Alphanate 2000 IU powder for injection – patient leaflet, side effects, dosage

1. WHAT ALPHANATE^® IS AND WHAT IT IS USED FOR

Alphanate^® is supplied as a powder for solution for injection containing approximately 250, 500, 1000, 1500 or 2000 IU of human coagulation factor VIII and 300, 600, 1200, 1800 or 2400 IU of human von Willebrand factor per vial (Note IU stands for international unit, a standard measure of activity). Once reconstituted with the appropriate amount of solvent (water for injections), each vial contains approximately 50, 100, 150 or 200 IU of FVIII/ml and 60, 120, 180 or 240 IU VWF/ml.

Alphanate^® is one of the group of medicines called clotting factors.

Alphanate^® is used for the treatment and prevention of bleeding in patients with haemophilia A (congenital factor VIII deficiency).

Alphanate^® is used for the treatment and prevention of bleeding (haemorrhage) or surgical bleeding in von Willebrand disease (VWD), when desmopressin (DDAVP) treatment alone is ineffective or contra-indicated.

This product may be used in the management of acquired factor VIII deficiency.

2. WHAT YOU NEED TO KNOW BEFORE YOU USE ALPHANATE^®

Do not use Alphanate^®

• If you are allergic to human coagulation factor VIII

  and von Willebrand factor complex or any of the other ingredients of this medicine (listed in section 6).

• If you have not been fully trained how to inject

  yourself by your doctor or haemophilia nurse. If you want more detailed information then ask your doctor.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before using Alphanate^®.

• Rarely you may have an anaphylactic reaction

  (a sudden severe allergic reaction) such as rash, tightness of the chest, dizziness, vertigo or nausea, or feeling dizzy when you are standing. If these symptoms occur, you must stop using the product immediately and contact your doctor.

• Your doctor should perform some tests to make

  sure that the dosage of Alphanate^® you are receiving is enough to achieve and maintain appropriate factor VIII levels and thus stop any bleeding.

• The formation of inhibitors (antibodies) is a known

  complication that can occur during treatment with all Factor VIII medicines. These inhibitors, especially at high levels, stop the treatment working properly and you or your child will be monitored carefully for the development of these inhibitors. If you or your child´s bleeding is not being controlled with Alphanate^®, tell your doctor immediately.

• During the treatment of the von Willebrand

  disease, there is a chance you may develop blood clots, particularly if you have known clinical risk factors. Therefore, your doctor should perform some tests to detect early signs of blood clots and recommend the treatment if necessary.

• Patients with von Willebrand disease, especially

  type 3 patients, may develop antibodies (inhibitors) to von Willebrand factor. Your doctor may perform more blood tests to confirm whether the inhibitors are present in your blood.

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,

• the testing of each donation and pools of plasma

  for signs of virus/infections,

• the inclusion of 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. The measures taken may be of limited value against non-enveloped viruses such as hepatitis A virus and parvovirus B19. Parvovirus B19 infection may be serious for pregnant women (foetal infection) and for individuals whose immune system is depressed or who have some types of anaemia (e.g. sickle cell disease or haemolytic anaemia).

  Your doctor may recommend that you consider vaccination against hepatitis A and B if you regularly/repeatedly receive human plasma-derived factor VIII products.

  It is strongly recommended that every time you receive a dose of Alphanate^® the name and batch number of the product are recorded in order to maintain a record of the batches used.

  See also section 4.

  Other medicines and Alphanate^®

  Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. No interactions of Alphanate^® with other medicines are known.

  Do not mix Alphanate^® with any other medicines that you receive by injection.

  Pregnancy and breast-feeding

  Based on the rare occurrence of haemophilia A in women, experience regarding the use of FVIII/VWF complex during pregnancy and breast-feeding is not available.

  Ask your doctor or pharmacist for advice before taking any medicine.

  Driving and using machines

  Alphanate^® has little or none effect on your ability to drive and use machines.

  Sodium content

  The residual content of sodium in Alphanate^®, arising from the manufacturing process, does not exceed 23 mg (1 mmol) per vial in the 250, 500, 1000 and 1500 IU presentations, and 34.5 mg per vial in the 2000 IU presentation. This is equivalent to 1.15% and 1.72% respectively of the recommended maximum daily intake of sodium for an adult. However, depending on the body weight of the patient and the posology, the patient may receive more than one vial.

3. HOW TO USE ALPHANATE^®

Reconstitute the product as described at the end of this leaflet (please see pictograms on the back of the leaflet). The product must be given by intravenous route. The administration rate should be 3 ml/min and never more than 10 ml/min to avoid undesirable side effects. Inject Alphanate^® immediately after reconstitution.

The amount of Alphanate^® you should use depends on many factors, such as your weight, your clinical status and the type and severity of bleeding. Your doctor will calculate the dose, the frequency and the intervals of administration of Alphanate^® in order to reach the necessary level of factor VIII or von Willebrand factor in your blood.

Your doctor will tell you the duration of your treatment with Alphanate^®.

You will be given full training before using Alphanate^® without the hospital supervision. Please refer to all your training materials or contact your local haemophilia centre for more information. You should not self-administer Alphanate^® alone: always have a responsible adult present.

Use in children and adolescents

There are insufficient data from clinical trials to recommend the use of Alphanate^® in children less than 6 years of age for the authorised indications.

If you use more Alphanate^® than you should

No cases of overdose with Alphanate^® have been reported. However, if you have used Alphanate^® more than required, consult your doctor or pharmacist immediately.

If you forget to use Alphanate^®

Proceed immediately with the following dose and continue at regular intervals as directed by your doctor. Do not take a double dose to make up for a forgotten dose.

4. POSSIBLE SIDE EFFECTS

Like all medicines, this medicine can cause side effects, although not everybody gets them. On rare occasions, you may have some of the following side effects after the administration of Alphanate^®. Please contact your doctor immediately if you experience:

• itching, local reactions at the injection site (e.g.

  burning and transitory reddening)

Alphanate^® 250 IU, 500 IU, 1000 IU, 1500 IU and 2000 IU Powder and solvent for solution for injection PACKAGE LEAFLET: INFORMATION FOR THE USER

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• allergic reactions (e.g. tightness of the chest/

  feeling unwell, dizziness, nausea and slight drop of blood pressure than can make you feel dizzy when you are standing)

• fever
• faster heart beat (tachycardia)

Occasionally an anaphylactic shock may occur. If you observe any of the following symptoms during the injection/perfusion, interrupt the injection/ perfusion and contact your doctor immediately:

• tightness of the chest/feeling unwell
• dizziness

• slight hypotension (slight drop of blood pressure

  with dizziness when you are standing)

• nausea

Allergic reactions to the components of the product cannot be totally excluded. For children not previously treated with Factor VIII medicines, inhibitor antibodies (see section 2) may form very commonly (more than 1 in 10 patients); however patients who have received previous treatment with Factor VIII (more than 150 days of treatment) the risk is uncommon (less than 1 in 100 patients). If this happens your or your child’s medicines may stop working properly and you or your child may experience persistent bleeding. If this happens, you should contact your doctor immediately. There is a chance of blood clots, particularly if you have known clinical risk factors.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Yellow Card Scheme, Website: https://yellowcard.mhra.gov.uk. By reporting side effects you can help provide more information on the safety of this medicine.

5. HOW TO STORE ALPHANATE^®

Keep this medicine out of the sight and reach of children.

Do not store above 30 °C. Do not freeze. Protect from light.

Do not use this medicine after expiry date which is stated on the vial label and carton after EXP. Do not use this medicine if you notice the solution is cloudy or has deposits. Generally the solution is clear or slightly opalescent. If the solution is discoloured or cloudy discard it.

Alphanate^® should be administered immediately after reconstitution.

Any unused product or waste material should be disposed of in accordance with local requirements.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. CONTENTS OF THE PACK AND OTHER INFORMATION

What Alphanate^® contains

The active substance is human coagulation factor VIII and von Willebrand factor complex.

Alphanate^® is presented as powder for solution for injection containing approximately 250, 500, 1000, 1500 or 2000 IU human coagulation FVIII and 300, 600, 1200, 1800 or 2400 IU of human von Willebrand factor per vial. The product is reconstituted with 5 ml of water for injections for the presentations of 250 and 500 IU or 10 ml of water for injections for the presentations of 1000, 1500 and 2000 IU. The other ingredients are albumin, histidine and arginine.

What Alphanate^® looks like and contents of the pack

Vial containing white or pale yellow powder and syringe with water for injections (solvent). Presentations:

Alphanate^® 250 IU (250 IU/5 ml)

Alphanate^® 500 IU (500 IU/5 ml)

Alphanate^® 1000 IU (1000 IU/10 ml)

Alphanate^® 1500 IU (1500 IU/10 ml) PL 12930/0015 Alphanate^® 2000 IU (2000 IU/10 ml) PL 12930/0017 Water for Injections PL 4447/0016 Pack size: 1 lyophilised vial, 1 syringe pre-filled with solvent and accessories (vial adaptor, filter, 2 alcohol swabs and butterfly needle).

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder and Manufacturer: Instituto Grifols, S.A.

Can Guasc, 2 - Parets del Vallès

08150 Barcelona - SPAIN

Distributed by:

Grifols UK Ltd.

3980-3990 Cambridge Research Park

Beach Drive

Waterbeach

Cambridge, CB25 9PE

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3062456 Instructions for use/handling

Follow these instructions unless otherwise indicated by your doctor.

Left-over product must never be kept for later use, nor stored in a refrigerator.

To prepare the solution:

1. 1. Warm the vial and syringe but not above 30 ºC.
2. 2. Attach plunger to syringe containing solvent.
3. 3. Remove filter from packaging. Remove cap from syringe tip and attach syringe to filter.
4. 4. Remove vial adaptor from packaging and attach to syringe and filter.
5. 5. Remove cap from vial and wipe stopper with swabs provided.
6. 6. Pierce vial stopper with adaptor needle.
7. 7. Transfer all solvent from syringe to vial.
8. 8.

   Gently shake vial until all product is dissolved.

   As with other parenteral solutions, do not use if product is not properly dissolved or particles are visible.

9. 9. Briefly separate the syringe/filter from vial/ adaptor, to release the vacuum.
10. 10. Turn the vial upside down and draw the solution into the syringe.
11. 11. Prepare injection site, separate syringe and inject product using the butterfly needle provided. Injection rate should be 3 ml/min into a vein and never more than 10 ml/min to avoid vasomotor reactions.

Do not re-use administration sets.

It is important to use the infusion set provided with the medicine. If medical infusion systems are used, please check the compatibility of the system with the prefilled syringe. Adapters should be used when required to ensure proper administration of the product.

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