DEPO-SUBQ PROVERA 104® Dosage and Administration

2.1 Important Dosage and Administration Instructions

Depo-subQ provera 104 is only for subcutaneous administration and is only to be administered by a healthcare professional.

Use for longer than 2 years is not recommended (unless other birth control methods or medical therapies for endometriosis-associated pain are considered inadequate) due to the impact of long-term depo-subQ provera 104 treatment on bone mineral density (BMD) [see Warnings and Precautions (5.1)].

Prior to the first injection confirm that the patient is not pregnant. For women who are sexually active and who have regular menses, administer the first injection only during the first 5 days of a normal menstrual period. For women who are breast-feeding, administer the first injection during or after the sixth postpartum week.

The recommended dosage of depo-subQ provera 104 is 104 mg given subcutaneously every 12 to 14 weeks. If more than 14 weeks elapse between injections, confirm that the patient is not pregnant before the next injection. Instruct the patient that if they are unable to receive an injection within 12–14 weeks, another contraceptive method should be used until the next depo-subQ provera 104 injection. The dosage does not need to be adjusted for body weight.

Inject the entire contents of the pre-filled syringe using strict aseptic technique into the upper anterior thigh or abdomen, rotating the sites with every injection [see Dosage and Administration (2.3)].

2.2 Switching from Another Method of Contraception

When switching from another contraceptive method to depo-subQ provera 104, administer depo-subQ provera 104 in a manner that ensures continuous contraceptive coverage. Follow the respective recommendations when switching from the contraceptive methods listed below:

• Combined hormonal contraceptives: administer the first injection of depo-subQ provera 104 within 7 days after the last day of using the combined hormonal contraceptive method (i.e., within 7 days after taking the last active pill).
• An implant: administer the first injection of depo-subQ provera 104 on the day of implant removal.
• A contraceptive vaginal ring or transdermal system: administer the first injection of depo-subQ provera 104 on the day the patient would have inserted the next ring or applied the next transdermal system.
• An Intrauterine Device (IUD) or Intrauterine System (IUS): administer the first injection of depo-subQ provera 104 on the day of IUD/IUS removal. If the IUD/IUS is not removed on the first day of the patient's menstrual cycle, instruct patients to use a non-hormonal back-up method of birth control for the first 7 days after administration of depo-subQ provera 104.
• Depot medroxyprogesterone acetate injectable suspension for intramuscular use (DMPA-IM): inject depo-subQ provera 104 12 to 14 weeks after the last dose of DMPA-IM.

2.3 Preparation and Administration Instructions

Prior to injection:

• Ensure all the components in Figure A are available and that depo-subQ provera 104 is at room temperature.
• Shake the pre-filled syringe vigorously prior to injection to ensure appropriate viscosity of the suspension.
• Inspect depo-subQ provera 104 visually for particulate matter and discoloration.
  Figure A. Components in the Package

Step 1: Select & Prepare the Injection Area
Select a preferred injection area, i.e., the left or right upper thigh or the abdomen (see shaded areas, Figure B). Avoid selection of bony areas and the umbilicus. Clean the skin in the injection area you have chosen with a clean cotton pad or clean paper tissue. Rotate the injection site by injecting into a different puncture site than used for the previous injection.	Figure B. Preferred injection areas: Left or right upper thigh or abdomen
Step 2: Prepare Syringe
Carefully remove the needle and syringe from the packaging. Hold the syringe firmly by the barrel, with the barrel pointing upward. Shake the syringe vigorously for at least 1 minute to mix thoroughly (Figure C).	Figure C. Shake vigorously for 1 minute
While holding the syringe barrel firmly, remove the protective cap from the tip of the syringe barrel by unscrewing it (Figure D).	Figure D.
While holding the syringe barrel firmly, attach the needle to the barrel of the syringe firmly by pushing the plastic needle cover down fully and firmly with a slight twisting movement (Figure E).	Figure E.
Move the safety shield away from the needle and toward the syringe barrel. The safety shield will remain in an open 45- to 90-degree position (Figure F).	Figure F.
While holding the syringe barrel firmly, remove the plastic needle cover from the needle without twisting, ensuring the needle is still firmly attached to the syringe (Figure G).	Figure G.
While holding the syringe with the needle pointing upward, gently push in the plunger until the liquid is up to the top of the syringe (Figure H). There should be no air within the barrel.	Figure H.
Step 3: Injecting depo-Sub Q provera 104
Gently grasp and squeeze a large area of skin in the chosen injection area between the thumb and forefinger, pulling it away from the body (Figure I). Insert the needle at a 45-degree angle so that most of the needle is in the fatty tissue. The plastic hub of the needle should be nearly or almost touching the skin.	Figure I.
Inject slowly until the syringe is empty (Figure J). This should take about 5 to7 seconds. It is important that the entire dose is given.	Figure J. Inject slowly (5–7 seconds)
Step 4: Remove the Needle and Activate the Safety Shield
After completing the injection, remove the needle from the skin and activate the safety shield as follows: While positioning the shield about 40°– 45°, and with a firm quick motion, press down against a flat surface until a click is heard or felt (Figure K). If uncertain that the safety shield is fully engaged, repeat this step.	Figure K.
Use a clean cotton pad to press lightly on the injection area for a few seconds (Figure L). Do not rub the area.	Figure L.