Get to know your child’s pen : 
The NGENLA 24 mg pen with labels showing the pen cap, needle attachment, medicine, cartridge holder, dose window, expiration date, dose knob, and injection button
Step 1: Get ready
1A) Gather all the supplies you will need to inject:*
  • Ngenla pre-filled pen
  • One new, sterile needle for each injection 
    - What needles does my child need?
  • Alcohol swabs
  • Cotton balls or gauze pads
  • Adhesive bandage
  • Appropriate needle (“sharps”) disposal container
For help with injection supplies or to inquire about free injection supplies, please contact the Ngenla Support Program at 1-877-662-8373.    
* The Ngenla pre-filled pen is included in the carton; all other supplies are not included.
You can use the Ngenla pen straight from the refrigerator. 
For a more comfortable injection, leave the pen at room temperature for up to 30 minutes. 
1B) Check the pen:
  • Check the name, strength, and label of the pen to make sure it is the medicine your child’s doctor has prescribed for them.
  • Check the expiration date. Do not use if the expiration date has passed.
  • Do not use the pen if it:
  • has been frozen or exposed to heat       
  • has been dropped
  • looks broken or damaged
  • has been more than 28 days since the first use of the  pen
  • has been used five times
  • has been left out of the refrigerator (up to 32°C) for more than 2 hours with each use
  • has been exposed to temperatures above 32°C
1C) Wash and dry your hands.
Do not remove the pen cap from your child’s pen until you are ready to inject
    Step 2: Choose and clean the injection site 
    Injection sites and where they are located on the body, including the abdomen sites which must be kept at least 5 cm away from the belly button; the backs of the upper arms which are for caregiver administration only; the front, upper thighs; and the buttocks which are also for caregiver administration only
    2A) Choose the injection site:
    • Ngenla can be given in the abdomen, thighs, buttocks, or upper arms.
    • Choose the best place to inject, as recommended by your child’s doctor.
    • If more than one injection is needed to complete the full dose, each injection should be given at a different injection site.
    • Do not inject into bony areas; areas that are bruised, red, sore, or hard; or areas that have scars or skin conditions.
    2B) Clean the injection site:
    • Clean the injection site with an alcohol swab.
    • Allow the injection site to dry.
    Do not touch the injection site after cleaning 
    Step 3: Check the medicine
    The pen cap is being removed from the NGENLA 24 mg pen. Close-up of the medicine inside the cartridge holder.
    3A) Pull off the pen cap: 
    • Keep the pen cap for after the injection.
    3B) Check the medicine inside the cartridge holder:
    • Make sure the medicine is: 
      - clear and colourless to slightly light yellow
      - free of flakes or particles
    • Do not inject the medicine if it:
      ​​​​​​​- is cloudy or dark yellow
      - has flakes or particles
    • It is normal to see one or more bubbles in the medicine.
    Step 4: Attach the needle
    A new, sterile needle is being attached to the NGENLA 24 mg pen. The needle and the pen are lined up horizontally in a straight line. Do not attach the needle at an angle.
    • Take the new needle and pull off the protective paper.
    • Line the needle up with the pen, keeping them both straight.
    • Gently push and then screw the needle onto the pen. Do not overtighten.
    • Be careful to not attach the needle at an angle. This may cause the pen to leak.
    Warning iconNeedles have sharp tips at both ends. Handle with care to make sure you do not prick yourself (or anyone else) with the needle. 
    Step 5: Prepare the needle
    The outer needle cover is being removed from a needle attached to the NGENLA 24 mg pen. The inner needle cap can be seen after the outer needle cover is removed. The outer needle cover is placed upright on a flat surface for safe keeping as it will be used later.
    5A) Pull off the outer needle cover:
    • Make sure you keep the outer needle cover. 
      You will need it later to remove the needle.
    • You should see an inner needle cap after you have removed the outer cover. If you do not see this, try to attach the needle again.
      5B) Pull off the inner needle cap:
      • Do this carefully. You should be able to see the needle.
      • Throw away the inner needle cap in an appropriate “sharps” container. It is not needed again.
      The inner needle cap is being removed from a needle attached to the NGENLA 24 mg pen. The needle can be seen after the inner needle cap is removed. The inner needle cap is disposed of in an appropriate “sharps” container as it is not needed again.
      Step 6: Priming a new pen
      This step is for new pens only. If the pen is not new, go to Step 7. Each new pen must be primed before first use. 
      The purpose of priming a new pen is to remove air bubbles from the pen and make sure your child gets the correct dose.
      The dose knob is being turned until 0.4 is shown in the dose window.
      6A) Set the dose knob to 0.4:
      • If you turn the dose knob too far, you can turn it back.
        6B) Tap the cartridge holder: 
        • Hold the pen with the needle pointing up so that the air bubbles can rise.
        • Tap the cartridge holder gently to float any air bubbles 
          to the top.
        Warning icon Tap the cartridge holder even if you do not see air bubbles.
        The NGENLA 24 mg pen is being held vertically with one hand so that the needle is pointing up. With the other hand, a finger gently taps the cartridge holder.
        The NGENLA 24 mg pen continues to be held vertically with one hand so that the needle is pointing up. The injection button is being pushed with the thumb of the other hand. A drop of liquid has appeared at the tip of the needle. The dose window shows “0”.
        6C) Press the button and check for liquid: 
        • Press the injection button until it cannot go any farther and “0” is shown in the dose window.
        • Check for liquid at the needle tip. If liquid appears, the pen is primed. 
        • Always make sure that a drop of liquid appears before you inject. If liquid has not appeared, repeat Step 6A through to 6C.
        If liquid does not appear after you have repeated Step 6A through 6C five times, attach a new needle, and try one more time. Do not use the pen if a drop of liquid still does not appear. Contact your child’s doctor or pharmacist, and use a new pen. 
        Step 7: Set the dose
        • Turn the dose knob to set your child’s dose.
        • The dose can be increased or decreased by turning the dose knob in either direction. 
        • The dose knob turns 0.2 mg at a time.
        • The pen contains 24 mg of medicine, but you can only set a dose of up to 12 mg for a single injection. 
        • The dose window shows the dose in mg.
        Example A
        The dose knob is being turned so that the line between 3.6 and 4.0 mg is shown in the dose window. This line represents 3.8 mg.
        3.8 mg is shown in the dose window
        Example B
        The dose knob is being turned so that the 12 mg is shown in the dose window.
        12.0 mg is shown in the dose window
        Warning icon Do not press the injection button while setting the dose.
        Always check the dose window to make sure you have set the correct dose
        What should I do if I cannot set the dose my child needs?
        • If your child’s dose is more than 12 mg, you will need to give more than one injection.
        • You can give from 0.2 mg to 12 mg in a single injection.
        • If you need help dividing up the dose the right way, ask your child’s doctor.
        • Use a new needle for each injection.
        • If you normally need to give two injections for the full dose, do not forget to give the second dose.
        What should I do if there is not enough medication left in the pen? 
        • If the pen contains less than 12 mg of medicine, the dose knob will stop, with the remaining amount of medicine shown in the dose window.
        • If there is not enough medicine left in the pen for the full dose, you may either:
        • Inject the amount left in the pen, then prepare a new pen to complete the dose in full. Remember to subtract the dose you have already given. For example, if the dose is 3.8 mg and you can set the dose knob to only 1.8 mg, you should inject another 2.0 mg with a new pen.
        • Or get a new pen and inject the full dose.
        Warning icon Do not press the injection button while setting the dose.
        Always check the dose window to make sure you have set the correct dose
        Step 8: Inject the dose
        The NGENLA 24 mg pen is being held such that the dose window is visible. It is positioned so that the needle will be inserted straight into the skin.
        8A) Insert the needle:
        • Hold the pen so you can see the numbers in the dose window.
        • Insert the needle straight into your child’s skin.
          8B) Inject the medicine: ​​​​​​​
          • Keep holding the needle in the same position.
          • Press the injection button until it cannot go any farther and “0” is shown in the dose window.
          The NGENLA 24 mg pen is kept in the same position. The injection button is pressed with the thumb. The dose window shows “0”.
          The injection button continues to be pressed while counting to 10.
          8C) Count to 10:
          • Continue to press the injection button while counting to 10. Counting to 10 will allow the full dose of medicine to be given.
          • After counting to 10, let go of the injection button, and slowly remove the pen from the injection site by pulling the needle straight out.
          • Note: You may see a drop of medicine at the needle tip. This is normal and does not affect the dose you just gave.
          Step 9: Attach outer needle cover 
          The outer needle cover is laid on its side on a flat surface. While holding the pen closer towards the dose window, the needle is being carefully placed into the outer needle cover. While the outer needle cover is being attached, it is not touched or secured at all with a hand. Only one hand is required for this step.
          • Carefully place the outer needle cover back on the needle.
          • Press on the outer needle cover until it is secure.
          • Caution: Never try to put the inner needle cap back on the needle. You may prick yourself with the needle.
          Step 10: Remove the needle 
          The NGENLA 24 mg pen is being held in one hand while the other hand holds the outer needle cover and unscrews the needle from the pen.
          • Unscrew the capped needle from the pen.
          • Gently pull until the capped needle comes off.
          • Note:  If the needle is still on, replace the outer needle cover and try again. Be sure to apply pressure when unscrewing the needle.
          • Throw away the needle in an appropriate “sharps” container.
          Warning iconImportant: Always remove and throw away used needles. Do not reuse needles.
          Step 11: Replace the pen cap
          The pen cap is being placed back on the NGENLA 24 mg pen.
          • Replace the pen cap back onto your child’s pen.
          • Do not recap the pen with a needle attached.
          • If there is any medicine left in your child’s pen, store in the refrigerator between uses.
          Step 12: Finish up 
          After the injection is complete:
          • Press lightly on the injection site with a clean cotton ball or gauze pad, and hold for a few seconds.
          • Do not rub the injection site. Your child may have slight bleeding. This is normal.
          • You may cover the injection site with a small adhesive bandage, if needed.
          • If your child’s pen is empty, has been used five times, has been left out of the refrigerator (up to 32°C) for more than 2 hours with each use, has been exposed to temperatures above 32°C, or it has been more than 28 days since the pen’s first use, throw it away even if it contains unused medicine.