Chronic Hives: Symptoms, Treatments, Complications

Chronic Hives Are Distinct Because They Come Back Again and Again

Hives essentially fall into two categories: acute (which are more common) and chronic. The main difference is the length of time you’re dealing with them.

Hives are considered acute if they completely disappear (and don’t come back) within six weeks. Chronic hives are those that last (or keep coming back) for longer than six weeks. Up to 1.8 percent of the global population are affected by chronic hives at some point in their lives. (1)

How long it takes chronic hives to go away is unknown. “They can last months to years and, for some individuals, even decades,” says Sarina Elmariah, MD, PhD, a board-certified dermatologist at Massachusetts General Hospital in Boston.

Unfortunately, the longer you have chronic hives (which are also referred to as “chronic urticaria” — “urticaria” being the medical term for hives), the less likely it is they’ll go away for good. “Usually within a year of being in the chronic phase, only 50 percent of hives cases will be resolved,” says Adam Friedman, MD, a professor and the chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.

Why such a long and sometimes unsuccessful battle? Namely, because it’s difficult to pinpoint an exact cause. (3) “For chronic hives, half of them are idiopathic, meaning they have no known cause,” says Meghan Feely, MD, a board-certified dermatologist in private practice in New York City and New Jersey and a media expert for the American Academy of Dermatology.

Chronic Hives Are Caused by Acute Hives Triggers, Along With a Few Others

In general, hives (whether they’re chronic or acute) can occur because of an allergy to foods, environmental and occupational allergens, animals, insects, medications, and other agents. Other potential causes include systemic medical issues, like Hashimoto’s thyroiditis or hepatitis, infection, exercise, skin pressure, friction or scratching, contact with water, heat, cold, stress, and ultraviolet radiation, Dr. Feely says.

RELATED: Common Allergy Triggers and Symptoms

Autoimmune issues and long-standing infections are known to be associated with chronic hives (and such a relationship does not appear to exist between autoimmune diseases or ongoing infections and acute hives). “Autoimmune urticaria is characterized by autoantibodies that release histamine,” a chemical produced by your body that helps fight foreign invaders and is responsible for hives and their itching, Feely says.

Autoimmune disorders like lupus, rheumatoid arthritis, type 1 diabetes, thyroid disease, and celiac disease are all thought to be causes of recurring hives, which are often chronic in nature, Dr. Elmariah says. For individuals with these conditions who have chronic hives, the hives are just one of the many symptoms they’re dealing with.

Sometimes Doctors Can Prescribe Medication or Over-the-Counter Drugs to Help With Chronic Hives

If you’ve been suffering from hives for six weeks or longer, it’s time to seek help. That may seem like a long time to just ignore a medical problem, but Dr. Friedman says it’s not uncommon for people to wait up to a year to ask him about their hives.

Your doctor can help identify any underlying medical issue behind the hives that may require treatment, Friedman says. And your doctor can also help you manage the problem for better day-to-day living, he adds.

When you do see a doctor, come with a full history of your hives, including when they first started, how often you get them, if there’s anything that seems to trigger them, what medication you’ve already tried — and how well these worked.

As with acute hives, you can expect your doctor to start treatment by recommending that you take an antihistamine, most likely a prescription one. The good news is that about 50 percent of chronic hives that have no apparent causes will respond to antihistamines. (4)

If you’re in that other 50 percent and you’re not responding to antihistamines, doctors can also move to a new generation of biologic medications like omalizumab (Xolair), a treatment approved by the U. S. Food and Drug Administration (FDA) for chronic hives. The medication is injected under your skin, and success rates with this medication are much higher in treatment-resistant cases. Some doctors may even prescribe corticosteroids like prednisone (Deltasone), although these are usually just to provide short-term relief and aren’t recommended as a long-term strategy. (4)

Your doctor will also most likely test for autoimmune issues. They don’t do this with acute hives, because it’s more likely that chronic hives are a result of an autoimmune problem than acute hives, Elmariah says. Tests include a blood test that looks for certain autoimmune markers.

Fortunately, even though the struggle may be long, all hope is not lost in the quest to put chronic hives to bed. The American Academy of Allergy, Asthma, and Immunology reports that in about one-half of patients, the hives will be resolved in one to two years, while 80 to 90 percent of hives sufferers will see visible improvement within five years. (4)

Complications of Chronic Hives

Hives can irritate more than just your skin. “Chronic hives can have a substantial negative impact on quality of life for people,” Friedman says. Dealing with any long-term condition or illness is challenging, and the itchy skin that comes with hives can be especially difficult to live with. (5)

Besides physical discomfort and itchiness during the day, hives can interrupt sleep, making sufferers even more irritable and grumpy, Elmariah says. That change in mood can affect your interactions with other people, especially friends and family. Work and school performance may also suffer. And for some people, these symptoms may lead to withdrawal from social interactions, which may further worsen mood and emotional health.

RELATED: What Happens to Your Mind and Body When You Don’t Sleep

About one in every seven people with hives will deal with psychological conditions such as anxiety, depression, and stress. One study found that number to be much higher, with 48 percent of patients with chronic hives reporting feelings of depression and the same amount dealing with anxiety. If you’re feeling this way, it’s important to speak with friends and family about what you’re going through and tell your doctor, too. They may be able to prescribe a medication to help you cope. (5)

It’s Rare, but Acute and Chronic Hives Can Both Lead to Life-Threatening Complications

In the majority of cases, acute hives will go away on their own and do not pose a serious threat to your health. But sometimes, acute hives can be a sign of a more threatening problem.

Swelling in the eyes, lips, hands, feet, or genitals can be a sign you’re experiencing angioedema, which is a complication that occurs when fluid buildup in the skin causes deep swelling. Angioedema is generally treated with a combination of antihistamines and oral corticosteroids with the goal of decreasing swelling. (6)

Finally, while hives don’t put you at an increased risk of anaphylaxis, which is the name for a life-threatening allergic reaction, they are one of the first signs that such a reaction may be taking place. (6,7,8) In addition to the skin changes, you might notice swelling on the body, lightheadedness, abdominal pain, feeling faint, and shortness of breath. (6) Consider these symptoms an emergency, and call 911 as soon as possible.

During the attack, you’ll likely be treated with epinephrine, oxygen, antihistamines, cortisone (Cortone Acetate), and a beta-agonist to help you breathe and reduce your body’s allergic response. (9) In most cases, the best way to protect yourself against anaphylaxis is to avoid the trigger altogether and carry an adrenaline autoinjector, such as an EpiPen, so you can administer epinephrine in case of an emergency. (9)

RELATED: FDA Approves Generic Version of EpiPen

With additional reporting by Moira Lawler.

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By Karen AspMedically Reviewed by Jon E. Stahlman, MD

Reviewed: August 16, 2022

Medically Reviewed

Hives are red or skin-colored bumps or welts that appear on the skin in varying shapes and sizes.Shutterstock

Hives are welts on the skin that appear in varying sizes, shapes, and patterns — and for numerous reasons. Anybody can get them. And they can appear out of nowhere. One day you’re hive-free, and the next, you’re not. (1)

How do you know the rash is hives? If the rash comes and goes within 24 hours, it is most likely hives. But hives can either be acute or chronic. The two types share many common triggers. The big difference is timing. For acute hives, you’re just dealing with one bout of hives, or they may come and go, but they resolve within six weeks.

If you have chronic hives, the rashes continue to appear and disappear for longer than six weeks. In these cases it may be tougher to pinpoint a cause.

Here’s more on common triggers and what happens in the body that leads to hives.

Hives Develop in Reaction to the Chemicals That Help Control the Body’s Allergic Response

Experts know a lot more about what’s happening in the body when hives show up versus what actually triggers them and why. “While we can’t always identify what’s causing a hive, we do know what happens in the body to produce the hive,” says Adam Friedman, MD, a professor of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC.

To understand the basics, it helps to know a little bit about the body’s allergic response. Your body produces mast cells, which act as part of your allergic response. (2) When your body perceives it’s been exposed to a threat, the mast cells may secrete numerous chemicals, most notably histamine, explains Sarina Elmariah, MD, PhD, a board-certified dermatologist at Mass General Brigham in Boston.

In most situations, histamine causes your blood vessels to dilate and leak fluid, creating the raised areas on your skin (hives). Histamine also affects your nerve cells, signaling your skin to itch, Dr. Elmariah says.

A lot of people assume that hives are the result of the release of histamine, a chemical your body produces in response to allergens. Histamine does play a role in the majority of cases, but it’s important to know it can be more complex than that, Elmariah explains. “Some hives are beyond the scope of histamine and involve other chemicals.”

In other situations, basophils, another type of white blood cell, may be activated to release their hive-producing chemicals and cause the same effect, Elmariah says.

If you’re allergic to things like insects, medications, latex, or certain foods and you come in contact with your allergen, a protein found throughout the blood and body tissues called immunoglobulin E (IgE) will bind the allergen and signal the mast cells to release their contents, histamine included, Elmariah says.

RELATED: Common Allergy Symptoms and Triggers

Hives may also result when other blood protein antibodies (besides IgE) bind directly onto mast cells, prompting them to release their contents, or in other situations, mast cells may be completely degranulated or destabilized, which induces the chemical release, Elmariah says.

Hives Tend to Look the Same No Matter What Triggers Them

No matter what’s happening inside your body, hives look the same. They’re usually red or skin-colored bumps that can blanch (turn white) when you press on their center. They can change shapes and move around, and may break out all over your body, Friedman says.

Fortunately, although hives can be extremely itchy, they’re not contagious, and an individual hive usually disappears within 24 hours, Elmariah says. (If a single hive lasts for longer than 24 hours, the cause could be more serious and you should call your doctor.) For some people, hives can be so chronic in nature (with single hives coming and disappearing continuously) that they can be an issue for months. (3)

Hives can even be so problematic that they interrupt healthy sleep, work, and school and isolate people socially, affecting mental as well as physical health, Elmariah says.

Food, Drugs, Infections, and a Lot of Other Things Can Trigger Hives

A more practical question about why hives show up may be: What are the factors that trigger the above reactions in your body? The list of possible suspects is long, and does not differ greatly for acute versus chronic hives. “Some people with chronic hives can be exposed to the same acute trigger over and over again,” Elmariah says.

But some triggers are more common than others, and the three at the top of the list are food, drugs, and infections.

Foods That Trigger Hives

Hives from food are usually related to food allergies, especially fish, shellfish, and peanuts. You may even have hives as a result of a pseudoallergic reaction, a reaction to a food or chemical that mimics the symptoms of an allergic reaction, but without IgE antibodies being produced against the offending item. (4)

Pseudoallergic reaction triggers can include artificial food dyes, tomatoes, preservatives, sweeteners, herbs, wine, high dietary fats, alcohol, salicylic acid, orange oil, strawberries, and yellow and red food dyes.

Drugs That Trigger Hives

On the drug front, there are several that can cause hives, including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, muscle relaxants, antibiotics, diuretics, IV radiocontrast, ACE inhibitors, and angiotensin receptor blockers, explains Anthony M. Rossi, MD, an assistant attending dermatologist at Memorial Sloan Kettering Cancer Center in New York City.

Infections That Trigger Hives

Infections might include viral ones like the common cold and hepatitis or bacterial ones like strep throat or urinary tract infections, Dr. Rossi says.

Other Things That Trigger Hives

You can also get hives from touching things you may be allergic to. For instance, if you’re allergic to latex, you might get a hive if you touch a balloon or latex glove. The same is the case if you’re allergic to dogs and a dog licks you.

Other things that can cause hives include blood transfusions, insect bites or stings, plants (like nettle, also called stinging nettle), and to a smaller degree, stress (usually it takes emotional stress combined with some other factor to trigger hives, rather than emotional stress triggering hives on its own).

Environmental stimuli may cause hives, something experts call inducible urticaria (often referred to as physical urticaria). Things like pressure on your skin, exercise, changes in your body temperature, sweating, cold, heat, water, sun exposure, and vibrations can instigate an episode of hives. “You might simply be walking by a construction site or riding a train, and because of the vibrations from these things, you break out,” Elmariah says. These types of hives occur less frequently than those caused by food, drugs, or infections.

Chronic hives, meanwhile, can be caused by any of the above, but they may also be a sign of a health issue or autoimmune disease. “Autoimmune diseases in general have been strongly associated with the development of chronic hives,” Elmariah says.

Yet some have a stronger link to hives, such as thyroid disease, type 1 diabetes, celiac disease, lupus, and rheumatoid arthritis. (5)

When Should I See My Doctor About Hives?

Because hives usually disappear within 24 hours, it’s probably not necessary to see your doctor if you have just one bout (and they go away within a one-day time frame). If hives do not go away on their own in a few days (or if a single hive does not go away within 24 hours), do see your doctor. (6)

If your throat starts to swell or you’re having trouble breathing, seek emergency care immediately.

If hives appear to come and go for longer than six weeks, they’re considered chronic, and it’s best to visit a dermatologist to see what’s going on, Rossi adds.

The caveat? “Although hives in and of themselves generally aren’t life-threatening, they can be associated with a condition called angioedema and a severe allergic reaction known as anaphylaxis, both of which can cause breathing issues and require emergency care,” Elmariah explains.

Forty to 50 percent of hives cases are associated with angioedema, (4) which involves swelling of the eyes, mouth, hands, feet, or throat. It can be caused by medications, allergic reactions, or a hereditary deficiency of some enzymes in your body. (7) Meanwhile, anaphylaxis can result if you’ve been exposed to something you’re allergic to, especially if that allergy is severe.

Emergency visits aside, when you do see your doctor to determine what’s causing your hives, come prepared with information. Here’s what Elmariah recommends having on hand:

• Any trigger you’ve identified, including foods, chemicals, medication exposures, even travel history
• A list of all your current or recent medications
• Your medical history, including other personal and family history of medical problems
• A list of medications (and doses) you’ve already tried and the effects they’ve had

Hives may be an annoying condition, but with the right medical attention, you can learn how to manage them and, in many cases, prevent them from happening again.

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Editorial Sources and Fact-Checking

1. Hives: Overview. American Academy of Dermatology. September 28, 2021.
2. Krystel-Whittemore M, Dileepan KN, Wood JG. Mast Cell: A Multi-Functional Master Cell. Frontiers in Immunology. January 6, 2016.
3. Hives/Urticaria. Columbia University Medical Center.
4. Sachdeva S, Gupta V, Amin SS, et al. Chronic Urticaria. Indian Journal of Dermatology. November–December 2011.
5. Fraser K, Robertson L. Chronic Urticaria and Autoimmunity. Skin Therapy Letter. December 1, 2013.
6. Hives and Angioedema: Symptoms & Causes. Mayo Clinic. October 26, 2021.
7. Hives. American College of Allergy, Asthma, & Immunology. June 11, 2018.

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Instructions for Copaxone 40 40 mg/ml for injection syringe 1 ml No. 12

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Instruction

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speech: glatiramer acetate;

• 1 ml injectable glatiramer acetate 40 mg;

additional speech: mannit (E 421), water for injection.

*Glatiramer acetate is a cycloacetate of synthetic polypeptides, in order to compensate for the naturally occurring amino acids: L-glutamic acid, L-alanine, L-tyrosine and L-lysine, the molar fraction of which is 0.129-0.153, 0.392-0.462, 0.086- 0.100 and 0.300-0.374 are reasonable. The average molecular weight of glatiramer acetate becomes 5000-9000 Da.

Glatiramer acetate 40 mg is equivalent to 36 mg glatiramer base.

Pharmaceutical form

Injection retail.

Main physical and chemical powers:

It is practical to avoid visible particles.

Pharmacotherapeutic group

Antineoplastic and immunomodulatory agents, other immunostimulants. ATX code L03A X13.

Pharmacological authorities

Pharmacodynamics.

Mechanisms by which glatiramer acetate exerts its effects on patients with multiple sclerosis (MS) are not fully understood. However, it is important that it is a way of modifying the immune process, which, as one might guess today, is evidence for the pathogenesis of MS. Such a hypothesis is supported by the data of investigations carried out with the method of cultivating the pathogenesis of experimental allergic encephalomyelitis (EAE) – I will become a kind of exclamation in a number of creatures who have seen immunization on aphids possessed by material from the central ї nervous system, which is to revenge myelin, and which often zastosovuetsya as an experimental created model RS. Studies on animals and on the participation of patients with MS indicate those that, when glatiramer acetate is blocked on the periphery, it is induced to become active glatiramer acetate-specific suppressor T-cellin.

Remittent-relapsing MS

Efficacy data of Copaxone 40, administered in apparently subcutaneous injections at a dose of 40 mg/ml 3 times a day with a decrease in relapse rate, negative mani during a 12-month placebo-controlled follow-up. The total number of confirmed relapses was selected as the first criterion of effectiveness. Secondary MRI findings, which were measured on the 6th and 12th months, included the total number of follicles and accumulation of contrast on T2-image images and the total number of follicles and accumulation of contrast on T1-value images.

1404 patients were randomized to a 2:1 ratio to Copaxone 40 (40 mg/mL) (n=943) and placebo (n=461). Offended groups of jubilation fought behind the camp of the ailing on the cob of the cob, the clinical picture of the sickness and the MRI shows. Patients had an average of 2.0 relapses 2 weeks before the selection period.

Treatment with Copaxone 40 (40 mg/mL) was associated with a 34.4% decrease in overall recurrence rate (p < 0.0001) with a residual risk of 0.656 and a 95% confidence interval (CI) [0.539-0.799].

When copaxone 40 (40 mg/ml) was ingested, there were signs of significant and statistically significant changes in the first and second indications of efficacy, which were indicative of the efficacy of Copaxone-Teva (20 mg/ml) 1 time per loot.

In the tables below, the values ​​of the first and second indications of efficacy in the group of patients who passed the randomization are shown.

* An absolute decrease in risk was calculated as a difference between the estimated number of confirmed relapses over a period of 12 months when glatiramer acetate was ingested at a dose of 40 mg 3 times per day and it was estimated oh number of confirmed relapses for 12 months with placebo fixation.

** Visible risk was shown to be an increase in mean risk with glatiramer acetate ingestion at a dose of 40 mg 3 times and a mean risk with placebo.

Direct follow-up of safety in case of congestion with Copaxone-Teva (20 mg/ml) 1 time per dose of Copaxone 40 (40 mg/ml) 3 times per day was not carried out in one follow-up.

In this 12-month follow-up, there is no evidence that therapy with Copaxone 40 contributes to the progression of disabling changes or to the likelihood of relapse.

There is no evidence of Copaxone infection in 40 patients with primary or secondary disease progression.

Pharmacokinetics.

Pharmacokinetic studies for the participation of patients were not considered. In vitro data and inter-disciplinary studies carried out in healthy volunteers indicate that, with subcutaneous ingestion of glatiramer acetate, speech is easily absorbed, and a large part of the dose is rapidly disintegrated into smaller fragments even in subcutaneous tissue.

Clinical characteristics.

Indications

Copaxone 40 indications for treatment of recurrent forms of multiple sclerosis.

Copaxone 40 is not prescribed for primary or secondary progressive rosaceal sclerosis.

Contraindication to Copaxone

• Hypersensitivity to active speech (glatiramer acetate) or to any additional speech.

Come in especially safe.

The drug in an anteriorly overflowing syringe is used only for a single injection. Nevicoristaniy likarsky zasib or yogo surplus is necessary to be found.

Interactions with other medical practices and other types of interactions.

Interactions between Copaxone 40 and other medical practices were insufficiently treated.

Daily data on interactions with interferon beta.

An increase in the frequency of reactions in patients treated with Copaxone 40 and concomitant corticosteroid therapy was feared.

In vitro studies to report that glatiramer acetate in the blood is bound to blood plasma proteins, but is not substituted and does not replace phenytoin or carbamazepine. However, theoretically Copaxone 40 may be able to add to the rozpodil of speeches, as if they are connected with proteins, it is necessary to seriously guard for the concomitant accumulation of such medicinal diseases.

Precautions of ingesting

Copaxone 40 may only be ingested in seemingly minor injections. The drug cannot be administered internally or internally.

The doctor, which causes exultation, is responsible for explaining to the patient whether the reaction is associated with one of these symptoms, such as vasodilatation (blood rush), chest pain, dyspnea, palpitation or tachycardia, may appear through the sprat hvilin after injection Copaxone 40 (div. section “Adverse reactions”). Most of these symptoms last for a short period of time and appear spontaneously without any traces. In case of a serious side reaction, the patient is guilty of negligently succumbing to Copaxone 40 and turning to the doctor. In times of need, medication may indicate symptomatic treatment.

There is no evidence to suggest the risk of blaming these adverse reactions for any group of patients. Regardless of the price, it is necessary to protect Copaxone in 40 patients with a history of heart disorders. Slid regularly review the camp of such patients to improve the treatment.

In rare cases, it was reported about sudomy and/or anaphylactoid or allergic reactions. Rarely, a serious hypersensitivity reaction may be blamed (for example, bronchospasm, anaphylaxis, or cropidation). Even if the reaction is severe, it is necessary to rozpochati vіdpovіdne likuvannya and zapinit zastosuvannya drug.

Glatiramer acetate-reactive antibodies have been detected in blood syromatism of patients during prolonged post-treatment with Copaxone. The maximum level reached the average after 3-4 months of lubrication, after which the stench decreased and stabilized on the level, which is slightly higher than the cob level.

Not based on historical data, it was reported that glatiramer acetate-reactive antibodies are neutralizing or that their findings contribute to the clinical efficacy of Copaxone 40.

In patients with nirk deficiency, it is necessary to re-evaluate the function of nirk by using Copaxone 40. Although there are no recent reports of glomerular deposition of immune complexes, this possibility cannot be excluded.

In the period of post-transplantation, Copaxone was told about rare cases of severe liver damage (hepatitis and liver failure in other cases of liver transplantation) (div. section “According to biological reactions). Liver damage occurred in the period from a few days to a few years after Copaxon’s cob infestation. Accompanying symptoms, which were reported in these depressions, included supra-world exposure to alcohol, obviously or in the anamnesis of liver damage and infection of other potentially hepatotoxic drug diseases. In different clinically significant lesions of the liver, we can look at the nutrition about the ingestion of Copaxone.

Congestion during pregnancy and breastfeeding.

Vagity. Studies in animals have not demonstrated reproductive toxicity. Current data on ingestion of Copaxone-Teva (20 mg/ml) in pregnant women indicates the presence of feto/neonatal toxicity and disruption of fetal development. Give a dose of Copaxone 40 (40 mg/ml) to women compared to those for Copaxone-Teva (20 mg/ml). There are no available epidemiological data from this food until now. As an afterthought, it is necessary to uniquely beat the drug during the period of pregnancy, for a little fall, if the measles in the case of congestion for the vagity overwhelms the risk of a possible influx on the plaid.

Anniversary of the breast. There is no evidence of penetration of glatiramer acetate or other metabolites into breast milk. With the introduction of the drug, the scrotum did not fear a significant injection on the offspring, with a slight decrease in the rate of increase in body mass in animals born by females, such a drug test was introduced into the period of vagity and lactation. The rizik for new people/nemovlyat cannot be turned off. It is necessary to take a decision on how to apply breastfeeding or to administer / timchaline therapy due to copaxone 40 with breastfeeding breastfeeding for a child and corysteal therapy for a woman.

The cost of investing in the speed of the reaction when caring for vehicles or other mechanisms.

The risk of influencing the rapidity of the reaction when caring for vehicles or other mechanisms was not achieved.

Method of administering the dose of Copaxone

The beginning of therapy with the drug Copaxone 40 is guilty under the supervision of a neurologist or a doctor, which may be known to treat roseate sclerosis.

For older adults, the recommended dose is 40 mg glatiramer acetate (one anteriorly injectable syringe), which is administered in a seemingly minor injection 3 times a day. A break between injections is due to become at least 48 years old. It is recommended to zastosovuvat drug in one and the same days of skin tyzhnen.

Copaxone 40 has not established a splendid trivality.

Solution for trivality, take the drug individually for the skin condition.

Patients of the summer age. The appointment of Copaxone with 40 patients of the summer age was not specially treated.

Patients with impaired neurological function. There were no special follow-ups for Copaxone in 40 patients with impaired function (div. division “Features of the infection”).

Patients should be given instructions on the technique of self-administration of the drug and ensure the doctor’s sight at the first hour of self-administration and prodovzh 30 hours of sleep.

In order to change the severity of the teasing, or pain in the area of ​​the skin, the onset of the introduction of the drug should be carried out in another place. The drug can be injected into the stomach, arms, legs, and seats.

General recommendations on how to inject

When injecting Copaxone 40, it is important to comply with the following rules:

• administer only the drug rno;
• stop at the dose, acknowledging the drug;
• use a syringe for injecting only once, not a single drug or excess – discard;
• do not hesitate to administer Copaxone 40 at the same time with other drugs;
• if there are differences in the presence of important particles, do not wick the syringe forward, then take the other package.

Instructions for injection

0003

• one blister pack of Copaxone 40, which should be pushed forward with a syringe;
• disposal container for vicorous syringes and heads.

2. Take one blister from the front filled syringe from the top pack. All non-corrosive syringes must be stored in the original packaging.

3. If the drug is stored in the refrigerator, it is necessary to swipe the blister from a forward-filled syringe at room temperature with a stretch of at least 20 strands and perekonatisya, so that the wine is heated to room temperature.

4. Before administering the drug, it is necessary to thoroughly wash your hands with water and water.

5. Choose an injection site. Possible points on the body for injections: hands, quilts, seats, live (pripupkova litter). The middle of the skin injection site is a rich injection point. Slid schorazu vikoristovuvaty another point for the injection to change the viability of the injection or teasing pain in the mist of the injection.

It is necessary to permanently change the injection points in the middle of a particular lot.

Do not follow injection in the same place.

Not to be used for injections of sore points, znebarvleni dіlyanki shkіri аbo dіlyanki with indentations and vuzlikami.

It is recommended to write down the procedure for changing the place for the introduction of injections and making additional notes at the worker of injections. Deyakі dіlyanki tіla є unruly for zdіysnennya іn’єktsії independently (for example, hands). In such situations, third-party assistance may be needed.

Dilyanka 1

Pupupkova dilyanka. Robiti in’єktsії, vіdstavshi not less than 5 cm from the navel

Dіlyanka 3

Lіve Stehno. Approximately 5 cm above the knee and 5 cm below the groin

Dilyanka 2

Right tight. Approximately 5 cm above the knee and 5 cm below the groin

Dilyanka 4

Left arm. M’yazova part of the upper rear plot

Dilyanka 5

Right hand. M’yazova part of the upper rear lot

Dilyanka 7

Rights of the seat. M’yazova part above the quilting, lower waist

Dilyanka 6

Liva seat. M’yazova part above the buckle, zavzhd below the waist

6. Remove the syringe from the blister pack, removing the paper marking.

7. Take the syringe from the hand, which is how to write, that trim like that, like a sheep. Take the zahisny koppachok from the neck.

8. Lightly pick up the skin at the fold with your great and pointed fingers.

9. Insert the neck at the neck. The drug is injected, evenly pressing down on the syringe plunger until it is empty.

10. View the syringe with the needle arm upright.

11. Place the vicarious syringe in a disposal container.

Children.

The safety and efficacy of ingestion of glatiramer acetate in children and adolescents has not been established. There is enough information for 40 children (up to 18 years of age) to give Copaxon a referral for a referral. That’s not the reason to stop Copaxone 40th century category.

Overdose

There have been reports of a spate of overdose with Copaxone (up to 300 mg of glatiramer acetate). The fluctuations were not accompanied by other reactions, but the ones that were induced in the “Adverse reactions” section.

In the event of an overdose, it is necessary to monitor the patient’s camp and indicate whether symptomatic and supportive therapy is indicated.

Adverse reactions to Copaxone

Most of the data on the safety of ingestion of glatiramer acetate is based on half-way administration of the drug Copaxone-Teva (20 mg/ml) 1 time per dose. Lower data on safety of glatiramer acetate withdrawn as a result of 4 placebo-controlled trials of Copaxone-Teva (20 mg/ml) 1 time for the 1st placebo-controlled trial of Copaxone 40 (40 mg/ml) 3 break it down.

Direct follow-up of safety in case of ingestion of Copaxone-Teva (20 mg / ml) 1 time per dose of Copaxone 40 (40 mg / ml) 3 times per day in one follow-up was not carried out.

Copaxone-Teva (20 mg/ml) 1 time per dose

tsії, scho feared in most patients, yakі zastosovuvali drug. In the control studies, a proportion of patients, in whom there were fears of a reaction if they wanted to, were greater after treatment with Copaxone-Teva (20 mg / ml) (70%), lower after injection with placebo (37%). Reactions in the field of injections, which were most often feared when Copaxone-Teva (20 mg/ml) was ingested, compared with placebo, included erythema, leucorrhoea, neoplasm, erythema, swelling, flushing, and hypersensitivity.

A reaction associated with at least one of these symptoms, such as vasodilatation (blood rush), chest pain, dyspnoea, palpitation or tachycardia, is described as a non-negative reaction after incoccia. Tsya reaction can be blamed for the stretching of a few wheezes after an injection of Copaxone. The least one of the symptoms of a non-negative reaction after an injection (other than symptoms of a non-negative reaction after an injection due to the indicated frequency of indication is lower) was observed in 31% of patients, if they took the drug Copac sleepa-Teva (20 mg/ml), taken from 13% of patients, they took placebo.

All adverse reactions most commonly reported in patients treated with Copaxone-Teva (20 mg/ml) were equal to those treated with placebo, pointing lower.

Number of data taken in 4 baseline, submotionally blind, placebo-controlled clinical trials for the participation of 512 patients in total; placebo was administered for 36 months. In three subsequent relapsing-relapsing MS patients, 269patients who received Copaxone-Teva (20 mg/dose), and 271 patients in the group received placebo for 35 months. The fourth clinical follow-up was taken from patients with the first clinical episode, as they were designated as a group of high risk patients with the development of clinically confirmed MS. In this study, 243 patients received Copaxone-Teva (20 mg/dobu) and 238 patients received placebo for 36 months.

Adverse reactions, listed below, classified by organ system class and frequency: very common (≥1/10), common (≥1/100 – <1/10), infrequent (≥1/1000 - <1/100) .

Infections and invasions

• More common: infections, influenza.
• Common: bronchitis, gastroenteritis, herpes simplex, otitis media, rhinitis, dental abscess, vaginal candidiasis*.
• Uncommon: abscess, cellulitis, furuncle, operative herpes, pyelonephritis.

Good, bad and unspecified new creations (including brushes and polyps)

Lateral blood and lymphatic system

• Often: lymphadenopathy*.
• Uncommon: leukocytosis, leukopenia, enlarged spleen, thrombocytopenia, abnormal lymphocyte morphology.

Side of the immune system

• Often: hypersensitivity.

From the side of the endocrine system

• Uncommon: goiter, hyperthyroidism.

Sideways metabolism and eating

• Often: anorexia, increased body mass*.
• Uncommon: alcohol intolerance, gout, hyperlipidemia, elevated blood sodium levels, decreased plasma ferritin.

From the side of the psyche

• More often: anxiety*, depression.
• Often: nervousness.
• Infrequently: abnormal dreams, confusion of information, euphoria, hallucinations, divination, mania, disorder of special features, self-destruction.

Nervous system side

• More common: headache.
• Often: dysgeusia, hypertonicity, migraine, impaired movement, syncope, tremor*.
• Uncommon: carpal tunnel syndrome, cognitive disorder, sudomi, dysgraphia, dyslexia, dystonia, motor dysfunction, myoclonus, neuritis, neuromuscular blockade, nystagmus, palsy, peroneal nerve palsy, stupor, field defect.

To the side of the eye

• Often: twins in the eyes, apart from the side of the eye*.
• Infrequently: cataract, cornea lesions, dry eyes, ocular hemorrhage, lowering of the upper lower limbs, mydriasis, atrophy of the optic nerve.

On the side of the ear and equal

• Often: disorder on the side of the ear.

From the side of the cardiovascular system

• More common: vasodilation*.
• Often: palpation*, tachycardia*.
• Uncommon: extrasystole, sinus bradycardia, paroxysmal tachycardia, varicose veins.

From the side of the dichal system, chest organs and the middle

• More often: backside*.
• Common: cough, seasonal rhinitis.
• Uncommon: apnea, epistaxis, hyperventilation, laryngospasm, disease of the lungs, breathlessness.

To the side of the intestinal tract

• More common: tedium*.
• Common: anorectal disorders, constipation, dental caries, dyspepsia, dysphagia, fecal incontinence, vomiting*.
• Infrequently: colitis, intestinal polyp, enterocolitis, tremors, stravohod’s disease, periodontitis, rectal bleeding, increased sloughing.

From the side of the hepatobiliary system

• Often: impaired liver function tests.
• Uncommon: cholelithiasis, liver disease, liver damage, toxic hepatitis.

On the side of the coat and under the coat

• More common: hanging*.
• Often: ekhimozy, hyperhidrosis, sverbіzh, decompression on the side of the skin*, kropivyanka.
• Uncommon: angioedema, contact dermatitis, erythema nodosum, dermatitis.

From the side of the cystic-mucosal system and successful tissue

On the side of the sciatic system

• Often: imperative pull before cutting, polyuria, cutting.
• Infrequently: hematuria, nephrolithiasis, disorder of the sciatic tract, impairment of sciatica analysis of the sciatica.

Pregnancy, postnatal period and perinatal period

• Uncommon: abortion.

Lateral reproductive system breast malformations

• Uncommon: engorgement of the uterine folds, erectile dysfunction, pelvic organ prolapse, priapism, lateral prostate disorder, abnormal cervical smear, testicular disorder, aginal bleeding, vulvovaginal disorder. 9, bіl*.
• Often: chills*, distention*, atrophy of the muscles in the absence of◊, mast reaction*, peripheral distension, distention, hyperthermia.
• Infrequently: cyst, hangover syndrome, hypothermia, negative reaction after injection, inflammation, necrosis at the injection site, derangement of the mucosal membrane.

Injuries, disorders and complications

• Uncommon: post-vaccination syndrome.

*The number of withdrawals was greater than 2% (>2/100) in the Copaxone 40 group compared with the placebo group. Side reactions without the symbol * mean a difference of less than 2% or equivalent to 2%. 9The term “reactions in the misc in’єktsії” (various types) refers to all side reactions that are blamed in the misc in’єktsії, atrophy in the mіstsі in’єktsії and necrosis in m іsсі іn’єktsії, scho okremo.

◊Includes terms indicating localized lipoatrophy in the field of injection.

In the 4th follow-up, assigned to the second, after the placebo-controlled period, a post-critical phase of the treatment was carried out. Changes in the known safety profile of Copaxone-Teva (20 mg / ml) for an hour of a distant 5-fold follow-up were not observed.

Copaxone 40 (40 mg/ml) to be administered 3 times per week

The safety of copaxone 40 (40 mg/ml) was assessed in a sub-blind, placebo-controlled follow-up for the incidence of disease in remitting cho-recurrent roslian sclerosis. A total of 943 patients were treated with Copaxone 40 (40 mg/ml) three times a week, and 461 patients were treated with placebo for 12 months.

Patients who were treated with Copaxone 40 (40 mg/mL) (3 times per week) overdue, experienced the same adverse reactions with a similar frequency as when Copaxone®-Teva (20 mg/m) was ingested l) ( sparingly).

Zocrema, side effects in the field and non-specific reactions after injections in patients who were treated with Copaxone 40 (40 mg/ml) (3 times a day), vinicals less frequency, lower in patients, yakі otrimuvannya drug Copaxone®-Tev

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