Extavia

Extavia is a prescription medication used to treat relapsing forms of multiple sclerosis (MS) and reduce the frequency of exacerbations of multiple sclerosis. Extavia belongs to a group of drugs called interferons. The way that Extavia works to treat multiple sclerosis is not yet fully understood. 

This medication comes in an injectable form to be injected directly under the skin typically every other day.

Common side effects of Extavia include decreased blood counts, flu-like symptoms, and headache.

Extavia can also cause dizziness. Do not drive or operate heavy machinery until you know how Extvia affects you.

Extavia is a prescription medication used to treat relapsing forms of multiple sclerosis and reduce the frequency of multiple sclerosis exacerbations.

Extavia will not cure multiple sclerosis (MS), but it has been shown to decrease the number of multiple sclerosis exacerbations that occur per year.

• Novartis Pharmaceuticals Corporation

Serious side effects have been repoted with Extavia. See the “Extavia Precautions” section.

Common side effects of Extavia include:

• Flu-like symptoms
• Headache
• Increases in muscle tension and/or muscle pain
• Skin rash
• Insomnia
• Stomach pains
• General weakness

This is not a complete list of Extavia side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

No drug interaction studies have been conducted by the manufacturer. However, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Serious side effects have been reported with Extavia including the following:

Depression. Depression is not uncommon in people with multiple sclerosis. Some people who take Extavia become depressed and have thoughts about killing themselves or try to kill themselves. Before you start to take Extavia, tell your doctor if you ever had any mental illness, including depression, or if you take any medicines for depression. While you take Extavia, if you feel noticeably sadder or helpless, or feel like hurting yourself or others, you should tell a family member or friend right away and call your doctor as soon as possible. You may need to stop taking Extavia.

Severe allergic reactions. Some people who take Extavia have severe allergic reactions which can lead to trouble breathing and swallowing. Significant swelling of the mouth and tongue may occur with these severe allergic reactions. These reactions can happen quickly, after your first dose of Extavia, or may not happen until after you have taken Extavia many times. Less severe allergic reactions such as rash, itching, skin bumps or minor swelling of the mouth and tongue can also happen. If you think you are having an allergic reaction, stop taking Extavia right away and call your doctor. Most skin reactions are not serious, but you may need medical treatment if you develop a serious skin reaction. In most cases healing was associated with scarring. If multiple lesions occur, therapy should be discontinued until healing occurs.

Seizures. Some people have had seizures while taking Extavia, including people who have never had seizures before. It is not known if the seizures were related to their MS, to Extavia, or to a combination of both. If you have a seizure after taking Extavia call your healthcare provider right away.

Blood problems. You may have a decrease in the amount of certain blood cells, including white blood cells (blood cells that fight infection), red blood cells (blood cells that carry oxygen to body tissues), or platelets (blood cells that help you form blood clots). If this decrease is severe, your body may be less able to fight infections, you may feel tired or sluggish, or you may bruise or bleed easily. You should discuss with your doctor the need for blood testing to monitor for these problems. Your doctor will arrange for testing your blood at regular intervals to help detect blood, thyroid, liver, or other problems that may develop. These blood tests will be needed even if you do not have any symptoms.

Thyroid problems. Your thyroid function may change whilt taking Extavia. Symptoms of changes in the function of your thyroid include feeling cold or hot most of the time, or a change in your weight (gain or loss) without a change in your diet or amount of exercise you are getting.

Severe general weakness. You may feel excessively or unusually fatigued while taking Extavia. Talk to your doctor about your fatigue if it is persistent and bothersome to you.

Injection site reactions. Extavia may cause redness, pain and/or swelling at the place where an injection was given. Serious skin reactions can happen in some people, including skin infections or areas of severe damage to skin and tissue below the skin. These reactions can happen anywhere you inject Extavia. Call your doctor right away if you have any of these signs of a serious problem at any of your injection sites:

• the area is swollen and painful
• the area looks infected, and does not heal within a few days
• the area has fluid draining from it
• you notice any breaks in your skin or blue-black skin discoloration of your skin along with a break in your skin.

Liver problems including liver failure. Extavia may affect your liver function. Your doctor will do blood tests to check for these problems while you take Extavia. Symptoms of liver problems may include:

• yellowing of your eyes
• itchy skin
• feeling very tired
• flu-like symptoms
• nausea or vomiting
• bruising easily or bleeding problems

Your healthcare provider will do blood tests to check for these problems while you take Extavia.

Do not take Extavia if you:

• have had an allergic reaction such as trouble breathing, skin flushing, or hives, with another interferon beta product, or to human albumin. 
• are allergic to any of the ingredients in Extavia. 

Extavia can also cause dizziness. Do not drive or operate heavy machinery until you know how Extavia affects you.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Extavia, there are no specific foods that you must exclude from your diet when receiving this medication.

Tell your doctor about all your medical conditions, including if you:  

• are allergic to Extavia, interferon beta, albumin, or any of Extavia's ingredients
• have or have had depression (sinking feeling or sadness), anxiety (feeling uneasy, nervous, or fearful for no reason) or trouble sleeping
• have or have had liver problems
• have or have had blood problems such as bleeding or bruising easily, low red blood cells (anemia) or low white blood cells
• have or have had seizures
• have or have had heart problems
• are pregnant or plan to become pregnant
• breastfeeding or plan to breastfeed

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Extavia falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if Extavia crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. You and your doctor will decide if the benefits outweigh the risk of using Extavia.

Take Extavia exactly as prescribed.

Extavia is available in an injectable form and is given directly under the skin (subcutaneous injection) typically every other day.

If your doctor decides that you or a caregiver may be able to give your injections of Extavia at home, your doctor or nurse should instruct you on the correct way to prepare and inject Extavia. Do not try to inject Extavia yourself until you have been instructed by your doctor or nurse the correct way to prepare and give the injections. To lower your risk of infection, it is important that you follow the technique that your doctor or nurse discussed with you to prepare and inject Extavia.

Always use a new, unopened, vial of Extavia and syringe for each injection. Throw away any unused medicine. Do not reuse any vials, syringes, or needles. 

It is important for you to read, understand, and follow these instructions. Call your doctor if you or your caregiver has any questions about the correct way to prepare or inject Extavia.

Prepare for self-injection

1. Wash your hands well with soap and water.
2. Open the blister pack by peeling off the label and take out all of the items. Make sure the blister pack containing the vial adapter is sealed. Check to make sure the rubber cap on the diluent syringe is firmly attached.
3. Turn the blister pack over, and place the vial in the well (vial holder) and place the prefilled syringe in the U-shaped trough.

Mix Extavia

1.  Remove Extavia vial from the well and take the cap off the vial.
2.  Place the vial back in the vial holder.
3.  Use an alcohol wipe to clean the top of the vial. Wipe in one direction only.
4.  Leave the alcohol wipe on top of the vial until step 9 below.
5.  Peel the label off the container with the vial adapter in it, but do not remove the vial adapter. The vial adapter is sterile, so do not touch it.
6.  Remove the alcohol wipe from the top of the vial. Pick up the container that holds the vial adapter. Turn over the container keeping the vial adaptor inside. Put the adapter on top of the vial. Push down on the adapter until it pierces the rubber top of the vial and snaps in place. Lift the container off the vial adapter.
7.  Remove the rubber cap from the prefilled syringe using a twist and pull motion. Throw away the rubber cap.
8.  Remove the vial from the vial holder by grasping the vial. Do not touch any part of the vial adapter. Be careful not to pull the vial adapter off the top of the vial.
9.  Connect the prefilled syringe of diluent to the vial adapter by turning clockwise and tighten carefully.
10.  Slowly push the plunger of the prefilled syringe all the way in. This will push all of the liquid from the syringe into the vial. Continue to hold the plunger while you mix Extavia with the liquid from the syringe. If you do not hold the plunger in it may return to its original position after you let go.
11.  Gently swirl the vial to completely dissolve the white powder (Extavia). Do not shake. Shaking and even gentle mixing can cause foaming of the medicine. If there is foam, let the vial sit until the foam settles.
12.  After the powder dissolves, look closely at the solution in the vial. Do not use the solution if it is not clear or colorless, or if it contains particles. The injection should be given right away after you mix Extavia and let any foam in the solution settle. If you must wait for any reason before giving yourself the injection, you may refrigerate the medicine after you mix it. But you should use it within three hours.
13.  With your thumb still pushing the plunger, turn the syringe and vial, so that the vial is on top.
14.  Slowly pull the plunger back to withdraw the entire contents of the vial into the syringe.
15.  Turn the syringe so that the needle end is pointing up. Remove any air bubbles by tapping the outside of the syringe with your fingers. Slowly push the plunger to the 1 mL mark on the syringe or to the mark that matches the amount of interferon beta-1b prescribed by your doctor. If too much solution is pushed back into the vial, return to step 16.
16.  Remove the vial adapter and the vial from the syringe by twisting the vial adapter.

Choose an Injection Site

1. Extavia is injected under the skin and into the fat layer between the skin and the muscles (subcutaneous tissue). The best areas for injection are where the skin is loose and soft and away from the joints, nerves, and bones. Do not use the area near your navel (belly button) or waistline. If you are very thin, use only the thigh or outer surface of the arm for injection.
2. Choose a different site each time you give yourself an injection. Do not inject in the same area for two injections in a row. Keep a record of your injections to help make sure you change (rotate) your injection sites. If there are any sites that are difficult for you to reach, you can ask someone who has been trained to give the injection to you.
3. Do not inject Extavia in a site where the skin is red, bruised, infected, or scabbed, has broken open, or has lumps, bumps, or pain. Tell your doctor if you find skin conditions like the ones mentioned here or any other unusual looking areas where you have been given injections.

Injecting Extavia

1. Using a circular motion, clean the injection site with an alcohol wipe, starting at the injection site and moving outward. Let the skin area air dry.
2. Remove the cap from the needle.
3. Gently pinch the skin around the site with your thumb and forefinger of the other hand. Insert the needle straight up and down into your skin at a 90˚angle with a quick, dart-like motion.
4. Once the needle is in your skin, slowly pull back on the plunger. If blood appears in the syringe it means that you have entered a blood vessel. Do not inject Extavia. Withdraw the needle. Throw away the syringe and needle in your puncture-proof container. Do not use the same syringe or any of the other supplies that you used for this injection. Repeat the above steps to prepare your dose using a new blister pack. Choose and clean a new injection site.
5. If no blood appears in the syringe, slowly push the plunger all the way in until the syringe is empty. Remove the needle from the skin; then place a dry cotton ball or gauze pad over the injection site. Gently massage the injection site for a few minutes with the dry cotton ball or gauze pad. Throw away the syringe in your puncture-proof disposal container.

Dispose of used syringes, needles, and vials 

1. To prevent needle-stick injury and spread of infection, do not try to re-cap the needle.
2. Place used needles, syringes, and vials in a closeable, puncture-resistant container. You may use a sharps container (such as a red biohazard container), a hard plastic container (such as a detergent bottle), or a metal container (such as an empty coffee can). Do not use glass or clear plastic containers. Ask your doctor for instructions on the right way to throw away (dispose of) the container. There may be state and local laws about how you should throw away used needles and syringes.
3. Do not throw used needles, syringes, or vials in your household trash or recycle. Throw away any unused medicine. Do not save any unused Extavia for a future dose.
4. Keep the disposal container, needles, syringes, and vials of Extavia out of the reach of children.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of Extavia at the same time and do not take Extavia on two consecutive days.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication
• your weight
• your age

The recommended dose range of Extavia for the treatment of relapsing-form multiple sclerosis is 0.0625 mg to 0.25 mg injected subcutaneously every other day.

If you take too much Extavia, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Do not leave the blister pack containing Extavia where others might tamper with it.
• Do not open the blister pack or take out any of the items until right before you are ready to use them.
• Do not use Extavia if the seal on the vial is broken. If the seal is broken, the product may not be safe for you to use.
• Do not use Extavia after the expiration date shown on the blister pack label or box. If it has expired, return the entire pack to the pharmacy.
• Do not use any of the items in the blister pack more than one time.
• Before mixing, store Extavia at room temperature 25°C (77°F). Storage at temperatures between 15° to 30°C (59° to 86°F) for brief periods of time are acceptable.
• After mixing, if you can not inject Extavia right away, refrigerate the medicine and inject it within 3 hours. If you can not inject the mixed medicine within 3 hours, do not use it.
• Follow the information in the Patient Instructions for Use section “Dispose of used needles, syringes, and vials” for the right way to throw away the syringe with the unused medicine, and needle. 
• Do not freeze Extavia.
• Keep Extavia and all medicines out of the reach of children.