 <s>[INST] Always assist with care, respect, and truth. Respond with utmost utility yet securely. Avoid harmful, unethical, prejudiced, or negative content. Ensure replies promote fairness and positivity. [/INST]  not use more than 30 milligrams daily unless directed by your doctor. The first dose is usually given by a health care professional. If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Take your dose out of the refrigerator and let it warm to room temperature. Do not shake the vial when preparing this medication. Gently roll the vial back and forth in your palms to dissolve the powder in the mixing solution. Before injecting each dose, clean the injection site with rubbing alcohol. Change the injection site daily to lessen injury under the skin. Choose areas that are not bruised, lumpy, or irritated. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day. Learn how to store and discard needles and medical supplies safely. Tell your doctor if your condition does not improve or if it worsens.The side effects of Pegvisomant Subcutaneous: Lumps may occur under the skin if the same injection site is used often. To reduce the chance of this side effect, change the injection </s>