The patient must also be residing in the US. Zilretta is an FDA-approved treatment for knee pain caused by osteoarthritis. However, Zilretta has saved her from constant pain. Ophthalmic: Exophthalmos, glaucoma, increased intraocular pressure [see Warnings and Precautions (5.9)], posterior subcapsular cataracts, rare instances of blindness associated with periocular injections. Monitor patients with renal insufficiency for signs of edema, weight gain, and imbalance in serum electrolytes. Repeat administration resulted in an increase in the incidence, severity (minimal to slight) and duration of microscopic changes (infiltration of macrophages, lymphocytes, plasma cells, neutrophils; fibrosis; neovascularization; granulation tissue; and debris) and decreased Safranin O staining (decreased proteoglycan content in the cartilage of the knees) compared to the equivalent dose of immediate-release triamcinolone acetonide. 2 DOSAGE AND ADMINISTRATION Please login or register first to view this content. Medicare benefits for knee injections Platelet-rich plasma (PRP) injections are intended to change the immune response by using the patients own blood and platelets. Medicare benefits for knee injections. Corticosteroids may increase blood glucose concentrations. How Zilretta Prolongs Pain Relief After the Zilretta microspheres of TA are injected, they immediately begin releasing TA into the arthritic knee. The result is painful, swollen and stiff joints. (Opens in a new browser tab), Will Medicare Cover Emergency Room Visits? Intra-articular injection may result in damage to joint tissues. Monitor patients with congestive heart failure or hypertension for signs of edema, weight gain, and imbalance in serum electrolytes. Infection and discomfort at the site of the infection are possible side effects. ZILRETTA (triamcinolone acetonide extended-release injectable suspension), for intra-articular use Initial U.S. Approval: 1957 _____ _____ INDICATIONS AND USAGE. I found out Zilretta has revolutionized pain relief. What I love about Zilretta is I don??t have any more ??Crushing Pain Days?. All rights reserved. It is not known whether intra-articular administration of Zilretta could result in sufficient systemic absorption to produce detectable quantities in human milk. (Opens in a new browser tab). Can't find the answer you're looking for? Grip the plastic holder that contains the vial adapter. I cannot afford to pay for it as it is very expensive. Zilretta is proven and medically necessary for the treatment ofOsteoarthritis pain of the knee when all of the following criteria are met: Diagnosis of osteoarthritis pain of the knee; and Advise patients to inform their health care provider if they develop fever or other signs or symptoms of infection. Corticosteroids can produce reversible hypothalamic-pituitary-adrenal axis suppression, with the potential for adrenal insufficiency after withdrawal of treatment, which may persist for months. The inside of both knees are worn out. Zilretta is a savior !! Can triamcinolone acetonide B be used to treat severe diaper rash on a little girl? So one month to even work, then repeat in as. Gastrointestinal: Abdominal distention, bowel/bladder dysfunction (after intrathecal administration) [see Warnings and Precautions (5.2)], elevation in serum liver enzyme levels (usually reversible upon discontinuation), hepatomegaly, increased appetite, nausea, pancreatitis, peptic ulcer with possible perforation and hemorrhage, perforation of the small and large intestine (particularly in patients with inflammatory bowel disease) [see Warnings and Precautions (5.10)], ulcerative esophagitis. Metabolic clearance of corticosteroids is decreased in hypothyroid patients and increased in hyperthyroid patients. These local responses were still reversing at 6 months post the last injection. Of course, every drug carries risk, and the risk of corticosteroid is infection and an increase in blood sugar levels. Visit Website, Kenalog-40, Aristocort, Kenalog-10, Azmacort, +5 more, prednisone, aspirin, ibuprofen, meloxicam, naproxen, Cymbalta. Advise patients and/or caregivers to immediately report any new or worsening behavior or mood disturbances to their health care provider. 844-353-9466 Tenderness when light pressure is applied. 2015). [See also Nonclinical Toxicology (13.2)]. Do not expose the Zilretta single-dose kit to temperatures above 77F (25C). Before continuing, ensure that powder moves freely within the vial. discounted medicines and copay programs to low income or uninsured and under-insured people who meet specific guidelines. Tap for at least one minute until all powder is completely dispersed. Loss of flexibility and loss of full range of the joints movement. I had zero pain in my knee, but dibilitating itb pain. 4). To assess potential effects of the systemic levels of triamcinolone acetonide associated with a single intra-articular (IA) administration of Zilretta on hypothalamic pituitary adrenal (HPA) axis function, serum and urine cortisol levels were monitored over 6 weeks post injection. You have a metabolic disease such as diabetes or hemochromatosis. I would not do injections again and would opt instead for laparoscopy surgery if available. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Much worse than mine. It worked very well on my left knee within one week. Swelling that is usually from inflammation of the soft tissue around the joint. I have been suffering from itb pain following a hip revision. The purpose of this study is to examine the pre-post effects of a single ZILRETTA knee injection on physiological measures of self-reported pain and disability, physical performance, and physical activity in individuals with knee osteoarthritis (OA). I got the injections done to both knees at the same office visit. The following serious adverse reactions are described elsewhere in the labeling. Last updated on Dec 1, 2022. Clobetasol vs. triamcinolone - how do they compare? Carefully observe pediatric patients, including weight, height, linear growth, blood pressure, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis. Eliminate all bubbles by slowly depressing the plunger to displace the air from the syringe. 5 mL single-dose vial to deliver 32 mg of triamcinolone acetonide supplied as a sterile, white to off-white powder in a cerium glass (clear) vial with a rubber stopper and an aluminum seal with a gray plastic cap. One 32 mg vial of Zilretta microsphere powder, Three sterile needles, 21-gauge, 1" length, One sterile Luer Lock compatible syringe, 5 mL, Paper towels or pad to cushion vial tapping (not shown in Fig. Zilretta (triamcinolone) Available for Android and iOS devices. When corticosteroids are administered concomitantly with potassium-depleting agents (i.e., amphotericin B, diuretics), observe patients closely for development of hypokalemia. with the supplied diluent. Increased activity of both cyclosporine and corticosteroids may occur when the two are used concurrently. ?s even a candidate for total knee replacement. The second type of injection is hyaluronic acid (HA). No overall differences in safety or effectiveness were observed between elderly and younger subjects, and other reported clinical experience with triamcinolone acetonide has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Medicare.Org Is Privately Owned And Operated By Health Network Group, LLC. Some people feel relief after injections. Aerobics followed by stretching after exercise lessens the impact of aging because these activities support the flow of fluid around the joints and promote full range of motion. Side effects include inflammation. She? Osteoarthritis, the most common joint disorder in the United States, affects the knee joints of 10 percent of all men, and 13 percent of all women over the age of 60. I got my first Zilretta shot almost 8 weeks ago. A total of 470 patients (97%) completed follow-up to Week 12, the time point for primary efficacy determination, and 443 (91.5%) completed to Week 24. The last injection (in a prior course) was given at least six (6) months ago. A properly mixed suspension will be uniformly milky white and contain no clumps. Zilretta is a suspension product and it is normal for some residue to be left behind on the vial walls after withdrawing the contents. The physician who prescribes the drug, as well as the pharmacy where you get it, must accept Medicare assignment. Viscosupplementation is a procedure in which hyaluronate is injected into the knee joint for treatment of osteoarthritis in the knee in persons who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics (e.g., acetaminophen). Valid at all major chains including Walgreens, CVS Pharmacy, Target, WalMart Pharmacy, extended-release injectable suspension). Concomitant use of aspirin (or other nonsteroidal anti-inflammatory drugs) and corticosteroids increases the risk of gastrointestinal side effects. Zilretta is not interchangeable with other formulations of injectable triamcinolone acetonide. "Zilretta is a non-opioid medicine that employs Flexion's proprietary microsphere technology to provide proven pain relief over 12 weeks," the company said in a news release. Eligibility requirements vary for each program. A friend told me about how much Zilretta had been helping her with pain relief. WHAT DO YOU HAVE TO PAY FOR THE INJECTIONS?? It is mobile and weight bearing, and its stability relies on connected ligaments and muscles. Quoted prices are for cash-paying customers and are not valid with insurance plans. These opinions do not represent the opinions of WebMD. Estrogens may decrease the hepatic metabolism of certain corticosteroids, thereby increasing their effect. Advise patients and/or caregivers to immediately report any new or worsening behavioral or mood disturbances to their health care provider [see Warnings and Precautions (5.12)]. Read More Read Less. I would not do injections again and would opt instead for laparoscopy surgery if available. Aspirin should be used cautiously in conjunction with corticosteroids in hypoprothrombinemia. I tried it and I am very very happy. What pain relief! Attach a needle to the syringe and remove the needle guard. 2). Table 3 contains drug interactions associated with systemic corticosteroids. We comply with the HONcode standard for trustworthy health information. for weeks to wait for medicare to pay for another injection. 1), Medical-grade gloves (not shown in Fig. The Coverage and Analysis Group at the Centers for Medicare and Medicaid Services (CMS) requested from The Technology Assessment Program (TAP) at the Agency for Healthcare . What I love about Zilretta is I don??t have any more ??Crushing Pain Days?. It lasted almost 4 months. In this study, all participants will receive an intra-articular glenohumeral injection of ZILRETTA and will be followed up with at four time points over 1 year to observe pain, function and range of motion following the injection. Promptly inject Zilretta after preparation to avoid settling of the suspension. Special consideration should be given to patients with or at increased risk of osteoporosis (e.g., postmenopausal women) before initiating corticosteroid therapy. Zilretta is first and only extended-release, intra-articular therapy for patients with osteoarthritis-related knee pain. Thanks for a reply! We do not offer every plan available in your area. Zilretta is supplied as a single-dose kit, containing: Zilretta is contraindicated in patients who are hypersensitive to triamcinolone acetonide, corticosteroids or any components of the product [see Warnings and Precautions (5.3) and How Supplied/Storage and Handling (16)]. Zilretta is formulated in 75:25 poly(lactic-co-glycolic acid) (PLGA) microspheres with a nominal drug load of 25% (w/w) and is provided as a sterile white to off-white powder. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. I barely have any pain. Swirl gently every five or six taps. All she talks about is how great Zilretta isso I asked my doctor what is opinion is. Musculoskeletal: Aseptic necrosis of femoral and humeral heads, calcinosis (following intra-articular or intralesional use), Charcot-like arthropathy, loss of muscle mass, muscle weakness, osteoporosis, pathologic fracture of long bones, post injection flare (following intra-articular use), steroid myopathy, tendon rupture, vertebral compression fractures. The syringe must remain on the vial adapter while the suspension remains in the vial. A recent large randomized Endocrine: Decreased carbohydrate and glucose tolerance, development of Cushingoid state, glycosuria, hirsutism, hypertrichosis, increased requirements for insulin or oral hypoglycemic agents in diabetes, manifestations of latent diabetes mellitus, menstrual irregularities, secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in trauma, surgery, or illness), suppression of growth in pediatric patients. If an aspiration and an injection procedure are performed at the same session, bill only one unit for CPT code 20610 or 20611 (if applicable). Zilretta is for intra-articular use only and should not be administered by the following routes: epidural, intrathecal, intravenous, intraocular, intramuscular, intradermal, subcutaneous. You pay nothing for the home health nurse visit to inject the drug. Had to go to physical therapy for several weeks & use pain medicine for several weeks. It worked for me Big Time. Instruct patients to contact their health care provider immediately if they are exposed [see Patient Counseling Information (17)]. Your costs in Original Medicare After you meet the Part B deductible , you pay 20% of the Medicare-approved amount for the cost of the drug. Zilretta is prepared with a supplied diluent containing an isotonic, sterile, aqueous solution of sodium chloride (NaCl; 0.9% w/w), sodium carboxymethylcellulose (CMC; 0.5% w/w) and polysorbate-80 (0.1% w/w) to form a 5 mL sterile suspension intended for intra-articular injection. Advise patients who have not been vaccinated to avoid exposure to chicken pox or measles. Subscribe to newsletters for the latest medication news, new drug approvals, alerts and updates. Cases of serious anaphylaxis, including death, have been reported in individuals receiving triamcinolone acetonide injection, regardless of the route of administration [see Adverse Reactions (6)]. Note To find out how much your test, item, or service will cost, talk to your doctor or health care provider. Since osteo arthritis is degenerative, I'm sure a total knee replacement is in my future. Rare instances of anaphylaxis have occurred in patients with hypersensitivity to corticosteroids. However, knee injections are typically administered by a physician in a medical office or clinic. (triamcinolone acetonide Corticosteroids decrease bone formation and increase bone resorption through their effect on calcium regulation and inhibition of osteoblast function. Zilretta also demonstrated a reduction in pain intensity scores each week from Weeks 1 through 12 (Figure 1). The adapter will snap into place. I was pain free for the first time in years! The safety and effectiveness of epidural and intrathecal administration of corticosteroids have not been established, and corticosteroids are not approved for this use. Any information we provide is limited to those plans we do offer in your area. insurance paid was over $2,000.00 So, basically one grand per knee, for something that is neither a quick fix, and is not long lasting at all. As shown in Figure 3, the vial on the left, with the X, requires additional tapping because the powder is not properly dislodged. Immediately depress the plunger fully and then invert the syringe so the vial is directly on top of the syringe (Fig. Infection with any pathogen (viral, bacterial, fungal, protozoan, or helminthic) in any location of the body may be associated with the use of corticosteroids alone or in combination with other immunosuppressive agents. Speak with a Licensed Medicare Sales Agent 877-388-0596 - TTY 711. Attach Vial Adapter to Zilretta Powder Vial. Note: Avoid vigorous shaking of the vial to minimize foaming. I can? Contact your bank to set up an online bill payment from your checking or savings . This price guide is based on using the discount card which is accepted at most U.S. pharmacies. Read More Read Less. Weigh potential growth effects of treatment against clinical benefits obtained and the availability of treatment alternatives. The primary efficacy endpoint comparing Zilretta to placebo was change from baseline at Week 12 in the weekly mean of the Average Daily Pain intensity scores (ADP) as assessed by a 0-10 Numeric Rating Scale (NRS). Think twice before doing this. For more information, go to or call 1-844-353-9466. The majority of published literature with corticosteroid exposure during pregnancy includes the oral, topical and inhaled dosage formulations; therefore, the applicability of these findings to a single intra-articular injection of triamcinolone acetonide is limited. Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. I have moderate osteo arthritis in both knees. Zilretta is an injectable suspension of a type of non-opioid corticosteroid that is injected into the affected knee joints. Speak with a Licensed Medicare Sales Agent 877-388-0596 - TTY 711. Zilretta (triamcinolone) is a member of the glucocorticoids drug class and is commonly used for Osteoarthritis. Refer to the Instructions for Use for directions on the preparation and administration of Zilretta. Can't find the answer you're looking for? Some of the symptoms of osteoarthritis include: Pain in the affected joint during movement or at rest after movement. I have been getting regular cortisone shots every few months for the last couple years. Had Ziretta injection for flare of OA. I got the injections done to both knees at the same office visit. After Zilretta, I can focus on enjoying activities like walking and fishing. In the U.S. general population, the estimated risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Foot care. 2005 - 2023 WebMD LLC. The following adverse reactions, presented alphabetically by body system, have been identified during post-approval use of Zilretta. After conclusion of the study (May 2018) received Zilretta in both knees and just received another round this month. The injection is the worst thing I've ever experienced. After 1 week,of getting a shot in both knees, I felt like Superman. Peel off the paper cover from the vial adapter package (Fig. Institute appropriate care upon occurrence of an anaphylactic reaction. However, don??t expect miracles and then bad mouth the drug. Hoping for the same great experience I had with the first shots. Extended Release; Injectable Suspension; Intra-Articular, Medically Necessary as determined by a Doctor. Zilretta is supplied as a single-dose kit containing a vial of Zilretta microsphere powder, a vial of sterile diluent, and a sterile vial adapter. The orthopedic Dr. who did them said that Zilretta can take up to a month to even work, and you need the injections repeated every 6 to 8 months. Zilretta gets an A . Swirl the vial gently for at least 10 seconds to ensure the powder is fully suspended. Special consideration should be given to patients with previous or current emotional instability or psychiatric illness before initiating corticosteroid therapy. Note: If needed, the Zilretta suspension can be stored in the vial for up to 4 hours at ambient conditions. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Overall, the incidence and nature of adverse reactions was similar to that observed with placebo. Read More Read Less, I have had more problems since having the injections in both knees, I had to go to my primary care doctor twice because apparently I had an allergic reaction to this drug. Pregnant primates dosed with triamcinolone acetonide via intramuscular injection for 4 days during organogenesis at doses equivalent to 3 times the MRHD or higher caused severe craniofacial CNS and skeletal/visceral malformation and higher prenatal death. No peri- and post-natal development studies of triamcinolone acetonide in animals have been conducted. Zilretta is a suspension product and it is normal for some residue to be left behind on the vial walls after withdrawing the contents. treatment for foot injuries or diseases (like hammer toe, bunion deformities, and heel spurs). The clinical relevance of these findings in the arthritic knee is unknown. ii. Corticosteroids can cause salt and water retention, and increased excretion of potassium. Published studies on the association between corticosteroids and fetal outcomes have reported inconsistent findings and have important methodological limitations. The data from this study are insufficient to fully characterize the safety of repeat administration of Zilretta. In situations of stress during that period (as in trauma, surgery, or illness), institute corticosteroid replacement therapy. I treated both knees at the same time. (triamcinolone acetonide) Inspect all kit components to confirm they have not expired and the seals are intact. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. For Government Resources Regarding Medicare, Please Visit (1) Limitation of Use (Opens in a new browser tab), Does Medicare Cover Fitness Clubs? Grating of the bones against each other. The orthopedic Dr. who did them said that Zilretta can take up to a month to even work, and you need the injections repeated every 6 to 8 months. The syringe on the right shows the suspension properly mixed and ready for the next step. g. Zilretta (triamcinolone acetonide extended- release) is an extended-release intraarticular corticosteroid - injection indicated for the management of osteoarthritis pain of the knee. Instruct patients to contact their health care provider if they develop fever or other signs or symptoms of infection. In a vertical orientation, gently push the adapter down onto the Zilretta powder vial until the spike on the adapter penetrates the rubber stopper on the Zilretta powder vial. However, due to stock shortages and other unknown variables we cannot provide any guarantee. Preparation of Zilretta requires close attention to the Instructions for Use to ensure successful administration. Medicare.Org Is A Non-Government Resource That Provides Information Regarding Medicare, Medicare Advantage, And More. This is my 3 time to get the treatment. Attach the syringe onto the vial adapter by pushing down and turning clockwise until you feel resistance (Fig. The usual technique for intra-articular injection should be followed. Zilretta must be prepared using the diluent supplied in the kit. I am super satisfied with Zilretta. is a member of the glucocorticoids drug class and is commonly used for So severe that I was unable to flex my knee at all & patella was unmovable. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Significant improvement in pain and functional capacity from the prior series of injections is documented in the medical record; and. Withdraw the full contents from the Zilretta vial into the syringe. It's very short lived and very expensive. You have a hereditary predisposition for osteoarthritis. Other: Abnormal fat deposits, decreased resistance to infection, hiccups, increased or decreased motility and number of spermatozoa, malaise, moon face, weight gain. Up to 52weeks of radiographic data collected in this study revealed no adverse effects, including no evidence of osteonecrosis, clinically significant subchondral bone changes, insufficiency fracture, or accelerated joint space narrowing suggestive of chondrolysis, the study authors reported. They need to change this and pay for it when it is needed again.Read More Read Less, 67 year old male. Osteoarthritis is mostly an age-related condition that breaks down the cartilage that would normally function as a cushion to prevent bones from chafing. Clinical studies included randomized, double-blind, parallel-group, placebo and/or active-controlled, and pharmacokinetic/pharmacodynamic studies with follow-up ranging from 6-24 weeks. Drugs like Zilretta work by blocking the substances within the body that can cause inflammation. Cholestyramine may increase the clearance of corticosteroids. Because some of these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. General and administration site conditions, Figure 1: Weekly Change from Baseline to Week 12 in Average Daily Pain. Of the total number of patients administered 32 mg Zilretta in clinical studies (N=424), 143 patients were 65 years of age or older. There may be decreased resistance and inability to localize infection when corticosteroids are used. Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance. General and administration site conditions: Pain including injection site pain or discomfort and leg pain. Osteoarthritis. Zilretta is the answer for me ! TRICARE covers medications that are approved by the U.S. Food and Drug Administration. The average price at a hospital is. The product combines triamcinolone acetonide, a short-acting corticosteroid, with a poly lactic-co-glycolic acid matrix to provide pain relief over 12 weeks. What is Osteoarthritis? First my heart and swelling of my kneesthen I though I had the flu but I had a flu shot and didnt have the flusore throat, sinus issues, rash, headache. Available for Android and iOS devices. Treatment emergent adverse reactions reported by greater than or equal to 1% of patients in the Zilretta arms are summarized below (Table 1 and 2). If you get a "Medicare Premium Bill" from Medicare, there are 4 ways to pay your premium, including 2 ways to pay online:. In 2020, the . The chemical name for triamcinolone acetonide is 9-fluoro-11,16,17,21-tetrahydroxypregna-1,4-diene- 3,20-dione cyclic 16,17-acetal with acetone. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. The rate at which TA is released is both consistent and prolonged enough to deliver pain management for as long as three months. The Zilretta powder vial contains an overfill to allow the appropriate dose to be withdrawn. I have tried laser treatments, 3 different types of injections which includes Zilretta and I have had no relief. The last 8 weeks have been the best weeks I have had in years. Of a total of 208 patients who received a first injection of Zilretta, a second injection was administered to 179 patients (median time to second injection was 16.6 weeks). Dermatologic: Acne, allergic dermatitis, cutaneous and subcutaneous atrophy, dry scaly skin, ecchymoses and petechiae, edema, erythema, hyperpigmentation, hypopigmentation, impaired wound healing, increased sweating, lupus erythematosus-like lesions, purpura, rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp hair, urticaria. Dietary salt restriction and potassium supplementation may be necessary. Her knees are in bad shape. Medicare Coverage for Zilretta Zilretta is available as a brand name drug only, a generic version is not yet available. I am on my 2nd injection! Drugs which induce hepatic microsomal drug metabolizing enzyme activity may enhance metabolism of corticosteroids and require that the dosage of corticosteroid be increased. Beginning to think a total knee replacement would have been the best bet from the beginning. Commenting on the study results, Andrew Spitzer, MD, Co-Director, Joint Replacement Program, Cedars-Sinai Orthopaedic Center and lead investigator said, This valuable study suggests that repeat administration of Zilretta can provide patients suffering from knee OA consistent, substantial, and durable pain relief, and is generally well-tolerated. Your use of this website constitutes acceptance of Haymarket MediasPrivacy PolicyandTerms & Conditions. I knew after the 1st right knee was done, but my doctor insisted I do the 2nd knee even though I told him no.Read More Read Less. I? Does Medicare Cover DME? After Zilretta, I can focus on enjoying activities like walking and fishing. She? Intra-articular injection of corticosteroid may be complicated by joint infection. 5 mL single-dose vial supplied as a sterile, clear liquid solution of 0.9% w/w sodium chloride (normal saline) containing 0.5% w/w sodium carboxymethylcellulose, and 0.1% w/w polysorbate-80 in a glass vial with a rubber stopper, aluminum seal and white plastic cap. See Home Infusion Therapy for information on medication coverage for self-injection/infusion in the . Immune system: Hypersensitivity reactions including pruritus, rash, angioedema, and anaphylaxis [see Contraindications (4), Warnings and Precautions (5.3)]. As shown in Figure 6, place the Zilretta powder vial on a flat surface.
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