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Click ‘Get Form’ to open the endo advantage xiaflex form in the editor.
Begin by filling out the 'Patient Information' section. Enter your first name, last name, middle initial, address, and contact details including mobile phone number and email.
In the 'Patient Authorization' section, read through the authorization statement carefully. Sign and date where indicated to allow disclosure of your health information.
Complete the 'Rx and Clinical Information' section if applicable. Provide details such as date of symptom onset, penile curvature deformity, and any prior treatments for Peyronie’s disease.
Fill in the 'Physician Ship-to Information' with your physician's name, specialty, practice name, and address. Ensure that you include their signature where required.
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Due to the risks of serious injury, Xiaflex is only available through a drug safety program when used for Peyronies disease. This is called the Xiaflex Risk Evaluation and Mitigation Strategy (REMS) program.
How do you mix Xiaflex injections?
d) Using a 1-mL syringe with 0.01-mL graduations with a 27-gauge 1/2-inch needle (not supplied), withdraw a volume of 0.39 mL of the diluent supplied. e) Inject the diluent slowly into the sides of the vial containing the lyophilized powder of XIAFLEX. Do not invert the vial or shake the solution.
How painful are Xiaflex injections?
Out of 135 injections, 57% reported slight or inconsequential pain, 18% reported moderate pain, and 25% reported serious/intense pain despite anesthetic administration and pinprick-insensitive numbness at the fingertips.
Who can dispense Xiaflex?
XIAFLEX should only be administered by a doctor experienced in the treatment of male urological diseases who has completed required Risk Evaluation and Mitigation Strategy (REMS) training for use of XIAFLEX in the treatment of Peyronies disease.
Does Xiaflex come in pill form?
XIAFLEX is an injection given in a doctors office by a Hand Specialist trained in XIAFLEX.
xiaflex discontinued
Endo Advantage portalXIAFLEX Benefits Investigation Form
People also ask
Is Xiaflex a pill or injection?
Collagenase Clostridium histolyticum injection comes as a powder to be mixed with a liquid and injected by a doctor. If you are receiving collagenase Clostridium histolyticum injection (Xiaflex) to treat Dupuytrens contracture, your doctor will inject the medicine into a cord just under the skin in the affected hand.
Is there an oral medication for Dupuytrens contracture?
Medication Summary Collagenase Clostridium histolyticum (Xiaflex) was approved for the treatment of Dupuytren contracture by the US Food and Drug Administration (FDA) in 2010.
xiaflex benefits investigation form
in the united states district court
form suitable for delivery to a patient, such as intravenous or oral administrations. David K. Barr et al., Types of Biological and Pharmaceutical Patents
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