




Side effects with Allegra-D 12 Hour and Allegra-D 24 Hour were similar to Allegra® 60 mg alone (headache, insomnia or nausea)
and Allegra 180 mg alone (headache, cold or backache) respectively. Due to the decongestant (pseudoephedrine) component in
both Allegra-D 12 Hour and Allegra-D 24 Hour, these products must not be used if you: are taking an MAO inhibitor (a medication
for depression) or have stopped taking an MAO inhibitor within 14 days; retain urine; have narrow-angle glaucoma; have
severe high blood pressure or severe heart disease. Side effects with pseudoephedrine may include nervousness, restlessness,
dizziness, or insomnia. Headache, drowsiness, increased heart rate, palpitations, increased blood pressure, and abnormal
heart rhythms have been reported. You should also tell your doctor if you have high blood pressure, diabetes, heart disease,
glaucoma, thyroid disease, impaired kidney function, or symptoms of an enlarged prostate such as difficulty urinating.
*Rebate offer is for up to $24 per prescription off your out-of-pocket payment when you purchase
Allegra-D 24 Hour or Allegra-D 12 Hour and send in rebate certificate with original pharmacy receipt. Offer
not valid for prescriptions reimbursed
or paid under Medicare, Medicaid, or any similar federal or state health care program, including any state medical or
pharmaceutical assistance programs. Void in Massachusetts if any insurer or other third-party payer reimburses you or
pays for any part of the prescription price. Offer also void where prohibited by law, taxed, or restricted. Amount of rebate
for the purchase of Allegra-D 24 Hour or Allegra-D 12 Hour will not exceed $24 or amount of copay, whichever is less. This
certificate may not be reproduced and must accompany your request. Offer good only
for prescription of Allegra-D 24 Hour & Allegra-D 12 Hour and only in the USA. Offer expires 12/31/09. Sanofi-aventis U.S. reserves the
right to rescind, revoke, or amend this offer without notice. You are responsible for reporting receipt of a rebate to
any private insurer that pays for or reimburses you for any part of the prescription filled. Limit of 12 rebates per
year (up to $288).

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Rebate Program may use your information for marketing purposes, including sending you materials such as tips and rebate offers
and developing additional products and services to serve you better. Sanofi-aventis U.S. respects your interest in keeping your
personal health information private. We will not sell or rent your information to any third party or outside mailing lists. For
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0-30 days (1 mo.) |
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31-60 days (2 mos.) |
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61-90 days (3 mos.) |
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91-120 days (4 mos.) |
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121-180 days (6 mos.) |
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181-240 days (8 mos.) |
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241-300 days (10 mos.) |
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301-365 days (year round) |
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Alavert® |
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Benadryl® |
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Benadryl-D™ |
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Claritin® |
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Claritin-D® |
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Clarinex® |
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Sudafed® |
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Sudafed® Sinus & Allery |
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Tylenol® Allergy/Sinus |
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Tylenol® Severe Allergy |
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Zyrtec® |
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Zyrtec-D® |
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rebate.
Please sign here to certify that you understand, accept, and are complying with all the requirements and
restrictions listed on this form. This also certifies that redeeming this certificate is consistent with the requirements
of your health plan.