1. Combating Another Side of Smoke Cyanide Poisoning and How to Treat It Using Two 2.5-g Vials of CYANOKIT® 5 g (hydroxocobalamin for injection)

2. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 2 Table of Contents Identifying Cyanide PoisoningIdentifying Cyanide Poisoning 5 CYANOKIT® 5 g (hydroxocobalamin for injection)CYANOKIT® 5 g (hydroxocobalamin for injection)11 How to Administer CYANOKIT®How to Administer CYANOKIT®16 Storing and Stocking CYANOKIT®Storing and Stocking CYANOKIT®22 Grant InformationGrant Information27 Full Prescribing InformationFull Prescribing Information35

3. Indication CYANOKIT® (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT® should be administered without delay. Important Safety Information Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT®, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx; and altered mental status. In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Allergic reactions may include: anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash, and angioneurotic edema. Please see full Prescribing Information for CYANOKIT®.Prescribing Information Indication and Important Safety Information 3

4. Important Safety Information (cont’d) Substantial increases in blood pressure may occur following CYANOKIT® therapy. Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a “blood leak.” This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves. CYANOKIT® is Pregnancy Category C and should be used during pregnancy only if the potential benefit justifies the potential risk. Safety and effectiveness of CYANOKIT® have not been established in pediatric patients. The most common adverse reactions (>5%) are transient and include chromaturia, erythema, rash (predominantly acneiform), increased blood pressure, nausea, headache, decreased lymphocyte percentage, and injection site reactions. Please see full Prescribing Information for CYANOKIT®.Prescribing Information 4

5. Identifying Cyanide Poisoning A hidden threat in some closed-space fires ► Click for Table of Contents Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT® on slide 35.Important Safety InformationPrescribing Information

6. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 6 Cyanide Is an Often Unrecognized Danger in Some Closed-Space Fires Cyanide (CN) can be released by virtually any material containing carbon and nitrogen when burned under high temperature and low oxygen conditions 2 There is potential for CN toxicity due to the increased use of synthetic materials that produce CN during combustion in closed-space fires 2,3 1. Hertzberg T, Blomqvist P, Dalene M, Skarping G. Particles and Isocyanates From Fires. Borås, Sweden: SP Swedish National Testing and Research Institute; 2005:1-51. 2. Agency for Toxic Substances and Disease Registry. Cyanide toxicity. Am Fam Physician.1993;48(1):107-114. 3. Alcorta R. Smoke inhalation & acute cyanide poisoning. In: Losavio K, ed. Smoke Inhalation & Hydrogen Cyanide Poisoning. San Diego, CA: JEMS Communications; 2004:6-17. Common Building Materials Known to Release High Levels of Cyanide During Combustion* 1 *Items pictured may not be accurate representations. Important Note Not all smoke inhalation victims will have cyanide poisoning and may present with burns, trauma, and exposure to other toxic substances making a diagnosis of cyanide poisoning particularly difficult.

7. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 7 Difficult to Diagnose, Easy to Suspect Many symptoms of cyanide (CN) and carbon monoxide poisoning are common to both or very similar, 1 and There is no diagnostic test to confirm or distinguish cyanide poisoning from carbon monoxide poisoning in the field 1 Should be suspected in any person exposed to smoke in a closed-space fire, 1,3 and When suspicion of cyanide poisoning is high, an antidote should be considered for empiric treatment 1,3 1. O'Brien DJ, Augustine J, Walsh DW. Cyanide exposure, smoke inhalation, and pre-hospital treatment: recognizing the signs and symptoms and available treatment options. In: Smoke: Cyanide and Carbon Monoxide: The Toxic Twins of Smoke Inhalation. Cyanide Poisoning Treatment Coalition: Indianapolis, IN: 2009:20-24. 2. Lawson-Smith P, Jansen EC, Hyldegaard O. Cyanide intoxication as part of smoke inhalation—a review on diagnosis and treatment from the emergency perspective. Scand J Trauma Resusc Emerg Med. 2011;19:1-5. 3. Eckstein M, Maniscalco PM. Focus on smoke inhalation—the most common cause of acute cyanide poisoning. Prehosp Disaster Med. 2006;21(2):s49-s55. BECAUSE… CYANIDE POISONING… Moderate to Severe Poisoning Signs/Symptoms 1,2 Distinguishing between cyanide and carbon monoxide poisoning can be difficult

8. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 8 When to Suspect Cyanide Poisoning * 1,2 Cyanide poisoning in smoke-inhalation victims should be suspected if the following manifestations are present* 1,2 :  Exposure to fire or smoke in an enclosed area  Soot around mouth, nose, or back of mouth  Altered mental status (eg, confusion, disorientation) 1. Eckstein M, Maniscalco PM. Focus on smoke inhalation—the most common cause of acute cyanide poisoning. Prehosp Disaster Med. 2006;21(2):s49-s55. 2. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. Important Note In some settings, panic symptoms including tachypnea and vomiting may mimic early cyanide poisoning signs. The presence of altered mental status (eg, confusion and disorientation) and/or mydriasis is suggestive of true cyanide poisoning although these signs can occur with other toxic exposures as well. *List may not be comprehensive.

9. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 9 How Cyanide Affects Cellular Respiration Cyanide may disable the body’s ability to use oxygen so it can be fatal despite the amount of oxygen available to the body. 1,2 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 2. Schnepp R. Where there's fire—there's smoke! In: Smoke: Cyanide and Carbon Monoxide: The Toxic Twins of Smoke Inhalation. Indianapolis, IN: Cyanide Poisoning Treatment Coalition; 2009:3-8.

10. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 10 How Hydroxocobalamin Interacts With Cyanide CYANOKIT® 5 g (hydroxocobalamin for injection) is the only cyanide antidote that contains hydroxocobalamin, which binds to cyanide, allowing the body to use oxygen again. 1,2 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 2. Schnepp R. Where there's fire—there's smoke! In: Smoke: Cyanide and Carbon Monoxide: The Toxic Twins of Smoke Inhalation. Indianapolis, IN: Cyanide Poisoning Treatment Coalition; 2009:3-8.

11. CYANOKIT® 5 g (hydroxocobalamin for injection) FDA-approved for the treatment of known or suspected cyanide poisoning. ► Click for Table of Contents Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT® on slide 35.Important Safety InformationPrescribing Information

12. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 12 Indication 1 CYANOKIT® 5 g (hydroxocobalamin for injection) is indicated for the treatment of known or suspected cyanide poisoning If clinical suspicion of cyanide poisoning is high, CYANOKIT® should be administered without delay 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. Important Safety Information In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Consideration should be given to decontamination measures based on the route of exposure.

13. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 13 For Known or Suspected Cyanide Poisoning 1 It has been shown that the concentration of blood lactate increases proportionally with the severity of cyanide (CN) poisoning and that hydroxocobalamin treatment results in rapid resolution of CN-induced lactic acidemia 1-3 Studies have shown CYANOKIT® 5 g (hydroxocobalamin for injection) to be generally well-tolerated even in the absence of cyanide poisoning 4-7 Has been used in France since 1996 and in the U.S. since 2007 to treat suspected or known cyanide poisoning 8 1. Lawson-Smith P, Jansen EC, Hyldegaard O. Cyanide intoxication as part of smoke inhalation—a review on diagnosis and treatment from the emergency perspective. Scand J Trauma Resusc Emerg Med. 2011;19:1-5. 2. Baud FJ, Borron SW, Mégarbane B, et al. Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning. Crit Care Med. 2002;30(9):2044-2050. 3. Torres EC, Bustamante RS, Granizo EG, et al. Hydroxocobalamin and lactate concentration in patients suspected of having cyanuric acid poisoning related to smoke inhalation syndrome. Emergencias. 2010;22:9-14. 4. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. 5. Borron SW, Baud FJ, Barriot P, Imbert M, Bismuth C. Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med. 2007;49(6):794-801. 6. Borron SW, Baud FJ, Mégarbane B, Bismuth C. Hydroxocobalamin for severe acute cyanide poisoning by ingestion or inhalation. Am J Emerg Med. 2007;25(5):551-558. 7. Fortin JL, Giocanti JP, Ruttimann M, Kowalski JJ. Prehospital administration of hydroxocobalamin for smoke inhalation-associated cyanide poisoning: 8 years of experience in the Paris Fire Brigade. Clin Toxicol (Phila). 2006;44(suppl 1):37-44. 8. Borron SW. Recognition and treatment of acute cyanide poisoning. J Emerg Nurs. 2006;32(4 suppl):s12-s18. Important Safety Information Substantial increases in blood pressure may occur following CYANOKIT® therapy. Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a “blood leak.” This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin.

14. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 14 Contents of CYANOKIT ® 5 g (hydroxocobalamin for injection) 1 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

15. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 15 Recommended Dosing 1 The starting dose of CYANOKIT® 5 g (hydroxocobalamin for injection) for adults is 5 g –Two 2.5-g vials –Administer by intravenous (IV) infusion over 15 minutes, that is, 7.5 minutes per vial Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion up to a total dose of 10 g –The rate of infusion for a potential second dose may range from 15 minutes (for patients in extremis) to 2 hours, as clinically indicated Important Safety Information Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Allergic reactions may include anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash, and angioneurotic edema. Substantial increases in blood pressure may occur following treatment with CYANOKIT®. 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

16. How to Administer CYANOKIT® 5 g (hydroxocobalamin for injection) Prepare and administer in 4 steps. ► Click for Table of Contents Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT® on slide 35.Important Safety InformationPrescribing Information

17. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 17 Step 1: RECONSTITUTE 1 Add 100 mL of 0.9% Sodium Chloride Injection to vial using sterile transfer spike –0.9% Sodium Chloride Injection is the recommended diluent –Diluent is not included in the kit –Lactated Ringer's Solution and 5% Dextrose Injection have also been found to be compatible with hydroxocobalamin Fill to line, which represents 100 mL Keep vial in upright position 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

18. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 18 Step 2: MIX 1 Rock or rotate vial for 30 seconds to mix solution Do not shake 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

19. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 19 Step 3: INFUSE FIRST VIAL 1 Use vented IV tubing Hang and infuse over 7.5 minutes 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

20. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 20 Step 4: INFUSE SECOND VIAL 1 Repeat steps 1 and 2 before second infusion 1.Reconstitute 2.Mix Use vented IV tubing Hang and infuse over 7.5 minutes for a total of 15 minutes 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

21. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 21 Considerations During Administration 1 Inspect CYANOKIT® 5 g (hydroxocobalamin for injection) solution for particulate matter and color prior to administration –Discard if particulate matter is present –Discard if solution is not dark red Use a separate IV line for infusion –A separate line is required as a number of drugs used in resuscitation efforts are incompatible with CYANOKIT® Use caution when administering other cyanide antidotes simultaneously with CYANOKIT® –If the decision is made to administer another antidote, do not use the same IV line Important Safety Information In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Consideration should be given to decontamination measures based on the route of exposure. 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

22. Storing and Stocking CYANOKIT® 5 g (hydroxocobalamin for injection) ► Click for Table of Contents Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT® on slide 35.Important Safety InformationPrescribing Information

23. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 23 Storage of Lyophilized Form 1 CYANOKIT® 5 g (hydroxocobalamin for injection) should be stored at 25°C (77°F) –Excursions are permitted to 15° to 30°C (59° to 86°F) CYANOKIT® may be exposed, during short periods, to temperature variations of usual transport, transport in the desert, and freezing/defrosting cycles –Usual transport defined as 15 days subjected to temperatures ranging from 5° to 40°C (41° to 104°F) –Transport in the desert defined as 4 days subjected to temperatures ranging from 5° to 60°C (41° to 140°F) –Freezing/defrosting cycles defined as 15 days subjected to temperatures ranging from –20° to 40°C (–4° to 104°F) 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

24. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 24 Storage of Reconstituted Drug Product 1 CYANOKIT® 5 g (hydroxocobalamin for injection) may be kept up to 6 hours at a temperature not exceeding 40°C (104°F) Do not freeze Product not used by 6 hours should be discarded 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

25. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 25 Prehospital Stocking Reasons to consider stocking CYANOKIT® 5 g (hydroxocobalamin for injection) directly on first responder vehicles: –Existence of cyanide in fire smoke from closed-space fires 1 –Toxic threat cyanide presents to fire victims as well as firefighters 1,2  Death can occur within minutes of exposure to moderate to high concentrations of cyanide 1 –Apparent low risk of causing harm by administering hydroxocobalamin for prehospital empiric treatment of smoke inhalation-associated cyanide poisoning 1 1. Eckstein M, Maniscalco PM. Focus on smoke inhalation—the most common cause of acute cyanide poisoning. Prehosp Disaster Med. 2006;21(2):s49-s55. 2. Walsh DW, Eckstein M. Hydrogen cyanide in fire smoke: an underappreciated threat. Emerg Med Serv. 2004;33(10):160-163. Important Safety Information Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Allergic reactions may include anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash, and angioneurotic edema. Substantial increases in blood pressure may occur following treatment with CYANOKIT®.

26. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 26 Hospital Stocking It has been recommended by an expert panel of physicians for consensus guidelines for stocking antidotes that hydroxocobalamin be stocked in the emergency department 1 –It must be available immediately because the administration of a cyanide antidote can resuscitate a patient only of it is given before irreversible injury develops 1 1. Dart RC, Borron SW, Caravati EM, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2009;54:386-394. Important Safety Information Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a “blood leak.” This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves.

27. Grant Information ► Click for Table of Contents Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT® on slide 35.Important Safety InformationPrescribing Information

28. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 28 Grant Eligibility CYANOKIT® 5 g (hydroxocobalamin for injection) is approved on the Department of Homeland Security's Authorized Equipment List (AEL), making it eligible for the following grant programs 1 : –State Homeland Security Program (SHSP)State Homeland Security Program –Urban Area Security Initiative (UASI)Urban Area Security Initiative –Metropolitan Medical Response System (MMRS)Metropolitan Medical Response System –Transit Security Grant Program (TSGP)Transit Security Grant Program Additional grant information and resources can be found at: –emsgrantshelp.comemsgrantshelp.com –firegrantshelp.comfiregrantshelp.com –usfa.dhs.gov/grantsusfa.dhs.gov/grants –fema.gov/firegrants/fema.gov/firegrants/ –usfa.dhs.gov/fireservice/grants/afgpusfa.dhs.gov/fireservice/grants/afgp 1. Department of Homeland Security. Authorized equipment list. https://www.rkb.us/mel.cfm?subtypeid=549. Accessed September 2, 2011. These Web sites are neither owned nor controlled by Meridian. Meridian is not responsible for the content or services of these sites.

29. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 29 Questions? For more information about CYANOKIT® 5 g (hydroxocobalamin for injection): Call 1-800-638-8093 or Visit CYANOKIT.comCYANOKIT.com For medical questions concerning CYANOKIT® call 1-800-438-1985, Monday through Friday, 8:00 am to 8:00 pm EST. To report an adverse event or speak to a member of Pfizer U.S. Medical Information, call 1-800-438-1985.

30. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 30 SUSPECT IT. * Cyanide poisoning in smoke-inhalation victims should be suspected if the following manifestations are present* 1,2 :  Exposure to fire or smoke in an enclosed area  Soot around mouth, nose, or back of mouth  Altered mental status (eg, confusion, disorientation) Cyanide poisoning should be suspected. 1. Eckstein M, Maniscalco PM. Focus on smoke inhalation—the most common cause of acute cyanide poisoning. Prehosp Disaster Med. 2006;21(2):s49-s55. 2. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011. Cyanide Poisoning 1,2 Important Safety Information Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT®, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx; and altered mental status. In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. *List may not be comprehensive.

31. Please see Important Safety Information on slide 3 and full Prescribing Information for CYANOKIT ® on slide 35.Important Safety InformationPrescribing Information 31 TREAT IT. Cyanide Poisoning 1 Prepare and administer CYANOKIT® 5 g (hydroxocobalamin for injection) in 4 steps 1 : 1.Reconstitute 2. Mix 3. Infuse first vial 4.Infuse second vial (repeat steps 1 and 2 before second infusion) 1. Cyanokit (two 2.5-g vials) [package insert]. Columbia, MD: Meridian Medical Technologies, Inc.; 2011.

32. Indication CYANOKIT® (hydroxocobalamin for injection) 5 g for intravenous infusion is indicated for the treatment of known or suspected cyanide poisoning. If clinical suspicion of cyanide poisoning is high, CYANOKIT® should be administered without delay. Important Safety Information Cyanide poisoning may result from inhalation, ingestion, or dermal exposure. Prior to administration of CYANOKIT®, smoke-inhalation victims should be assessed for: exposure to fire or smoke in an enclosed area; presence of soot around the mouth, nose, or oropharynx; and altered mental status. In addition to CYANOKIT®, treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Use caution in the management of patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin. Allergic reactions may include: anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, rash, and angioneurotic edema. Indication and Important Safety Information 32 Please see full Prescribing Information for CYANOKIT®.Prescribing Information ► Click for Table of Contents

33. Important Safety Information (cont’d) Substantial increases in blood pressure may occur following CYANOKIT® therapy. Usage may interfere with some clinical laboratory evaluations. Also, because of its deep red color, hydroxocobalamin may cause hemodialysis machines to shut down due to an erroneous detection of a “blood leak.” This should be considered before hemodialysis is initiated in patients treated with hydroxocobalamin. Due to potential photosensitivity, patients should avoid direct sun until erythema resolves. CYANOKIT® is Pregnancy Category C and should be used during pregnancy only if the potential benefit justifies the potential risk. Safety and effectiveness of CYANOKIT® have not been established in pediatric patients. The most common adverse reactions (>5%) are transient and include chromaturia, erythema, rash (predominantly acneiform), increased blood pressure, nausea, headache, decreased lymphocyte percentage, and injection site reactions. Please see full Prescribing Information for CYANOKIT®.Prescribing Information CYANOKIT ® is a registered trademark of Merck Santé s.a.s., licensed by Meridian Medical Technologies™, Inc., a Pfizer company. Copyright © 2011 Meridian Medical Technologies™, Inc., a Pfizer company. All rights reserved. CYK290629-01 10/2011 33

34. Prescribing Information for CYANOKIT® 5 g (hydroxocobalamin for injection) ► Click for Table of Contents