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Instructions for Use

(omacetaxine mepesuccinate) for Injection, for Subcutaneous Use

Read this Instructions for Use before you inject SYNRIBO for the first time and each time you get a refill. Also read the Medication Guide for SYNRIBO. 

Before you or your caregiver injects SYNRIBO, your healthcare provider will show you how to properly: 

  • handle syringes and inject SYNRIBO
  • dispose of used supplies for injecting SYNRIBO
  • clean up any spilled SYNRIBO


  • Be sure that you store SYNRIBO exactly as your healthcare provider tells you to. See the section “How should I store SYNRIBO?” in the Medication Guide.  
  • Never try to re-cap the needle. This could cause a needle-stick injury.
  • If SYNRIBO comes into contact with your skin, wash the area well with soap and water.

Your healthcare provider will arrange for you to receive all of the supplies that you will need for each injection of SYNRIBO:

  • syringe with attached needle, containing SYNRIBO for injection
  • protective eyewear, such as protective eyeglasses (not regular eyeglasses) or face shield
  • gloves
  • disposal biohazard container
  • absorbent pads for use to clean up an accidental spill of SYNRIBO
  • alcohol swabs
  • gauze pads

You may also need an adhesive bandage.

Never mix SYNRIBO yourself. If you don't receive syringes already filled with SYNRIBO, contact your doctor or pharmacy.  

Step 1. Preparing to give an injection of SYNRIBO.

  • Find a clean flat work surface.    
  • Wash your hands well with soap and water. 
  • Put on a pair of gloves and your protective eyewear before you handle the syringe containing SYNRIBO. Wearing gloves and protective eyewear protects you from splashes or spills. See Figure A.
  • Look at the date printed on the syringe label to make sure that the expiration date has not passed. Do not use if the expiration date has passed and contact your doctor or pharmacy immediately.
  • Gather the rest of your supplies and place them on your work surface.

Figure A


Step 2. Choose an injection site.

  • You may inject SYNRIBO into your thigh or stomach-area (abdomen). See Figure B. The injection can be given in the back of your arm if a caregiver is giving the injection. See Figure C.   
  • Use a different site for each injection to help decrease tenderness at the injection site. Each injection site should be at least 1 inch away from any recently used injection site.
  • Do not inject SYNRIBO into areas of your skin that are tender, red, bruised, hard, or that have scars or stretch marks.   


Step 3. Prepare the injection site.

  • Clean the injection site well with an alcohol wipe and allow it to air dry. See Figure D.


Step 4. Inject SYNRIBO.

  • Carefully remove the needle cap by pulling, taking care not to stick yourself. See Figure E.   
  • Do not press down on the plunger.

  • With one hand, pinch skin of injection site between your thumb and forefinger. See Figure F.


  • With your other hand, hold the syringe at a 45 degree or 90 degree angle to your skin. Use a quick dart-like motion to insert the needle through the skin at the injection site. See Figures G and H. The needle should go through the skin but not into your muscle.


  • Slowly push down on the plunger with your thumb until syringe is empty. See Figure I. 


  • Stop pinching your skin. Quickly remove needle and then apply pressure on injection site with a dry gauze pad. You can put a small adhesive bandage over the injection site if there is bleeding. See Figure J.


  • Follow the instructions below for how to dispose of the syringe, needle, and other supplies used to give your injection. Never try to re-cap the needle. This could cause a needle-stick injury.
  • Remove your gloves. Wash your hands right away with soap and water, and then remove your protective eyewear.

How should I throw away (dispose of) used SYNRIBO syringes, needles, and other supplies?

  • Throw away (dispose of) used SYNRIBO syringes, needles, and other used supplies in an appropriate biohazard container.
  • Return the biohazard container to your healthcare provider for disposal.  
  • Do not place used syringes, needles, or other supplies in a household trash or recycle container. Do not re-cap or clip the used needle. This could cause a needle-stick injury.
  • Do not throw away the protective eyewear. You will need them for each dose of SYNRIBO.

What should I do in case of an accidental SYNRIBO spill?

  • Your healthcare provider will arrange for you to receive supplies to use in case you spill SYNRIBO.  
  • Follow your healthcare provider's instructions about how to clean up a SYNRIBO spill.
  • Do not touch a spill unless you are wearing gloves and protective eyewear.  
  • Use an absorbent pad to wipe up the spill. Wash the area with soap and water. Use an extra absorbent pad or paper towel to dry the area.
  • Place the pad, gloves, and other supplies that were used to clean the spill in the biohazard container.   
  • Call your healthcare provider right away to report the spill.   

This Instructions for Use has been approved by the U.S. Food and Drug Administration

Last reviewed on RxList: 6/27/2016
This monograph has been modified to include the generic and brand name in many instances.

Report Problems to the Food and Drug Administration


You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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