a. Wash your hands before preparing the pen for use.

b. Check the label on the pen before each use to ensure that you are taking Osteotide only,
as many other medications also come with a pen delivery device.

c. Look at the Osteotide medicine in the cartridge. It should be clear & colourless,
and it should not have any particles in it. If it is not clear & colourless, or if it has particles,
 do not use it.

d. Use alcohol swab to swipe the rubber seal on the end of the pen.

Step 2 : Loading the cartridge into the pen

a. Remove cap of pen injector by pulling,   while holding it in one hand (Fig. 1).	b. Rotate the cartridge holder from the pen  body until it stops, then pull apart to separate (Fig. 2).
c. Insert the cartridge, metal cap first,  into the cartridge holder(Fig. 3).	d. Lower the pen body onto the cartridge holder, then push and screw them together  (Fig. 4). e. Always store cartridge attached pen in refrigerator (Do not freeze).

Note: Use only new cartridge when loading the pen injector. Never load a partially filled cartridge. Never remove & reload partially used cartridge.

Step 3: Attaching the needle

a. Always use a new needle for each injection. Do not store the pen with the needle attached,
as this may let Osteotide leak from the pen and air bubbles can form in the cartridge.

b. Pull off the paper tab from the outer needle shield and throw the paper tab away (Fig. 5).

c. Holding the cartridge holder, attach the capped needle to the end of the pen by pushing it
on and turning it clockwise (to the right).Do not over-tighten the needle since it must be removed
after the injection (Fig. 6a, 6b).

d. Hold the pen with the needle pointing up and remove the outer needle shield. Keep the
outer needle shield because you will need it to remove the needle after the injection is
given (Fig. 7).

e. Pull off the inner needle shield and throw it away (Fig 8).

Step 4: Priming the pen

• The pen must be primed before every injection.

• You must prime the pen to make sure the medicine is flowing and that you are receiving the
correct dose. Priming removes air bubbles that might affect the dose you get. Small air
bubbles may collect in the Osteotide cartridge during normal use.

• The very small amount of the prime dose does not affect the total supply of 28 days of
therapy that the pen will deliver.

a. Turn the dose dialler clockwise (to the right) until the number “2” in the dose window coincides with marker appearing in window (Fig. 9).	b. With the arrow and the number “2” in the dose  window in line,hold your pen with the needle  pointing up.Tap the clear cartridge holder gently with your finger so that any air bubbles collect near the top  (Fig. 10).
c. Using your thumb, if possible, push in the thumb button all the way and keep pressing.	d. Continue to hold the thumb button firmly and count slowly 1 to 5. You should see either a few drops or a tiny stream of Osteotide come out of the tip of needle.  If it has stopped, this step is complete  (Fig. 12).

If nothing comes out of the tip of the needle, dial up 2 more units, press in the thumb button fully,
and check for medication.Continue to dial up 2 units and press in thumb button fully until you
see medication come out of the pen needle.

Note: A small air bubble may stay in the cartridge when you finish the priming step. If you have properly primed the pen, this small air bubble will not harm or affect your Osteotide dose.

Step 5: Setting the dose

The numbers in the dose indicate the size of the dose. Number “2” means 20 µL, number “4” means  40 µL etc. a. Turn the dialler clockwise (to the right) until you see the arrow and number “8” are in the dose window. You will hear a click for each increment you dial. Do not rely on counting these clicks to measure the correct dose. b. When the number “8” and arrow are in line, you have set the 20-mcg dose and the pen is “ready to inject” (Fig. 13)

Step 6: Dose correction

• If you turn dose dialler beyond the required dose, turn backwards in anti-clockwise direction.

Note: Do not press button to readjust the dose

Step 7: Injecting the dose

• Make injections just below the surface of tissue the subcutaneous tissue). a. Rub the skin with alcohol swab where injection has to be administered (Fig. 14) b. Lightly hold a fold of skin as shown along- side, and push the needle straight into your skin.  The skin may need to be pinched up to avoid a deep injection into a muscle (intramuscular), especially in the thigh area (Fig. 15) Ask your doctor for more instructions about  injection technique and changing sites (rotation).

c. See that number “8” and arrow are in line in the dose window. Inject the Osteotide by using your thumb, possible, to push in the blue injection button all the way. d. Continue to hold down the thumb button firmly and count slowly to 5 to ensure that the Osteotide has been completely injected into the skin. Remove the needle from your skin when you finish counting. e. When the injection is complete, you must see number “0” and arrow are in line in the dose window.This tells you the thumb button has been pushed in fully and your correct dose has been injected.

Note: If the thumb button stops before the end of its travel and the window does not read “0”, the
cartridge is empty and the full dose has not been dispensed. The dose window will show the amount
of medication still required. Remove the pen needle from the skin and write down the number. Remove the pen needle from the injector as described in step 8. Reset the dialler to “0” by simply rotating anti-clockwise. Remove the empty cartridge by unscrewing the cartridge holder from the pen body. Insert a new cartridge and check the medication flow as described in step 3-4. Set the dose which you noted, and inject. This will complete the dose.

Step 8: After an injection

a. Carefully replace the outer needle shield as instructed by your doctor.

b. Remove the capped needle by turning it anti-clockwise (to the left). Place the used needle
in a puncture resistant disposable container and properly throw it away as directed by your doctor.

c. Replace the cap on pen.

d. Store your cartridge attached Osteotide pen in the refrigerator at 2° to 8° C (36° to 46° F)
at all times. You should inject Osteotide right after you take the pen out of the refrigerator.
Put the pen back into the refrigerator right after use.

e. You can use your Osteotide cartridge for up to 28 days including the first injection from the pen. After 28 days, throw away the cartridge even if it is not completely empty.

f. Never share an Osteotide pen.

g. Do not freeze the Osteotide pen. Do not use Osteotide if it has been frozen.

h. Do not use the Osteotide cartridge after the expiration date printed on the carton and cartridge label.