After your doctor has prescribed growth hormone therapy, this section is an overview of the steps you will follow in preparing and giving TEV-TROPIN® to your child. Click on the links below to review each step.

Step 1: Overview of Supplies
Before getting started, let's review all the supplies you will need.

•  TEV-TROPIN®

•  Preparation syringe

•  Disposal container

•  Diluent (mixing liquid)  

•  Injection Syringe

•  Alcohol swabs

•  Dry gauze pad/adhesive bandage

How to Give Your Child Growth Hormone

Step 2: Preparation
TEV-TROPIN® is packaged in a dry powdered form that can be stored for long periods, but is not ready for immediate use. Follow the storage instructions on the box. To prepare the medication for injection, you must mix or reconstitute the dry powder with the proper diluent included with your medication.


Step 3: Measurement
Withdraw the correct amount of reconstituted medication from the vial with a syringe. Do not exceed the doctor's dosing instructions.


Step 4: Site Selection
Each time you give your child TEV-TROPIN®, you need to select a different injection site.


Step 5: Injection
Cleanse the injection site with an alcohol swab and give the injection.


Step 6: Disposal
Properly dispose of all used needles and syringes to prevent injuries. Remember to keep all needles out of the reach of children. Return unused TEV-TROPIN® to the refrigerator for storage.

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Step 1: Overview of Supplies

These are the supplies you'll need to get your child started on TEV-TROPIN® therapy.

  • Vial of TEV-TROPIN®
    [somatropin (rDNA origin) for injection]
    This is the actual medication, which is supplied in a powder form.

  • Vial of Diluent (mixing liquid)
    [bacteriostatic 0.9% sodium chloride for injection, USP (benzyl alcohol as a preservative)]
    Bacteriostatic sodium chloride diluent is special water for preparing the medicine. You should only use the diluent provided with TEV-TROPIN®. Your doctor will prescribe the exact amount. Because of toxicity in newborns, your physician will have you use another diluent if your child is a newborn.

  • Preparation Syringe
    Your doctor may recommend two different-sized syringes. Important: The larger is for adding the diluent to the powder for mixing the medicine only.

  • Injection Syringe
    The second syringe is usually smaller, and is used to draw the right amount of medication for injection. Be sure to store all needles and syringes out of the reach of children.

  • Alcohol Swabs
    These are used to clean and disinfect the injection site and vials.

  • Dry Gauze Pads or Adhesive Bandages
    These can be used to clean or cover the injection site after the injection.
  • Disposal Container
    Your pharmacy will provide you with a Sharps Disposal Container. This is needed for discarding plastic needle guards, used needles, and syringes.

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Step 2: Preparation

How to Prepare TEV-TROPIN®

Since TEV-TROPIN® is not ready for immediate use, you must mix the dry powder with the
special diluent (mixing liquid) before injection. This process is called reconstitution. If the patient
is a newborn, your physician will prescribe another diluent other than the one provided with
TEV-TROPIN®.

Prepare Yourself

1. To help prevent infection, wash your hands thoroughly with an antibacterial soap before preparing TEV-TROPIN®.


Sanitize the Materials

2. Remove the hard plastic caps from the tops of both the diluent and the medication vials. Do not remove the rubber stoppers or the metal ring holding the stopper in place.
3. Using an alcohol swab, wipe off the rubber stopper on the top of each vial. After cleansing, do not touch this area.
4. Carefully remove the needle guard from your larger preparation syringe. Only hold the end of the syringe; make sure that you do not touch the skinny part of the plunger or the needle.


Measure the Diluent

5. Pull back on the plunger of the syringe and draw in air. Stop when the amount of air is equal to the amount of diluent your doctor has prescribed.
6. Slowly insert the needle into the diluent vial through the rubber stopper. Gently push down on the plunger and slowly release the air into the vial. The added air will help you to withdraw liquid from the vial.
7. Carefully turn the vial upside down, making sure that the needle stays inside. Then be sure the tip of the needle is in the diluent and begin to pull back on the plunger until the correct amount of diluent fills your syringe. Double-check to be sure you have the correct amount.



Reconstitute TEV-TROPIN®

8. Remove the needle from the diluent vial and insert it into the rubber stopper of the
TEV-TROPIN® vial. Do not allow the needle to touch anything but the rubber stopper.
9. Slowly inject the diluent pointing the needle against the side of the vial. This will help to avoid creating air bubbles. Do not squirt the diluent directly onto the powder.
10. When the syringe is empty, remove the needle from the vial and safely dispose of the used syringe. Do not recap the needle. See Step 5 (Disposal) for more information on the safe disposal of needles and syringes.
11. Hold the vial between your hands and gently roll it until the mixture becomes clear. NEVER SHAKE THE VIAL! Sometimes the vial may need to sit a few seconds before the powder is completely dissolved and all the air bubbles disappear. Do not use the mixture in the vial if it becomes cloudy or you see particles floating in the liquid.
12. Write the date you reconstituted the TEV-TROPIN® on the label of the vial.


Storing TEV-TROPIN®

13. If the vial of reconstituted medication contains more than one dose, you can store extra doses in the refrigerator for later use. Always check your refrigerator first before reconstituting new medication.
14. Store all vials, including the reconstituted TEV-TROPIN® in a refrigerator. Check to make sure the reconstituted medication is not more than 14 days old. Do not use mixed TEV-TROPIN® to reconstitute a new vial of medication. Do not freeze the medication. Do not use medication if it appears frozen.
15. Unused growth hormone must be used within 14 days.

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Step 3: Measurement

How to Measure TEV-TROPIN®

Once you have reconstituted the medication, it is time to measure the dose for injection. Your child's doctor will prescribe an exact dosage and select the size of syringe you need for injection.

Prepare Yourself

1. To help prevent infection, wash your hands thoroughly before measuring and injecting TEV-TROPIN®.


Prepare the Materials

2. Check to see if the reconstituted medication is clear. If the medicine is cloudy or hazy do not inject it. Refrigerated TEV-TROPIN® may clear if left to sit at room temperature. Do not use TEV-TROPIN® if it remains cloudy.
3. Check to make sure the medication is not more than 14 days old, once it has been mixed. If the medicine has passed the expiration date do not use it.
4. Cleanse the top of the rubber stopper on the vial with an alcohol swab. Do not touch the rubber stopper.

5. Carefully remove the needle guard from your injection syringe and set it aside. Do not touch the needle.


Measure the Medication

6. Pull back on the plunger of the injection syringe and draw in air. Stop when the amount of air is equal to the dosage of TEV-TROPIN® your doctor has prescribed.

7. Slowly insert the needle into the TEV-TROPIN® vial through the center of the rubber stopper. Gently push down on the plunger and slowly release the air into the vial. The air will help you to draw liquid from the vial.
8. Carefully turn the vial upside down, making sure that the needle stays inside. Then be sure the tip of the needle is below the surface of the solution and begin to pull back on the plunger until the correct amount of TEV-TROPIN® fills your syringe.
Note: When taking the last dose you may need to gently tap the vial to withdraw the final drops.
9. Remove the needle from the vial.


Final Preparations

10. Keeping the needle in an upright position, gently tap the syringe to loosen any air bubbles. The bubbles will rise to the top of the syringe and can be pushed out of the syringe by gently pushing in the plunger. A small drop of liquid will appear at the end of the needle when all air is out. Double-check to be sure you still have the correct amount of TEV-TROPIN®; if there were many air bubbles you may need to withdraw more TEV-TROPIN®.

11. Carefully replace the needle guard until you’re ready for the injection.
12. Let the filled syringe sit for a few minutes until it reaches room temperature. The injection should be given as soon as possible after this time. Do not store TEV-TROPIN® in the syringe.

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Step 4: Site Selection

How to Select the Injection Site

Certain areas of the body are better than others for injections to allow you to grasp the right amount of skin needed for the injection and reduce the amount of discomfort. It is very important to rotate the site of injections, meaning that you must always choose a different injection site than the last time you gave TEV-TROPIN® — even if your child develops a preference for one particular site. The following are good injection sites for children:

Abdomen or Belly
The abdomen is a good choice for injections because it can be used for both younger and older children.


Buttocks (Left and Right)
The outer upper section of the buttocks is another good injection site.

Tips: Your child should lie facedown on a flat surface with toes pointed inward to relax the muscle.

Thighs (Left and Right)
The thighs provide a good injection site for anyone, especially infants and toddlers. The best area for the injection is in the middle of the front or side of the thigh.

Tips: Your child can be lying down or sitting with the feet flat on the floor.


Upper Arms (Left and Right)
The arms are only recommended for use in older children. The ideal area for injection is the upper fleshy part of the arm.

Note: You may find that attempting injections at night while children are asleep is an alternative method for younger children who are afraid of needles.

Watch for Potential Problems

Contact your child's doctor if you notice any of the following:

  • a lump or bruise that doesn't go away
  • sharp pain or pain that doesn't go away
  • skin that is hot to the touch
  • swelling, pus, redness, or rash

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Step 5: Injection

How to Give the Injection
Your child's doctor or nurse will give you hands-on training on how to give injections. The instructions below are just a helpful reminder for you to have if you need them.

Prepare the Injection Site

1. Remove clothing from the injection site so that you can locate the correct area and allow the muscles to relax. Never give an injection through clothing.
2. Clean the site completely with an alcohol swab. Allow the alcohol to dry from the skin before inserting the needle (about two minutes).

Prepare the Needle

3. Double-check that the correct amount of TEV-TROPIN® is in the syringe.
4. Remove the needle guard and hold the syringe the way you hold a pencil.
5. Gently tap the syringe to loosen any air bubbles. The bubbles will rise to the top of the syringe and can be released by slowly pushing in the plunger. A small drop of liquid will appear at the end of the needle when all air is out.

Insert the Needle

6. Gently pinch your child’s skin between your fingers.
7. Insert the needle into the skin at a 90-degree angle. Use a quick, firm motion to reduce discomfort.

Inject the Medication

8. Let go of the skin and slowly and gently push the plunger to inject the medication (this should take a few seconds).
9. Quickly remove the needle, pulling it straight out.

10. Promptly dispose of the needle in the proper container.
11. Apply pressure over the injection site with a dry gauze pad or cotton ball. Your child may also want an adhesive bandage.

Note: After time, injections can become routine, but it is always essential that you pay close attention to what you are doing.

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Step 6: Disposal

How to Dispose of All Used Needles and Syringes

After you've given an injection, it's important to correctly dispose of used needles and syringes.

Safely Dispose of All Materials in a Special Disposal Container

1. For safety reasons, you cannot throw away needles and syringes like ordinary trash. They must be disposed of separately in their own Sharps Disposal Container.
2. There may be special laws in your state about what type of container can be used. Check with your doctor, nurse, or pharmacist.

3. After every injection, you should throw away the needles, the syringes, and the plastic needle guards. This applies to both the preparation needle and the injection needle. To prevent infection, they should only be used once.
4. Always store your Sharps Disposal Container out of the reach of children.

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Growth SolutionsSM is a service mark of TEVA Pharmaceuticals USA.
TEV-TROPIN® is a registered trademark of TEVA Pharmaceuticals USA.

©2005 TEVA Pharmaceuticals USA