Patent Publication Number: US-2020289761-A1

Title: Syringe having at least one radially-outwardly extending panel

Description:
FIELD OF THE INVENTION 
     The subject invention relates to syringes. 
     BACKGROUND OF THE INVENTION 
     Syringes are well known in the art for administering injections. With plastic disposable syringes, there is a need to aspirate an amount of medication from a vial or other drug container with subsequent injection into a patient. This process may require calculations or other determinations (e.g., table or chart look-ups) for a medical practitioner to determine a proper dose, as the dose may be based on a physiological parameter of a patient, such as the patient&#39;s weight. Such injections, as opposed to fixed-dose amounts, run the risk of possible error. 
     Arrangements have been provided in the prior art to simplify the calculation or determination of an unknown dose, wherein scales have been provided with a syringe in units of a target physiological characteristic, such as a patient&#39;s weight. This allows for a practitioner to administer medication based on the provided scale, rather than requiring the calculation or determination of a dose in fixed units of volume, such as milliliters, cubic centimeters, etc. For example, U.S. Pat. No. 9,566,388 to Jones provides a plunger for a syringe having disposed thereon a scale in units of a patient&#39;s weight. WO 2016/176523 discloses a transparent sleeve that is mountable to a standard syringe with the sleeve having thereon scales related to weight and other patient characteristics. 
     SUMMARY OF THE INVENTION 
     A syringe is provided herein for injecting medication into a patient, the syringe including a tubular barrel having opposing inner and outer surfaces, an open proximal end, and a distal end having a wall extending thereacross. An opening is defined in the wall with a needle mount extending distally from the wall about the opening. A first panel extends radially outwardly from the outer surface of the barrel, the first panel having opposing first and second faces. Further, a first scale including a series of spaced-apart first graduations is disposed on the first face of the first panel. Advantageously, with the subject invention, a syringe may be provided having a planar portion, in addition to its barrel, with graduations marked thereon for improved viewing by a practitioner in determining a proper dose amount. 
     As used herein, the term “proximal”, and derivatives thereof, refers to a direction away from a patient. In addition, as used herein, the term “distal”, and derivatives thereof, refers to a direction towards a patient. 
     These and other features of the invention will be better understood through a study of the following detailed description and accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1-7  depict an embodiment of a syringe with a first panel formed in accordance with the subject invention; and, 
         FIGS. 8-13  depict an embodiment of a syringe with first and second panels formed in accordance with the subject invention. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     With reference to the Figures, a syringe  10  is shown and generally designated with the reference numeral  10 . The syringe  10  generally includes a tubular barrel  12  and a first panel  14 , with a first scale  16  being disposed on the first panel  14 . With this embodiment, and with the various additional embodiments described herein, the scale may be provided on a panel having a planar surface or a curved surface. In preferred embodiments, the scale is provided on a panel having a planar surface for improved viewing by a practitioner. The syringe  10  is for injection of a medication into a patient. As used herein, a “medication” refers to any injectable liquid having one or more active pharmaceutical and/or biological ingredients. 
     The syringe  10  may be configured and dimensioned as any syringe. The syringe  10  is particularly well-suited to serve as a plastic, disposable syringe, with the barrel  12  being formed of thermoplastic. The barrel  12  and the first panel  14  may be unitarily formed using any technique such as injection molding. The syringe  10  may be used to aspirate a medication from a vial or other drug container in an amount as needed, with the syringe  10  being subsequently used to administer an injection of medication. The barrel  12  acts as a reservoir for the medication. 
     The barrel  12  includes opposing inner and outer surfaces  18 ,  20 . Proximal end  22  of the barrel  12  is open while distal end  24  of the barrel  12  includes wall  26  extending thereacross. An opening  28  is provided in the wall  28  through which medication may be delivered. Needle mount  30  is provided extending distally from the wall  26  about the opening  28 . The needle mount  30  may be any needle mount useable for securement of a needle for injection, including a luer tip  30 A mount, optionally, in combination with threaded mount  30 B, such as in a luer lock configuration. The needle mount  30  may be used with any needle assembly  32  having a needle  34 , with a lumen  36  and a sharpened distal tip  38  for insertion into a patient. The needle assembly  32  includes a hub  40  for cooperatively mounting onto the needle mount  30  such that a liquid passageway  42  is defined from the opening  28  and through the lumen  36  to the distal tip  38  with the needle assembly  32  mounted onto the needle mount  30 . The hub  40  may include a luer tip mount and threads, as necessary, to cooperatively engage the needle mount  30 . 
     As known in the art, the inner surface  18  of the barrel  12  may be coated with a lubricant or other substance, e.g., for compatibility with the medication. In addition, the wall  26  may be provided as funnel-shaped configured to direct flow towards the opening  28 . 
     A flange  44  may be provided on the outer surface  20  of the barrel  12  about the proximal end  22 . The flange  44  may include first and second flange portions  46 ,  48  which protrude in opposite directions. As appreciated by those skilled in the art, the first and second flange portions  46 ,  48  may be shaped and sized to be pressingly engaged by a user&#39;s index and middle fingers, respectively, during an injection. A plunger  50  may be provided sized to pass through the proximal end  22  and into the barrel  12 . The plunger  50  includes a plunger piston  52  at a distal end  54  thereof. The plunger piston  52  is preferably elastomeric and configured to sealingly engage the inner surface  18  of the barrel  12  with sliding movement relative thereto for aspirating into, and urging from, the barrel  12  medication via the opening  28  as a result of proximal or distal advancement of the plunger piston  52  within the barrel  12 . A thumb pad  57  may be provided at a proximal end  59  of the plunger  50 . 
     With reference to  FIGS. 1-5 , the first panel  14  may be provided to extend radially outwardly from the outer surface  20  of the barrel  12 . The first panel  14  includes opposing first and second faces  56 ,  58 . Preferably, the first panel  14  is generally plate-shaped with the first and second faces  56 ,  58  being generally parallel. 
     The first panel  14  may include a plurality of edges  60  extending between the first and second faces  56 ,  58 . A first edge  60 A may face proximally, with a second edge  60 B facing distally. A third edge  60 C may extend between the first and second edges  60 A,  60 B. The first edge  60 A is preferably spaced distally from the flange  44  to define a space therebetween. Preferably, the space is sufficient to accommodate a user&#39;s index or middle finger during use. 
     It is preferred that the syringe  10  overall be provided with a profile which allows for disposal in a standard sharps container (i.e., biohazard container for used syringes). As such, it is preferred that the first panel  14  be limited in radial extent from the barrel  12 . This radial extent may be characterized relative to the size of the flange  44 . In particular, as shown in  FIG. 8 , the third edge  60 C may be located maximally at a first distance D 1  from the outer surface  20  of the barrel  12  with the first flange portion  46  extending maximally a second distance D 2  from the outer surface of the barrel  12 . The first distance D 1  is preferably in the range of 80%-150% of the second distance D 2 . It is also preferred that the first panel  14  be radially aligned with the first flange portion  46 . 
     The first scale  16  is disposed on the first panel  14 , particularly, on the first face  56  thereof, as shown in  FIG. 1 . The first scale  16  includes a series of first graduations  62 , spaced at intervals which may be regular or irregular. The first graduations  62  are generally perpendicular to the barrel  12 . As shown in  FIG. 2 , the first graduations  62  preferably extend uninterruptedly onto the barrel  12  particularly to extend about a portion, possibly about the entirety, of the circumference thereof, e.g., along the outer surface  20 . The barrel  12  is preferably transparent or sufficiently translucent to allow for a user to see the plunger piston  52  therewithin. As shown in  FIG. 13 , this arrangement allows for a user to visually align the piston plunger  52  with the first graduations  62  to aspirate a target amount into the barrel  12  for dosing and/or administer a target dose from the barrel  12 . With the first graduations  62  being presented on at least the first panel  14 , more precise alignment between the piston plunger  52  and a targeted first graduation  62  may be achieved. 
     Indicia  64  may be provided with the first scale  16  to assign numerical values to some or all of the first graduations  62 . This allows for a user to identify amounts. The indicia  64  may be arranged to increase in value in a proximal direction so that the first scale  16  increases in magnitude in a proximal direction. 
     The first scale  16  may be presented based on one or more physiological parameters related to the medication and/or the patient intended for injection. The physiological parameters may be selected on the basis of one or more of: age of a patient, gender of a patient, actual weight of a patient, ideal weight of a patient, body surface area of a patient, indication to be treated, severity of a patient&#39;s condition, level of impairment of a patient&#39;s one or more organs, concentration of the medication being administered, patient&#39;s resistance (or tolerance) to a medication, pharmacokinetics of a medication, and allometrically scaled dosing of a medication. The first scale  16  may have the first graduations  62  spaced at intervals based on the physiological parameter(s) with the indicia  64  presenting associated values. For example, the first graduations  62  may be spaced apart for a particular medication at intervals corresponding to target amounts based on a patient&#39;s weight, with the indicia  64  presenting different possible weights (in any units, such as pounds, kilograms, and so forth). 
     As shown in  FIGS. 8-13 , a second panel  114  may be provided with the syringe  10  which includes the same characteristics as the first panel  14 . The numbering from the first panel  14  has been applied to the second panel  114 , but with the addition of 100 and the modifier “second” or “secondary”, so that reference number  14  (first panel) corresponds to reference number  114  (second panel) and so forth. Unless noted otherwise, all elements for the second panel  114  are the same as in the first panel  14 , with the configuration, dimensioning and spacing of the elements in the first panel  14  applying equally to the elements of the second panel  114 . 
     The second panel  114 , as best shown in  FIG. 10 , is preferably aligned so that the first face  56  and the first secondary face  156  both face generally in the same direction. The second panel  114  may extend from the outer surface  20  of the barrel  12  in a diametrically opposing direction from the first panel  14 . The second panel  114  may be distally spaced from the flange  44  at the same, or a different, distance as the first panel  14  is spaced from the flange  44 . It is preferred that the second panel  114  be sufficiently spaced from the flange  44  to accommodate a user&#39;s index or middle finger during use. Also, the second panel  114  includes the secondary third edge  160 C which may be located maximally at a first distance D 1  from the outer surface  20  of the barrel  12  with the second flange portion  48  extending maximally a second distance D 2  from the outer surface of the barrel  12 . The first distance D 1  is preferably in the range of 80%-150% of the second distance D 2 . It is also preferred that the first panel  14  be radially aligned with the first flange portion  46 . The first distance D 1  for the third edge  60 C may be the same as or different from the first distance D 1  for the secondary third edge  160 C. 
     The second scale  116  may be disposed on the second panel  114 , particularly, on the first secondary face  156  ( FIG. 12 ). The second scale  116  may be based on one or more of the physiological parameters related to the medication and/or the patient intended for injection as discussed above in connection with the first scale  16 . The second graduations  162  preferably extend interruptedly onto the barrel  12  particularly to extend about a portion of the circumference thereof, e.g., along the outer surface  20 , as shown in  FIG. 8 . The first graduations  62  may extend to, and possibly onto, the second panel  114 . In addition, the second graduations  162  may extend to, and possibly onto, the first panel  14 . 
     The first and second scales,  16 ,  116  may be provided to be complementary, e.g., with the first and second graduations  62 ,  162  and the first and second indicia  64 ,  164  defining a combined, single scale, as shown in  FIG. 8 . Alternatively, the first and second scales  16 ,  116  may be provided as different scales with different intervals between the graduations to allow for multiple uses of the syringe  10 , as shown in  FIG. 13 . For example, the first scale  16  may be established to represent dosing of a medication based on a patient&#39;s weight, whereas, the second scale  116  may be established to represent dosing of a medication based on a patient&#39;s body surface area. The same or different medications may be used. 
     The first and second graduations  62 ,  162  may be provided in part or in whole in different colors, and/or stylizations (shape, presentation) to be distinguishable on or near the barrel  12 . Headers or other explanatory indicia  66  may be provided to indicate what each scale represents. In addition, either or both of the second face  58  and/or the second secondary face  158  may be utilized in combination with either or both of the first face  56  and/or the first secondary face  156 . This allows for additional scales to be used, e.g., four different scales, one on each face of each panel. In addition, the first face  56  and the first secondary face  156  may have complementary scales, while the second face  58  and the second secondary face  158  also have complementary scales. This allows for a user to flip the syringe  10  to a particular orientation depending on the target dosing. 
     As will be appreciated by those skilled in the art, although the subject invention is discussed and shown with one or two panels, it is to be understood that additional panels may be used at various radial spacing about the barrel  12 . 
     As indicated above, one or more scales (e.g., the first and/or second scales  16 ,  116 ) may be based on one or more physiological parameters related to the medication and/or the patient intended for injection. The following presents non-limiting examples of drugs and physiological parameters which may be used in determining the one or more scales. As also indicated above, where additional panels are used at various radial spacing about the barrel  12 , additional scales may be shown on each face of each such panel. Each of the examples below can be configured according to any of the above described embodiments and configurations of syringe  10 , as will be appreciated by those of ordinary skill in the art. 
     Example 1: Differentiating Dose Markings by Indication 
     In some cases, a particular medication formulated for injection can be administered for two or more different indications, each at different dosing regimens depending upon the indication being treated. Non-limiting examples of such medications include antibiotics, chemotherapeutic agents, aspirin, and sugammadex. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments, wherein the syringe comprises two or more panels, wherein each side of each panel is labeled with an independently selected indication and further comprises a scale, graduations, and indicia corresponding to the dose regimen appropriate to the indication. In one such embodiment, both sides of each panel may be labeled for the same indication. In another such embodiment, each side of each panel is labeled for a different independently selected indication. 
     By way of further illustration, the drug sugammadex is approved for two indications: for the reversal of deep neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults and for the reversal of moderate neuromuscular blockade induced by rocuronium bromide and vecuronium bromide in adults. US FDA Prescribing Information, BRIDION® (sugammadex) Injection, for intravenous use Initial U.S. Approval: 2015. The approved label instructs the relevant heath care worker (e.g., anesthesiologists) to select one of two dosing scales based on the level of a patient&#39;s neuromuscular block (2 mg/mL vs 4 mg/mL) at the time of administration. Accordingly, in a non-limiting illustration of this embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments, wherein the syringe comprises first and second panels  14 ,  114  which include two different (separate) dosing scales labeled as “deep neuromuscular block” and “moderate neuromuscular block”, respectively. The first and second scales  16 ,  116 , are each independently marked with the appropriate graduations  62 ,  162 , and with the appropriate indicia  64 ,  164 , to represent the proper dose as a function of patient weight and the indication for which the drug is to be administered. In use, the attending health care worker selects the panel of the syringe based on the patient&#39;s indication (deep (4 mg/mL) or moderate (2 mg/mL) neuromuscular block) at the end of a surgery. The user fills the syringe based on the patient&#39;s weight, using the first or second graduations  62 ,  162  that display the appropriate dose for the chosen indication. 
     Example 2: Differentiating Dose Markings for Adult and Pediatric Use 
     In some cases, a particular medication formulated for injection will be administered for two or more patient populations, each at different doses depending upon the patient type to which the drug is administered. For example, a particular drug may be administered to adult and pediatric patients, each at different dose rates. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments, wherein the syringe comprises a first panel  14  labeled for adult use, which first panel  14  is marked with a first scale  16  having the appropriate graduations  62  and the appropriate indicia  64  for adult dosing of the drug; and further comprising a second panel  114  labeled for pediatric use, which second panel  114  is marked with a second scale  116  having the appropriate graduations  162  and the appropriate indicia  164  for pediatric administration of the drug. In each panel the appropriate units of measure based on patient weight (e.g., km, mL) or patient surface area (e.g., m 2 ) are indicated in the respective scale. The two (or more) panels may optionally be differentiated in any suitable way, including but not limited to labeling, color, branding, and the like. 
     By way of further illustration, the drug PEGINTRON® (peginterferon alfa-2b) injection is an antiviral medication administered by injection and indicated for the treatment of Chronic Hepatitis C (CHC) in patients with compensated liver disease. US FDA Prescribing Information, PEGINTRON® (peginterferon alfa-2b) injection U.S. Approval: 2001. According to its approved US label, peginterferon alfa-2b injection is approved for use in adult and pediatric patients. Accordingly, in a non-limiting illustration of this embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments, wherein the syringe  10  comprises a first panel  14  labeled for adult use, which first panel  14  is marked with a first scale  16  having the appropriate graduations  62  and the appropriate indicia  64  for adult administration of (peginterferon alfa-2b) injection once weekly and wherein the adult dose rate is displayed in terms of patient weight (e.g., 1.5 micrograms drug per kg patient weight); and further comprising a second panel  114  labeled for pediatric use, which second panel  114  is marked with a second scale  116  having the appropriate graduations  162  and the appropriate indicia  164  for pediatric administration of (peginterferon alfa-2b) injection and wherein the pediatric dose rate is displayed in terms of patient body surface area (e.g., 60 micrograms of drug per m 2  of patient). In each panel the appropriate units of measure based on patient weight (e.g., km, mL) or patient surface area (e.g., m 2 ) are indicated in the respective scale. The two (or more) panels may be arranged in any configuration described herein and may further and optionally be marked for easy identification and differentiation in any suitable way, including but not limited to labeling and color. 
     In a related embodiment, and by way of further illustration, certain pediatric medications are dosed according to the body surface area (BSA) of the pediatric patient. In such embodiments, the scale of the syringe  10  according to the invention and comprising at least one panel wherein at least one side of the at least one panel comprises a scale wherein the gradations and indicia are spaced in accordance with the approved dose rate as a function of surface area of the pediatric patient group to whom it is to be administered. In such embodiments, the BSA may be calculated by using the patient&#39;s weight and height using one of the following formulas (or other similar formulas): 
     
       
         
           
             
               
                 ( 
                 1 
                 ) 
               
                
               
                   
               
                
               BSA 
             
             = 
             
               
                 
                   
                     Body 
                      
                     
                         
                     
                      
                     Weight 
                      
                     
                         
                     
                      
                     
                       ( 
                       kg 
                       ) 
                     
                     * 
                     Height 
                      
                     
                         
                     
                      
                     
                       ( 
                       cm 
                       ) 
                     
                   
                   3600 
                 
               
                
               
                   
               
                
               
                 ( 
                 
                   Mosteller 
                    
                   
                       
                   
                    
                   Formula 
                 
                 ) 
               
             
           
         
       
       
         
           
             
               
                 ( 
                 2 
                 ) 
               
                
               
                   
               
                
               BSA 
             
             = 
             
               
                 ( 
                 
                   
                     W 
                     0.425 
                   
                   × 
                   
                     H 
                     0.725 
                   
                 
                 ) 
               
               × 
               0.007184 
                
               
                   
               
                
               
                 ( 
                 
                   
                     Du 
                      
                     
                         
                     
                      
                     Bois 
                   
                   , 
                   
                     Du 
                      
                     
                         
                     
                      
                     Bois 
                      
                     
                         
                     
                      
                     Formula 
                   
                 
                 ) 
               
             
           
         
       
     
     In such embodiments, doses are displayed on the panel in terms of surface area (e.g., square meters, square feet, etc.) on the syringe  10 . By way of further illustration, the drug 
     Example 3: Differentiating Dose Markings for Patient Age or Weight 
     The Center for Drug Evaluation and Research generally divides the pediatric population into the following groups: Neonates: birth up to 1 month; Infants: 1 month up to 2 years; Children: 2 up to 12 years; and Adolescents: 12 years up to 16 years. In such populations, dose is not necessarily linearly correlated with patient age or body weight; thus, medications indicated for these patient populations are administered at different dose rates depending on the patient group. Non-limiting examples of medications having different adult and pediatric dose rates are shown in the table below. 
     
       
         
           
               
               
               
               
             
               
                   
               
               
                   
                 Therapeutic 
                   
                 Pediatric 
               
               
                 Drug 
                 Indication 
                 Adult Dose 
                 Dose 
               
               
                   
               
             
            
               
                 Chloramphenicol 
                 Bacterial 
                 50 mg 
                 50 mg 
               
               
                   
                 infection 
                 kg −1  day −1   
                 kg −1  day −1   
               
               
                   
                   
                   
                 neonates: 25 
               
               
                   
                   
                   
                 mg kg −1  day −1   
               
               
                 Carbamazepine 
                 Epilepsy 
                 5-8 mg 
                 &gt;12 years:  
               
               
                   
                   
                 kg −1  every 
                 5-8 mg kg −1    
               
               
                   
                   
                 12 h 
                 every 12 h 
               
               
                   
                   
                   
                 Children:  
               
               
                   
                   
                   
                 3-10 mg 
               
               
                   
                   
                   
                 kg −1  every 8 h 
               
               
                   
                   
                   
                 Infants: 3-10 
               
               
                   
                   
                   
                 mg kg −1  every 
               
               
                   
                   
                   
                 8 h 
               
               
                 Phenytoin 
                 Epilepsy 
                 2 mg 
                 Children: 2.3- 
               
               
                   
                   
                 kg −1  every 
                 2.6 mg −1  kg 
               
               
                   
                   
                 12 h 
                 every 8 h 
               
               
                   
                   
                   
                 Infants: 2.3 
               
               
                   
                   
                   
                 mg kg −1    
               
               
                   
                   
                   
                 every 8 h 
               
               
                   
                   
                   
                 Neonates: 
               
               
                   
                   
                   
                 2.5-4.0 mg 
               
               
                   
                   
                   
                 kg −1  every 12 h 
               
               
                 Propofol 
                 Anaesthesia 
                 &lt;55 years: 
                 2 months-16 
               
               
                   
                   
                 6-12 mg 
                 years: 7.5-18 
               
               
                   
                   
                 kg −1  h −1   
                 mg kg −1  h −1   
               
               
                   
                   
                 &gt;55 years: 
                   
               
               
                   
                   
                 3-6 mg 
                   
               
               
                   
                   
                 kg−1 h−1 
                   
               
               
                 Busulfan 
                 Cancer 
                 0.8 mg 
                 ≤12 kg: 1.1 
               
               
                   
                   
                 kg −1  every  
                 mg kg −1    
               
               
                   
                   
                 6 h 
                 every 6 h 
               
               
                   
                   
                   
                 &gt;12 kg: 0.8 
               
               
                   
                   
                   
                 mg kg −1  every 
               
               
                   
                   
                   
                 6 h 
               
               
                 Tobramycin 
                 Bacterial 
                 3 mg 
                 Children:  
               
               
                   
                 infection 
                 kg −1  day −1   
                 6-7.5 mg 
               
               
                   
                   
                   
                 kg −1  day −1   
               
               
                   
                   
                   
                 &lt;2 weeks: 4 
               
               
                   
                   
                   
                 mg kg −1  day −1   
               
               
                   
                   
                   
                 With cystic 
               
               
                   
                   
                   
                 fibrosis: 10 
               
               
                   
                   
                   
                 mg kg −1  day −1   
               
               
                   
               
            
           
         
       
     
     Thus, in another alternative of the above embodiments, there is provided a syringe  10  in accordance with any of the above described embodiments comprising two or more panels, wherein each panel (or each side of each panel) is marked with a scale having the appropriate graduations and the appropriate indicia for at least one or more of neonatal administration, infant administration, children administration, and adolescent administration of a drug, wherein, in each panel the appropriate units of measure based on patient weight (e.g., km, mL) or patient surface area (e.g., m 2 ) or other chosen parameter are indicated in the respective scale. The two (or more) panels may be arranged in any configuration described herein and may further and optionally be marked for easy identification and differentiation in any suitable way, including but not limited to labeling and color. By way of further non-limiting illustration, if a particular medication has a different dose rate for children and for adolescents, the dose rate for children could appear on one side of a panel and the rate for adolescents could appear on the other. 
     Example 4: Differentiating Dose Markings for Normal and Impaired Organ Function 
     For some drugs, lower dose rates are indicated for individuals with impaired organ function, such as, kidney or liver function. This generally occurs when a medication or its metabolites depend on the kidney or liver for excretion and may add additional burden to the organ. Non-limiting examples of medications for which different dosing is required depending on the state of renal impairment include ACE inhibitors (e.g., Benazepril (Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Zestril), Quinapril (Accupril), Ramipril (Altace)); Beta blockers (e.g., Acebutolol (Sectral), Atenolol (Tenormin), Bisoprolol (Zeberta), Nadolol (Corgard)); and Diuretics (e.g., Amiloride (Midamor), Burnetanide (Bumex), Furosemide (Lasix), Metolazone Zaroxolyn), Spironolactone (Aldactone), Thiasidesil, Torsemide (Demadex), and Triaamterene (Dyresium)). Munar &amp; Sing, American Family Physician, vo. 75, no. 10, 2007. Kidney function is generally assessed based on creatinine clearance measurements in a blood test. Typically, dose rates are differentiated for individuals with creatinine clearance of &lt;50 mL/min, but other thresholds may apply. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments comprising at least one panel  14  having a scale  16  and graduations  62  and indicia  64  each suitable to indicate the dose rate for the selected drug in non-organ impaired patients, and at least one additional panel having a scale, graduations and indicia indicating the dose rate for selected organ impaired patients. The scales for “normal” and impaired dose may each be displayed on different panels of the syringe  10 , or on opposing sides of the same panels, respectively. As will be readily appreciated by those of ordinary skill in the art, the respective scales will be displayed in units appropriate to the medication (e.g., kg, mL, m 2 ). 
     Example 5: Differentiating Dose Markings for Multiple Medication Concentrations 
     Some medications come in multiple strengths and concentrations for different indications. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments comprising one or more panels, wherein each panel is marked with a scale having the appropriate graduations and indicia for dosing the selected drug in accordance with the strength or concentration. The syringe according to the invention may advantageously be used to reduce or prevent dosing error, with the dose rates corresponding to each medication concentration being displayed on each panel of the syringe  10 . By way of further non-limiting example, the drug PEGINTRON® (peginterferon alfa-2b) for injection discussed above is available in multiple concentrations, e.g.: 50 mcg per 0.5 mL, 80 mcg per 0.5 mL, 120 mcg per 0.5 mL, 150 mcg per 0.5 mL in single-use vials (with 1.25 mL diluent). In one such embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments comprising one or more panels comprising two or more scales for each of two or more such concentrations displayed thereon. In variations of such embodiments, the different scales are displayed on the same or different panel(s) as described herein. 
     Example 6: Differentiating Dose Markings for Initial and Increased Dose Rate Due to Drug Resistance or Tolerance 
     Some medications may have two or more dose rates: one for new-users, and a higher one for users who have developed resistance or tolerance to the medication over time. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments comprising one or more panels wherein the dosing rate for the initial use is shown on at least one panel having a scale, gradations, and indicia indicative of the appropriate dose for initial use, and further comprising at least one additional scale, wherein the at least one additional scale is shown in the opposite side of the first panel or on the side of one or more additional panels each having a scale, gradations, and indicia indicative of the appropriate dose for subsequent use. By way of further illustration, the drug RENFLEXIS™ (infliximab-abda) for injection is a TNF alpha inhibitor indicated for the treatment of Chrone&#39;s disease, pediatric chrone&#39;s disease, ulcerative cholitis, rheumatoid arthritis, and other related indications. Renflexis™ is initially dosed at either 3 mg/kg or 5 mg/kg, depending on the indication. However, higher subsequent doses are indicated in some patients over time. In such patients, the dose can be increased to 10 mg/kg. In such embodiments, there is provided a syringe  10  in accordance with any of the above described embodiments comprising two or more scales, wherein a first such scale comprises the gradations and indicia indicative of the dose rate for patients who have not developed drug resistance or tolerance, and wherein the second scale comprises the gradations and indicia indicative of the dose rate for patients for whom higher approved doses are indicated. 
     Example 7: Differentiating Dose Markings for Actual and Lean Body Weight 
     In some drugs, doses are prescribed or indicated as a function of a patient&#39;s body weight. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments comprising at least one panel  14 , wherein said at least one panel comprises a scale having the appropriate gradations and indicia dosed according to patient body weight. Such body weight may be expressed as actual body weight or lean body weight in accordance with the prescribing information. By way of further illustration, the drug sugammadex, discussed above, is administered as a one-time injection at a dose of either 2 mg/kg or 4 mg/kg of patient weight, and the medication is dispensed in 100 mg/mL concentrations. In such embodiments, the syringe  10  comprising at least one panel  14  is configured with the appropriate scale, gradations and indicia to display medication volume in terms of patient weight, such that the following dosing scales (e.g., in kg) are displayed on the face of either of two panels of the syringe  10 : 
     
       
         
           
               
               
               
               
             
               
                   
                   
               
               
                   
                   
                 First Panel  
                 Second Panel  
               
               
                   
                   
                 14 (First  
                 114 (Second  
               
               
                   
                   
                 scale 16) 
                 scale 116) 
               
               
                   
                 Volume 
                 (2 mg/kg) 
                 (4 mg/kg) 
               
               
                   
                   
               
             
            
               
                   
                 0.8 mL 
                  40 kg 
                   
               
               
                   
                 1.0 mL 
                  50 kg 
                   
               
               
                   
                 1.2 mL 
                  60 kg 
                   
               
               
                   
                 1.4 mL 
                  70 kg 
                   
               
               
                   
                 1.6 mL 
                  80 kg 
                 40 kg 
               
               
                   
                 1.8 mL 
                  90 kg 
                   
               
               
                   
                 2.0 mL 
                 100 kg 
                 50 kg 
               
               
                   
                 2.2 mL 
                 110 kg 
                   
               
               
                   
                 2.4 mL 
                 120 kg 
                 60 kg 
               
               
                   
                 2.6 mL 
                 130 kg 
                   
               
               
                   
                 2.8 mL 
                   
                 70 kg 
               
               
                   
                 3.0 mL 
                   
                   
               
               
                   
                 3.2 mL 
                   
                 80 kg 
               
               
                   
                 Etc. 
               
               
                   
                   
               
            
           
         
       
     
     Example 8: Differentiating Dose Markings in Terms of Patient Ideal Weight 
     In a related embodiment, “ideal weight,” rather than the actual weight of the patient, is used to calculate an appropriate dose in overweight and obese patients, particularly in instances where the administered drug is not fat soluble. In such cases, dosing by body weight alone would cause an overdose of overweight and obese patients, because the drug would distribute in the non-fatty regions of the body at supra-therapeutic concentrations. Thus, in another embodiment, the patient “ideal weight” may be displayed on the syringe  10  in addition to, or instead of, real body weight. Non-limiting examples of drugs dosed according to patient ideal weight include Acyclovir, Amikacin, Atracurium, Colistin, Dalteparin, Daptomycin, Digoxin, Dobutamine, Dopamine, Enoxaparin, Epinephrine, Fondaparinux, Gentamicin, Heparin (unfractionated), Immunoglobulin (IVIG), Levothyroxine, Linezolid, Lorazepam, Methylprednisolone, Midazolam, Norepinephrine, Oseltamivir, Phenytoin, Propofol, Rasburicase, Remifentanil, Rocuronium, Succinylcholine, Tigecycline, Tinzaparin, Tobramycin, Vancomycin, Vecuronium, Voriconazole and Warfarin. 
     Example 9: Differentiating Dose Markings to Display Minimum and Maximum Dose 
     Some medications have minimal effective doses, and all medications have maximum doses that can be administered without a toxic effect. Thus, in another embodiment, there is provided a syringe  10  in accordance with any of the above described embodiments comprising at least one panel  14 , wherein said at least one panel comprises a scale having the appropriate gradations and indicia that displays the minimum dose together with the variable-dependent dosing scale. In another such embodiment, the scale displays the maximum dose together with the variable-dependent dosing scale, and in another such embodiment, the scale displays the minimum and maximum dose together with the variable-dependent dosing scale. Such embodiments may advantageously make minimum and/or maximum dosing limits more obvious to the person administering the medication. 
     By way of further illustration, the drug haloperidol decanoate is approved for injection for the long term treatment of certain mental and mood disorders such as schizophrenia. According to approved labels, the maximum volume of haloperidol decanoate per injection should not exceed 3 mL, and the maximum dose per injection should not exceed 100 mg. Thus, in such embodiments, either the maximum volume or the maximum dose (or both) may be displayed on at least one side of a panel  14  of the syringe  10  according to the invention. 
     Example 10: Differentiating Dose Markings to Display Dosing Scale for Drugs Exhibiting Non-Linear Pharmacokinetics 
     Typically, blood concentrations of medications are assumed to follow a nearly-linear dependence on dose. However, a concentration/dose relationship can become non-linear when the medication&#39;s bioavailability, fraction of unbound drug in the blood, and clearance rate change based on the medication&#39;s blood concentration. When a drug exhibits non-linear pharmacokinetics, these parameters are usually dependent on the reaction rates of steps in the drug metabolism process. If a reaction has a maximum rate, or if a critical enzyme becomes saturated, drug may accumulate in the blood stream at a higher rate at higher drug doses. In such cases, administering increasing volumes of medication may require a relatively higher or lower dose rate than the original rate to achieve or maintain a drug&#39;s effect or desired blood concentration. Drugs are typically not dosed this way because appropriate doses are difficult to predict and calculate. A syringe  10  according to this embodiment may advantageously reduce the error rate or increase the convenience of such dosing. Thus, in another embodiment, there is provided a syringe  10  according to the invention comprising at least one panel  14 , wherein said at least one panel comprises a scale having the appropriate graduations and indicia showing the calculated increased (or decreased) dose in terms of weight or another appropriate unit. 
     Erythropoietin is a drug or class of drugs used by injection for the treatment of various indications including anemia. Erythropoietin has been shown to be eliminated from the body through a series of non-linear pathways. Veng-Pedersen et al., J Pharm Sci. 1995 June; 84(6):760-7. In this study, clearance was shown to decrease significantly (and therefore accumulation and medication exposure increased significantly and non-linearly) at doses of 100 and 500 U/kg compared to 10 U/kg. This non-linearity occurs once blood concentration exceeds the concentration required to saturate the drug&#39;s metabolic pathways. Thus, in another embodiment, there is provided a syringe  10  according to the invention comprising at least one panel, said panel having a scale with gradations and indicia suitable to display decreasing marginal volume per unit weight at dosages above the saturation threshold to account for decreasing amount of medication needed to achieve an additional medicinal effect. 
     Example 11: Differentiating Dose Markings to Display Pediatric Dose Based on Allometric Scaling 
     While most pediatric doses for drugs are calculated by linearly scaling adult doses down to pediatric ranges (the scaling ratio is usually calculated either by body weight or body surface area, e.g., as described above), this method may lack desired accuracy, as differences in metabolic capacity do not always scale linearly with body size or weight, and may either under- or over-dose pediatric patients. Several studies have shown this method to more accurately predictor drug clearance and drug metabolism than conventional models in a variety of medications, including morphine, fentanyl, and remifentanil. Cella M, et al., Br J Clin Pharmacol, 2010. Mahmood, I., Ther Drug Monit. 2007; 29:271-8. Mahmood, I., Br J Clin Pharmacol. 2006; 61:545-57. Anderson B J, et al., Annu. Rev. Pharmacol. Toxicol. 2008; 48:303-32. The allometric exponent can either be assumed constant, or can be calculated on a per-drug basis. Allometric scaling is an alternative to linear dosing which has been shown to be the most accurate dosing method in many examples. Allometric scaling follows the following relationship: 
     
       
         
           
             
               P 
               
                 c 
                  
                 h 
                  
                 i 
                  
                 l 
                  
                 d 
               
             
             = 
             
               
                 
                   P 
                   adults 
                 
                  
                 
                   ( 
                   
                     
                       W 
                        
                       T 
                     
                     
                       7 
                        
                       0 
                     
                   
                   ) 
                 
               
               x 
             
           
         
       
     
     where P is the parameter of interest (e.g., drug clearance or dose, WT is the bodyweight of the individual child and x is the allometric exponent. Allometric scaling has not gained widespread acceptance as standard practice due to continued debate as to modeling best practices. Further, even where allometric scaling is desired for use, difficulties in performing the appropriate dose for a given drug can impede its use at the point of use. Where allometric scaling is desired, a syringe according to the invention can advantageously reduce the impediments to use related to difficulties of calculation by including the allometric dose scaling for the particular drug on the panel of the syring. Thus, in another embodiment, there is provided a syringe  10  according to the invention comprising at least one panel, wherein said at least one panel comprises a scale having the gradations and indicia displayed for allometric dosing. Such doses may be displayed in the appropriate units (e.g., kg, m 2 , etc.).