Bravelle™

Description: Bravelle (urofollitropin) is a highly purified preparation of human follicle stimulating (FSH) extracted from the urine of postmenopausal women. Each vial contains 75IU of FSH. Bravelle in conjunction with hCG (human chorionic gonadotropin) is indicated for ovulation induction in patients who have previously received pituitary suppression.

How It Works: Bravelle is administered as an injection either subcutaneously or intramuscularly. Bravelle is a purified form of a naturally occurring hormone FSH. Bravelle is used to stimulate a follicle (egg) to develop and mature in the ovary. Bravelle is also used to stimulate the development of multiple eggs with assisted reproductive technologies.

Potential Side Effects: Side effects that may occur include: ovarian pain, ovarian cyst, nausea, enlarged abdomen, abdominal pain, headache, mild to moderate ovarian enlargement. Treatment with Bravelle may increase the likelihood of multiple births. The risk of ovarian hyperstimulation syndrome (OHSS) should be discussed with your physician prior to treatment. Early warning signs include severe pelvic pain, nausea, vomiting and weight gain.

If you experience an allergic reaction: difficulty breathing; closing of the throat; swelling of the lips, tongue or face; or hives; seek emergency medical attention immediately. And if at any time you experience: pain, warmth, redness, numbness, or tingling in an arm or leg; confusion, severe dizziness or severe headache, seek medical attention immediately.

PLEASE NOTE: If these or any other side effects occur, contact your physician.

Storage: Bravelle may be stored refrigerated or at room temperature 37-77ºF. Protect from light. Use immediately after reconstitution. Discard unused material.

Bravelle™ NOTE: Bravelle may be given as a subcutaneous injection or an intramuscular injection depending on your physician'sorders. Instructions for both injections are included. (This medication is known as a Gonadotropin)

Description:	Bravelle is an injectable medication that stimulates the ovaries to produce eggs. Each vial contains 75 IU (International Units) of powdered medicationto be mixed with diluent.
How it works:	Bravelle™ is a gonadotropin that contains follicle stimulating hormone (FSH).
Side effects:	Side effects may include some local discomfort, bruising and soreness at theinjection site. Changes in mood, abdominal discomfort, bloating and crampingare other possible minor side effects. Multiple births occur in about 20-25% ofpregnancies of which 70% are twins. Excessive enlargement of the ovaries,called ovarian hyperstimulation (OHSS) may occur. Symptoms of OHSS includeexcessive fluid retention and severe abdominal discomfort.
Storage:	Store Bravelle at room temperature or refrigerate. Bravelle cannot be mixed in advance. Once it is mixed, it must be used within 15 minutes.
Mixing:	Pop off the plastic top of powdered medication and diluent (liquid). Swab the top of each vial with an alcohol pad to prevent contamination. Select a 3cc syringe with 1 ½" needle for mixing. Twist to secure needle. Using your syringe, draw back 1cc of air into the syringe. Firmly insert the needle through the rubber stopper into the vial of diluent. Invert, or turn upside down, the vial and syringe as one complete unit anddepress the air into the vial in order to equalize the pressure, which will makewithdrawal of the diluent easier. Once you depress the plunger of the air-filled syringe into the vial, make sure the tip of the needle is BELOW the liquid level and pull the plunger to withdraw 1cc of the diluent. Slowly and cautiously deposit the diluent into the vial of powdered medication. Rotate the vial between your thumb and index finger until the solution is clear. Withdraw the newly mixed medication back into the syringe. Remove the syringe from the vial. Invert the syringe so the needle is pointing upwards and tap the syringe to force any air bubbles to the top. Depress the plunger to expel the air.

If you are mixing a single vial, you are now ready for your injection. Recap and remove the mixing needle by twisting and replace it with the smaller
subcutaneous injection needle (usually 1/2” needle). PROCEED TO SUBCUTANEOUS INJECTION INSTRUCTIONS

If you are mixing a single vial, you are now ready for your injection. Recap and remove the mixing needle by twisting and replace it with the
intramuscular injection needle (usually 1 1/2” needle). PROCEED TO INTRAMUSCULAR INJECTION INSTRUCTIONS

If Mixing More than One Vial of BRAVELLE

• Inject the contents of the syringe (powdered medication mixed with diluent) directly into the next vial of powdered medication, slowly and cautiously. This will increase the dosage without increasing the liquid volume. Do not use more diluent for additional vials of Bravelle. Again, rotate the vial between your thumb and index finger until the solution is clear.
  
• Again, rotate the vial between your thumb and index finger until the solution is clear.
• Withdraw the newly mixed Bravelle from the second vial back into the syringe. Repeat until you have reached your prescribed vial dosage.
• Withdraw the medication mixture from the final vial into the syringe and prepare for your injection.
  
• SUBCUTANEOUS INJECTION- When you are ready for your injection,
  recap and remove the mixing needle by twisting and replace it with a smaller
  subcutaneous injection needle (usually 1/2" needle).
   PROCEED TO SUBCUTANEOUS INJECTION INSTRUCTIONS.
  

  INTRAMUSCULAR INJECTION- When you are ready for your injection,
  recap and remove the mixing needle by twisting and replace it with an intramuscular needle (usually 1 1/2" needle).
  PROCEED TO INTRAMUSCULAR INJECTION INSTRUCTIONS.

   

   

Subcutaneous Injection Instructions

	Cleanse your selected SUBCUTANEOUS injection site with an alcohol wipe and allow to dry. While holding the syringe with your dominant hand between your thumb and finger (as you would a pencil), pinch the skin (with your other hand) at the site you have selected. With a quick, dart-like motion, insert the entire needle (up to the hub of the syringe) at a 90° or a 45° angle and depressthe plunger slowly and carefully. After the injection is complete, quickly pull out the needle. If bleeding, apply pressure to the injection site with a sterile gauze pad. If discomfort occurs after your injection, you maygently massage the injection site to alleviate your discomfort. After injecting the medication, dispose of the syringe into the Sharps waste container. It is unnecessary to recap the needle as this could cause injury.

Intramuscular Injection Instructions

	Cleanse your selected INTRAMUSCULAR injection site with an alcohol wipe and allow to dry. Hold the syringe with your dominant hand between your thumb and index finger (as you would a pencil). With your other hand, firmly stretch your skin at the selected injection site. Make sure you are using the intramuscularneedle (usually 1 ½ ”). NOTE: To minimize bruising, firmly stretch the skin. With a quick, dart-like motion, insert the entire needle (up to the hub of the syringe) at a 90° angle into the stretched skin area between your thumb and index finger. Using either hand to stabilize the syringe, pull back slightlyon the plunger and watch for blood in the syringe. (This is rare). You may feel slight resistance or see a small bubble - this is normal. If blood is not seen in the syringe, the needle is inserted properly.If blood appears in the syringe, DO NOT INJECT YOUR MEDICATIONS. Withdraw the needle, cover the site with a gauze pad, and apply pressure. Discard the syringe into the Sharps container. Repeat mixing and injection instructions. Depress the plunger slowly and steadily. Pull the syringe out in one motion. After injecting the medication, dispose of the syringe into the Sharps waste container. It is unnecessary to recap the needle as this could cause injury. Apply pressure to the site with a gauze pad and gently massage the area to help disperse themedication and relieve discomfort. Apply a bandage if necessary.