`For optional use by the prescribing physician to
`organize the titration dosage of XYREM for patients.
`
`Call the SDS Pharmacy with any titration questions
`at 1-866-997-3688.
`
`-
`
`-
`Fax completed Titration Schedule, along with the Patient Enrollment/
`Prescription Form, to the SDS Pharmacy (toll-free) at 1-866-470-1744.
`=
`
`-
`
`(sodium oxybate) oral solution @
`
`SUCCESS
`" - - - - - PRoGRAM •
`for physicians
`
`---
`
`Patient Name
`
`Physician Name
`
`Date of Birth
`
`Date
`
`Titration and Dosage for XYREM
`
`Starting dose
`
`First dose:
`
`grams; Second dose:
`
`grams for
`
`days
`
`1•t Titration
`
`First dose:
`
`grams; Second dose:
`
`grams for
`
`days
`
`2"d Titration
`
`First dose:
`
`grams; Second dose:
`
`grams for
`
`days
`
`3'd Titration
`
`First dose:
`
`grams; Second dose:
`
`grams for
`
`days
`
`1 to 2 weeks are recommended between dosage increases to evaluate clinical response
`and minimize adverse effects.
`
`Dosing and Titration Calculator
`
`1'1 Dose
`
`+
`
`2nd Dose
`
`=
`
`Total Nightly Dose
`
`2.25 grams
`
`2.25 grams
`
`3 grams
`
`3 grams
`
`3.75 grams
`
`3.75 grams
`
`4.5 grams
`
`4.5 grams
`
`Maximum dose :
`'
`
`Effective
`dose range
`
`Due to its short half-life, XYREM is taken in 2 equal doses at night.
`
`Recommended starting dose is 4.5 g/night. Dosage should be titrated to effect in ......--------------,
`increments of 1.5 g/night (0.75 g per dose) to a maximum dose of 9 g/night.
`Ranbaxy Ex. 1006
`IPR Petition - USP 8, 772,306
`
`Please see enclosed full Prescribing Information, including boxed warning.
`
`©2008 Jazz Pharmaceuticals, Inc.
`
`Print ed in the USA
`
`MDPF- 02 Rev 0808
`
`Page 1
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