Boxed warning (anaphylactic reactions): Cases of life-threatening and fatal anaphylaxis have been reported with COPAXONE. Anaphylaxis can occur at any time following initiation of therapy, from as early as after the first dose, up to years following initiation of therapy. Immediate Post-Injection Reaction (flushing, chest pain, palpitations, tachycardia, anxiety, dyspnea, throat constriction, and/or urticaria), may occur within seconds to minutes after injection and are generally transient and self-limiting. Chest pain, usually transient. Lipoatrophy and skin necrosis may occur. Instruct patients in proper injection technique and to rotate injection sites. COPAXONE can modify immune response. Hepatic Injury: if signs or symptoms of hepatic dysfunction occur, consider discontinuing COPAXONE.