1. Protecting those who protect us
Meridian Medical Technologies
a King Pharmaceuticals, Inc. Company

2. Meridian Medical Technologies
Meridian Medical Technologies, in business since 1958, was acquired on January 8, 2003 by King Pharmaceuticals, Inc.
Headquarters located in Bristol, Tennessee

3. Meridian’s Manufacturing Facilities
Missouri, USA
Manufacture auto-injectors
Meet current Good Manufacturing Practices Guidelines of the U.S. Food & Drug Administration
Aseptic filling, drug formulation
Meet United Kingdom’s MHRA guidelines
Meet German BfArM guidelines

4. Meridian’s Business Groups
Pharmaceutical Systems
Government Systems
Military and Homeland Security
Auto-Injectors
Drug formulation development
Specialty Pharmaceuticals
EpiPen

5. Meridian’s Experience
Development and production of automatic injector products for military and first responders use in the defense against chemical warfare
Ability to apply injector technology to non-military medical problems
Supplied more than million auto-injectors for emergency use

6. Meridian’s Capabilities
Pharmaceutical development laboratory, product formulation, process development
Cleaning and preparation capability for assembly in aseptic production environment
Product formulation consistent with product processing requirements
Clean room and product filling operations
New Class100 filling suite for sterile product manufacturing

7. Chemical Agent Threat
Many countries engage in production of nerve agents
Most can deliver agents via ballistic missiles, aircraft, artillery, bombs
More than 20 terrorist organizations exist worldwide
Chemical terrorism against civilians became a reality in 1995 (Tokyo subway incident)

8. Chemical Warfare Agents
Extremely potent organophosphorous compounds
More widely know agents: tabun (GA), sarin (GB), soman (GD), GF and VX
Colourless, odorless liquids
Penetrate skin and normal clothing
Can be absorbed through lungs

9. Chemical Warfare Agents (continued)
Depending on exposure, symptoms include:
Watering eyes, unexplained runny nose
Pinpointed pupils of the eye resulting in blurred vision
Tightness in chest, difficulty breathing
Drooling, excessive sweating, nausea, vomiting and abdominal cramps
Involuntary urination and defecation, jerking, twitching and staggering
Headache, drowsiness, coma, convulsions, and stoppage of breathing
Treat immediately with antidotes:
Atropine followed by oxime

10. Meridian’s Medical Readiness Support
Pre-stocking of auto-injector components
Pre-stocking of medications
Scheduled product delivery
Maintaining a constant production base

11. Advantages of Meridian’s Services
Experienced and reliable producer of drug delivery systems
Stock filled only as needed
Pre-planned manufacturing schedule
Access to scarce medications

12. Medications in Meridian’s Auto-Injector Delivery Systems
Atropine
Pralidoxime chloride
Obidoxime chloride and atropine sulphate
Diazepam
Morphine
Avisafone, atropine sulphate, pralidoxime methane sulphonate
HI-6
Other injectable medications possible

13. Meridian’s Auto-Injectors
Auto-injectors are designed for use by military personnel under combat conditions for the self-administration of medication, and by civilian emergency response teams to treat mass casualties
AtroPen®
Delivers: 2mg atropine sulfate equivalent in 0.7mL
Pralidoxime Chloride ComboPen®
Delivers: 600mg pralidoxime chloride in 2mL
ATOXTM ComboPen®
Delivers: 220mg obidoxime chloride plus 2mg atropine sulfate in 2mL

14. Meridian’s Auto-Injectors
Autoject ComboPen® Nerve Agent Antidote (L4A1)
Delivers: 10 mg avisafone/ 2mg atropine sulfate/ 500 mg pralidoxime methane sulphonate in 2mL
Diazepam Auto-Injector C-IV
Delivers: 10mg diazepam in 2mL
Morphine C-II
Delivers: 10mg morphine sulfate in 1mL
Trainers
AtroPen Trainer, ComboPen Trainer

15. New Product Introduction: Multichambered Auto-injector
A two chambered auto-injector
Nose pressure activated
Delivers the solutions sequentially through a single needle
A choice of oxime in the rear chamber will be available along with atropine in the front chamber
Pralidoxime chloride
Obidoxime chloride

16. New Product Introduction: ATNAA Multichambered Auto-injector
A two chambered auto-injector (ATNAA) [NSN ]
Delivers: 2mg atropine sulfate equivalent and 600 mg pralidoxime chloride in 2.2mL sequentially through a single needle
Intended to replace the Mark I Nerve Agent Antidote Kit, [NAAK], (1 AtroPen + 1 ComboPen)
Fielded by U.S. Armed Forces in 2003

17. In Development: ATOXTM Multichambered Auto-injector
Under development for a NATO country
Delivers: 2mg atropine sulfate equivalent and 200 mg obidoxime chloride in 2.2mL sequentially through a single needle
Intended to provide an alternative to the ATOXTM ComboPen
Marketing Authorization Application to be filed early 2004 with the regulatory agency

18. In Development: Wet / Dry Auto-injector
Two chambered [wet and dry], single needle auto-injection system
One step, dissolves HI-6 and atropine sulfate (2.0 mg) as it is injected
Rear chamber contains 2.0 mg atropine sulfate in 2.4 mL and 500 mg HI-6 in front chamber for a single injection
Delivers the solution intramuscular
Nose end pressure activated
Anticipated availability in 2005

19. Treatment Regimens per Soldier by Country
United Kingdom
3 ComboPens (avisafone/ 2mg atropine sulfate/ 500 mg pralidoxime methane sulphonate)
1 Morphine auto-injector
Pyridostigmine pre-treatment
USA
3 Atropens (atropine sulphate equivalent)
3 ComboPens (pralidoxime chloride)
Germany
1 ATOXTM ComboPen (atropine sulphate /obidoxime chloride)
2 Atropens (atropine)

20. Treatment Regimens per Soldier by Country
Canada
3 Atropine/HI-6 auto-injectors
1 Morphine auto-injector
Netherlands, Belgium, Italy, Norway, Greece, Turkey, Czech Republic, Slovak Republic
3 ATOXTM ComboPens (atropine sulphate /obidoxime chloride)

21. Features of Auto-Injector Systems
Individual self injections
Improved effectiveness
Prefilled dosage
Deep Intramuscular injections through clothing
Pressure activated
Safe for non-medical personnel
Sterile, small, light-weight
Ease of administration
Trainers available

22. Country Profile: Example of Treatment Requirement
Total Armed Forces (active) ,000
Recommended regime atropine/obidoxime
Recommended auto-injector treatment per soldier
Shelf-life of auto-injector years from manufacture date
Production batch size ,000
Total auto-injector requirement (55,000 x 3) ,000

23. INTERNATIONAL CUSTOMER BASE [examples]
Argentina
Australia
Belgium
Canada
Chile
Czech Republic
Finland
Germany
Greece
Hong Kong
Italy
Japan
Kuwait
New Zealand
Norway
Portugal
Singapore
Slovak Republic
South Africa
Spain
UAE
UK MoD and MoH
USA