[1] DuoDote™ Auto-Injector (atropine and pralidoxime chloride injection) [package insert]. Columbia, MD: Meridian Medical Technologies™, Inc.; 2007.

[2] Agency for Toxic Substances and Disease Registry. Medical Management Guidelines (MMGs) for nerve agents: tabun (GA); sarin (GB); soman (GD); and VX. Available at: http://www.atsdr.cdc.gov/MHMI/mmg166.html. Accessed February 21, 2007.

[3] Sidell FR. Nerve agents. In: Sidell FR, Takafuji ET, Franz DR, eds. Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare. Washington, DC: Office of The Surgeon General at TMM Publications Borden Institute; 1997:129-181.

[4] Cannard K. The acute treatment of nerve agent exposure. J Neurol Sci. 2006;249:86-94.

[5] Department of Health and Human Services. Centers for Disease Control and Prevention. Third National Report on Human Exposure to Environmental Chemicals. Atlanta, GA: National Center for Environmental Health; 2005; NCEH Pub. No. 05-0570.

[6] AtroPen® Auto-Injector (atropine injection) [package insert]. Columbia, MD: Meridian Medical Technologies™, Inc.; 2007.

[7] Pralidoxime Chloride Injection (Auto-Injector) [package insert]. Columbia, MD: Meridian Medical Technologies™, Inc.; 2007

[8] Diazepam Auto-Injector (C-IV) [package insert]. Columbia, MD: Meridian Medical Technologies™, Inc.; 2007.

[9] Olson KB. Aum Shinrikyo: once and future threat? Emerg Infect Dis. 1999;5:512-516.

[10] Boureston J. Strategic Insight: Assessing Al Qaeda's WMD Capabilities. Center for Contemporary Conflict. National Security Affairs Department, Naval Postgraduate School. Available at: http://www.ccc.nps.navy.mil/rsepResources/si/sept02/wmd.asp. Accessed June 1, 2007.

[11] Wiener SW, Hoffman RS. Nerve agents: a comprehensive review. J Intensive Care Med. 2004;19:22-37.

[12] U.S. Department of State. Bureau of Public Affairs. Saddam’s chemical weapons campaign: Halabja, March 16, 1988. Available at: http://www.state.gov/documents/organization/18817.pdf. Accessed July 17, 2007.

[13] Testar J. What Tokyo taught us. Homeland Defense J. 2003:34-39.

[14] Barletta M. Chemical weapons in the Sudan: allegations and evidence. Nonproliferation Rev. 1998:115-136. Available at: http://cns.miis.edu/pubs/npr/vol06/61/barlet61.pdf. Accessed June 1, 2007.

[15] Watson WA, Litovitz TL, Klein-Schwartz W, et al. 2003 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med. 2004;22:335-404.

[16] Strong LL, Thompson B, Coronado GD, Griffith WC, Vigoren EM, Islas I. Health symptoms and exposure to organophosphate pesticides in farmworkers. Am J Indust Med. 2004;46:599-606.

[17] Jaga K, Dharmani C. Sources of exposure to and public health implications of organophosphate pesticides. Pan Am J Public Health. 2003;14:171-185.

[18] U.S. Department of Transportation. Departmentwide Program Evaluation of the Hazardous Materials Transportation Programs: Final Report. March 2000. Available at: http://hazmat.dot.gov/pubs/reports/hmpe_report.pdf. Accessed June 1, 2007.

[19] Cox C. From factories and tank cars to you: hazards of manufacturing and transporting pesticides. J Pesticide Reform. 1993;13:1-10.

[20] Leikin JB, Thomas RG, Walter FG, Klein R, Meislin HW.A review of nerve agent exposure for the critical care physician. Crit Care Med. 2002;30:2346-2354.

[21] Huebner KD, Arnold JL. CBRNE—nerve agents, G-series: tabun, sarin, soman. Available at: http://www.emedicine.com/emerg/topic898.htm. Accessed July 13, 2007.

[22] Department of Health and Human Services. Centers for Disease Control and Prevention. Facts about Tabun. Available at: http://www.bt.cdc.gov/agent/tabun/basics/facts.asp. Accessed July 13, 2007.

[23] Department of Health and Human Services. Centers for Disease Control and Prevention. Facts about Sarin. Available at: http://www.bt.cdc.gov/agent/sarin/basics/facts.asp. Accessed July 13, 2007.

[24] Department of Health and Human Services. Centers for Disease Control and Prevention. Facts about Soman. Available at: http://www.bt.cdc.gov/agent/soman/basics/facts.asp Accessed July 13, 2007.

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The DuoDote™ Auto-Injector (atropine 2.1 mg/0.7 mL and pralidoxime chloride 600 mg/2 mL) is indicated for the treatment of poisoning by organophosphorus nerve agents as well as organophosphorus insecticides.

IMPORTANT SAFETY INFORMATION

The DuoDote Auto-Injector is intended as an initial treatment of the symptoms of organophosphorus insecticide or nerve agent poisonings; definitive medical care should be sought immediately. The DuoDote Auto-Injector should be administered by Emergency Medical Services personnel who have had adequate training in the recognition and treatment of nerve agent or insecticide intoxication.

Individuals should not rely solely upon agents such as atropine and pralidoxime to provide complete protection from chemical nerve agents and insecticide poisoning. Primary protection against exposure to chemical nerve agents and insecticide poisoning is the wearing of protective garments including masks designed specifically for this use. Evacuation and decontamination procedures should be undertaken as soon as possible. Medical Personnel assisting evacuated victims of nerve agent poisoning should avoid contaminating themselves by exposure to the victim's clothing.

In the presence of life-threatening poisoning by organophosphorus nerve agents or insecticides, there are no absolute contraindications to the use of the DuoDote Auto-Injector. When symptoms of poisoning are not severe, DuoDote Auto-Injector should be used with extreme caution in people with heart disease, arrhythmias, recent myocardial infarction, severe narrow angle glaucoma, pyloric stenosis, prostatic hypertrophy, significant renal insufficiency, chronic pulmonary disease, or hypersensitivity to any component of the product.

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© 2007 Meridian Medical Technologies™ Inc., a subsidiary of King Pharmaceuticals®, Inc. DuoDote™ Auto-Injector, the DuoDote logo, BinaJect™, and Mark I™ Kit are trademarks of Meridian Medical Technologies™, Inc. AtroPen® is a registered trademark of Meridian Medical Technologies™, Inc. MMT 4908 10/07®