By signing and submitting this form, you agree that you have answered all questions truthfully and to the best of your ability, and you are requesting a prescription for Sermorelin. A basic evaluation will be administered at the time of your appointment. If you feel that you are not healthy enough to receive this medication or do not meet the requirements, do not submit this form.
STORAGE OF SERMORELIN
Store dry powder at 68°F to 77°F (20°C to 25°C) and away from heat, moisture and light. Once reconstituted, keep this medicine in a refrigerator between 36°F to 46°F (2°C to 8°C). Keep all medicine out of the reach of children. Throw away any unused medicine after the beyond use date. Do not flush unused medications or pour down a sink or drain.
RECONSTITUTION
- Draw up 9mL of diluent for reconstitution in a syringe
- Inject the provided bacteriostatic water into the vial of powder, aiming the liquid against the vial's inner wall.
- Gently roll the vial between the palms of your hands, 30 up to 120 seconds until the drug dissolves completely.
- Do not use if particles are visible.
- The reconstituted solution yields a final concentration of 100 micrograms per 0.1 ml
- Store reconstituted solution under refrigeration.
- Do not shake or freeze.
- Keep Out Of Reach of children.
ADMINISTRATION AND DOSAGE
The patient must not eat or drink anything but water 90 minutes before and after administering the Sermorelin. Eating in close proximity to the Sermorelin administration might block some of the effects of the injection.
Sermorelin doses commonly range from 200mcg (0.2mg) to 1000mcg (1mg) given 1 to 3 times daily. The peptide is commonly administered subcutaneously once daily before bed or split into 2 – 3 smaller doses spread throughout the day. Both approaches to administration can be effective and have been shown to have positive results in clinical studies. It is best to use a different place on the body for each injection, for example, abdomen, hip, thigh, or upper arm.
Although Sermorelin has a relatively short half-life of 10 – 20 minutes, the peptide stimulates the release of GH for 2 hours after administration. Once daily protocols with administration before bed are very effective for ease of use and patient compliance. Clinical studies have shown a once daily injection before bed to produce a substantial increase in 12 hour nocturnal GH production as well as an overall increase in GH and IGF-1 levels.
To prevent possible contamination, wipe the rubber vial stopper with an antiseptic solution before puncturing it with the needle. It is recommended that Sermorelin be administered using sterile, disposable syringes and needles.
DRUG INTERACTIONS
Taking glucocorticoid steroids in combination with SERMORELIN ACETATE | GHRP THERAPY may reduce the effectiveness of therapy.
FERTILITY IMPAIRMENT, MUTAGENESIS, CANCER RISK
There has been no longitudinal animal research regarding fertility impairment or carcinogenicity risk regarding S SERMORELIN ACETATE | GHRP THERAPY. There has been absolutely no clinical research linking S SERMORELIN ACETATE | GHRP THERAPY to genetic abnormalities.
PREGNANCY
There has been some animal research conducted regarding SERMORELIN ACETATE | GHRP THERAPY. At a dosage somewhere between three and six times the normal daily dosage that a human patient receives adjusted for physical surface area, minor fetal changes occurred in rabbits and rats. There have been no adequately controlled studies regarding the usage of SERMORELIN ACETATE | GHRP THERAPY by women who are pregnant. SERMORELIN ACETATE | GHRP THERAPY should NOT be administered to women that are pregnant.
NURSING WOMEN
It is unknown if SERMORELIN ACETATE | GHRP is produced in human milk. There are many medications that are released by the mother in the nursing process, and for this reason mothers and physicians should exercise caution when using SERMORELIN ACETATE | GHRP THERAPY while nursing.
SHARPS DISPOSAL INFORMATION
If the physician approves home usage, the patient should use SHARPS containers meant for the proper disposal of used needles and syringes accumulated as a result of SERMORELIN ACETATE | GHRP THERAPY. These containers are puncture resistant and are a necessary safety measure to protect both patient and anyone who may come in contact with the used needles and syringes. It is vital that patient (and parent, if applicable) be directed thoroughly as to the vital important of proper needle disposal. Also, they should be informed of the dangers of reusing syringes and needles as well.
SIDE EFFECTS
A significant portion of SERMORELIN ACETATE | GHRP THERAPY patients develop antibodies against Growth Hormone Factor during at least one point of therapy. There is no clear assessment of the significance of the presence of these antibodies, and the levels of these antibodies can change quickly from test to test. A positive result at one juncture regularly turns into a negative result after the next test. The production of these antibodies does not seem to have any adverse effect on the patient. Also, these antibodies do not seem to produce any change in the effectiveness of SERMORELIN ACETATE | GHRP THERAPY.
If you have any questions as to the risks or hazards of the treatment, or any questions concerning this proposed treatment or other possible treatments, ask now before signing this consent form. It is vital that patient be aware that such responses can potentially occur. If the patient suffers an allergic reaction as a result of SERMORELIN ACETATE | GHRP THERAPY it is vital that they receive medical attention promptly. Clinical Tests have shown that increased blood-serum levels of Insulin-Like Growth Factor One (IGF-1), Human Growth Hormone, alkaline phosphatase, and inorganic mineral phosphorus can occur as a result of SERMORELIN ACETATE | GHRP THERAPY.
ALLERGIC REACTIONS
There have been no reported general allergic responses to SERMORELIN ACETATE | GHRP THERAPY. The most common reaction to SERMORELIN ACETATE | GHRP THERAPY is related to local irritation around the injection site, which occurs in around one of every six patients. This irritation is characterized by redness, pain, or swelling. Though this side effect is relatively common, only a small minority of patients find the irritation bothersome enough to suspend therapy. Out of a sample of 350 patients who underwent SERMORELIN ACETATE | GHRP THERAPY in clinical trial, only three suspended therapy as a result of injection-site irritation. There are other side effects which occurred in less than one percent of patients. These side effects include: severe drowsiness, hives, vomiting, headache, nausea, difficulty swallowing, hyperactivity, chest tightness and pallor, distortion in perception of taste, and flushing of the skin.
SERMORELIN ACETATE | GHRP THERAPY DEPENDENCY AND ABUSE
There is no evidence to suggest that the use of SERMORELIN ACETATE | GHRP THERAPY for any period of time will result in any sort of dependency or proclivity toward abuse. The general pharmacology of SERMORELIN ACETATE | GHRP THERAPY does not produce any addictive effect, and clinical trials have produced no evidence of such an effect.
NEVER TAKE MORE THAN PRESCRIBED
It is not recommended to exceed the recommended dosage of SERMORELIN ACETATE | GHRP THERAPY prescribed by your physician. Overdose will not provide better results. It will only increase the occurrence of side effects.
RELEASE FROM MEDICAL LIABILITY AND MALPRACTICE CLAIMS:
I agree to release Dr Brian Crenshaw and all his associates from all medical liability and malpractice claims related to any and all care.
This consent covers the initial and all future prescriptions for this medication.
I understand that this is a prescription therapy and is not eligible for a refund or reimbursement.
I certify that I have been informed of the risks and benefits of off-label treatment
I will review the side effects of all medications I am prescribed and immediately inform the doctor of any side effects.
By signing, I certify that I have read and understand the contents of this form. My questions have been answered and I understand the treatment and goals, however if I have any further questions I will ask the doctor. I understand and accept the potential risks associated with Sermorelin therapy as stated above and consent to treatment. I am aware of the possible side effects and drug interactions and give my consent for treatment, and will immediately inform the doctor of any side effects. I have informed the medical staff of any known allergies to drugs or other substances, and any past adverse reaction I've experienced. I have informed the medical staff of all medications and supplements I'm currently taking. I understand that there are ways in programs that can assist me in my desire to decrease my body weight and acknowledge that no guarantees have been made to me concerning my results.