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Sep 1 2016;194(5):613-20

Warning signs that require immediate medical consultation include severe or persistent gastrointestinal symptoms (severe abdominal pain, persistent nausea and vomiting, signs of pancreatitis), symptoms of thyroid problems (neck mass, difficulty swallowing, persistent hoarseness), signs of gallbladder disease (right upper abdominal pain, especially after eating fatty foods), symptoms of kidney problems (decreased urination, swelling, fatigue), severe allergic reactions (call 911 for signs of anaphylaxis), or significant mood changes

Sharps disposal: remind patients to return used pens to the pharmacy or a local council collection point