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CSL Behring UK Limited

Hayworth House, Market Place, Haywards Heath, West Sussex, RH16 1DB, UK
Telephone: +44 (0)1444 447 400
Fax: +44 (0)1444 447 403
WWW: http://www.cslbehring.co.uk
Medical Information Direct Line: +44 (0)1444 447 405
Medical Information e-mail: medinfo@cslbehring.com
Customer Care direct line: +44 (0)1444 447 402
Out of Hours contact: +44 (0)1444 447 405

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Summary of Product Characteristics last updated on the eMC: 15/01/2014

Fibrogammin



1. Name of the medicinal product

Fibrogammin® 250 IU

Powder and solvent for solution for injection or infusion


2. Qualitative and quantitative composition

Active ingredient: Fibrogammin is a purified concentrate of blood coagulation factor XIII. It is derived from human plasma, and is presented as a white powder.

Powder

68 - 135 mg

Human plasma fraction with a factor XIII activity of

250 IU

Total protein

24 - 64 mg

Excipients with known effect:

Sodium (as chloride and hydroxide): 2.78 to 4.36 mg/ml (120 to 189 mmol/L)

For the full list of excipients, see section 6.1.


3. Pharmaceutical form

Powder (white) and solvent for solution for injection or infusion.


4. Clinical particulars

4.1 Therapeutic indications

Congenital deficiency of Factor XIII and resultant haemorrhagic diathesis, haemorrhages and disturbances in wound healing.


4.2 Posology and method of administration

Posology

1 ml is equivalent to 62.5 IU, and 100 IU are equivalent to 1.6 ml, respectively.

Important: The amount to be administered and the frequency of administration should always be orientated towards clinical efficacy in the individual case.

The following table can be used to guide dosing in bleeding episodes and surgery for adults and children:

Type of treatment

Dosage International Units [IU] per kg body weight [b.w.]

Frequency of doses / Duration of Treatment

Prophylaxis of haemorrhages

10

Approx. once a month. The interval is to be shortened if spontaneous haemorrhages develop.

Before surgical operations

Up to 35

Immediately before surgery, then the required efficacy should be maintained by repeated injections until the wound has healed completely.

Therapy

10-20

Daily, for severe haemorrhages and extensive haematomas until bleeding has stopped.

In acute bleeding episodes, especially intracranial bleedings, factor XIII must be raised to normal levels, which can be achieved by doses up to 50 IU/kg.

Due to the different pathogenesis of factor-XIII-deficiencies the data available on half-lives differ considerably. Thus, monitoring the increase in factor-XIII-activity with a factor-XIII-assay is recommended. In the case of major surgery and severe haemorrhages the aim is to obtain normal values.

Paediatric population

No data are available.

Method of administration

For instructions on reconstitution of the medicinal product before administration, see section 6.6. The preparation should be warmed to room or body temperature before administration. Slowly inject or infuse intravenously at a rate which the patient finds comfortable. The injection or infusion rate should not exceed approx. 4ml per minute.

Observe the patient for any immediate reaction. If any reaction takes place during the administration of Fibrogammin, the rate of infusion should be decreased or the infusion stopped, as required by the clinical condition of the patient (see also section 4.4).


4.3 Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.


4.4 Special warnings and precautions for use

If anaphylactic reactions occur (see section 4.8) the administration of Fibrogammin should be discontinued immediately and appropriate treatment initiated. The current medical standards for shock treatment should be observed.

In the case of patients with known allergies to the product, with symptoms such as generalised urticaria, rash, a fall in blood pressure, dyspnoea, antihistamines and corticosteroids may be administered prophylactically.

In cases of fresh thromboses caution should be exercised on account of the fibrin-stabilising effect of Factor XIII.

After repeated Fibrogammin treatment, patients should be carefully monitored for the development of inhibitors to FXIII by appropriate clinical observation and laboratory tests.

Note for diabetic patients

Fibrogammin contains glucose (24 mg per 250 IU). When administering a dose of 10 IU/kg body weight to a patient with 75 kg body weight, a maximum of 72 mg glucose will be supplied. In cases of the maximum daily dose of 35 IU/kg body weight (assuming the same body weight), a maximum of 252 mg glucose would be supplied.

Note for patients on a low sodium diet

Fibrogammin contains 116.6 to 183.2 mg (5.07 to 7.97 mmol) sodium per dose (bodyweight 75 kg), if the maximal daily dose (2625 IU = 42 ml) is applied. To be taken into consideration in patients on a controlled sodium diet.

Virus safety

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 viruses. Despite this, when medicinal products 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 and other pathogens.

The measures taken are considered effective for enveloped viruses such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) and for the non-enveloped viruses hepatitis A and parvovirus B19.

Appropriate vaccination (hepatitis A and B) should be considered for patients in regular/repeated receipt of human plasma-derived factor XIII products.

It is strongly recommended that whenever Fibrogammin is administered to a patient, the product name and batch number are recorded in order to maintain a link between the patient and the batch of the product.


4.5 Interaction with other medicinal products and other forms of interaction

No interaction studies have been performed.


4.6 Fertility, pregnancy and lactation

Pregnancy

The safety of Fibrogammin for use in human pregnancy has not been established in controlled clinical trials.

Experimental animal studies are insufficient to assess the safety with respect to development of the embryo or foetus, the course of gestation and peri- and postnatal development.

The clinical use of Fibrogammin in pregnancy did not show any negative effects on the course of gestation and the peri- or postnatal development. The efficacy of Fibrogammin in pregnant women with congenital factor-XIII-deficiency has been described.

Therefore, Fibrogammin may be used during pregnancy after careful consideration.

Lactation

The safety of Fibrogammin for use during breastfeeding has not been established in controlled clinical trials. Fibrogammin may be used during lactation after careful consideration.

Fertility

Experimental animal studies are insufficient to assess the safety with respect to reproduction.


4.7 Effects on ability to drive and use machines

No studies on the effects on the ability to drive and use machines have been performed.


4.8 Undesirable effects

The following adverse reactions are based on post-marketing experience.

The following standard categories of frequency are used:

Very common: ≥ 1/10

Common: ≥ 1/100 and < 1/10

Uncommon: ≥ 1/1,000 and < 1/100

Rare: ≥ 1/10,000 and < 1/1,000

Very rare: < 1/10,000

Immune system disorders

In rare cases allergic-anaphylactic reactions, e.g. generalised urticaria, rash, hypotension, dyspnoea are observed. The treatment required depends on the nature and severity of the side effects (see section 4.4).

In very rare cases the development of inhibitors to Factor XIII may occur.

General disorders and administration site conditions

In rare cases a rise in temperature can be observed.

For safety with respect to transmissible agents, see section 4.4.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme.

Website: www.mhra.gov.uk/yellowcard


4.9 Overdose

No cases of overdose have been reported.


5. Pharmacological properties

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Antihaemorrhagics

ATC code: B02B D07

Biochemically, factor XIII acts as transglutaminase.

Factor XIII connects the amino group of lysine with glutamine via its enzymatic function (transamidase activity), thereby leading to the cross-linking of fibrin molecules. This is the final stage of blood coagulation. Fibrin cross-linking and stabilisation promote the penetration of fibroblasts and support wound healing.


5.2 Pharmacokinetic properties

Distribution

The product is administered intravenously, and is thus immediately bioavailable resulting in a plasma concentration corresponding to the applied dose.

Elimination

In congenital factor-XIII-deficiency the biological half-life of Fibrogammin was determined to be 9.2 days (median). Fibrogammin is metabolised in the same way as is the endogenous coagulation factor XIII.


5.3 Preclinical safety data

Concentrate of human factor XIII as a normal constituent of the human plasma acts like the physiological factor XIII. Single dose toxicity testing revealed no adverse findings in different species even at dose levels several times higher than the recommended human dose.

Repeated dose toxicity testing is impracticable due to the development of antibodies in animal models.

To date, Fibrogammin has not been reported to be associated with embryo-foetal toxicity, oncogenic or mutagenic potential.


6. Pharmaceutical particulars

6.1 List of excipients

Human albumin

Glucose

Sodium chloride*

Hydrochloric acid or sodium hydroxide (for pH adjustment)

*see also section 4.4

Supplied solvent: Water for Injections 4 ml


6.2 Incompatibilities

Fibrogammin must not be mixed with other medicinal products except those mentioned in section 6.6 and should be administered by a separate infusion line.


6.3 Shelf life

3 years

Do not use after the expiry date given on the pack and container.

From a microbiological point of view, and as Fibrogammin contains no preservative, the reconstituted product should be used immediately.

If it is not administered immediately, storage shall not exceed 8 hours at +2 to +8 °C.


6.4 Special precautions for storage

Store in a refrigerator (+2 to +8 °C). Do not freeze.

Keep the vial in the outer carton in order to protect from light.


6.5 Nature and contents of container

Vials:

Powder: 6 ml injection vial of colourless glass, sealed with a rubber stopper, an aluminium cap and a plastic disc.

Solvent (Water for Injections): 6 ml vial of colourless glass

Presentation:

1 vial with powder

1 vial with 4 ml Water for Injections

1 filter transfer device 20/20


6.6 Special precautions for disposal and other handling

General instructions

• The solution should be clear or slightly opalescent. After filtering/withdrawal (see below) the reconstituted product should be inspected visually for particulate matter and discoloration prior to administration.

• Reconstitution and withdrawal must be carried out under aseptic conditions.

• Do not use solutions which are cloudy or contain residues (deposits/particles).

Reconstitution:

Bring the solvent to room temperature. Ensure product and solvent vial flip caps are removed and the stoppers are treated with an aseptic solution and allowed to dry prior to opening the Mix2Vial package.

1

1. Open the Mix2Vial package by peeling off the lid. Do not remove the Mix2Vial from the blister package!

2

2. Place the solvent vial on an even, clean surface and hold the vial tight. Take the Mix2Vial together with the blister package and push the spike of the blue adapter end straight down through the solvent vial stopper.

3

3. Carefully remove the blister package from the Mix2Vial set by holding at the rim, and pulling vertically upwards. Make sure that you only pull away the blister package and not the Mix2Vial set.

4

4. Place the product vial on an even and firm surface. Invert the solvent vial with the Mix2Vial set attached and push the spike of the transparent adapter end straight down through the product vial stopper.

The solvent will automatically flow into the product vial.

5

5. With one hand grasp the product-side of the Mix2Vial set and with the other hand grasp the solvent-side and unscrew the set carefully into two pieces.

Discard the solvent vial with the blue Mix2Vial adapter attached.

6

6. Gently swirl the product vial with the transparent adapter attached until the substance is fully dissolved. Do not shake.

7

7. Draw air into an empty, sterile syringe.

While the product vial is upright, connect the syringe to the Mix2Vial's Luer Lock fitting.

Inject air into the product vial.

Withdrawal and application

8

8. While keeping the syringe plunger pressed, turn the system upside down and draw the solution into the syringe by pulling the plunger back slowly.

9

9. Now that the solution has been transferred into the syringe, firmly hold on to the barrel of the syringe (keeping the syringe plunger facing down) and disconnect the transparent Mix2Vial adapter from the syringe.

Care should be taken that no blood enters the syringe filled with product, as there is a risk that the blood could coagulate in the syringe and fibrin clots could therefore be administered to the patient.

In case more than one vial of Fibrogammin is required, it is possible to pool several vials of Fibrogammin for a single infusion via a commercially available infusion device.

The Fibrogammin solution must not be diluted.

The reconstituted solution should be administered by a separate injection / infusion line by slow intravenous injection, at a rate not exceeding 4 ml per minute.

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


7. Marketing authorisation holder

CSL Behring GmbH

Emil-von-Behring-Strasse 76

35041 Marburg

Germany


8. Marketing authorisation number(s)

PL 15036/0006


9. Date of first authorisation/renewal of the authorisation

22 June 1998 / 30 October 2003


10. Date of revision of the text

08 January 2014