MULTIPLE SCLEROSIS -
USING PROKARIN

How to Apply the Prokarin Patch

IMPORTANT NOTE:  The Prokarin gel must be refrigerated at all times.  When traveling carry Prokarin in an insulated carrier with ice packs.  Do not freeze the Prokarin gel.

• 1. Make sure the skin is clean and dry.  See the attached chart for appropriate sites to apply the patch.
• 2. Inspect the skin for any open areas or sores. Do not apply the patch to any areas that have a sore, crack in the skin, or open areas.
• 3. Apply a small amount of hydrocortisone cream 1% to the skin where the patch is to be applied.  Gently rub the cream into the skin until it is completely absorbed and the area is dry.
• 4. Peel back the white paper backing on the adhesive patch until ¾ of the sticky adhesive side is exposed.
• 5. Apply 0.2ml of the medication in the syringe to the middle portion of the exposed sticky side of the adhesive patch. The medication should be applied as a “glob” in the center of the patch.
• 6. Completely remove the adhesive patch from the white paper backing and apply the patch to the skin that has been prepared with the hydrocortisone cream.  Make sure there are no wrinkles in the patch and that all edges are well sealed to the skin.  If wrinkles occur, try applying the patch on the front of the thigh while the thigh muscle is flexed such as in a standing position or sitting with the leg extended out in front of you on a chair.  Apply the patch horizontal on the thigh.
• 7. Apply the patch as prepared above in the AM.  Remove this patch 8 hours later. Gently rub any medication remaining on the skin or patch into the skin. There should be about 25% of the medication left on the skin or patch when the patch is removed and this remaining medication should be as moist as the medication was when it was first applied from the syringe. If the remaining medication is flaked, clumpy, or caked, air got under the patch and this will affect the absorption of the medication.
• 8. Follow steps 1 through 6 to prepare a new patch to be applied in the afternoon (8 hours after the first patch). Be sure to rotate the sites where the patch is applied.  Never apply the patch to the same site twice in 24 hours.
• Note:  If the temperature of the environment is greater than 85 degrees Fahrenheit, the patch may need to be changed more frequently than every 8 hours under the direction of your doctor.  A person with a higher metabolism, or experiencing increased mental or physical stress may need to increase the frequency of dosing under the direction of his or her doctor.
• 9. Remove the afternoon patch at bedtime.  Gently rub any medication remaining on the skin or patch into the skin.  If there is no skin irritation, the second patch of the day may be worn all night and removed the next morning.  It is important that the patches be worn for 2 consecutive 8 hour intervals during the waking hours. 
• 10. Repeat steps 1 through 9 every day.
• Note:    Do not get the patch wet.  If the patch gets wet, remove the patch immediately, gently pat the area dry and apply a new patch at a different site following the above steps.  Do not apply a heating pad over the patch site.

It may take several weeks after continual use to see a beneficial effect.

Precautions: If any sores develop on your skin or you experience any nausea, diarrhea, stomach pains, difficulty breathing, frequent headaches or a headache that does not resolve with acetaminophen, rapid pulse, or chest pain, remove the immediately and call your doctor.

Side Effects:  Possible side effects of Prokarin use include: pain, tenderness, bruising, swelling, inflammation, or rash at the patch site, flushing, dizziness, headache, fainting, cyanosis (bluish coloring) of the face, hypotension, hypertension, pulse irregularities, rapid pulse, chest pain, dyspnea (difficult or painful breathing), abdominal discomfort, nausea, vomiting, diarrhea, increased urination, increase in symptoms of bursitis and tendonitis, burning or itching skin, nervousness, metallic taste, blurred vision, blood clots in arms or legs, may decrease blood sugars in diabetics, (use caution in patients with hypoglycemia), and severe allergic reaction that could result in shock, convulsions, and death.

Contraindications: Contraindicated in respiratory disorders (asthma, chronic bronchitis, emphysema, etc.), gastrointestinal ulceration, or concurrent use with some medications used to treat stomach or esophageal disorders (e.g. Zantac , Tagamet, Pepcid, Axid , ranitidine, cimetidine).  Baclofen (lioresal) and Zanaflex may decrease the effectiveness of Prokarin.

The preceding information was provided to compounding pharmacists by EDMS,LLC, the company that has been responsible for the introduction of Prokarin. You can obtain more information about Prokarin by contacting EDMS.