Skip to Content

UK Edition. Click here for US version.

METOJECT PEN 12.5 MG SOLUTION FOR INJECTION IN PRE-FILLED PEN

Active substance(s): METHOTREXATE / METHOTREXATE / METHOTREXATE

View full screen / Print PDF » Download PDF ⇩

PDF Transcript

Metoject PEN · 91300-VPGB · AC · 04.16 · Pharma-Code: 1655
Format: 888 x 150 mm · HKS 44 · Perforation · Corrective action: KV01_jem_16.10.15 / KV02_jem_19.10.15 / KV03_jem_24.03.16 / KV04_jem_11.04.16

Package leaflet: Information for the user
Metoject PEN 7.5 mg solution for injection in pre-filled pen
Metoject PEN 10 mg solution for injection in pre-filled pen
Metoject PEN 12.5 mg solution for injection in pre-filled pen
Metoject PEN 15 mg solution for injection in pre-filled pen
Metoject PEN 17.5 mg solution for injection in pre-filled pen
Metoject PEN 20 mg solution for injection in pre-filled pen
Metoject PEN 22.5 mg solution for injection in pre-filled pen
Metoject PEN 25 mg solution for injection in pre-filled pen
Metoject PEN 27.5 mg solution for injection in pre-filled pen
Metoject PEN 30 mg solution for injection in pre-filled pen
methotrexate
Read all of this leaflet carefully before you start using
this medicine because it contains important information
for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor
or pharmacist.
• This medicine has been prescribed for you only.
Do not pass it on to others. It may harm them, even
if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or
pharmacist. This includes any possible side effects
not listed in this leaflet. See section 4.
What is in this leaflet
1. What Metoject PEN is and what it is used for
2. What you need to know before you use Metoject PEN
3. How to use Metoject PEN
4. Possible side effects
5. How to store Metoject PEN
6. Contents of the pack and other information

1. What Metoject PEN is and what it is used for
Metoject PEN is indicated for the treatment of
• active rheumatoid arthritis in adult patients.
• polyarthritic forms of severe, active juvenile idiopathic
arthritis, when the response to nonsteroidal antiinflammatory drugs (NSAIDs) has been inadequate,
• severe recalcitrant disabling psoriasis, which is not
adequately responsive to other forms of therapy such as
phototherapy, PUVA, and retinoids, and severe psoriatic
arthritis in adult patients.
Rheumatoid arthritis (RA) is a chronic collagen disease,
characterised by inflammation of the synovial membranes
(joint membranes). These membranes produce a fluid which
acts as a lubricant for many joints. The inflammation causes
thickening of the membrane and swelling of the joint.
Juvenile arthritis concerns children and adolescents less
than 16 years. Polyarthritic forms are indicated if 5 or more
joints are affected within the first 6 months of the disease.
Psoriasis is a common chronic skin disease, characterised by
red patches covered by thick, dry, silvery, adherent scales.
Psoriatic arthritis is a kind of arthritis with psoriatric lesions of
the skin and nails, especially at the joints of fingers and toes.
Metoject PEN modifies and slows down the progression of the
disease.
2. What you need to know before you use Metoject PEN
Do not use Metoject PEN if you
• are allergic to methotrexate or any of the other ingredients
of this medicine (listed in section 6).
• suffer from liver or severe kidney diseases or blood diseases.
• regularly drink large amounts of alcohol.
• suffer from a severe infection, such as tuberculosis,
HIV or other immunodeficiency syndromes.

• suffer from mouth ulcers, stomach ulcer or intestinal ulcer.
• are pregnant or breast-feeding.
• receive vaccinations with live vaccines at the same time.
Warnings and precautions
Talk to your doctor or pharmacist before taking Metoject PEN
if you:
• are elderly or if you feel generally unwell and weak.
• have problems with the way your liver works.
• suffer from dehydration (water loss).
Recommended follow-up examinations and safety
measures:
Even when Metoject PEN is administered in low doses,
severe side effects can occur. In order to detect them in time,
check-ups and laboratory tests have to be carried out by your
doctor.
Before therapy:
Before starting the treatment, blood samples will be taken
in order to check that you have enough blood cells, tests to
check your liver function, serum albumin (a protein in the blood)
and kidney function. Your doctor will also check if you suffer
from tuberculosis (infectious disease in combination with little
nodules in the affected tissue) and a chest X-ray will be taken.
During therapy:
You will have the following tests at least once a month during
the first six months and at least every three months thereafter:
• Examination of the mouth and throat for changes
of the mucosa.
• Blood tests.
• Check of liver function.
• Check of kidney function.
• Check of respiratory system and if necessary
lung function test.
Methotrexate may affect your immune system and vaccination
results. It may also affect the result of immunological tests.
Inactive, chronic infections (such as herpes zoster [shingles],
tuberculosis, hepatitis B or C) may flare up. During therapy

Stop breast-feeding prior to and during treatment with
Metoject PEN.

arthritis, psoriasis vulgaris and psoriatic arthritis with Metoject
PEN is a long-term treatment.

Radiation induced dermatitis and sun-burn can reappear
under methotrexate therapy (recall-reaction). Psoriatic lesions
can exacerbate during UV-irradiation and simultaneous
administration of methotrexate.
Enlarged lymph nodes (lymphoma) may occur and if this is
the case, therapy must be stopped.

• Mercaptopurine (a cytostatic agent).
• Retinoids (medicine against psoriasis and other
dermatological diseases).
• Theophylline (medicine against bronchial asthma
and other lung diseases).
• Some medicines against stomach trouble such as
omeprazole and pantoprazole.
• Hypoglycaemics (medicines that are used to lower
the blood sugar).

Driving and using machines
Treatment with Metoject PEN may cause adverse reactions
affecting the central nervous system, such as tiredness and
dizziness. Thus the ability to drive a vehicle and/or to operate
machines may, in certain cases, be compromised. If you feel
tired or drowsy do not drive or use machines.

At the start of your therapy, Metoject PEN will be injected
by medical staff. However, your doctor may decide that you
are able to learn how to inject Metoject PEN under the skin
yourself. You will then receive appropriate training.
Under no circumstances should you try to inject Metoject
PEN yourself before you have received such training.

Diarrhoea can be a possible side effect of Metoject PEN and
requires an interruption of therapy. If you suffer from diarrhoea
please speak to your doctor.

Vitamins containing folic acid may impair the effect of your
treatment and should only be taken when advised by your
doctor.

Metoject PEN contains sodium
This medicine contains less than 1 mmol sodium (23 mg)
per dose; i.e. essentially “sodium-free”.

You can also find guidance on how to use Metoject PEN in the
section “Instructions for use” at the end of this leaflet.
Please note that all of the contents have to be used.

Certain brain disorders (encephalopathy/leukoencephalopathy)
have been reported in cancer patients receiving methotrexate.
Such side effects cannot be excluded when methotrexate is
used to treat other diseases.

Vaccination with live vaccine must be avoided.

with Metoject PEN you must not be vaccinated with live
vaccines.

Other medicines and Metoject PEN
Tell your doctor or pharmacist if you are taking, have recently
taken or might take any other medicines. Please note that this
also applies to medicines that you will take in the future.
The effect of the treatment may be affected if Metoject PEN is
administered at the same time as certain other medicines:
• Antibiotics such as: tetracyclines, chloramphenicol,
non-absorbable broad-spectrum antibiotics, penicillines,
glycopeptides, sulphonamides, ciprofloxacin and cefalotin
(medicines to prevent/fight certain infections).
• Non-steroidal anti-inflammatory drugs or salicylates
(medicines against pain and/or inflammation such as
acetylsalicylic acid, diclofenac and ibuprofen or pyrazole).
• Probenecid (medicine against gout).
• Weak organic acids like loop diuretics (“water tablets”).
• Medicines, which may have adverse effects on the bone
marrow, such as trimethoprim-sulphamethoxazole (an
antibiotic) and pyrimethamine.
• Other medicines used to treat rheumatoid arthritis such
as leflunomide, sulphasalazine and azathioprine.

3. How to use Metoject PEN
Metoject PEN with food, drink and alcohol
Alcohol as well as large amounts of coffee, caffeine-containing
soft drinks and black tea should be avoided during treatment
with Metoject PEN.
Pregnancy, breast-feeding and fertility
If you are pregnant or breast-feeding, think you may be
pregnant or are planning to have a baby, ask your doctor or
pharmacist for advice before taking this medicine.
Do not take Metoject PEN during pregnancy. There is a risk of
harm to the foetus and miscarriage. Men and women should
use an effective method of birth control during treatment and
during a further six months after treatment with Metoject PEN
has been discontinued.
In women of child-bearing age, any existing pregnancy must
be excluded with certainty by taking appropriate measures,
such as pregnancy test, prior to therapy.
As methotrexate can be genotoxic, all women who wish to
become pregnant are advised to consult a genetic counselling
centre, if possible, already prior to therapy. Men should seek
advice about the possibility of sperm preservation before
starting therapy.

Always take this medicine exactly as your doctor has told you.
Check with your doctor or pharmacist if you are not sure.
Your doctor decides on the dosage, which is adjusted
individually to you. Usually it takes 4 – 8 weeks before there is
any effect of the treatment.
Metoject PEN is administered subcutaneously (under the skin)
by or under the supervision of a physician or healthcare staff
as an injection once a week only. Together with your doctor
you decide on a suitable weekday each week on which you
receive your injection.
Use in children and adolescents
The doctor decides on the appropriate dose in children and
adolescents with polyarthritic forms of juvenile idiopathic
arthritis.
Metoject PEN is not recommended in children less than
3 years of age due to insufficient experience in this age group.
Method and duration of administration
Metoject PEN is injected once weekly!
The duration of the treatment is determined by the treating
physician. Treatment of rheumatoid arthritis, juvenile idiopathic

The manner of handling and throwing away of the medicine
and pre-filled pen must be in accordance with local
requirements. Pregnant health care personnel should not
handle and/or administer Metoject PEN.
Methotrexate should not come into contact with the surface of
the skin or mucosa. In the event of contamination, the affected
area must be rinsed immediately with plenty of water.
If you use more Metoject PEN than you should
If you use more Metoject PEN than you should, talk to your
doctor immediately.
If you forget to use Metoject PEN
Do not take a double dose to make up for a forgotten dose.
If you stop using Metoject PEN
If you stop using Metoject PEN, talk to your doctor
immediately.
If you have the impression that the effect of Metoject PEN is
too strong or too weak, talk to your doctor or pharmacist.

Instructions for use

a) With cap before injection

Recommendations

Carefully read the instructions below before starting your
injection.

Always use the injection technique advised by your doctor,
pharmacist or nurse.

b) After cap removal before injection
c) After injection

Additional information
The manner of handling and throwing away of the medicine
and pre-filled pen must be in accordance with local
requirements. Pregnant healthcare personnel should not
handle and/or administer Metoject PEN.

What you need to do before administering your injection

Methotrexate should not come into contact with the surface of
the skin or mucosa. In the event of contamination, the affected
area must be rinsed immediately with plenty of water.

1. Wash your hands very carefully.
2. Remove the system from its packaging.
3. Check the Metoject PEN pre-filled pen before using it:

What you need in order to administer your injection using
the Metoject PEN pre-filled pen
You need:
• 1 Metoject PEN pre-filled pen
• 1 alcohol pad
Metoject PEN pre-filled pen components:
Injection button
Handling area
Transparent control zone
Cap

If the Metoject PEN pre-filled pen
appears to be damaged do not use
it. Use another one and contact your
doctor, pharmacist or nurse.
In case a small air bubble is visible
through the transparent control
zone, this will not affect your dose
nor will it harm you.
If you are not able to see or to
check the system correctly prior to
injection, ask someone around you
for assistance.
4. Set the Metoject PEN pre-filled pen on a clean flat surface
(such as a table).

Where you should administer the injection
The most appropriate zones for your
injection are:
• upper thighs,
• abdomen except around the navel.
• If someone around you
administers the injection for you,
the person may also use the top
of the zone at the back of the
arm, just below the shoulder.
• Change the injection area with
each injection. This will minimize
any reactions at the injection site.
• Never inject into areas where the skin is tender, bruised,
red or hard or where you have scars or stretch marks. If you
have psoriasis, you should not try to inject directly into any
raised, thick, red or scaly skin patches or lesions.
How to prepare the injection
5. Clean your skin in the chosen
injection zone using the enclosed
alcohol pad.
6. Hold the Metoject PEN pre-filled
pen with one hand in the handling
area.
• Do not remove the cap before
you are ready to administer the
injection.

Metoject PEN · 91300-VPGB · AC · 04.16 · Pharma-Code: 1655
Format: 888 x 150 mm · HKS 44 · Perforation · Corrective action: KV01_jem_16.10.15 / KV02_jem_19.10.15 / KV03_jem_24.03.16 / KV04_jem_11.04.16

7. Use your other hand to pull the
cap straight off. The small needle
shield comes off with the cap
automatically. If not, use another
pen and contact your doctor,
pharmacist or nurse.
• Do not press the button until you
are ready to inject.
• If you are unable to remove the
cap, ask someone around you for
assistance.
Note: Once you have removed the cap, perform your
injection without delay.
8. With your free hand, build a skin
fold by gently squeezing the
area of the cleaned skin at the
injection site.
• The fold must be held pinched
until the Metoject PEN pre-filled
pen is removed from the skin
after the injection.

How to administer the injection:
11. While holding the Metoject PEN
pre-filled pen firmly against the
skin, now press the button with
your thumb.
12. You will hear a click which
indicates the start of the injection.
Keep holding the pen against
the raised skin until all of the
medicine is injected. This can
take up to 5 seconds.
Note:
Do not remove the Metoject PEN pre-filled pen from the skin
before the end of the injection to avoid incomplete injection.
If the injection is not triggered, release the button, make sure
that the Metoject PEN pre-filled pen is pressed firmly against
the skin and push hard on the button.
If you have troubles with your hearing, count 5 seconds from
the moment you have pressed the button and then lift the
Metoject PEN pre-filled pen from the injection site.

Before throwing away the Metoject PEN pre-filled pen, check
visually that there is no liquid left in the pen, at the bottom of
the transparent control zone. If there is liquid left in the pen,
not all of the medicine has been injected correctly and you
should consult your doctor.
Note
To avoid any injury, never insert your fingers in the opening
of the protective tube covering the needle. Do not destroy
the pen.

Like all medicines, this medicine can cause side effects,
although not everybody gets them.
The frequency as well as the degree of severity of the side
effects depends on the dosage level and the frequency of
administration. As severe side effects may occur even at low
dosage, it is important that you are monitored regularly by your
doctor. Your doctor will do tests to check for abnormalities
developing in the blood (such as low white blood cells, low
platelets, lymphoma) and changes in the kidneys and the liver.

Whom should you contact in case of need

For any problem or question, contact your doctor,
pharmacist or nurse.

If you or someone around you is injured by the needle,
consult your doctor immediately and throw away the
Metoject PEN pre-filled pen.

13. Remove the Metoject PEN prefilled pen from the injection site,
perpendicular to the skin (pull up).
9. Position the uncapped
transparent end of Metoject PEN
pre-filled pen perpendicular to the
fold of skin.
10. Without pressing the button,
push the Metoject PEN pre-filled
pen firmly onto your skin in order
to unlock the button.
• If you are unable to push the
Metoject PEN pre-filled pen to the
stop-point, ask someone around
you for assistance.

4. Possible side effects

14. The protective shield
automatically moves into place
over the needle. The protective
shield is then locked and the
needle is protected.
15. In case of a slight bleeding use a
plaster.

91300-VPGB AC
V1655 / R9 - 000000

Tell your doctor immediately if you experience any of
the following symptoms, as these may indicate a serious,
potentially life-threatening side effect, which require urgent
specific treatment:
• persistent dry, non-productive cough, shortness of
breath and fever; these may be signs of an inflammation
of the lungs [common]
• symptoms of liver damage such as yellowing of the skin
and whites of the eyes; methotrexate can cause chronic
liver damage (liver cirrhosis), formation of scar tissue in
the liver (liver fibrosis), fatty degeneration of the liver [all
uncommon], inflammation of the liver (acute hepatitis) [rare]
and liver failure [very rare]
• allergy symptoms such as skin rash including red
itchy skin, swelling of the hands, feet, ankles, face,
lips, mouth or throat (which may cause difficulty in
swallowing or breathing) and feeling you are going to
faint; these may be signs of severe allergic reactions or an
anaphylactic shock [rare]
• symptoms of kidney damage such as swelling of
the hands, ankles or feet or changes in frequency of
urination or decrease (oliguria) or absence of urine
(anuria); these may be signs of kidney failure [rare]
• symptoms of infections, e.g. fever, chills, achiness,
sore throat; methotrexate can make you more susceptible
to infections. Severe infections like a certain type of
pneumonia (Pneumocystis carinii pneumonia) or blood
poisoning (sepsis) may occur [rare]

• symptoms such as weakness of one side of the body
(stroke) or pain, swelling, redness and unusual warmth
in one of your legs (deep vein thrombosis); this may
happen when a dislodged blood clot causes blockage
of a blood vessel (thromboembolic event) [rare]
• fever and serious deterioration of your general condition,
or sudden fever accompanied by a sore throat or mouth,
or urinary problems; methotrexate can cause a sharp fall in
certain white blood cells (agranulocytosis) and severe bone
marrow suppression [very rare]
• unexpected bleeding, e.g. bleeding gums, blood in the
urine, vomiting blood or bruising, these can be signs of
a severely reduced number of blood platelets caused by
severe courses of bone marrow depression [very rare]
• symptoms such as severe headache often in
combination with fever, neck stiffness, feeling sick,
vomiting, disorientation and sensitivity to light may
indicate an inflammation of the membranes of the brain
(acute aseptic meningitis) [very rare]
• certain brain disorders (encephalopathy/
leukoencephalopathy) have been reported in cancer
patients receiving methotrexate. Such side effects cannot
be excluded when methotrexate therapy is used to treat
other diseases. Signs of this kind of brain disorders may be
altered mental state, movement disorders (ataxia), visual
disturbances or disturbances of memory [not known]
• severe skin rash or blistering of the skin (this can also
affect your mouth, eyes and genitals); these may be signs
of conditions called Stevens Johnson syndrome or burned
skin syndrome (toxic epidermal necrolysis/Lyell’s syndrome)
[very rare]
In the following, please find the other side effects that may
occur:
Very common: may affect more than 1 in 10 people
• Inflammation of the mouth lining, indigestion, feeling sick,
loss of appetite, abdominal pain.
• Abnormal liver function tests (ASAT, ALAT, bilirubin,
alkaline phosphatase).

Common: may affect up to 1 in 10 people
• Mouth ulcers, diarrhoea.
• Rash, reddening of the skin, itching.
• Headache, tiredness, drowsiness.
• Reduced blood cell formation with decrease in white and/or
red blood cells and/or platelets.
Uncommon: may affect up to 1 in 100 people
• Throat inflammation.
• Inflammation of the bowels, vomiting, inflammation of
pancreas, black or tarry stools, gastrointestinal ulcers and
bleeding.
• Increased sensitivity to light, loss of hair, increased number
of rheumatic nodules, skin ulcer, shingles, inflammation of
blood vessels, herpes-like skin rash, hives.
• Onset of diabetes mellitus.
• Dizziness, confusion, depression.
• Decrease in serum albumin.
• Decrease in the number of all blood cells and platelets.
• Inflammation and ulcer of the urinary bladder or vagina,
reduced kidney function, disturbed urination.
• Joint pain, muscle pain, reduction of bone mass.
Rare: may affect up to 1 in 1,000 people
• Inflammation of gum tissue
• Increased skin pigmentation, acne, blue spots on the skin
due to vessel bleeding (ecchymosis, petechiae), allergic
inflammation of blood vessels.
• Decreased number of anti-bodies in the blood.
• Infection (incl. reactivation of inactive chronic infection),
red eyes (conjunctivitis).
• Mood swings (mood alterations).
• Visual disturbances.
• Inflammation of the sac around the heart, accumulation
of fluid in the sac around the heart, obstruction of cardiac
filling due to fluid in the sac around the heart.
• Low blood pressure.
• Formation of scar tissue in the lung, shortness of breath and
bronchial asthma, accumulation of fluid in the sac around
the lung.
• Stress fracture.

• Electrolyte disturbances.
• Fever, wound-healing impairment.

5. How to store Metoject PEN
Keep this medicine out of the sight and reach of children.

Very rare: may affect up to 1 in 10,000 people
• Acute toxic dilatation of the gut (toxic megacolon).
• Increased pigmentation of the nails, inflammation of the
cuticles (acute paronychia), deep infection of hair follicles
(furunculosis), visible enlargement of small blood vessels.
• Pain, loss of strength or sensation of numbness or
tingling in arms and legs, changes in taste (metallic taste),
convulsions, paralysis, meningism.
• Impaired vision, non-inflammatory eye disorder
(retinopathy).
• Loss of sexual drive, impotence, male breast enlargement,
defective sperm formation (oligospermia), menstrual
disorder, vaginal discharge.
• Enlargement of lymphatic nodes (lymphoma).

Subcutaneous application of methotrexate is locally well
tolerated. Only mild local skin reactions (such as burning
sensations, erythema, swelling, discolouration, severe itching,
pain) were observed, decreasing during therapy.
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or
nurse. This includes any possible side effects not listed in this
leaflet. You can also report side effects directly via the Yellow
Card Scheme at: www.mhra.gov.uk/yellowcard.
By reporting side effects you can help provide more
information on the safety of this medicine.

Poland, Portugal:
Metex PEN
Denmark:
Metex Pen

Store below 25 °C.
Keep the pre-filled pens in the outer carton in order to protect
from light.

What Metoject PEN looks like and contents of the pack
This medicinal product is presented as a solution for injection
in pre-filled pen.
The solution is clear, yellow-brown.

Belgium:
Metoject

Do not use this medicine after the expiry date stated on the
carton and pre-filled pen after EXP. The expiry date refers to
the last day of that month.

The following pack sizes are available:

This leaflet was last revised in April 2016.

Do not throw away any medicines via wastewater or
household waste. Ask your pharmacist how to throw away
medicines you no longer use. These measures will help protect
the environment.
6. Contents of the pack and other information

Not known: frequency cannot be estimated from the
available data
• Increased number of white blood cells.
• Nosebleed.
• Proteins in urine.
• Feeling of weakness.

• The other ingredients are sodium chloride, sodium
hydroxide and hydrochloric acid for pH adjustment and
water for injections.

What Metoject PEN contains
• The active substance is methotrexate.
1 pre-filled pen with 0.15 ml solution contains
7.5 mg methotrexate.
1 pre-filled pen with 0.2 ml solution contains
10 mg methotrexate.
1 pre-filled pen with 0.25 ml solution contains
12.5 mg methotrexate.
1 pre-filled pen with 0.3 ml solution contains
15 mg methotrexate.
1 pre-filled pen with 0.35 ml solution contains
17.5 mg methotrexate.
1 pre-filled pen with 0.4 ml solution contains
20 mg methotrexate.
1 pre-filled pen with 0.45 ml solution contains
22.5 mg methotrexate.
1 pre-filled pen with 0.5 ml solution contains
25 mg methotrexate.
1 pre-filled pen with 0.55 ml solution contains
27.5 mg methotrexate.
1 pre-filled pen with 0.6 ml solution contains
30 mg methotrexate.

Metoject PEN is available in packs of 1, 2, 4, 5, 6, 10, 11, 12,
14, 15, and 24 pre-filled pens. Alcohol pads are included in the
package.
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
medac Gesellschaft für klinische Spezialpräparate mbH
Theaterstr. 6
22880 Wedel
Germany
Tel.: +49 4103 8006-0
Fax: +49 4103 8006-100
This medicinal product is authorised in the Member States
of the EEA under the following names:
Austria, Bulgaria, Czech Republic, Finland, Greece, Hungary,
Netherlands, Romania, Slovak Republic, Slovenia, Spain,
United Kingdom:
Metoject PEN
Iceland, Sweden:
Metojectpen
Germany:
metex PEN
Estonia, Latvia, Lithuania, Norway:
Metex

91300-VPGB AC
V1655 / R9 - 000000

Expand Transcript

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

Hide