DOSAGE INSTRUCTIONS

FOR BUILD-UP OF SUBLINGUAL DROPS

NAME____________________________________            DOB___________________

Date                          Daily Dose     Site              Comments and Observations

Bottle #1

Day 1 _________      1 drop          under tongue    ___________________

Day 2 _________       2 drops        under tongue      ___________________

Day 3 _________       3 drops        under tongue      ___________________

Day 4 _________      4 drops        under tongue      ___________________

Day 5 _________       5 drops        under tongue      ___________________

Bottle #2

Day 6 _________      1 drop         under tongue      ___________________

Day 7 _________       2 drops         under tongue      ___________________

Day 8 _________       3 drops         under tongue      ___________________

Day 9 _________      4 drops         under tongue      ___________________

Day 10_________       5 drops         under tongue      ___________________

Start of Maintenance

Day 11_________        5 drops          under tongue     ___________________

Drops are to be held under the tongue for 2 minutes, then swallow.

Seek immediate medical attention and use Epipen if severe allergic reaction occurs including difficulty breathing, severe swelling of tongue, severe rash, or hives.

Discontinue drops until you notify our office if you experience oral swelling, skin rash, cough, severe vomiting/diarrhea, worsening of asthma.

You must have a current EpiPen available. Check the expiration date.

If it has been 3 weeks since your last dose, do not proceed. Call our office and speak with an allergy nurse for further instructions.