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    PHYSICIAN LOCATOR TERMS AND CONDITIONS

    Endo Pharmaceuticals Inc. maintains a list of appropriate physicians who prescribe NASCOBAL® and Nutrition Direct. This list is updated on a rolling quarterly basis. These physicians are not affiliated with Endo Pharmaceuticals Inc. and do not pay to be on this list. Included here are the names of physicians in your geographic area that meet this specific criteria. Inclusion of a physician on this list does not constitute a referral, recommendation, endorsement, or verification of the credentials, qualifications, or abilities of the physician listed. Conversely, the absence of a physician’s name and information should not be construed as a negative comment from Endo Pharmaceuticals Inc. about the physician’s credentials, qualifications, or abilities.


    Endo Pharmaceuticals Inc. shall not be liable for any harm resulting from your reliance on information contained on this list.

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    After weight loss surgery, receive your
    recommended vitamins and minerals in...

    ONE SIMPLE DELIVERY WITH Nutrition Direct

    nutrition-direct-pat-hero-bottles

    WEIGHT LOSS SURGERY AND NUTRITION

    Why you need nutritional supplements – and how Nutrition Direct can help

    After having bariatric (weight loss) surgery, you may be closer to your goals than before - whether it is being healthy enough to keep up with the kids or just wanting to feel better. You will probably lose weight, which can help if you have weight-related conditions, such as:

    • Type 2 diabetes
    • Sleep apnea
    • High blood pressure
    • Acid reflux
    • High cholesterol

    Before weight loss surgery, you may have taken in vitamins and minerals you needed from your diet. But it is a little different after weight loss surgery, because surgery often changes how your body processes nutrients. For example, if part of your digestive tract has been altered or removed, your body may not be able to absorb several important vitamins or minerals the way it did before.

    Doctors test and monitor patients regularly after surgery to help ensure they are getting the appropriate vitamins and minerals they need, based on specific nutritional guidelines that have been put in place. These nutritional guidelines were issued by the American Society of Metabolic and Bariatric Surgery (ASMBS) and recommend the vitamins and minerals patients need to help them stay healthy after weight loss surgery.* These include vitamin B12 and other important supplements like iron, calcium, vitamin D3, magnesium, and vitamin C. A convenient way to get the nutritional supplements you need delivered to you after weight loss surgery is with Nutrition Direct. Talk to your doctor about this program to see if it is right for you.

    nutrition-patient-46-percent

    ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient — 2016 Update: Micronutrients.

    THE IMPORTANCE OF VITAMIN B12 AFTER WEIGHT LOSS SURGERY

    To help you stay healthy after surgery, you must give your body the nutritional supplements it needs. Vitamin B12 is a good example of this.

    Weight loss surgery can limit the amount of vitamin B12 that is absorbed in your body. There are a few reasons this happens. Your new diet might have fewer vitamin B12-rich foods. Vitamin B12 is released from food by acids in the stomach, and if food bypasses the stomach completely, vitamin B12 may not be released. Vitamin B12 attaches to a substance called “intrinsic factor” (IF) and is carried into the small intestine, where it is absorbed into the body. After weight loss surgery, the amount of IF made by the stomach may be limited. It can be common to have vitamin B12 deficiency after surgery.

    Talk to your doctor about being screened for vitamin B12 deficiency. Vitamin B12 deficiency has a wide range of non-specific symptoms. Symptoms may include:

      • Diarrhea or constipation
      • Fatigue, lack of energy, or lightheadedness when standing up or with exertion
      • Loss of appetite
      • Pale skin
      • Problems concentrating
      • Shortness of breath, mostly during exercise
      • Swollen, red tongue or bleeding gums
      • Numbness and tingling of hands and feet
      • Confusion or change in mental status
      • Loss of balance

      VITAMIN B12 OPTIONS AT A GLANCE

      NASCOBAL®
      Nasal Spray
      FDA-approved
      Prescription
      Once-a-week dosing
      Odorless
      Tasteless
      Can be taken at home
      Not an injection
      SUBLINGUAL
      (under-the-tongue)
      Can be taken at home
      Not an injection
      INJECTIONS

      FDA-approved
      Prescription
      Odorless
      Tasteless

      WHY Nutrition Direct?

      why-nutrition-direct-block-hero why-nutrition-direct-hero

      Designed for people who have had bariatric (weight loss) surgery

      After weight loss surgery, you have to take nutritional supplements for the rest of your life because your digestive tract and stomach work differently now. Nutrition Direct helps to make it easy for you to stay on track with important nutrients. It gives you the micronutrients recommended in the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.* Enrolling in Nutrition Direct has many benefits:

      Your monthly supply of bariatric supplements are delivered together to your doorstep:

      • NASCOBAL® Vitamin B12 Nasal Spray
      • BariActiv® Multivitamin
      • BariActiv® Calcium + D3 & Magnesium
      • BariActiv® Iron + Vitamin C

      Nutrition Direct: RECOMMENDED MICRONUTRIENTS WITH THE CONVENIENCE OF FREE HOME DELIVERY—AT AN AFFORDABLE PRICE

      When you enroll in Nutrition Direct, you have a lot to look forward to: A 30-day supply of nutritional supplements sent each month in one simple delivery; NASCOBAL®, a prescription vitamin B12 nasal spray; micronutrients that meet the specific ASMBS guidelines* recommended for people who have had weight loss surgery; convenient, free home delivery; automatic refills; educational materials and other ongoing support.

      What’s more, many people are eligible to get Nutrition Direct for as little as $0 per month.

      Nutrition Direct is made especially for people like you.

      Get Nutrition Direct delivered right to your doorstep for less than you would expect.

      It is easy to get Nutrition Direct.

      NASCOBAL® Nasal Spray prescription with enrollment in Nutrition Direct:

      nutrition-pay-callout

      Learn how to take your nutritional supplements

      Enroll for FREE home delivery and automatic refills

      ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient — 2016 Update: Micronutrients.

      Patients may redeem this offer ONLY when accompanied by a valid prescription. Offer is valid up to a maximum benefit of $130. Offer is not valid for patients whose prescriptions are reimbursed in whole or in part under Medicaid, Medicare, Medigap, VA, DoD, TRICARE, or any other federal or state programs (such as medical assistance programs) or where otherwise prohibited by law. Offer is not valid in VT or where prohibited in whole or in part. This offer may be amended or ended at any time without notice.

      NASCOBAL® NASAL SPRAY

      What is NASCOBAL® nasal spray?

      NASCOBAL® (Cyanocobalamin, USP) Nasal Spray is a prescription medicine used as a supplement to treat vitamin B12 deficiency. People who have had bariatric (weight loss) surgery may not absorb enough vitamin B12 from food. That is why NASCOBAL® is a good option. It is a fine-mist nasal spray that gets absorbed directly into the bloodstream, bypassing the stomach and digestive tract. It is odorless and tasteless.

      NASCOBAL® dosing is simple:

      1 spray, 1 nostril, 1x a week

      patient-nascobal-spray

      Product shown may not be actual size.

      NASCOBAL® Nasal Spray is the only FDA-approved vitamin B12 nasal spray. Here are some features of this product:

      • Once-weekly nasal spray
      • Fewer visits to the doctor’s office for vitamin B12 dose
      • Not a painful injection
      • Tasteless and odorless fine mist
      • Increased and maintained vitamin B12 levels in clinical trials
      • Absorbed directly into the bloodstream—designed to bypass the digestive tract
      • Self-administered
      Do not drink hot liquids or eat hot foods at least 1 hour before and 1 hour after taking NASCOBAL® Nasal Spray.

      How to use NASCOBAL® Nasal Spray

      NASCOBAL® is especially useful for people who have had weight loss surgery. It is just 1 spray, 1 nostril, 1x a week. That is how simple it is.

      nasal-spray-step1
      • The unit contains only 1 spray: DO NOT prime before use
      • Blow nose gently to clear both nostrils
      • Hold the unit with your thumb, supporting it at the bottom, and your index and middle fingers on either side of the nozzle
      nasal-spray-step2
      • Gently close 1 nostril with your other index finger. Insert the nozzle into open nostril approximately ½ inch, or as far as feels comfortable, and tilt your head slightly forward. Do not press the plunger yet
      • Breathe in gently through your nose, close your mouth, and at the same time, press the plunger firmly with your thumb
      nasal-spray-step3
      • Remove the nozzle from your nostril. At the same time, keep your head level for 10 to 20 seconds while gently breathing in through your nose and breathing out through your mouth
      Do not drink hot liquids or eat hot foods at least 1 hour before and 1 hour after taking NASCOBAL® Nasal Spray.

      BariActiv® SUPPLEMENTS

      ABOUT BariActiv® SUPPLEMENTS

      With Nutrition Direct, you receive a monthly supply of nutrients that includes NASCOBAL® vitamin B12 Nasal Spray and BariActiv® supplements. Together, NASCOBAL® and BariActiv® supplements give you the micronutrients recommended by the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.*

      2 great options for getting the nutritional supplements you need for lifelong nutritional support after bariatric surgery:

      bariactiv-bottle tablet-capsule-bariactiv-bottle

      BariActiv® Chewable:

      • Can be started soon after surgery as discussed with your healthcare provider
      • Used for lifelong nutritional support
      • Great-tasting fruit flavor
      bariactiv-bottle tablet-capsule-bariactiv-bottle

      BariActiv® Tablets/Capsules:

      • When chewable tablets are no longer required, tablets/capsules can be started as discussed with your healthcare provider
      • Used for lifelong nutritional support

      Nutrition Direct: designed to meet the ASMBS Nutritional Guidelines*

      Your monthly delivery from Nutrition Direct includes supplements that provide the micronutrients the American Society for Metabolic and Bariatric Surgery recommends for people who have had weight loss surgery.

      ASMBS RECOMMENDED NUTRITIONAL SUPPLEMENTATION*NUTRITION DIRECT
      Adult multivitamins and minerals
      Chewable tablets
      Thiamine (Vitamin B1) 12 mg/day
      Folic acid 800 mcg/day
      Copper 2 mg/day
      Ferronyl iron 54 mg/day
      Vitamin D3 3800 IU/day
      Calcium Citrate in divided doses 1200 mg/day
      Vitamin B12 500 mcg/week
      asmbs-logo

      ASMBS Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient — 2016 Update: Micronutrients.

      For all types of surgery, including Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB).

      HOW TO TAKE YOUR SUPPLEMENTS

      It’s important to take your nutritional supplements provided by Nutrition Direct™ correctly. Important note: The directions are different for chewable supplements and the tablets/capsules.

      patient-nascobal-spray

      How to use NASCOBAL®
      Nasal Spray

      FDA-approved NASCOBAL® Nasal Spray1 spray, 1 nostril, 1x a week

      Do not drink hot liquids or eat hot foods at least 1 hour before and 1 hour after taking NASCOBAL® Nasal Spray.
      bariactiv-battler tablet-capsule-bariactiv-bottle

      How to take BariActiv®
      Chewable Supplements:

      BariActiv® Calcium + D3 & Magnesium Chewable§Take one serving (2 tablets) twice a dayNutrition Facts

      BariActiv® Multivitamin ChewableTake one serving (2 tablets) once a dayNutrition Facts

      BariActiv® Iron + Vitamin C Chewable§Take one serving (3 tablets) once a dayNutrition Facts

      bariactiv-battler tablet-capsule-bariactiv-bottle

      How to take BariActiv®
      Tablet/Capsule Supplements:

      BariActiv® Calcium + D3 & Magnesium Tablets§Take one serving (2 tablets) twice a dayNutrition Facts

      BariActiv® Multivitamin CapsuleTake one serving (1 capsule) once a dayNutrition Facts

      BariActiv® Iron + Vitamin C Tablet§Take one serving (1 tablet) once a dayNutrition Facts

      §It is very important NOT to take calcium and iron pills at the same time. Take them at least 2 hours apart.
      TIP: Some medicines and nutritional supplements can affect each other. It is always a good idea to tell your healthcare provider about any medicines you are taking, including vitamins and nutritional supplements.

      SOME TIPS TO HELP YOU REMEMBER TO TAKE YOUR VITAMINS

      It can be easy to forget to take your vitamins and minerals. Here are some reminders to help keep you on track:

      • Set an alarm. Most phones have them. Be sure to set yours so you will remember when it is time to take your vitamins. If you wear a watch, set the alarm so you will remember to take your vitamins when you are away from the house
      • Remind yourself with notes, diaries, or checklists. Post a calendar or a Post-it® note where you will see it. You can also make a “to-do” list so you will always remember
      • Keep the bottles of your nutritional supplements in a place where you will see them easily. This way, you will remember to take them as your healthcare provider prescribes. But make sure that they are out of the reach of children
      • Have a support network. Ask a friend or family member to remind you by phone or text

      ENROLLMENT AND FAQs

      ENROLL IN Nutrition Direct

      It offers eligible patients the nutritional supplements they need after weight loss surgery for as little as $0 per month.

      If your doctor thinks Nutrition Direct may be right for you, you can enroll in 3 steps:

      Talk to your doctor about Nutrition Direct at your next appointment.

      Your doctor will ask you to complete the top half of the enrollment form. The doctor will sign the prescription on the bottom half.

      The doctor’s office will fax the completed form to ProCare PharmacyCare at 855-828-1492.

      You will receive a welcome communication (text and/or phone call) from the pharmacy to confirm your order. After that, ProCare PharmacyCare will ship your nutritional supplements to you within 3 to 5 days. You will receive an email confirming shipping with tracking information so you can track your shipment.

      Your order will be automatically refilled each month. The pharmacy will help you with insurance claim processing each month so that the nutritional supplements in Nutrition Direct will arrive at your home. In addition to your nutritional supplements, the package will include materials to help you maintain a healthy lifestyle.

      LEARN MORE ABOUT Nutrition Direct

      Learn why vitamins are so important after weight loss surgery. See how Nutrition Direct can help you get important nutritional supplements at an affordable cost and with the convenience of home delivery.

      FREQUENTLY ASKED QUESTIONS (FAQs) ABOUT Nutrition Direct

      It is not unusual to have some questions. Here are some of the most common questions and their answers.

      What is NASCOBAL®?

      NASCOBAL® (Cyanocobalamin, USP) Nasal Spray is a prescription medicine used as a supplement to treat vitamin B12 deficiency.

      IMPORTANT SAFETY INFORMATION for NASCOBAL®

      Do not use NASCOBAL® if you are allergic to cobalt, vitamin B12, or any of the ingredients in NASCOBAL®. Severe allergic reactions and death have occurred with other types of vitamin B12 supplements.

      If you have Leber’s disease, NASCOBAL® can cause serious nerve damage in your eyes. Talk to your doctor if you have vision problems before or during treatment.

      Life-threatening side effects may occur in people with a certain kind of anemia (a blood problem), treated aggressively with vitamin B12. Additionally, taking a drug called folic acid in place of vitamin B12 can lead to worsening and permanent nerve damage.

      Your doctor will check your blood before starting NASCOBAL® and during therapy. It is important to return for follow-up visits as directed by your doctor to make sure NASCOBAL® is working.

      Since NASCOBAL® is inhaled by nose, tell your doctor if you have breathing problems such as stuffy nose, allergic rhinitis, or upper respiratory infection. Your doctor may choose to delay your treatment.

      Tell your doctor if you are pregnant or planning to become pregnant (it is not known if NASCOBAL® will harm your unborn baby). However, vitamin B12 is an essential vitamin and requirements are increased during pregnancy. Tell your doctor if you are breastfeeding.

      Tell your doctor about all of the medicines you take, both before and during your treatment with NASCOBAL®. Certain medicines can affect blood test results and how NASCOBAL® works.

      Side effects include weakness, headache, sore throat, common cold, swollen tongue, nausea, tingling and rhinitis.

      These are not all the possible side effects of NASCOBAL®. Talk to your doctor about any side effects you experience.

      Please see full Prescribing Information.

      What is NASCOBAL®?

      NASCOBAL® (Cyanocobalamin, USP) Nasal Spray is a prescription medicine used as a supplement to treat vitamin B12 deficiency.

      IMPORTANT SAFETY INFORMATION for NASCOBAL®

      Do not use NASCOBAL® if you are allergic to cobalt, vitamin B12, or any of the ingredients in NASCOBAL®. Severe allergic reactions and death have occurred with other types of vitamin B12 supplements.

      If you have Leber’s disease, NASCOBAL® can cause serious nerve damage in your eyes. Talk to your doctor if you have vision problems before or during treatment.

      Life-threatening side effects may occur in people with a certain kind of anemia (a blood problem), treated aggressively with vitamin B12. Additionally, taking a drug called folic acid in place of vitamin B12 can lead to worsening and permanent nerve damage.

      Your doctor will check your blood before starting NASCOBAL® and during therapy. It is important to return for follow-up visits as directed by your doctor to make sure NASCOBAL® is working.

      Since NASCOBAL® is inhaled by nose, tell your doctor if you have breathing problems such as stuffy nose, allergic rhinitis, or upper respiratory infection. Your doctor may choose to delay your treatment.

      Tell your doctor if you are pregnant or planning to become pregnant (it is not known if NASCOBAL® will harm your unborn baby). However, vitamin B12 is an essential vitamin and requirements are increased during pregnancy. Tell your doctor if you are breastfeeding.

      Tell your doctor about all of the medicines you take, both before and during your treatment with NASCOBAL®. Certain medicines can affect blood test results and how NASCOBAL® works.

      Side effects include weakness, headache, sore throat, common cold, swollen tongue, nausea, tingling and rhinitis.

      These are not all the possible side effects of NASCOBAL®. Talk to your doctor about any side effects you experience.

      Please see full Prescribing Information.