV><FONT size=2><SPAN class=504271601-07112007></SPAN></FONT> </DIV>
<DIV><FONT size=2><SPAN class=504271601-07112007><FONT size=3><STRONG>More FDA
flushing list questions.</STRONG></FONT> <FONT size=3>The White House website
- (and today's AP article note - Once, patients were told to flush old drugs
down the toilet. No more — do not flush unless you have one of the few
prescriptions that the Food and Drug Administration specifically labels for
flushing....).<BR></FONT></SPAN></FONT></DIV>
<DIV><SPAN class=504271601-07112007>I researched the list - and that is not
the case for every drug - at least not from what I could find on the FDA
website - patient and/or label info. In addition, most of the
disposal information is buried - not sure how patients would even see
it.</DIV></SPAN><FONT face=Arial size=2></FONT>
<DIV><BR><FONT size=2> The FDA advises that the
following drugs be flushed down the<BR> toilet
instead of thrown in the trash:<SPAN class=504271601-07112007>
</SPAN><BR>
Actiq (fentanyl citrate)<SPAN class=504271601-07112007> -<FONT
color=#ff0000> - narc pain med - lollipop - rinse down drain - toss
the
sticks</FONT></SPAN><BR>
Daytrana Transdermal Patch (methylphenidate)<SPAN class=504271601-07112007>
-<FONT color=#ff0000> - this is an adhd patch - Says</FONT><SPAN
class=012281114-07112007><FONT face=Arial color=#0000ff> <FONT
face="Times New Roman" color=#ff0000> Toss or
flush</FONT> </FONT></SPAN></SPAN><BR>
Duragesic Transdermal System (fentanyl)<SPAN class=504271601-07112007>
- <FONT color=#ff0000>pain patch - do
flush</FONT></SPAN><BR>
OxyContin Tablets (oxycodone)<SPAN class=504271601-07112007> - <FONT
color=#ff0000>narcoctic pain med -
flush</FONT></SPAN><BR>
Avinza Capsules (morphine sulfate)<SPAN class=504271601-07112007> <FONT
color=#ff0000>narcotic pain -
flush</FONT></SPAN><BR>
Baraclude Tablets (entecavir)<SPAN class=504271601-07112007> <FONT
color=#ff0000>hep b medicine - flush or down
sink</FONT></SPAN><BR>
Reyataz Capsules (atazanavir sulfate)<SPAN class=504271601-07112007> <FONT
color=#ff0000>hiv med - flush or down
sink</FONT></SPAN><BR>
Tequin Tablets (gatifloxacin)<SPAN class=504271601-07112007> - <FONT
color=#ff0000>antibiotic -
flush</FONT></SPAN><BR>
Zerit for Oral Solution (stavudine)<SPAN class=504271601-07112007>
- <FONT color=#ff0000>HIV - oral kids drug - first rec says throw away,
bottom notes
flush</FONT></SPAN><BR>
Meperidine HCl Tablets<SPAN class=504271601-07112007> - <FONT
color=#ff0000>narcotic
flush</FONT></SPAN><BR>
Percocet (Oxycodone and Acetaminophen)<SPAN class=504271601-07112007> - <FONT
color=#ff0000>narcotic
flush</FONT></SPAN><BR>
Xyrem (Sodium Oxybate)<SPAN class=504271601-07112007> - <FONT
color=#ff0000>narcolepsy drug/controlled -
flush</FONT></SPAN><BR>
Fentora (fentanyl buccal tablet)<SPAN class=504271601-07112007> - <FONT
color=#ff0000>narc/pain for cancer patients - flush</FONT></SPAN></FONT></DIV>
<DIV><FONT size=2></FONT> </DIV>
<DIV><SPAN class=504271601-07112007><FONT size=2>Details from website search:
</FONT></SPAN></DIV>
<DIV><FONT size=2>FDA consumer drug disposal information from FDA website: -
no flush - but rinse down drain or trhow away<BR>1. How should I dispose of
Actiq after use?<BR>Partially used Actiq units may contain enough medicine to
be harmful or fatal to a child or other adults<BR>who have not been prescribed
Actiq. You must properly dispose of the Actiq handle right away<BR>after use
even if there is little or no medicine left on it. Please follow these
directions to dispose of<BR>the handle:<BR>1. Once you have finished the Actiq
unit and the medicine is totally gone, throw the handle away<BR>in a place
that is out of the reach of children.<BR>2. If any medicine remains on the
handle after you have finished, place the handle under hot<BR>running water
until the medicine is gone, and then throw the handle away out of the reach
of<BR>children and pets.<BR>3. NDA 20-747/S-023<BR>Page 54<BR>3. If you did
not finish the entire Actiq unit and you cannot dissolve the medicine under
hot<BR>running water right away, put the Actiq in the temporary storage bottle
that you received in the<BR>Actiq Welcome Kit for safe keeping. Push the Actiq
unit into the opening on the top until it falls<BR>completely into the bottle.
Never leave unused or partially used Actiq units where children<BR>or pets can
get to them.<BR>4. Dispose of the handles in the temporary storage bottle as
soon as you can by following the<BR>directions in steps 1 and 2. You must
dispose of all handles in the temporary storage bottle at<BR>least once a
day.<BR>Do not flush entire unused Actiq units, Actiq handles, or blister
packages down the toilet.</FONT></DIV>
<P><FONT color=#ff0000><FONT color=#000000 size=2>2. How should I store
DaytranaTM? - no flush<BR>• Store DaytranaTM in a safe place at room
temperature, 59 to 86° F (15 to 30° C). Keep DaytranaTM patches in<BR>their
unopened pouches until ready to use.<BR>• Once a tray of patches has been
opened, use or discard the patches within 2 months.<BR>• Keep DaytranaTM and
all medicines out of the reach of children.</FONT></FONT><FONT
color=#ff0000><FONT color=#000000 size=2> HOW TO REMOVE AND DISCARD
DAYTRANATM<BR>• When you remove the patch, peel it off slowly.<BR>• Fold the
used DaytranaTM patch in half and press firmly so that the sticky side sticks
to<BR>the used patch down the toilet or dispose of it in a lidded container
right away.<BR>• Do not flush the pouches or the protective liners down the
toilet. These items should be<BR>in a lidded container.<BR>• If any sticky
material (adhesive) remains on the child’s skin after removing the patch,
gently<BR>area with oil or lotion to remove the adhesive from the skin.<BR>•
Wash your hands after handling the patch.<BR>• After the patch is removed and
disposed of, record this time on the administration chart.</FONT></FONT></P>
<P><FONT size=2>3. Duragesic Transdermal System (fentanyl) - yes flu<SPAN
class=504271601-07112007>sh </SPAN></FONT><FONT color=#ff0000><FONT
color=#000000><FONT size=2>After you have stopped using a patch, be sure to
fold the sticky sides of the patch together and flush it down the toilet. Do
not put used fentanyl skin patches in a garbage c</FONT></P>
<LI><FONT size=2>If your healthcare professional tells you to stop using the
fentanyl skin patch, throw away the unused packages. Open the unused packages
and fold the sticky sides of the patchtogether, and flush them down the
toilet. </FONT>
<LI>
<DIV><FONT color=#0000ff size=2></FONT> </DIV>
<DIV><FONT color=#0000ff size=2>4. Oxycontin - yes flush</FONT></DIV>
<DIV><FONT color=#0000ff size=2>11. Patients should be instructed to keep
OxyContin in a secure place out of the reach of<BR>children. When OxyContin is
no longer needed, the unused tablets should be destroyed<BR>by flushing down
the toilet.</FONT></DIV>
<DIV><FONT color=#0000ff size=2>you have been taking it for more than a few
days.<BR>After you stop taking OxyContin, flush the unused tablets down the
toilet.<BR>What Should I Avoid While Taking OxyContin®?</FONT></DIV>
<DIV><FONT color=#0000ff size=2></FONT> </DIV>
<DIV><FONT color=#0000ff size=2>4. Avinza - Narcotic - yes -
Flush</FONT></DIV>
<DIV><FONT color=#0000ff size=2> Patients should be instructed to keep
AVINZA in a secure place out of the reach<BR>of children. When AVINZA is no
longer needed, the unused capsules should be<BR>destroyed by flushing down the
toilet.</FONT></DIV>
<DIV><FONT color=#0000ff size=2></FONT> </DIV>
<DIV><FONT color=#0000ff size=2>5. Baraclude is a prescription medicine used
for chronic infection with hepatitis B virus (HBV) in adults who also have
active liver damage. - No disposal info on patient info sheet. Lactic
Acidosis/Liver problems side effects. - Found flushing info on more
detailed label section:</FONT></DIV>
<DIV><STRONG><FONT color=#0000ff size=2></FONT></STRONG> </DIV>
<DIV><FONT color=#0000ff><FONT size=2>Storage<BR>616 BARCLUDE Tablets should
be stored in a tightly closed container at 25° C (77° F);<BR>617 excursions
permitted between 15-30° C (59-86° F) (see USP Controlled Room<BR>61 8
Temperature).<BR>619 BARCLUDE Oral Solution should be stored in the outer
carton at 25° C (77° F);<BR>620 excursions permitted between 15-30° C (59-86°
F) (see USP Controlled Room<BR>621 Temperature). Protect from light. After
opening, the oral solution can be used up to the<BR>622 expiration date on the
botte.</FONT><FONT size=2><STRONG> The bottle and its contents should be
discarded after the<BR>623 expiration
date.<BR></STRONG>624</FONT></FONT></DIV>
<DIV><FONT color=#0000ff size=2></FONT> </DIV>
<DIV><FONT color=#0000ff size=2>side effects.<BR>771 How should i store
BARACLUDE?<BR>772 · Store BARCLUDE Tablets or Oral Solution at room
temperature, 59° to 86° F (15°<BR>773 to 30° C). They do not require
refrigeration. Do not store BARCLUDE Tablets in a<BR>77 4 damp place such as a
bathroom medicine cabinet or near the kitchen sink.<BR>775 . Keep the
container tightly closed. BARCLUDE Oral Solution should be stored in<BR>776
the original carton and protected from light.<BR>777 . Throwaway BARCLUDE when
it is outdated or no longer needed by flushing<BR>778 tablets down the toilet
or pouring the oral solution down the sink.<BR>779 . Keep BARACLUDE and all
medicines out of the reach of children and pets.</FONT></DIV>
<DIV><BR><FONT color=#0000ff size=2> </FONT></DIV>
<DIV><FONT color=#0000ff size=2>6. Reyataz is a prescription medicine used
with other anti-HIV medicines to treat people who are infected with the human
immunodeficiency virus (HIV). Reyataz is a type of anti-HIV medicine called a
protease inhibitor. Reyataz helps to block HIV protease, an enzyme that is
</FONT></DIV>
<DIV><FONT color=#0000ff size=2>FLush - yes </FONT></DIV>
<DIV><FONT color=#0000ff size=2>Store REYATAZ Capsules at room temperature,
59° to 86° F (15° to 30° C). Do not store this<BR>medicine in a damp place
such as a bathroom medicine cabinet or near the kitchen sink.<BR>• Keep your
medicine in a tightly closed container.<BR>• Throw away REYATAZ when it is
outdated or no longer needed by flushing it down the toilet or<BR>pouring it
down the sink.<BR>General information about REYATAZ</FONT></DIV>
<DIV><FONT color=#0000ff size=2></FONT> </DIV>
<DIV><FONT size=2><FONT color=#0000ff>7. Tequin<SPAN class=504271601-07112007>
- flushing yes - Tequin</SPAN> is an antibiotic used to treat adults with
lung, sinus, or urinary tract infections and also to treat certain sexually
transmitted diseases caused by germs called bacteria. <SPAN
class=504271601-07112007> </SPAN></FONT><FONT color=#0000ff>The sexually
transmitted disease called gonorrhea is treated by Tequin. Other sexually
transmitted diseases including syphilis and non-gonococcal diseases are not
treated by Tequin. </FONT></FONT></DIV>
<DIV><FONT color=#0000ff></FONT><FONT color=#0000ff></FONT><FONT color=#0000ff
size=2>Remember<BR>• Take your dose of TEQUIN once a day.<BR>• Complete the
course of medication (take all of the pills) even if you are feeling
better.<BR>• Do not use TEQUIN for another condition or give it to
others.<BR>• Store TEQUIN tablets at room temperature in a tightly sealed
container.<BR>• Throw away TEQUIN when it is outdated or no longer needed by
flushing it down the<BR>toilet.<BR>• Keep this and all medications out of
reach of children.<BR></FONT></DIV>
<LI>
<DIV><SPAN class=504271601-07112007></SPAN><FONT color=#0000ff><FONT
size=2>8</FONT><SPAN class=504271601-07112007><FONT size=2>. Zerit - ZERIT
oral solution - "throw away - then at very bottom -
Flush" (pronounced ZAIR it) is a prescription medicine used in
combination with other<BR>drugs to treat adults and childen who are infected
with HIV (the human<BR>immunodeficiency virus), the virus that causes AIDS.
ZERIT belongs to a class of drugs<BR>called nucleoside reverse transcriptase
inhibitors (NRTIs). By reducing the growth of<BR>HIV, ZERIT helps your body
maintain its supply of CD4 cells, which are important for<BR>fighting HIV and
other infections.</FONT></SPAN></FONT><BR></FONT><FONT color=#000000><FONT
size=2>Oral solution (for children): ZERIT for Oral Solution is taken twice a
day (every 12<BR>hours). If your child will be taking ZERIT, the doctor should
give you written<BR>instructions on how to give this medicine. Before
measuring each dose, shake the<BR>bottle well. Store ZERIT for Oral Solution
in a tightly closed container in a<BR>refrigerator and <STRONG>throw away any
unused portion after 30 days.</STRONG></FONT></FONT></DIV>
<LI>
<DIV><FONT color=#000000 size=2>This medicine was prescribed for your
particular condition. Do not use ZERIT for another<BR>condition or give it to
others. Keep ZERIT and all other medicines out of the reach of
children.<BR>Throw away ZERIT when it is outdated or no longer needed by
flushing it down the toilet or<BR>pouring it down the sink.<BR></FONT></DIV>
<LI>
<DIV><SPAN class=504271601-07112007></SPAN><FONT color=#000000
size=2>9</FONT><SPAN class=504271601-07112007><FONT color=#000000 size=2>.
Meperidine HCl Tablets - morphine like substance - for pain
relief</FONT></DIV>
<OL>
<LI>
<P class=First><FONT color=#000000 size=2>Patients should be advised that if
they have been receiving treatment with meperidine for more than a few weeks
and cessation of therapy is indicated, it may be appropriate to taper the
meperidine dose, rather than abruptly discontinue it, due to the risk of
precipitating withdrawal symptoms. Their physician can provide a dose
schedule to accomplish a gradual discontinuation of the
medication.</FONT></P>
<LI>
<P class=First><FONT color=#000000><FONT size=2>Patients should be
instructed to keep meperidine in a secure place out of the reach of
children. When meperidine is no longer needed, the unused tablets should be
destroyed by flushing down the toile<SPAN class=504271601-07112007>t.
</SPAN></FONT></FONT></P></LI></OL>
<P class=First><FONT color=#000000 size=2><SPAN class=504271601-07112007>10.
percocet - Percocet (Oxycodone and
Acetaminophen) narcotic pain relief - flush</SPAN></FONT></P></SPAN>
<LI><SPAN class=504271601-07112007>
<P class=First><FONT color=#000000 size=2><SPAN class=504271601-07112007>When
PERCOCET tablets are no longer needed, the unused tablets should be destroyed
by<BR>flushing down the toilet.<BR>4. Patients should be
advised</SPAN></FONT></P></SPAN><SPAN class=504271601-07112007>
<P class=First><FONT color=#000000 size=2><SPAN class=504271601-07112007>11.
Xyrem - Xyremâ (sodium oxybate) is a central nervous system depressant with
anti-cataplectic activity in<BR>patients with narcolepsy<BR>Your doctor has
determined that you may benefit<BR>from taking Xyrem. Xyrem has been shown
to<BR>reduce excessive daytime sleepiness and<BR>cataplexy in patients with
narcolepsy.<BR></SPAN></FONT></SPAN></FONT><FONT face=Arial size=2> When
you can no longer draw medication<BR>out of the bottle with the measuring
device,<BR>it is time to throw the bottle away. Use a<BR>marker or pen to
deface the bottle label<BR>so someone else cannot use it for
illicit<BR>purposes. Pour any unused Xyrem®<BR>down the drain. Place the empty
bottle<BR>in the trash so it is not used for illegal<BR>purposes.</FONT></P>
<P class=First><SPAN class=504271601-07112007></SPAN><FONT face=Arial><FONT
size=2>1<SPAN class=504271601-07112007>2. Fentora - Flush Yes - FENTORA
is a prescription medicine that contains the medicine
fentanyl.</SPAN></FONT></FONT></P>
<P class=First><FONT size=2><FONT size=+0><SPAN
class=504271601-07112007> Patients and caregivers should be advised that
if they have been receiving treatment<BR>with FENTORA and the medicine is no
longer needed they should flush any<BR>remaining product down the toilet, and
if they then need further assistance, contact<BR>Cephalon at
1-800-896-5855.<BR>Disposal of Unopened FENTORA Blister Packages When No
Longer Needed<BR>Patients and members of their household must be advised to
dispose of any unopened<BR>blister packages remaining from a prescription as
soon as they are no longer needed.<BR>To dispose of unused FENTORA, remove
FENTORA tablets from blister packages and<BR>flush down the toilet. Do not
flush the FENTORA blister packages or cartons down the<BR>toilet. (See SAFETY
AND HANDLING.)<BR>Detailed instructions for the proper storage,
administration, disposal, and important<BR>instructions for managing an
overdose of FENTORA are provided in the FENTORA<BR>Medication Guide. Patients
should be encouraged to read this information in its entirety<BR>and be given
an opportunity to have their questions answered.<BR>In the event that a
caregiver requires additional assistance in disposing of excess
unusable<BR>tablets that remain in the home after a patient has expired, they
should be instructed to<BR>call the Cephalon toll-free number (1-800-896-5855)
or seek assistance</SPAN></FONT><BR><SPAN class=504271601-07112007><FONT
face=Arial> </FONT></SPAN></FONT></P></LI></BLOCKQUOTE></BODY></HTML>