Nanokine injection 2000iu/0.5ml Nonagen treat anemia

Dosage form Box X 0.5ml
Specifications Recomminant Human Erythropoietin Alfa

Ingredient

Thành phần cho 1ml

Composition information	Content
Recomminant Human Erythropoietin Alfa	2000iu

Uses

indications

Nanokine 2000 IU drugs are indicated in the following cases:

Anemia in patients with chronic renal impairment, including patients whether or not dialysis.

Pharmacology

erythropoietin is an essential hormone to create red blood cells from the red blood cell tissue in the bone marrow. Most of this hormone produced by the kidneys to respond to tissue oxygen deficiency, a small part (10% to 14%) due to the synthetic liver (the liver is the main organ that produces erythropoietin in the fetus). Erythropoietin acts as a growth factor, stimulating the activity of the stem cells of red blood cells and pre -early red blood cells (Red blood cells).

This hormone also has the effect of differentiating, stimulating the conversion of the unit to create red blood cell population (CPU) into red blood cells. After about 1 week of injection, Erythropoietin significantly increased peripheral hematopoietic stem cells. Within 3 to 4 weeks, hematocrit increases, depending on the dose. Ordinary stem cells (CFU - GM and CFU) are not red blood cells. Thus, when used in treatment, Erythropoietin works on both cell lines (red blood cells and cellular pulp).

In patients with iron deficiency anemia or discreet blood loss, erythropoietin may not be responded and maintained.

pharmacokinetics

intravenous injection:

The half -life is measured after using Erythropoietin ALFA in response to the dose of 50 - 100 IU/kg on healthy people and the half -life is about 5 hours longer on kidney failure, after doses of 50, 100 IU/kg. The selling time of about 6 hours is recorded in children.

subcutaneous injection:

Serum concentration when subcutaneously is lower than intravenously. Serum concentration increased slowly and peaked 12 - 18 hours after subcutaneous injection. The concentration of subcutaneous injection is always lower than intravenous injection. No accumulation: Serum concentration remains unchanged whether the data is received 24 hours after the first dose or 24 hours after the last dose. Selling time when using subcutaneous injection is about 24 hours.

Before taking Nanokine injection 2000iu/0.5ml Nonagen treat anemia

How to use

subcutaneous injection or intravenous injection. Only intravenously for patients with chronic kidney disease.

Dosage

The treatment effect of erythropoietin depends on the dose; However, the dose is higher than 300 units/kg, three times a week does not give better results. The maximum dose of erythropoietin has not been determined. Using more iron or l - carnitin increases response to erythropoietin, so it can be reduced the dose needed to stimulate red blood cells.

Anemia in patients with chronic renal failure

intravenous injection:

Initially used dose is 50 - 100 units/kg, three times a week. Erythropoietin dose is required when Hematocrit reaches 30% to 36% or when every two weeks, Hematocrit increases over 4%. If after 8 weeks of treatment, hematocrit does not increase to 5 to 6% and is still lower than the need to be achieved, it is necessary to increase the dose. Hematocrit must not increase higher than 36%.

It is necessary to calculate the dose for each patient; The maintenance dose is from 12.5 to 525 units/kg, three times a week. Hematocrit increases depending on the dose, but if the dose is higher than 300 units/kg, three times a week, will not give better results.

Dosage to treat anemia in patients with renal disease in the end stage is from 3 units/kg/dose to 500 units/kg/dose, three times a week; Start at low doses and then gradually increase hiccups depending on hematology. The dose may increase twice the previous dose and 1 to 2 weeks apart.

subcutaneous injection:

erythropoietin is often used in the initial dose of 50 - 100 units/kg, three times a week. Erythropoietin dose is required when hematocrit reaches 30% to 36% or up 4% within 2 weeks. It is necessary to increase the dose if after 8 weeks of treatment, hematocrit does not increase 5 to 6% and is still lower than the need.

Hematocrit increases depending on the dose but the dose is higher than 300 units/kg, three times a week does not give better results. Need to dose by case; Each month should not change the dose 1 time, unless clinical indications.

It is possible to reduce the maintenance dose per week from 23% to 52% when subcutaneously injecting the skin rather than veins (because the drug is absorbed from the subcutaneous line). The subcutaneous dose to maintain hemoglobin concentration is at 9.4 to 10 g/Decilids from 2800 to 6720 units per week; Compared to 8350 to 20300 units per week when intravenous injection.

erythropoietin may be injected subcutaneously or intravenously; Venous lines should be used in the patient. The subcutaneous injection takes more days to reach the concentration of hemoglobin that needs to be compared to intravenous injection. Erythropoietin can also be injected into the muscle (Delta muscle) with a dose of 4000 to 8000 units, once a week; Hematocrit can increase to 30% to 33%. Intramuscular pain less than subcutaneous injection.

Dosage recommended in children

The initial dose is 150 units/kg under the skin, 3 times a week; If hematocrit increases to 35%, reduces the dose of 25 units/kg/dose and stops the drug if hematocrit reaches 40%. This usage is safe and effective for children with end -stage renal failure.

Dosage adjustment during discrimination

dialysis:

erythropoietin is used 12 hours after dialysis.

Peritonics:

The effective use is to take one, two or three times a week. After using 2000 to 8,000 units, once a week for 2 to 10 months, the average hematocrit increases from 20% to 30%. Or you can use a dose of 60 to 120 units/kg, injected under the skin twice a week. The next dose must be based on Hemoglobin response. The dose needed to maintain hemoglobin concentration is from 11 to 11.5 g/Decilids is from 12.5 to 50 units/kg, 3 times/week.

Erythropoietin's biological abundance is used by subcutaneous injection (22%) 7 times higher than the peritoneal injection (3%); 3 to 4 days after subcutaneous injection, the drug is still in serum.

Anemia due to cancer chemotherapy

It is necessary to start at a dose of 150 units/kg under the skin, three times/week. If after 8 weeks, the results are not good, the dose can be increased to 300 units/kg. Higher doses do not increase the effectiveness. During treatment, if hematocrit is 40% higher, it is necessary to suspend the use of erythropoietin until hematocrit drops to 36% lower, then it is necessary to reduce 25% of the dose and adjust.

Reducing blood transfusion needs in patients with surgery

erythropoietin is indicated to treat anemia (hemoglobin from 10 to 13 g/decadite) preparing selective surgery (not heart or blood vessels) to reduce the need for genetic blood transfusion; Or the patient is at high risk of blood loss that needs blood transfusions first, clear, and after surgery. The recommended dose is 300 units/kg/day, subcutaneously 10 days before surgery, on surgery and 4 days after surgery. Another way is to be subcontracted by 600 units/kg, once a week (before surgery, 14, 14, and 7 days) add the fourth dose on the surgery day. Need to supplement iron.

erythropoietin subcutaneous or vein (300 units/kg/day until the appropriate response, then 150 units/kg, a day) for 3 to 10 days, combined with folat, cyanocobalamin, drinking or injecting iron and enhancing nutrition can cause hemoglobin or hematocrit daily to 5% or more.

Anemia in patients treated with zidovudin

The initial dose is recommended to treat anemia for HIV -infected patients treated with zidovudine is 100 units/kg intravenously or under the skin, 3 times/week for 8 weeks. If after 8 weeks, the results are not good, it may increase from 50 to 100 units per kg, 3 times/day.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose? The overdose of erythropoietin can lead to hypertension. Venous deductions may be extracted if the hemoglobin concentration is too high. If necessary, extra support treatment.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Nanokine 2000 IU you may experience unwanted effects (ADR).

Common, ADR> 1/100

Systemic: headache, edema, chills and bone pain (symptoms like the flu) mainly in the first intravenous injection.

circulating: Hypertension, thrombosis in intravenous injections, clots of blood clots in the machine, platelets increased temporarily. Blood: changes too quickly in hematocrit, hyperkalemia.

Neurological: cramps, whole seizures.

Skin: Form irritation, acne, pain in the subcutaneous injection area.

Rare, ADR

Platelets, angina.

sweat.

Instructions on how to handle ADR

Need to monitor hematocrit regularly and adjust the dose according to the concentration of hemoglobin.

To avoid increasing blood clotting, after being injected into the vein, there is an additional 10 ml of sub isal salt solution and heparin dose during dialysis to prevent thrombosis.

When hypertension is so dangerous that anti -hypertension therapies do not work, the vein incision can be taken out the blood.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

contraindicated

Nanokine 2000 IU contraindications in the following cases:

Unsatisfied high blood pressure.

Hypersensitivity to erythropoietin or any ingredients of the drug.

malignant bone marrow.

Patients who have progressed simply red blood cells (PRCA) after treatment with non -erythropoietin preparations.

Be cautious when using

should not use drugs for babies and children under 3 years old, because the drug has excipients Benzyl alcohol.

Patients with myocardial ischemia.

Patients begin to hypertension, or go along with headache, should treat hypertension. In case of increased blood pressure, it is difficult to control, patients need to be carefully monitored until the blood pressure is appropriate. The patient increased muscle tone without controlling cramps, with a history of epilepsy.

Patients with platelets.

There are blood diseases including sickle cell anemia, medullary dysplasia syndrome, and bloody condition.

Patients with cerebral hemorrhage.

Use erythropoietin for athletes who are considered to use stimulants, without the physician's supervision and do not monitor dehydration while competing requires toughness, it is likely to occur seriously about changes in blood, fatigue.

The effect of erythropoietin is slow or decreasing due to many causes such as iron deficiency, bacterial infection, inflammation or cancer, blood disease (thalassemi anemia, anti -therapy anemia, bone marrow), folic acid deficiency or vitamin B12 deficiency, hemolysis, aluminum poisoning.

Soldness of red blood cells (PRCA) related to the use of erythropoietin has been recorded at a very rare rate. Prca occurs mainly in patients with chronic kidney disease using erythropoietin injections under the skin. This syndrome is described by the sudden loss of effectiveness of the drug, severe anemia, hemoglobin decrease (1 - 2 g/dl or 0.62–1.25 mmol/lthly monthly), low number of red blood cells (

Need to closely monitor patient response during treatment. If the effect is reduced or lost suddenly, anemia is more serious, it is necessary to assess other causes that may cause non -response to drugs such as iron deficiency, folat, vitamin B12; Aluminum poisoning, bacterial or inflammation, blood loss and hemorrhage. If the red blood cell suspect (PRCA) is suspected and does not detect other causes, it is necessary to stop using erythropoietin, test antibodies of erythropoietin antibodies and bone marrow, should not switch to other Erythropoietin due to antibodies that are likely to react between erythropoietin. Other causes should be eliminated and applied appropriate management measures.

In patients with chronic renal failure, the treatment of anemia increases the appetite of the patient and the amount of potassium eat. If there is an increase in potassium in patients who are being separated, the diet and the diet must be adjusted. Increasing urea and cretinin premature jurisdiction can occur in several patients due to the increase in the amount of protein intake, in this case the regime needs to be adjusted. Patients with hemorrhage must be carefully monitored with hyperplasia, if there is an increase in hyperactivity, heparin hyperplation.

The ability to drive and operate machinery

The drug does not affect the ability to drive and operate machinery.

Pregnancy

There is no test to use Erythropoietin Alfa during pregnancy, only medication during pregnancy if the benefit of using drugs is higher than possible.

The period of breastfeeding

There is no evidence that Erythropoietin Alfa is excreted through human milk. Should be cautious when used in breastfeeding women.

Medicinal interaction

Using enzyme inhibitors simultaneously with erythropoietin may increase the risk of hyperkalemia, especially in patients with reduced kidney function.

There are no important clinical interactions between Erythropoietin ALFA and other drugs. However, the effectiveness of erythropoietin alfa increases when used simultaneously with sulfate iron when symptoms of iron deficiency.

Storage

Store at 2 ° C - 8 ° C (refrigerator) in the original packaging packaging. Do not let freezing; Avoid light.

Note: In case the patient self -use at home: Health staff should inform the patient about how to preserve Erythropoietin preparations to ensure compliance with the preservation conditions as recommended above.

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