ANNEX I
SUMMARY OF PRODUCT CHARACTERISTICS
1.
Nonafact 100 IU/ml powder and solvent for solution for injection.
2.
Nonafact contains 100 IU/ml (500 IU/5ml or 1000 IU/10ml) human coagulation factor IX when
reconstituted with 5 ml or 10 ml, respectively, of water for injections.
Each vial contains 500 IU or 1000 IU of human coagulation factor IX.
The potency (IU) is determined using a method equivalent to the test method described in the
European Pharmacopoeia. The specific activity of Nonafact is at least 200 IU/mg protein.
For a full list of excipients, see section 6.1.
3.
Powder and solvent for solution for injection. White powder.
4.
Treatment and prophylaxis of bleeding in patients with haemophilia B (congenital factor IX
deficiency).
Posology
Treatment should be initiated under the supervision of a physician experienced in the treatment of
haemophilia.
The dose and the duration of substitution therapy depend on the severity of the factor IX deficiency.
Other determining factors are the site and extent of the haemorrhage and the patient’s clinical
condition.
The number of units of factor IX administered is expressed in International Units (IU), which are
related to the current International Standard for factor IX concentrate as approved by the WHO. Factor
IX activity in plasma is expressed either as a percentage (relative to normal human plasma) or in
International Units (relative to an international standard for factor IX in plasma).
One International Unit (IU) of factor IX activity is related to the quantity of factor IX in the
International Standard for factor II, VII, IX and X in human plasma (approved by the WHO) which
approximates to the quantity of factor IX in one ml of normal human plasma. The calculation of the
required dosage of factor IX is based on the empirical finding that 1 International Unit (IU) factor IX
per kg body weight raises the plasma factor IX activity by 1.1 % of normal activity. The required
dosage is determined using the following formula:
Required units = body weight (kg) x desired factor IX rise (%) (IU/dl) x 0.9
2
The amount to be administered and the frequency of treatment should always be determined on the
basis of clinical effectiveness in the individual patient. Factor IX products rarely require to be
administered more than once daily.
In the case of the following haemorrhagic events, the factor IX activity should not fall below the given
plasma activity level (in % of normal or IU/dl) in the corresponding period. The following table can be
used to guide dosing in bleeding episodes and surgery:
Degree of haemorrhage / Type of
surgical procedure
Factor IX level
required (%)
(IU/dl)
Frequency of doses (hours)/Duration
of therapy (days)
Haemorrhage
Early haemarthrosis, muscle
bleeding or oral bleeding
20-40
Repeat every 24 hours. At least 1
day, until the bleeding episode as
indicated by pain is resolved or
healing is achieved.
More extensive haemarthrosis,
muscle bleeding or haematoma
30-60
Repeat infusion every 24 hours for
3-4 days or more until pain and
acute disability are resolved.
Life threatening haemorrhages
60-100
Repeat infusion every 8 to 24 hours
until threat is resolved.
Surgery
Minor
including tooth extraction
30-60
Every 24 hours, at least 1 day, until
healing is achieved.
Major
80-100
Repeat infusion every 8-24 hours
until adequate wound healing, then
therapy for at least another 7 days to
maintain a factor IX activity of 30 %
to 60 % (IU/dl).
(pre- and
postoperative)
During the course of treatment, appropriate determination of factor IX levels is advised to guide the
dose to be administered and the frequency of repeated injections. In the case of major surgical
interventions in particular, precise monitoring of substitution therapy by means of coagulation analysis
(plasma factor IX activity) is indispensable. Individual patients may vary in their response to factor
IX, achieving different levels of
in vivo
recovery and demonstrating different half-lives.
For long-term prophylaxis of haemorrhages in patients with severe haemophilia B, doses of 20 to 40
IU of factor IX per kilogram of body weight could be given at intervals of 3 to 4 days.
In some cases, especially in younger patients, shorter dosage intervals or higher doses may be
necessary.
Paediatric population
The safety and efficacy of Nonafact in children less than 6 years of age has not been established.
There are insufficient data to recommend the use of Nonafact in children less than 6 years of age.
Patients should be monitored for the development of factor IX inhibitors. If the expected factor IX
activity plasma levels are not attained, or if bleeding is not controlled with an appropriate dose, an
assay should be performed to determine if a factor IX inhibitor is present. In patients with high levels
of inhibitor, factor IX therapy may not be effective and other therapeutic options should be considered.
Management of such patients should be directed by physicians with experience in the care of patients
with haemophilia, see also 4.4.
3
Method of administration
The product should be administered via the intravenous route. It is recommended that the rate of
administration should not exceed 2 ml/min. For instructions on reconstitution of the medicinal product
before administration, see section 6.6.
-
Hypersensitivity to the active substance or to any of the excipients;
-
Hypersensitivity to mouse proteins.
As with any intravenous protein product, allergic type hypersensitivity reactions are possible. The
product contains traces of mouse proteins. Patients should be informed of the early signs of
hypersensitivity reactions including urticaria, tightness of the chest, wheezing, hypotension, and
anaphylaxis. If these symptoms occur, patients should be advised to discontinue use of the product
immediately and contact their physician.
In case of shock, the current medical standards for shock-treatment should be observed.
Since the use of factor IX complex concentrates has historically been associated with the development
of thromboembolic complications, the risk being higher in low purity preparations, the use of factor
IX-containing products may be potentially hazardous in patients with signs of fibrinolysis and in
patients with disseminated intravascular coagulation (DIC). Because of the potential risk of thrombotic
complications, clinical surveillance for early signs of thrombotic and consumptive coagulopathy
should be initiated with appropriate biological testing when administering this product to patients with
liver disease, to patients post-operatively, to new-born infants, or to patients at risk of thrombotic
phenomena or DIC. In each of these situations, the benefit of treatment with Nonafact should be
weighed against the risk of these complications.
Standard measures to prevent infections resulting from the use of medicinal products prepared from
human blood or plasma include selection of donors, screening of individual donations and plasma
pools for specific markers of infection and the inclusion of effective manufacturing steps for the
inactivation/removal of virus. Despite this, when medicines prepared from human blood or plasma are
administered, the possibility of transmitting infective agents cannot be totally excluded. This also
applies to unknown or emerging viruses or other pathogens.
The measures taken are considered effective for enveloped viruses such as HIV, HBV and HCV, and
for the non-enveloped viruses HAV and parvovirus B19.
Appropriate vaccination (hepatitis A and B) should be considered for patients in regular/repeated
receipt of plasma-derived factor IX concentrates.
It is strongly recommended that every time that Nonafact is administered to a patient, the name and
batch number of the product are recorded in order to maintain a link between the patient and the batch
of the product.
After repeated treatment with Nonafact, patients should be monitored for the development of
neutralising antibodies (inhibitors) that should be quantified in Bethesda Units (BU) using appropriate
biological testing.
There have been reports in the literature showing a correlation between the occurrence of a factor IX
inhibitor and allergic reactions. Therefore, patients experiencing allergic reactions should be evaluated
for the presence of an inhibitor. It should be noted that patients with factor IX inhibitors may be at an
increased risk of anaphylaxis with subsequent challenge with factor IX.
Because of the risk of allergic reactions with factor IX concentrates, the initial administrations of
factor IX should, according to the treating physician’s judgement, be performed under medical
observation where proper medical care for allergic reactions could be provided.
4
This medicinal product contains less than 1 mmol sodium (23 mg) per dose, i.e. essentially ‘sodium-
free’.
No interactions of Nonafact with other medicinal products are known.
Animal reproduction studies have not been conducted with factor IX. Based on the rare occurrence of
haemophilia B in women, experience regarding the use of factor IX during pregnancy and breast-
feeding is not available. Therefore, factor IX should be used during pregnancy and lactation only if
clearly indicated.
Nonafact has no influence on the ability to drive and use machines.
Hypersensitivity or allergic reactions (which may include angioedema, burning and stinging at the
infusion site, chills, flushing, generalised urticaria, headache, hives, hypotension, lethargy, nausea,
restlessness, tachycardia, tightness of the chest, tingling, vomiting, wheezing) have been observed
infrequently in patients treated with factor IX containing products. In some case, these reactions have
progressed to severe anaphylaxis, and they have occurred in close temporal association with
development of factor IX inhibitors (see also 4.4).
Nephrotic syndrome has been reported following attempted immune tolerance induction on
haemophilia B patients with factor IX inhibitors and a history of allergic reaction.
On rare occasions, fever has been observed.
Haemophilia B patients may develop antibodies (inhibitors) to factor IX. If such inhibitors occur, the
condition will manifest itself as an insufficient clinical response. In such cases, it is recommended that
a specialised haemophilia centre be contacted. During clinical trials with Nonafact conducted in
previously treated patients development of inhibitors was not reported. There is no experience of the
treatment of previously untreated patients with Nonafact.
There is a potential risk of thromboembolic episodes following the administration of factor IX
products, with a higher risk for low purity preparations. The use of low purity factor IX products has
been associated with instances of myocardial infarction, disseminated intravascular coagulation,
venous thrombosis and pulmonary embolism. The use of high purity factor IX is rarely associated with
such side effects.
Nonafact contains trace amounts (< 0.1 ng mouse IgG/IU of factor IX) of the murine monoclonal
antibody used in its purification. In theory, therefore, the use of Nonafact could generate antibodies to
mouse protein. The clinical relevance of antibodies to mouse protein, if these do indeed arise, is not
known.
For safety with respect to transmissible agents, see 4.4.
No symptoms of overdose with human coagulation factor IX have been reported.
5.
5
5.1 Pharmacodynamic properties
Pharmacotherapeutic Group: antihaemorrhagics, blood coagulation factor IX. ATC code: B02BD04.
Factor IX is a single chain glycoprotein with a molecular weight of about 68,000 Dalton. It is a
vitamin K-dependent coagulation factor and is synthesised in the liver. Factor IX is activated by factor
XIa in the intrinsic coagulation pathway and by the factor VII/tissue factor complex in the extrinsic
pathway. Activated factor IX, in combination with activated factor VIII, activates factor X. Activated
factor X converts prothrombin into thrombin. Thrombin then converts fibrinogen into fibrin and a clot
is formed. Haemophilia B is a sex-linked hereditary disorder of blood coagulation due to decreased
levels of factor IX and results in profuse bleeding into joints, muscles or internal organs, either
spontaneously or as a result of accidental or surgical trauma. By replacement therapy the plasma levels
of factor IX are increased, thereby enabling a temporary correction of the factor IX deficiency and
correction of the bleeding tendencies.
There are insufficient data to recommend the use of Nonafact in children less than 6 years of age.
5.2 Pharmacokinetic properties
The
in vivo
increase in factor IX levels obtained with Nonafact is 1.1 IU/dl per IU administered per kg
body weight, which corresponds to an
in vivo
recovery of 49 %. Nonafact has a half-life of
approximately 19 (17 – 21) hours.
5.3 Preclinical safety data
Plasma coagulation factor IX is a normal constituent of human plasma. Factor IX in this product
therefore behaves like endogenous factor IX. Conventional animal toxicity studies and mutagenicity
studies with plasma coagulation factor IX were not carried out. In pharmacodynamic studies in rabbits
and guinea pigs, the thrombogenicity of Nonafact was shown to be minimal.
6.
6.1 List of excipients
Powder:
Sodium chloride
Sucrose
Histidine.
Solvent:
Water for injections.
6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal
products.
6.3 Shelf life
2 years
After reconstitution:
Chemical and physical in-use stability has been demonstrated for 3 hours at a temperature of 21°C.
From a microbiological point of view, the product should be used immediately.If not used
immediately, in-use storage times and conditions prior to use are the responsibility of the user and
6
would normally not be longer than 24 hours at 2 to 8
0
C, unless reconstitution/dilution (etc) has taken
place in controlled and validated aseptic conditions.
6.4 Special precautions for storage
Store in a refrigerator (at 2°C – 8°C ). Do not freeze. Keep the vials in the outer carton, in order to
protect from light. For storage conditions of the reconstituted medicinal product, see section 6.3.
6.5 Nature and contents of container
500 IU: one vial (glass type I) of powder + one vial (glass type I) of 5 ml solvent with stoppers
(bromobutyl).
1000 IU: one vial (glass type I) of powder + one vial (glass type I) of 10 ml solvent with stoppers
(bromobutyl).
6.6 Instructions for use/and handling, and disposal
Reconstitution
1.
Bring the two vials to a temperature between 15°C and 25°C.
2.
Remove the plastic cap from the vials.
3.
Disinfect the surface of the stoppers of both vials with a gauze soaked in 70 % alcohol.
4.
Remove the protective sheath from one end of a transfer needle and pierce the stopper of the
vial containing water for injections. Remove the protective sheath from the other end of the
transfer needle. Invert the solvent vial and pierce the stopper of the vial containing the powder.
5.
Tilt the product vial when transferring the solvent to allow the solvent to flow down the side of
the vial.
6.
Remove the empty vial and the transfer needle.
7.
Swirl the vial gently to completely dissolve the powder within 5 minutes. The resulting solution
is clear, colourless to light yellow and has a neutral pH.
Reconstituted products should be inspected visually for particulate matter and discoloration prior to
administration. The solution should be clear or slightly opalescent. Do not use solutions that are
cloudy or have deposits.
Any unused product or waste material should be disposed of in accordance with local requirements.
7.
Sanquin
Plesmanlaan 125
NL-1066 CX Amsterdam
The Netherlands
8.
EU/1/01/186/001 (500 IU)
EU/1/01/186/002 (1000 IU)
9.
Date of first authorisation: 3 July 2001
Renewal of authorisation: 3 July 2006
7
Detailed information on this product is available on the website of the European Medicines Agency
(EMA)
http://www.ema.europa.eu
.
8
ANNEX II
A.
MANUFACTURER OF THE BIOLOGICAL ACTIVE
SUBSTANCE AND MANUFACTURING AUTHORISATION
HOLDER RESPONSIBLE FOR BATCH RELEASE
B.
CONDITIONS OF THE MARKETING AUTHORISATION
9
A
MANUFACTURER OF THE BIOLOGICAL ACTIVE SUBSTANCE AND
MANUFACTURING AUTHORISATION HOLDER RESPONSIBLE FOR BATCH
RELEASE
Name and address of the manufacturer of the biological active substance
Stichting Sanquin Bloedvoorziening,
Plesmanlaan 125
1066 CX Amsterdam
The Netherlands
Name and address of the manufacturers responsible for batch release
Stichting Sanquin Bloedvoorziening,
Plesmanlaan 125
1066 CX Amsterdam
The Netherlands
B
CONDITIONS OF THE MARKETING AUTHORISATION
•
CONDITIONS OR RESTRICTIONS REGARDING SUPPLY AND USE
Medicinal product subject to restricted medical prescription (See Annex I: Summary of Product
Characteristics, 4.2)
•
CONDITIONS OR RESTRICTIONS WITH REGARD TO THE SAFE AND
EFFECTIVE USE OF THE MEDICINAL PRODUCT
Not Applicable.
•
OTHER CONDITIONS
Official batch release: in accordance with Article 114 of Directive 2001/83/EC, the official batch
release will be undertaken by a state laboratory or a laboratory designated for that purpose.
10
ANNEX III
LABELLING AND PACKAGE LEAFLET
11
A. LABELLING
12
PARTICULARS TO APPEAR ON THE OUTER PACKAGING AND ON THE
IMMEDIATE PACKAGING
BOX VIAL OF POWDER 500 IU
BOX VIAL OF POWDER 1000 IU
1.
Nonafact 100 IU/ml powder and solvent for solution for injection
Human coagulation factor IX
2.
STATEMENT OF ACTIVE SUBSTANCE(S)
500 IU human coagulation factor IX (100 IU/ml after reconstitution).
1000 IU human coagulation factor IX (100 IU/ml after reconstitution).
3.
LIST OF EXCIPIENTS
Contains: sodium chloride, histidine and sucrose.
Solvent: water for injections
4.
Powder and solvent for solution for injection.
Contents:
1 vial of powder for solution for injection
1 vial water for injections 5 ml
1 vial water for injections 10 ml
5.
METHOD AND ROUTE(S) OF ADMINISTRATION
Reconstitute with 5 ml of water for injections.
Reconstitute with 10 ml of water for injections.
The product should be used immediately.
Single dose administration only.
for intravenous use
Read the package leaflet before use.
6.
SPECIAL WARNING THAT THE MEDICINAL PRODUCT MUST BE
Keep out of the reach and sight of children.
13
STORED OUT OF THE REACH AND SIGHT OF CHILDREN
7.
OTHER SPECIAL WARNING(S), IF NECESSARY
Do not use if the solution is not totally clear or if the powder is not totally reconstituted.
8.
EXPIRY DATE
EXP:
9.
SPECIAL STORAGE CONDITIONS
Store in a refrigerator (at 2°C – 8°C). Do not freeze.
Keep the container in the outer carton, in order to protect from light.
10. SPECIAL PRECAUTIONS FOR DISPOSAL OF UNUSED MEDICINAL
PRODUCTS OR WASTE MATERIALS DERIVED FROM SUCH MEDICINAL
Sanquin, Plesmanlaan 125, NL-1066 CX Amsterdam, the Netherlands
EU/1/01/186/001
EU/1/01/186/002
13. BATCH NUMBER
Lot: {number}
14. GENERAL CLASSIFICATION FOR SUPPLY
Medicinal product subject to medical prescription
15. INSTRUCTIONS ON USE
16. INFORMATION IN BRAIILE
14
PRODUCTS, IF APPROPRIATE
MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING
UNITS
VIAL OF POWDER 500 IU
VIAL OF POWDER 1000 IU
1.
Nonafact 100 IU/ml powder for solution for injection
Human coagulation factor IX
for intravenous use
2.
METHOD OF ADMINISTRATION
Reconstitute with 5 ml of water for injections.
Reconstitute with 10 ml of water for injections.
Administer immediately.
Read the package leaflet before use.
3.
EXPIRY DATE
EXP:
4.
BATCH NUMBER
Lot: {number}
5.
CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT
500 IU (100 IU/ml after reconstitution)
1000 IU (100 IU/ml after reconstitution)
15
ADMINISTRATION
MINIMUM PARTICULARS TO APPEAR ON SMALL IMMEDIATE PACKAGING
UNITS
VIAL OF SOLVENT 5 ml
VIAL OF SOLVENT 10 ml
1.
Water for injections
2.
METHOD OF ADMINISTRATION
For reconstitution of Nonafact.
Read the package leaflet before use.
3.
EXPIRY DATE
EXP:
4.
BATCH NUMBER
Lot: {number}
5.
CONTENTS BY WEIGHT, BY VOLUME OR BY UNIT
5 ml
10 ml
16
ADMINISTRATION
B. PACKAGE LEAFLET
17
PACKAGE LEAFLET: INFORMATION FOR THE USER
Nonafact 100 IU/ml Powder and solvent for solution for injection
Human coagulation factor IX
Read all of this leaflet carefully before you start using this medicine.
•
Keep this leaflet. You may need to read it again.
•
If you have further questions, please ask your doctor or your pharmacist.
•
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet,
please tell your doctor or pharmacist.
Powder
The active substance is
human coagulation factor IX.
The product contains 100 International Units (IU) per ml (500 IU/5 ml or 1000 IU/10 ml) human
coagulation factor IX when reconstituted with 5 ml or 10 ml, respectively, of water for injections.
The other ingredients are sodium chloride, sucrose and histidine.
Solvent
Water for injections.
In this leaflet:
1. What Nonafact is and what it is used for
2. Before you use Nonafact
3. How to use Nonafact
4. Possible side effects
5. How to store Nonafact
6. Further information
1.
WHAT NONAFACT IS AND WHAT IT IS USED FOR
Nonafact can be administered to prevent and treat bleeding in patients suffering from haemophilia B (a
congenital lack of active factor IX). Factor IX is a normal constituent of human blood. A deficiency of
factor IX causes blood coagulation problems, which may lead to bleeding in joints, muscles or internal
organs. The administration of Nonafact can compensate for this deficiency.
2.
BEFORE YOU USE NONAFACT
Do not use Nonafact:
-
if you are hypersensitive (allergic) to the active substance, human coagulation factor IX.
-
if you are hypersensitive (allergic) to any of the other ingredients or to mouse proteins.
Take special care with Nonafact:
See your doctor immediately, if bleeding does not stop as expected.
After it has been dissolved in the supplied water for injections, the product should be clear. Check this
immediately prior to administration. The product must not be administered if any cloudiness, lumps or
particulate matter are visible.
In rare cases, Nonafact can give rise to a severe allergic reaction (anaphylactic shock). If, after
administration, you develop hypersensitive reactions like hives, itching and rash, chest tightness,
wheezing and light headedness contact your physician immediately. If you have previously
experienced hypersensitivity in response to the administration of blood or a blood product,
Nonafact
18
should only be administered when absolutely necessary (in life-threatening situations). This must be
carried out in hospital or under the careful supervision of a doctor.
Individuals with haemophilia B who receive factor IX preparations, should be monitored for the
development of neutralising antibodies against factor IX (inhibitors) (see Possible side effects). Your
doctor will check your blood regularly for the presence of these antibodies, especially if you
experienced a severe allergic reaction with the previous use of a factor IX product.
The occurrence of activity-neutralising antibodies (inhibitors) is a very rare event in previously treated
patients receiving factor IX-containing products.
There is a slight risk that higher doses of Nonafact will cause clots to form in blood vessels, resulting
in thrombosis. If you suffer from a liver or cardiac disease or if you have recently had surgery, there is
an increased risk for coagulation complications. This also applies to newborn babies and patients with
an increased risk of thrombosis or “DIC”, disseminated intravascular coagulation, a disease in which
the blood coagulation system is disturbed. Your doctor will consider whether administration of
Nonafact imposes a risk for coagulation complications.
When medicines are made from human blood or plasma, certain measures are put in place to prevent
infections being passed on to patients. These include careful selection of blood and plasma donors to
make sure those at risk of carrying infections are excluded, and the testing of each donation and pools
of plasma for signs of virus/infections. Manufacturers of these products also include steps in the
processing of the blood or plasma that can inactivate or remove viruses. Despite these measures, when
medicines prepared from human blood or plasma are administered, the possibility of passing on
infection cannot be totally excluded. This also applies to any unknown or emerging viruses or other
types of infections
The measures taken are considered effective for enveloped viruses such as human immunodeficiency
virus (HIV), hepatitis B virus and hepatitis C virus, and for the non-enveloped hepatitis A and
parvovirus B19 viruses.
Your doctor may recommend that you consider vaccination against hepatitis A and B if you
regularly/repeatedly receive human plasma-derived coagulation factor IX
It is strongly recommended that every time you receive a dose of Nonafact the name and batch number
of the product are recorded in order to maintain a record of the batches used.
There is no experience of the treatment of previously untreated patients with Nonafact.
Use in children
There are insufficient data to recommend the use of Nonafact in children less than 6 years of age.
Using other medicines:
There are no known interactions between Nonafact and other medicinal products.
Please inform your doctor or pharmacist if you are taking or have recently taken any other medicines,
even those not prescribed.
Pregnancy and breast-feeding:
Based on the rare occurrence of haemophilia B in women, experience regarding the use of factor IX
during pregnancy and breast-feeding is not available. Therefore, factor IX should be used by pregnant
or breast-feeding women only if clearly indicated.
Ask your doctor or pharmacist for advice before taking any medicine.
Driving and using machines:
19
Nonafact has no known effects on the ability to drive and to use machines.
Information about some of the ingredients of Nonafact:
This medicinal product contains less than 1 mmol sodium (23 mg) per dose, i.e. essentially ‘sodium-
free’.
3.
HOW TO USE NONAFACT
Dosage:
Your doctor will decide how much Nonafact you require. The exact dose will depend on the
seriousness of the clinical situation, your body weight and the amount of factor IX in your blood. If
you have to undergo surgery or have a tooth extracted, inform your doctor or dentist that you have
factor IX deficiency. They will then ensure that factor IX is administered to you, should this prove
necessary.
Nonafact is given to you by your doctor or nurse. Nonafact may be self administered if it is an
approved practice in your country and when you have been trained sufficiently. Always use Nonafact
exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not
sure.
It is important that the concentration of factor IX in your blood is checked regularly. If you are
administered 1 IU per kilogram of body weight, the concentration of factor IX in your blood will
increase by 1.1 % of normal activity.
The required dosage is determined using the following formula:
Required units = body weight (kg) x desired factor IX rise (%) (IU/dl) x 0.9
Your doctor will determine the dose of Nonafact you need and how frequently you should use it
depending on the situation. The following table can be used to guide dosing in bleeding episodes and
surgery:
Degree of bleeding / Type of
surgical procedure
Factor IX level
required (%)
(IU/dl)
Frequency of doses (hours)/Duration
of therapy (days)
Bleeding
Early signs of bleeding in joints,
muscle bleeding or oral bleeding
20-40
Repeat every 24 hours. At least 1
day, until the bleeding episode as
indicated by pain is resolved or
healing is achieved.
More extensive bleeding in joints,
muscle bleeding or haematoma
30-60
Repeat infusion every 24 hours for
3-4 days or more until pain and
acute disability are resolved.
Life threatening bleeding
60-100
Repeat infusion every 8 to 24 hours
until threat is resolved
.
Surgery
Minor
including tooth extraction
30-60
Every 24 hours, at least 1 day, until
healing is achieved.
20
Major
80-100
Repeat infusion every 8-24 hours
until adequate wound healing, then
therapy for at least another 7 days.
(pre- and
postoperative)
During the course of treatment it is advised that the concentrations of factor IX in your blood are
checked regularly. Particularly with major surgery, it is important that the concentrations of factor IX
in your blood are checked carefully before and after the operation.
For long-term prevention of bleeding in individuals with severe haemophilia B, doses of 20 IU to 40
IU of factor IX per kilogram body weight should be given at intervals of 3 to 4 days. In some cases,
especially in younger patients, shorter dosage intervals or higher doses may be necessary.
If you have the impression that the effect of Nonafact is too strong or too weak, talk to your doctor.
Individuals with haemophilia B may develop antibodies (inhibitors) against factor IX. As a result, the
factor IX product used becomes inactivated (see Possible side effects). It is advised that the treatment
of this serious condition be taken care of in a haemophilia treating centre where an appropriate dose
will be determined. The administration of factor IX can repress these inhibitors.
Instructions for use:
Dissolving the powder
The powder should be dissolved in the supplied amount of water for injections. The solution should
not be too cold when it is administered. In addition, the powder will dissolve more readily if both vials
are first allowed to reach room temperature (15°C – 25°C).
1.
Remove from the refrigerator and allow the two vials to reach room temperature (15°C – 25°C).
2.
Remove the plastic cap from the vials.
3.
Disinfect the surface of the stoppers of both vials with a gauze soaked in 70 % alcohol.
4.
Remove the protective sheath from one end of a transfer needle and pierce the stopper of the
vial containing water for injections. Remove the protective sheath from the other end of the
transfer needle. Invert the solvent vial and pierce the stopper of the vial containing the powder.
5.
Tilt the product vial when transferring the solvent to allow the solvent to flow down the side of
the vial.
6.
Remove the empty vial and the transfer needle.
7.
Swirl the vial gently to completely dissolve the powder. Do not shake! The powder dissolves
within 5 minutes to produce a clear, colourless to light-yellow solution.
Immediately before administration, the solution should be inspected: the solution should be clear and
must be free of lumps. Once dissolved, the product should be used immediately (at least within 3
hours).
Nonafact should never be mixed with other medicinal products.
Administration
1.
Using a hypodermic needle and syringe, draw the dissolved product out of the vial.
2.
Nonafact should be injected into a vein (intravenous administration).
3.
Inject the dissolved product very gradually (approx. 2 ml per minute).
Disposal
Any unused product or waste material must be discarded as instructed by your doctor or pharmacist.
21
Duration of treatment:
Haemophilia B is a chronic disease, therefore lifelong treatment with a factor IX product may be
necessary.
If you use more Nonafact than you should:
No symptoms of overdose with human coagulation factor IX have been reported.
4.
POSSIBLE SIDE EFFECTS
As with all medicinal products derived from human blood, the use of Nonafact can cause allergic
reactions which may include swelling of the larynx, burning and stinging at the infusion site, chills,
flushing, hives, itching and rash, headache, tiredness, nausea, restlessness, fast heart beat, chest
tightness, tingling, vomiting, wheezing.
You should discuss the possible side effects with your doctor in order to know how to recognise them
and what to do if they occur. Where necessary, mild allergic reactions, such as hives, can be treated
with antihistamines (medicinal products which counteract allergies). In the case of a severe allergic
reaction (anaphylactic shock), immediately stop the administration of the product and contact your
doctor immediately.
There is a very slight risk that Nonafact will cause clots to form in blood vessels, resulting in
thrombosis. The use of Nonafact may also produce an increase in body temperature in rare cases.
Your body may develop antibodies (inhibitors) against factor IX, which will inactivate Nonafact. Your
doctor will check your blood regularly for the presence of these antibodies. Contact your doctor
immediately if you suspect that the product is becoming progressively less effective. This will show
itself as an increased tendency to bleed.
If you need therapy for repressing antibodies (inhibitors) this should be taken care of in a haemophilia
treating centre. You will be closely monitored for any possible side effect during this treatment.
If you should experience one of these side effects, you are advised to contact your doctor. If you notice
any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.
5.
HOW TO STORE NONAFACT
Keep out of the reach and sight of children.
Do not use after the expiry date stated on the label and carton.
Store in a refrigerator (at 2°C – 8°C ).
Keep the vial in the outer carton in order to protect from light.
From a microbiological point of view the product, once dissolved, should be used immediately, but no
longer than 3 hours after reconstitution.
Before administration, check that the solution is clear. The product must not be used if any cloudiness,
lumps or particulate matter are visible.
6.
FURTHER INFORMATION
Nonafact 100 IU/ml human coagulation factor IX
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What Nonafact contains:
-
The active substance is human coagulation factor IX. Each vial contains 500 IU or 1000 IU of
human coagulation factor IX.
-
The other ingredients are sodium chloride, sucrose, histidine and water for injections.
What Nonafact looks like and contents of the pack:
Nonafact is presented as a powder and a solvent for solution for injection (vial of 5 ml or 10 ml)
Nonafact consists of a carton containing:
•
A vial of Nonafact containing 500 IU or 1000 IU of factor IX
•
A vial water for injections containing 5 ml or 10 ml
Marketing Authorisation Holder and Manufacturer
Sanquin, Plesmanlaan 125 NL, 1066 CX Amsterdam, the Netherlands
This leaflet was last approved
Detailed information on this medicine is available on the European Medicines Agency (EMA) web
site:
http://www.ema.europa.eu
.
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Source: European Medicines Agency
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