ABOUT Nutrition Direct

Nutrition Direct TURNS A COMPLEX CHALLENGE INTO AN INTEGRATED SOLUTION

Designed to help make lifelong nutritional support as simple as possible for your appropriate patients3
Patients receive a monthly delivery with a 30-day supply of nutritional supplements

  • NASCOBAL® vitamin B12 Nasal Spray
  • Oral supplements that meet American Society for Metabolic and Bariatric Surgery (ASMBS) Nutritional Guidelines4*
    • BariActiv® Calcium + D3 & Magnesium
    • BariActiv® Multivitamin, with or without Iron
      NOTE: Vitamins are free of milk, egg, fish, shellfish, tree nuts, peanuts, wheat, and soy
  • Patient savings and support, including specialty pharmacy services, patient education, and more
  • Home delivery and auto-refills for as little as $0 per month

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® (Cyanocobalamin, usp) NASAL SPRAY

NASCOBAL® NASAL SPRAY: A UNIQUE WAY TO DELIVER VITAMIN B12

  • Unique intranasal delivery
    • Designed to bypass the GI tract and deliver vitamin B12 directly into the bloodstream through the nasal mucosa5
  • Not a painful injection
  • The only FDA-approved vitamin B12 nasal spray
    • Clinically proven to have increased and maintained healthy vitamin B12 levels2,6
  • Convenient, once-weekly dosing regimen
    • Self-administered, tasteless and odorless fine mist: 1 spray, 1 nostril, 1x a week2

The only FDA-approved prescription vitamin B12 nasal spray

nasal-spray-step1 nascobal-spray

Product shown may not be actual size.

NASCOBAL® Nasal Spray should be administered at least one hour before or one hour after ingestion of hot foods or liquids.

Dose adjustments may be required.

Clinically proven to have increased vitamin B12 levels from the first dose6

vitaminb12-mean-concentration
  • Achieved mean peak serum vitamin B12 concentration within 1.5 hours6‡
  • Reached mean peak concentration of 1021 pg/mL6‡
  • At 72 hours, mean serum vitamin B12 level was increased by 46% above baseline6‡

In 21 healthy volunteers under fasting conditions, a single 500-mcg dose of NASCOBAL® was given and monitored for 3 days. Data are based on baseline uncorrected serum vitamin B12 levels.

HOW TO USE NASCOBAL® NASAL SPRAY

nasal-spray-step1-hcp
  • 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-hcp
  • 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-hcp
  • 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
NASCOBAL® Nasal Spray should be administered at least one hour before or one hour after ingestion of hot foods or liquids.

Dose adjustments may be required.

BariActiv® SUPPLEMENTS

BariActiv® SUPPLEMENTS: 2 FORMULATIONS DESIGNED TO MEET ASMBS NUTRITIONAL GUIDELINES*

bariactiv-bottle

BariActiv® Chewable:

  • Can be taken immediately following surgery
  • Also good for lifelong nutritional support
  • Great-tasting fruit flavor
bariactiv-bottle

BariActiv® Tablets/Capsules:

  • For patients who no longer require chewable tablets
  • Upon Healthcare Provider recommendation, patients may switch to tablets/capsules by calling ProCare PharmacyCare at 1-855-828-1488

Nutrition Direct: DESIGNED SPECIFICALLY FOR BARIATRIC PATIENTS§

ASMBS RECOMMENDED NUTRITIONAL SUPPLEMENTATION*BARIACTIV® ONCE-DAILY MULTIVITAMINS
Vitamin B1 12 mg/day
Vitamin B12 500 mcg/week
Folate 1,360 DFE (800 mcg folic acid)
Calcium (see footnote below)
Vitamin A 3,000 mcg/day
Vitamin E 15 mg/day
Vitamin K 300 mcg/day
Vitamin D 75 mcg/day#
Iron Chewable: 18 mg/day
Tablet/Capsule: 45 mg/day
Zinc 16 mg/day
Copper 2 mg/day
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).

Calcium is provided in the Bariactiv® Calcium (1200 mg per day) + Vitamin D (3000 IU per day) supplement. It is very important NOT to take calcium and multivitamin with iron supplements at the same time. Take them at least 2 hours apart.

Equivalent to 10,000 IU/day (3000 mcg RAE/day) retinol.

Equivalent to 3,000 IU/day.

bariactiv-bottle tablet-capsul-baractiv-bottle

BARIACTIV® CHEWABLE
NUTRITIONAL INFORMATION

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

BariActiv® Multivitamin ChewableTake one serving (1 tablet) once a dayNutrition Facts

BariActiv® Multivitamin + Iron Chewable**Take one serving (1 tablet) once a dayNutrition Facts

bariactiv-bottle tablet-capsul-baractiv-bottle

BARIACTIV® TABLETS/CAPSULES
NUTRITIONAL INFORMATION

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® Multivitamin + Iron Chewable**Take one serving (1 tablet) once a dayNutrition Facts

**
It is very important NOT to take calcium and multivitamin with iron supplements at the same time. Take them at least 2 hours apart.

PATIENT Resources

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

Nutrition Direct PATIENT SUPPORT & SAVINGS

Learn about patient educational materials, patient savings and specialty pharmacy support services for Nutrition Direct.

AN INTEGRATED WAY TO DELIVER INFORMATION AND SUPPORT

Nutrition Direct provides resources to help patients stay on track.

Resources include:

  • Dosing instructions
  • Monthly reminders
  • Pharmacy services
  • Product information
  • Dedicated call center
  • Recipe cards
  • FAQs
  • Patient education
  • Food diary

Nutrition Direct OFFERS ONGOING SPECIALTY PHARMACY SUPPORT SERVICES FOR PHYSICIANS AND PATIENTS

Helps with smooth processing and fulfillment

  • Calls patients to welcome them and confirm order details
  • Ensures confirmed orders are shipped in 3 to 5 business days††
  • Emails confirmation of shipping and tracking information
  • Manages monthly refills of nutritional supplements and educational materials
  • Facilitates switch from chewable to tablet/capsule formulations
  • Addresses and processes insurance claims for your patients

Note: Incomplete prescription fax forms may cause delivery delays.

To contact ProCare PharmacyCare:
Tel: 855-828-1488
Fax: 855-828-1492
Monday through Friday, 8 AM to 8 PM ET

DOWNLOAD FAQs

NASCOBAL® Nasal Spray prescription with enrollment in Nutrition Direct:

nutrition-pay-calloutDOWNLOAD COPAY CARD

Nutrition Direct: A CONVENIENT WAY TO DELIVER SUPPLEMENTS AT AN AFFORDABLE PRICE

  • Home delivery
  • Free shipping and auto-refills
  • Pay as little as $0 a month

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.

Practice Resources

nutrition-hcp-enrollment-forms-heronutrition-hcp-enrollment-forms-hero
EASY ENROLLMENT FOR PHYSICIANS AND PATIENTS
  1. Patient completes top half of form.
  2. Prescriber signs preprinted prescription at bottom of form.
  3. Office faxes completed form to specialty pharmacy.
Watch Julie Johannes, physician assistant, and find out what you need to know about nutrition after weight loss surgery.
Download this resource with helpful tips to help you conduct a software system search to ePrescribe Nutrition Direct™.

IMPORTANT SAFETY INFORMATION FOR NASCOBAL® NASAL SPRAY

NASCOBAL® is contraindicated in patients with sensitivity to cobalt, vitamin B12, or any component of the medication. Anaphylactic shock and death have been reported with parenteral forms of vitamin B12. Consider administering an intradermal test dose of parenteral vitamin B12 to patients suspected of cyanocobalamin hypersensitivity prior to starting NASCOBAL®.

Patients with Leber's disease who were treated with vitamin B12 suffered severe and swift optic atrophy. NASCOBAL® is not recommended for use in patients with Leber’s optic atrophy.

Doses of vitamin B12 exceeding 10 mcg daily may produce hematologic response in patients with folate-deficient megaloblastic anemia, and may therefore mask a previously unrecognized folate deficiency. NASCOBAL® is not a substitute for folic acid. Assess both vitamin B12 and folate levels prior to initiating therapy with NASCOBAL®.

Hypokalemia, thrombocytosis and sudden death may occur in severe megaloblastic anemia which is treated intensely with vitamin B12. Serum potassium levels and platelet count should be monitored.

Treatment with vitamin B12 may unmask signs of polycythemia vera. Patients exhibiting clinical or hematologic response consistent with polycythemia vera should be referred for further evaluation.

Hematocrit, reticulocyte count, vitamin B12, folate and iron levels should be obtained prior to treatment. Consider the potential for concomitant drugs to interfere with vitamin B12 and folate diagnostic blood assays. Vitamin B12 and peripheral blood counts must be monitored initially at one month after the start of treatment, and then at intervals of 3 to 6 months. If a patient is not properly maintained with NASCOBAL®, consider alternative therapy.

If NASCOBAL® is used concomitantly with chloramphenicol, monitor for reduced efficacy and, if needed, consider an alternative therapy.

The limited available data on NASCOBAL® in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes.

The most common adverse reactions (≥4%) were infection, headache, glossitis, paresthesia, asthenia, nausea and rhinitis.

INDICATIONS

  • Vitamin B12 maintenance therapy in adult patients with pernicious anemia who are in remission following intramuscular vitamin B12 therapy and who have no nervous system involvement
  • Treatment of adult patients with dietary, drug-induced, or malabsorption-related vitamin B12 deficiency not due to pernicious anemia
  • Prevention of vitamin B12 deficiency in adult patients with vitamin B12 requirements in excess of normal

Limitations of Use

  • NASCOBAL® should not be used for the vitamin B12 absorption test (Schilling test).
  • In patients with correctible or temporary causes of vitamin B12 deficiency, the benefit of continued long-term use of NASCOBAL® following adequate correction of vitamin B12 deficiency and underlying disease has not been established.
  • The effectiveness of NASCOBAL® in patients with active symptoms of nasal congestion, allergic rhinitis or upper respiratory infection has not been determined. Treatment with NASCOBAL® should be deferred until symptoms have subsided.
Please see the full Prescribing Information.

IMPORTANT SAFETY INFORMATION FOR NASCOBAL® NASAL SPRAY

NASCOBAL® is contraindicated in patients with sensitivity to cobalt, vitamin B12, or any component of the medication. Anaphylactic shock and death have been reported with parenteral forms of vitamin B12. Consider administering an intradermal test dose of parenteral vitamin B12 to patients suspected of cyanocobalamin hypersensitivity prior to starting NASCOBAL®.

Patients with Leber's disease who were treated with vitamin B12 suffered severe and swift optic atrophy. NASCOBAL® is not recommended for use in patients with Leber’s optic atrophy.

Doses of vitamin B12 exceeding 10 mcg daily may produce hematologic response in patients with folate-deficient megaloblastic anemia, and may therefore mask a previously unrecognized folate deficiency. NASCOBAL® is not a substitute for folic acid. Assess both vitamin B12 and folate levels prior to initiating therapy with NASCOBAL®.

Hypokalemia, thrombocytosis and sudden death may occur in severe megaloblastic anemia which is treated intensely with vitamin B12. Serum potassium levels and platelet count should be monitored.

Treatment with vitamin B12 may unmask signs of polycythemia vera. Patients exhibiting clinical or hematologic response consistent with polycythemia vera should be referred for further evaluation.

Hematocrit, reticulocyte count, vitamin B12, folate and iron levels should be obtained prior to treatment. Consider the potential for concomitant drugs to interfere with vitamin B12 and folate diagnostic blood assays. Vitamin B12 and peripheral blood counts must be monitored initially at one month after the start of treatment, and then at intervals of 3 to 6 months. If a patient is not properly maintained with NASCOBAL®, consider alternative therapy.

If NASCOBAL® is used concomitantly with chloramphenicol, monitor for reduced efficacy and, if needed, consider an alternative therapy.

The limited available data on NASCOBAL® in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes.

The most common adverse reactions (≥4%) were infection, headache, glossitis, paresthesia, asthenia, nausea and rhinitis.

INDICATIONS

  • Vitamin B12 maintenance therapy in adult patients with pernicious anemia who are in remission following intramuscular vitamin B12 therapy and who have no nervous system involvement
  • Treatment of adult patients with dietary, drug-induced, or malabsorption-related vitamin B12 deficiency not due to pernicious anemia
  • Prevention of vitamin B12 deficiency in adult patients with vitamin B12 requirements in excess of normal

Limitations of Use

  • NASCOBAL® should not be used for the vitamin B12 absorption test (Schilling test).
  • In patients with correctible or temporary causes of vitamin B12 deficiency, the benefit of continued long-term use of NASCOBAL® following adequate correction of vitamin B12 deficiency and underlying disease has not been established.
  • The effectiveness of NASCOBAL® in patients with active symptoms of nasal congestion, allergic rhinitis or upper respiratory infection has not been determined. Treatment with NASCOBAL® should be deferred until symptoms have subsided.
Please see the full Prescribing Information.