Do not take TIKOSYN if you have congenital or acquired long QT syndrome (a disorder of the heartbeat which may be present from birth, or it may be acquired as a result of certain medical conditions or from taking certain medications. People with long QT syndrome may have symptoms including an unusually rapid heartbeat, fainting, and seizures. Sudden cardiac death may also result from long QT syndrome); have serious kidney problems or are on kidney dialysis; are taking certain other medicines, including cimetidine (Tagamet^®, Tagamet HB^®), verapamil (Calan^®, Calan SR^®, Covera-HS^®, Isoptin^®, Isoptin SR^®, Verelan^®, Verelan PM^®), ketoconazole (Nizoral^®), trimethoprim alone (Proloprim^®, Trimpex^®), the combination of trimethoprim and sulfamethoxazole (Bactrim^®, Septra^®), prochlorperazine (Compazine^®), megestrol (Megace^®), hydrochlorothiazide alone or in combination with other medicines (such as Esidrix^®, Ezide^®, Hydrodiuril^®, Hydro-Par^®, Microzide^®, or Oretic^®); or are allergic to dofetilide or other ingredients
in TIKOSYN.

The most common side effects of TIKOSYN are headache, chest pain, and dizziness. TIKOSYN can also cause other side effects. If you are concerned about these or any other side effects, ask your doctor.

Listed trademarks are the property of their respective owners.

Indication

TIKOSYN (dofetilide) is a medicine for highly symptomatic atrial fibrillation or atrial flutter (irregular heartbeats). TIKOSYN may help by converting the irregular heartbeats to normal rhythm. It may also help by keeping the normal rhythm for a longer period of time. It has not been shown to work on certain types of irregular heartbeats that may come and go on their own.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Terms and Conditions

By using the TIKOSYN^® (dofetilide) $10 Co-pay Card ("the Card"), you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:

• This Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as “La Reforma de Salud”])
• The Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs
• To qualify for this offer, your out-of-pocket expense must be greater than $10 per prescription. If your out-of-pocket expenses for a 1-month supply (60 capsules) are $110 or less, you will pay $10 for a 1-month supply. If your out-of-pocket expenses for a 1-month supply (60 capsules) exceed $110, you qualify for up to $100 in savings for a 1-month supply. In either case, you can only qualify for up to $1,200 of savings per calendar year. After maximum of $1,200, you will pay usual monthly out-of-pocket costs
• You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
• The Card is not valid where otherwise prohibited by law
• The Card cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription
• The Card will be accepted only at participating pharmacies
• The Card is not health insurance
• Offer good only in the U.S. and Puerto Rico
• The Card is limited to 1 per person during this offering period and is not transferable
• Offer limited to 1 use per month
• Pfizer reserves the right to rescind, revoke or amend the program without notice at any time

• Card and Program expire on 12/31/2013

• No membership fees

If you have questions about using your TIKOSYN $10 Co-pay Card, please call 1-877-TIKOSYN (1-877-845-6796).

For reimbursement when using a nonparticipating pharmacy/mail order: Pay for your TIKOSYN prescription and mail a copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to:
TIKOSYN Rebates
PO BOX 2242
Morrisville, PA 19067-0542
Be sure to include a copy of the front of your Co-pay Card and your name and mailing address.