ing warfarin, especially at the initiation and termination of androgen therapy. 7.3 corticosteroids the concurrent use of testosterone with corticosteroids may result in increased fluid retention and requires careful monitoring, particularly in patients with cardiac, renal or hepatic disease.

product outweigh the serious risks of pome and anaphylaxis. limitations of use safety and efficacy of aveed in men with “age-related hypogonadism” (also referred to as “late-onset hypogonadism”) have not been established. safety and efficacy of aveed in males less than 18 years old have not been established [see use in specific populations ( 8.4 )]. aveed (testosterone undecanoate) injection is an androgen indicated for testosterone replacement therapy in adult males for conditions associated with a deficiency or absence of endogenous testosterone: primary hypogonadism (congenital or acquired) ( 1 ) hypogonadotropic hypogonadism (congenital or acquired) ( 1 ) aveed should only be used in patients who require testosterone replacement therapy and in whom the benefits of the product outweigh the serious risks of pulmonary oil microembolism and anaphylaxis ( 1 ). limitations of use safety and efficacy of aveed in men with “age-related hypogonadism” have not been established ( 1 ). safety and efficacy of aveed in males less than 18 years old have not been established ( 1 , 8.4 ).

ous pome reactions, involving cough, urge to cough, dyspnea, hyperhidrosis, throat tightening, chest pain, dizziness, and syncope, have been reported to occur during or immediately after the injection of intramuscular testosterone undecanoate 1000 mg (4 ml). the majority of these events lasted a few minutes and resolved with supportive measures; however, some lasted up to several hours and some required emergency care and/or hospitalization. to minimize the risk of intravascular injection of aveed, care should be taken to inject the preparation deeply into the gluteal muscle, being sure to follow the recommended procedure for intramuscular administration [see dosage and administration ( 2.2 , 2.3 ) and adverse reactions ( 6.2 )] . in addition to serious pome reactions, episodes of anaphylaxis, including life-threatening reactions, have also been reported to occur following the injection of intramuscular testosterone undecanoate. both serious pome reactions and anaphylaxis can occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose. patients with suspected hypersensitivity reactions to aveed should not be re-treated with aveed. following each injection of aveed, observe patients in the healthcare setting for 30 minutes in order to provide appropriate medical treatment in the event of serious pome reactions and anaphylaxis. 5.2 aveed risk evaluation and mitigation strategy (rems) program aveed is available only through a restricted program called the aveed rems program because of the risk of serious pome and anaphylaxis . notable requirements of the aveed rems program include the following: healthcare providers who prescribe aveed must be certified with the rems program before ordering or dispensing aveed. healthcare settings must be certified with the rems program and have healthcare providers who are certified before ordering or dispensing aveed. healthcare settings must have on-site access to equipment and personnel trained to manage serious pome and anaphylaxis. further information is available at www.aveedrems.com or call 1-855-755-0494. 5.3 worsening of benign prostatic hyperplasia (bph) and potential risk of prostate cancer patients with bph treated with androgens are at an increased risk of worsening of signs and symptoms of bph. monitor patients with bph for worsening signs and symptoms. patients treated with androgens may be at an increased risk for prostate cancer. evaluate patients for prostate cancer prior to initiating and during treatment with androgens [see contraindications ( 4 )] . 5.4 polycythemia increases in hematocrit, reflective of increases in red blood cell mass, may require discontinuation of testosterone. check hematocrit prior to initiating testosterone treatment. it would be appropriate to re-evaluate the hematocrit 3 to 6 months after starting testosterone treatment, and then annually. if hematocrit becomes elevated, stop therapy until hematocrit decreases to an acceptable level. an increase in red blood cell mass may increase the risk of thromboembolic events. 5.5 venous thromboembolism (vte) there have been postmarketing reports of venous thromboembolic events, including deep vein thrombosis (dvt) and pulmonary embolism (pe), in patients using testosterone products, such as aveed. evaluate patients who report symptoms of pain, edema, warmth and erythema in the lower extremity for dvt and those who present with acute shortness of breath for pe. if a venous thromboembolic event is suspected, discontinue treatment with aveed and initiate appropriate workup and management. 5.6 cardiovascular risk long-term clinical safety trials have not been conducted to assess the cardiovascular outcomes of testosterone replacement therapy in men. to date, epidemiologic studies and randomized controlled trials have been inconclusive for determining the risk of major adverse cardiovascular events (mace), such as non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death, with the use of testosterone compared to non-use. some studies, but not all, have reported an increased risk of mace in association with use of testosterone replacement therapy in men. patients should be informed of this possible risk when deciding whether to use or to continue to use aveed. 5.7 abuse of testosterone and monitoring of serum testosterone concentrations testosterone has been subject to abuse, typically at doses higher than recommended for the approved indication and in combination with other anabolic androgenic steroids. anabolic androgenic steroid abuse can lead to serious cardiovascular and psychiatric adverse reactions [see drug abuse and dependence ( 9 )]. if testosterone abuse is suspected, check serum testosterone concentrations to ensure they are within therapeutic range. however, testosterone levels may be in the normal or subnormal range in men abusing synthetic testosterone derivatives. counsel patients concerning the serious adverse reactions associated with abuse of testosterone and anabolic androgenic steroids. conversely, consider the possibility of testosterone and anabolic androgenic steroid abuse in suspected patients who present with serious cardiovascular or psychiatric adverse events. 5.8 use in women due to lack of controlled evaluations in women and potential virilizing effects, aveed is not indicated for use in women [see contraindications ( 4 ) and use in specific populations ( 8.1 , 8.2 )] . 5.9 potential for adverse effects on spermatogenesis with large doses of exogenous androgens, including aveed, spermatogenesis may be suppressed through feedback inhibition of pituitary fsh which could possibly lead to adverse effects on semen parameters including sperm count. 5.10 hepatic adverse effects prolonged use of high doses of orally active 17-alpha-alkyl androgens (eg, methyltestosterone) has been associated with serious hepatic adverse effects (peliosis hepatis, hepatic neoplasms, cholestatic hepatitis, and jaundice). peliosis hepatis can be a life threatening or fatal complication. long-term therapy with intramuscular testosterone enanthate, which elevates blood levels for prolonged periods, has produced multiple hepatic adenomas. aveed is not known to produce these adverse effects. nonetheless, patients should be instructed to report any signs or symptoms of hepatic dysfunction (eg, jaundice). if these occur, promptly discontinue aveed while the cause is evaluated. 5.11 edema androgens, including aveed, may promote retention of sodium and water. edema with or without congestive heart failure may be a serious complication in patients with preexisting cardiac, renal, or hepatic disease. in addition to discontinuation of the drug, diuretic therapy may be required. 5.12 gynecomastia gynecomastia occasionally develops and occasionally persists in patients being treated for hypogonadism [see adverse reactions ( 6.1 )] . 5.13 sleep apnea the treatment of hypogonadal men with testosterone products may potentiate sleep apnea in some patients, especially those with risk factors such as obesity or chronic lung diseases. 5.14 lipids changes in serum lipid profile may require dose adjustment of lipid lowering drugs or discontinuation of testosterone therapy. 5.15 hypercalcemia androgens, including aveed, should be used with caution in cancer patients at risk of hypercalcemia (and associated hypercalciuria). regular monitoring of serum calcium concentrations is recommended in these patients. 5.16 decreased thyroxine-binding globulin androgens, including aveed, may decrease concentrations of thyroxine-binding globulin, resulting in decreased total t4 serum concentrations and increased resin uptake of t3 and t4. free thyroid hormone concentrations remain unchanged, however, and there is no clinical evidence of thyroid dysfunction.

s ( 2.3 ). 2.1 dosage aveed is for intramuscular use only. dosage titration is not necessary. inject aveed deeply into the gluteal muscle following the usual precautions for intramuscular administration; care must be taken to avoid intravascular injection [see dosage and administration ( 2.3 )] . intravascular injection of aveed may lead to pome [see warnings and precautions ( 5.1 )]. the recommended dose of aveed is 3 ml (750 mg) injected intramuscularly, followed by 3 ml (750 mg) injected after 4 weeks, then 3 ml (750 mg) injected every 10 weeks thereafter. 2.2 preparation instructions parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. carefully remove the gray plastic cap from the top of the vial by lifting it up from the edges with your fingers or by pushing the bottom edge of the cap upward using the top of your thumb. remove only the gray plastic cap while leaving the aluminum metal ring and crimp seal around the gray rubber stopper in place. to facilitate the removal of medication from the vial, attach an 18-gauge needle and draw 3 ml of air into the syringe. hold the needle at a 45° angle to the stopper with the bevel in the up orientation. inject through the gray rubber stopper into the vial to create positive pressure within the vial chamber. withdraw 3 ml (750 mg) of aveed solution from the vial. expel excess air bubbles from the syringe. replace the syringe needle used to draw up the solution from the vial with a new intramuscular needle and inject. discard any unused portion in the vial. 2.3 administration instructions the site for injection for aveed is the gluteus medius muscle site located in the upper outer quadrant of the buttock. care must be taken to avoid the needle hitting the superior gluteal arteries and sciatic nerve. between consecutive injections, alternate the injection site between left and right buttock. figure 1: identifying the injection site following antiseptic skin preparation, enter the muscle and maintain the syringe at a 90° angle with the needle in its deeply imbedded position. grasp the barrel of the syringe firmly with one hand. with the other hand, pull back on the plunger and aspirate for several seconds to ensure that no blood appears. if any blood is drawn into the syringe, immediately withdraw and discard the syringe and prepare another dose. if no blood is aspirated, reinforce the current needle position to avoid any movement of the needle and slowly (over 60 to 90 seconds) depress the plunger carefully and at a constant rate, until all the medication has been delivered. be sure to depress the plunger completely with sufficient controlled force. withdraw the needle. immediately upon removal of the needle from the muscle, apply gentle pressure with a sterile pad to the injection site. if there is bleeding at the site of injection, apply a bandage. following each injection of aveed, observe patients in the healthcare setting for 30 minutes in order to provide appropriate medical treatment in the event of serious pome reactions or anaphylaxis [see warnings and precautions ( 5.1 )]. figure1

creased (4.6%), hypogonadism (2.6%) and estradiol increased (2.6%). table 1 presents adverse reactions reported by ≥1% of patients in the 84-week clinical study. table 1: adverse reactions reported in at least 1% of patients in the 84-week clinical study of aveed meddra preferred term number of patients (%) aveed 750 mg (n=153) acne 8 (5.2%) injection site pain 7 (4.6%) prostatic specific antigen increased* 7 (4.6%) estradiol increased 4 (2.6%) hypogonadism 4 (2.6%) fatigue 3 (2%) irritability 3 (2%) hemoglobin increased 3 (2%) insomnia 3 (2%) mood swings 3 (2%) aggression 2 (1.3%) ejaculation disorder 2 (1.3%) injection site erythema 2 (1.3%) hematocrit increased 2 (1.3%) hyperhidrosis 2 (1.3%) prostate cancer 2 (1.3%) prostate induration 2 (1.3%) weight increased 2 (1.3%) *prostate-specific antigen increased defined as a serum psa concentration >4 ng/ml. in the 84-week clinical trial, 7 patients (4.6%) discontinued treatment because of adverse reactions. adverse reactions leading to discontinuation included: hematocrit increased, estradiol increased, prostatic specific antigen increased, prostate cancer, mood swings, prostatic dysplasia, acne, and deep vein thrombosis. during the 84-week clinical trial, the average serum psa increased from 1.0 ± 0.8 ng/ml at baseline to 1.5 ± 1.3 ng/ml at the end of study. fourteen (14) patients (10.9%) in whom the baseline psa was < 4 ng/ml had a post-baseline serum psa of > 4 ng/ml during the 84-week treatment period. a total of 725 hypogonadal men received intramuscular testosterone undecanoate in a total of 7 controlled clinical trials. in these clinical trials, the dose and dose frequency of intramuscular testosterone undecanoate varied from 750 mg to 1000 mg, and from every 9 weeks to every 14 weeks. several of these clinical trials incorporated additional doses upon initiation of therapy (eg, loading doses). in addition to those adverse reactions noted in table 1, the following adverse events were reported by at least 3% of patients in these trials, irrespective of the investigator’s assessment of relationship to study medication: sinusitis, prostatitis, arthralgia, nasopharyngitis, upper respiratory tract infection, bronchitis, back pain, hypertension, diarrhea and headache. pulmonary oil microembolism (pome) and anaphylaxis in controlled clinical studies adverse events attributable to pome and anaphylaxis were reported in a small number of patients in controlled clinical trials. in the 84-week clinical trial of aveed, 1 patient experienced a mild coughing fit lasting 10 minutes after his third injection, which was retrospectively attributed to pome. in another clinical trial of intramuscular testosterone undecanoate (1000 mg), a hypogonadal male patient experienced the urge to cough and respiratory distress at 1 minute after his tenth injection, which was also retrospectively attributed to pome. during a review that involved adjudication of all cases meeting specific criteria, 9 pome events in 8 patients and 2 events of anaphylaxis among 3,556 patients treated with intramuscular testosterone undecanoate in 18 clinical trials were judged to have occurred. 6.2 postmarketing experience the following adverse reactions have been identified during post-approval use of aveed. because the 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. pulmonary oil microembolism (pome) and anaphylaxis serious pome reactions, involving cough, urge to cough, dyspnea, hyperhidrosis, throat tightening, chest pain, dizziness, and syncope, have been reported to occur during or immediately after the injection of intramuscular testosterone undecanoate 1000 mg (4 ml) in post-approval use outside the united states. the majority of these events lasted a few minutes and resolved with supportive measures; however, some lasted up to several hours and some required emergency care and/or hospitalization. in addition to serious pome reactions, episodes of anaphylaxis, including life-threatening reactions, have also been reported to occur following the injection of intramuscular testosterone undecanoate in post-approval use outside of the united states. both serious pome reactions and anaphylaxis have been reported to occur after any injection of testosterone undecanoate during the course of therapy, including after the first dose. other events the following treatment emergent adverse events or adverse reactions have been identified during post-marketing clinical trials and during post-approval use of intramuscular testosterone undecanoate. in most cases, the dose being used was 1000 mg. blood and lymphatic system disorders : polycythemia, thrombocytopenia cardiac disorders : angina pectoris, cardiac arrest, cardiac failure, coronary artery disease, coronary artery occlusion, myocardial infarction, tachycardia ear and labyrinth disorders : sudden hearing loss, tinnitus endocrine disorders : hyperparathyroidism, hypoglycemia gastrointestinal disorders : abdominal pain upper, diarrhea, vomiting general disorders and administrative site conditions : chest pain, edema peripheral, injection site discomfort, injection site hematoma, injection site irritation, injection site pain, injection site reaction, malaise, paresthesia, procedural pain immune system disorders : anaphylactic reaction, anaphylactic shock, asthma, dermatitis allergic, hypersensitivity, leukocytoclastic vasculitis infections and infestations : injection site abscess, prostate infection investigations : alanine aminotransferase increased, aspartate aminotransferase increased, blood bilirubin increased, blood glucose increased, blood pressure increased, blood prolactin increased, blood testosterone decreased, blood testosterone increased, blood triglycerides increased, gamma-glutamyltransferase increased, hematocrit increased, intraocular pressure increased, liver function test abnormal, prostate examination abnormal, prostatic specific antigen increased, transaminases increased metabolism and nutrition disorders : diabetes mellitus, fluid retention, hyperlipidemia, hypertriglyceridemia musculoskeletal and connective tissue disorders : musculoskeletal chest pain, musculoskeletal pain, myalgia, osteopenia, osteoporosis, systemic lupus erythematosus neoplasms benign, malignant and unspecified (including cysts and polyps) : prostate cancer, prostatic intraepithelial neoplasia nervous system disorders : stroke, cerebrovascular insufficiency, reversible ischemic neurological deficiency, transient ischemic attack psychiatric disorders : aggression, anxiety, depression, insomnia, irritability, korsakoff’s psychosis non-alcoholic, male orgasmic disorder, nervousness, restlessness, sleep disorder renal and urinary disorders : calculus urinary, dysuria, hematuria, nephrolithiasis, pollakiuria, renal colic, renal pain, urinary tract disorder reproductive system and breast disorders : azoospermia, benign prostatic hyperplasia, breast induration, breast pain, erectile dysfunction, gynecomastia, libido decreased, libido increased, prostate induration, prostatitis, spermatocele, testicular pain respiratory, thoracic and mediastinal disorders : asthma, chronic obstructive pulmonary disease, cough, dysphonia, dyspnea, hyperventilation, obstructive airway disorder, pharyngeal edema, pharyngolaryngeal pain, pulmonary microemboli, pulmonary embolism, respiratory distress, rhinitis, sleep apnea syndrome, snoring skin and subcutaneous tissue disorders : acne, alopecia, angioedema, angioneurotic edema, dermatitis allergic, erythema, hyperhidrosis, pruritus, rash vascular disorders : cerebral infarction, cerebrovascular accident, circulatory collapse, deep venous thrombosis, hot flush, hypertension, syncope, thromboembolism, thrombosis, venous insufficiency

ing warfarin, especially at the initiation and termination of androgen therapy. 7.3 corticosteroids the concurrent use of testosterone with corticosteroids may result in increased fluid retention and requires careful monitoring, particularly in patients with cardiac, renal or hepatic disease.

of organogenesis. testosterone treatment at doses that were comparable to those used for testosterone replacement therapy resulted in structural impairments in both female and male offspring. structural impairments observed in females included increased anogenital distance, phallus development, empty scrotum, no external vagina, intrauterine growth retardation, reduced ovarian reserve, and increased ovarian follicular recruitment. structural impairments seen in male offspring included increased testicular weight, larger seminal tubular lumen diameter, and higher frequency of occluded tubule lumen. increased pituitary weight was seen in both sexes. testosterone exposure in utero also resulted in hormonal and behavioral changes in offspring. hypertension was observed in pregnant female rats and their offspring exposed to doses approximately twice those used for testosterone replacement therapy. 8.2 lactation risk summary aveed is not indicated for use in females. 8.3 females and males of reproductive potential infertility during treatment with large doses of exogenous androgens, including aveed, spermatogenesis may be suppressed through feedback inhibition of the hypothalamic-pituitary-testicular axis [see warnings and precautions ( 5.9 )] , possibly leading to adverse effects on semen parameters including sperm count. reduced fertility is observed in some men taking testosterone replacement therapy. testicular atrophy, subfertility, and infertility have also been reported in men who abuse anabolic androgenic steroids [see drug abuse and dependence ( 9.2 )] . with either type of use, the impact on fertility may be irreversible. 8.4 pediatric use safety and effectiveness of aveed in pediatric patients less than 18 years old have not been established. improper use may result in acceleration of bone age and premature closure of epiphyses. 8.5 geriatric use there have not been sufficient numbers of geriatric patients in controlled clinical studies with aveed to determine whether efficacy or safety in those over 65 years of age differs from younger subjects. of the153 patients enrolled in the pivotal clinical study utilizing aveed, 26 (17.0%) were over 65 years of age. additionally, there are insufficient long-term safety data in geriatric patients to assess the potentially increased risk of cardiovascular disease and prostate cancer . geriatric patients treated with androgens may also be at risk for worsening of signs and symptoms of bph [see warnings and precautions ( 5.3 )] . 8.6 renal impairment no studies were conducted in patients with renal impairment. 8.7 hepatic impairment no studies were conducted in patients with hepatic impairment.

offspring. structural impairments observed in females included increased anogenital distance, phallus development, empty scrotum, no external vagina, intrauterine growth retardation, reduced ovarian reserve, and increased ovarian follicular recruitment. structural impairments seen in male offspring included increased testicular weight, larger seminal tubular lumen diameter, and higher frequency of occluded tubule lumen. increased pituitary weight was seen in both sexes. testosterone exposure in utero also resulted in hormonal and behavioral changes in offspring. hypertension was observed in pregnant female rats and their offspring exposed to doses approximately twice those used for testosterone replacement therapy.

one, producing circulation testosterone concentrations that approximate normal concentrations (300-1000 ng/dl) seen in healthy men. testosterone esters in oil injected intramuscularly are absorbed from the lipid phase. cleavage of the undecanoic acid side chain of aveed by tissue esterases releases testosterone. following intramuscular injection of 750 mg of aveed, serum testosterone concentrations reach a maximum after a median of 7 days (range 4 to 42 days) then slowly decline (figure 3). steady-state serum testosterone concentration was achieved with the third injection of aveed at 14 weeks. figure 3 shows the mean serum total testosterone concentration-time profile during the third injection interval (at steady state, 14 to 24 weeks) for hypogonadal men (less than 300 ng/dl) given 750 mg aveed at initiation, at 4 weeks, and every 10 weeks thereafter. intramuscular injection of 750 mg of aveed generates mean steady-state serum total testosterone concentrations in the normal range for 10 weeks. figure 3: mean (sd) serum total testosterone concentrations (ng/dl) at 14 to 24 weeks distribution circulating testosterone is chiefly bound in the serum to sex hormone-binding globulin (shbg) and albumin. approximately 40% of testosterone in plasma is bound to shbg, 2% remains unbound (free), and the rest is loosely bound to albumin and other proteins. metabolism testosterone undecanoate is metabolized to testosterone via ester cleavage of the undecanoate group. the mean (sd) maximum concentration of testosterone undecanoate was 90.9 (68.8) ng/dl on day 4 following injection of aveed. testosterone undecanoate was nearly undetectable 42 days following injection of aveed. testosterone is metabolized to various 17-keto steroids through 2 different pathways. the major active metabolites of testosterone are estradiol and dht. dht concentrations increased in parallel with testosterone concentrations during aveed treatment. average dht concentrations during a dosing interval ranged from 244 to 451 ng/dl. the mean dht to testosterone ratios ranged from 0.05 to 0.07. excretion there is considerable variation in the half-life of testosterone as reported in the literature, ranging from 10 to 100 minutes. about 90% of a testosterone dose given intramuscularly is excreted in the urine as glucuronic and sulfuric acid-conjugates of testosterone or as metabolites. about 6% of a dose is excreted in the feces, mostly in the unconjugated form. inactivation of testosterone occurs primarily in the liver. effect of body weight and body mass index (bmi) analysis of serum testosterone concentrations from 117 hypogonadal men in the 84-week clinical study of aveed indicated that serum testosterone concentrations achieved were inversely correlated with the patient’s body weight. in 60 patients with pretreatment body weight of ≥100 kg, the mean (±sd) serum testosterone average concentration was 426 ± 104 ng/dl. a higher serum testosterone average concentration (568 ± 139 ng/dl) was observed in 57 patients weighing 65 to 100 kg. a similar trend was also observed for maximum serum testosterone concentrations. in 70 patients with pretreatment bmis of >30 kg/m 2 , the mean (±sd) serum testosterone average concentration was 445 ± 116 ng/dl. higher serum testosterone average concentrations (579 ± 101 ng/dl and 567± 155ng/dl) were observed in patients with bmis <26 kg/m 2 and 26 to 30 kg/m 2 , respectively. a similar trend was also observed for maximum serum testosterone concentrations. figure3

erates mean steady-state serum total testosterone concentrations in the normal range for 10 weeks. figure 3: mean (sd) serum total testosterone concentrations (ng/dl) at 14 to 24 weeks distribution circulating testosterone is chiefly bound in the serum to sex hormone-binding globulin (shbg) and albumin. approximately 40% of testosterone in plasma is bound to shbg, 2% remains unbound (free), and the rest is loosely bound to albumin and other proteins. metabolism testosterone undecanoate is metabolized to testosterone via ester cleavage of the undecanoate group. the mean (sd) maximum concentration of testosterone undecanoate was 90.9 (68.8) ng/dl on day 4 following injection of aveed. testosterone undecanoate was nearly undetectable 42 days following injection of aveed. testosterone is metabolized to various 17-keto steroids through 2 different pathways. the major active metabolites of testosterone are estradiol and dht. dht concentrations increased in parallel with testosterone concentrations during aveed treatment. average dht concentrations during a dosing interval ranged from 244 to 451 ng/dl. the mean dht to testosterone ratios ranged from 0.05 to 0.07. excretion there is considerable variation in the half-life of testosterone as reported in the literature, ranging from 10 to 100 minutes. about 90% of a testosterone dose given intramuscularly is excreted in the urine as glucuronic and sulfuric acid-conjugates of testosterone or as metabolites. about 6% of a dose is excreted in the feces, mostly in the unconjugated form. inactivation of testosterone occurs primarily in the liver. effect of body weight and body mass index (bmi) analysis of serum testosterone concentrations from 117 hypogonadal men in the 84-week clinical study of aveed indicated that serum testosterone concentrations achieved were inversely correlated with the patient’s body weight. in 60 patients with pretreatment body weight of ≥100 kg, the mean (±sd) serum testosterone average concentration was 426 ± 104 ng/dl. a higher serum testosterone average concentration (568 ± 139 ng/dl) was observed in 57 patients weighing 65 to 100 kg. a similar trend was also observed for maximum serum testosterone concentrations. in 70 patients with pretreatment bmis of >30 kg/m 2 , the mean (±sd) serum testosterone average concentration was 445 ± 116 ng/dl. higher serum testosterone average concentrations (579 ± 101 ng/dl and 567± 155ng/dl) were observed in patients with bmis <26 kg/m 2 and 26 to 30 kg/m 2 , respectively. a similar trend was also observed for maximum serum testosterone concentrations. figure3

1800 and 2499 ng/dl, and greater than 2500 ng/dl. a total of 117 out of 130 hypogonadal men completed study procedures through week 24 and were included in the evaluation of testosterone pharmacokinetics after the third aveed injection. ninety-four percent (94%) of patients maintained a c avg within the normal range (300 to 1000 ng/dl). the percentages of patients with c avg below the normal range (less than 300 ng/dl) and above the normal range (greater than 1000 ng/dl) were 5.1% and 0.9%, respectively. table 2 summarizes the mean (sd) serum total testosterone pharmacokinetic parameters at steady state for these 117 patients. table 2: mean (sd) serum total testosterone concentrations at steady state aveed 750 mg (n=117) c avg (0 to 10 weeks) (ng/dl) 495 (142) c max (ng/dl) 891 (345) c min (ng/dl) 324 (99) c avg = average concentration; c max = maximum concentration; c min = minimum concentration the percentage of patients with c max >1500 ng/dl was 7.7%. no patient had a c max >1800 ng/dl.

sheet titled "what you need to know about aveed ® treatment: a patient guide" . instruct patients to remain at the healthcare setting for 30 minutes after each aveed injection. 17.2 men with known or suspected carcinoma of the prostate or breast men with known or suspected prostate or breast cancer should not use aveed [see contraindications ( 4 )] . 17.3 potential adverse reactions to androgens patients should be informed that treatment with androgens may lead to adverse reactions which include: changes in urinary habits, such as increased urination at night, trouble starting the urine stream, passing urine many times during the day, having an urge to go the bathroom right away, having a urine accident, or being unable to pass urine or weak urine flow breathing disturbances, including those associated with sleep or excessive daytime sleepiness too frequent or persistent erections of the penis nausea, vomiting, changes in skin color, or ankle swelling 17.4 patients should be advised of the following instructions for use read the medication guide before starting aveed therapy and reread the guide before each injection . adhere to all recommended monitoring. report any changes in their state of health, such as changes in urinary habits, breathing, sleep, and mood. distributed by: endo pharmaceuticals inc. malvern, pa 19355 aveed is a registered trademark of endo pharmaceuticals inc. or one of its affiliates © 2021 endo pharmaceuticals inc. all rights reserved.