Nanokine injection 4000iu/0.5ml nanogen treatment

Dosage form Box X 0.5ml
Specifications Recomminant Human Erythropoietin Alfa

Ingredient

Thành phần cho 1ml

Composition information	Content
Recomminant Human Erythropoietin Alfa	4000iu

Uses

indications

Nanokine 4000 IU/0.5 ml is indicated in the following cases:

Anemia treatment in patients: Chronic kidney failure, including patients whether or not dialysis, cancer is using chemotherapy, HIV infection is being treated with zidovudine. Pharmacology: Hematropia agents.

ATC code: b03xa01.

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% - 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 early precursor 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 increases peripheral hematopoietic stem cells. Within 3-4 weeks, hematocrit increases, depending on the dose. Ordinary stem cells (CFU-GM and CFU-MIX) 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

intravenously

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, 150 IU/kg. The half -life 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 intravenously. There is no accumulation of serum concentration, whether the data is collected 24 hours after the first dose or 24 hours after the last dose.

Selling time when using subcutaneous injections is about 24 hours.

Before taking Nanokine injection 4000iu/0.5ml nanogen treatment

How to use

drugs for subcutaneous or intravenous injection.

should only use intravenously for patients with chronic kidney disease.

Dosage

Erythropoietin treatment effect depends on the dose, but the dose is higher than 300 units/kg, 3 times/week does not give better results. The maximum dose of erythropoietin has not been determined. Using more iron or l-carnitin increases the response to erythropoietin, so the drug can be reduced to stimulate the pinkness.

Anemia in patients with chronic renal failure:

intravenous injection:

Initially used dose is 50 - 100 IU/kg, 3 times/week. Erythropoietin dose should be reduced when hematocrit reaches 30-36% or when every two weeks, Hematocrit increases over 4%. If after 8 weeks of treatment, Hematocrit does not increase by 5-6% and is still lower than the need to be achieved, it is necessary to increase the dose. Hematocrit must not increase higher than 36%. Need to calculate the dose for each patient, maintenance dose from 12.5 - 525 IU/kg, 3 times/week. Hematocrit increases depending on the dose, but if the dose is higher than 300 IU/kg, 3 times/week, it will not give better results. Dosage to treat anemia in patients with end -stage renal disease is from 3 - 500 IU/kg of dose, 3 times/week, starting with low doses and then gradually increasing hiccups depending on hematology. The dose may increase twice the previous dose and 1-2 weeks apart.

subcutaneous injection:

erythropoietin is often used in the initial dose of 50 - 100 IU/kg, 3 times/week. Erythropoietin dose is required when hematocrit reaches 30-36% or up 4% within 2 weeks. Needs to increase the dose if after 8 weeks of treatment, hematocrit does not increase by 5-6% and is still lower than the level to be achieved. Hematocrit increases depending on the dose but the dose is higher than 300 IU/kg, 3 times/week also does not give better results. The dose should be calculated for each case, every month should not change the dose exceeding 1 time, unless clinically indicated. It is possible to reduce the maintenance dose per week to 23-22% when subcutaneously injecting the skin rather than intravenous injection (because the drug is absorbed from the subcutaneous line). The subcutaneous dose to maintain hemoglobin concentration is 9.4% to 10g/decor is from 2800 - 6720 IU per week, compared to 8350 - 20300 IU per week when intravenously.

erythropoietin can be injected subcutaneously or intravenously, should use intravenous tract in patients with fecal diseases. The subcutaneous injection takes more days to reach the concentration of hemoglobin that needs to be compared to intravenous injection. Erythropoietin can be injected into the muscle (Delta muscle) with a dose of 4000 - 8000 IU, once a week, hematocrit can increase to 30 - 33%. Intramuscular injection less than subcutaneous injection.

Dosage in children:

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

Adjust the dose during the fertilizer:

Dialysis: Erythropoietin is used for 12 hours after dialysis.

Peritoneal jurisdiction: The effective way is to take one, 2 or 3 times/week. After using 2000 - 8000 IU, 1 time/week for 2 - 10 months, the average hematocrit increased from 20-30%. Or you can use a dose of 60 - 120 IU/kg, subcutaneous injection, 2 times/week. The next dose must then be based on Hemoglobin response. The dose needed to maintain hemoglobin concentration is from 11 - 11.5 g/Decilids is from 12.5 - 50 IU/kg, 3 times/week. Erythropoietin's bioavailability is used by subcutaneous injection (22%) 7 times the peritoneal injection (3%); 3 - 4 days after subcutaneous injection, the drug is still in serum.

Anemia due to cancer chemotherapy:

Need to start at a dose of 150 IU/kg under the skin, 3 times/week. If after 8 weeks, the results are not good, the dose can be increased to 300 IU/kg. Higher doses do not increase the effectiveness. During treatment, if hematocrit is 40% higher, it is necessary to suspend erythropoietin until hematocrit drops lower than 360, then need to reduce 25% of the dose and adjust.

Reducing blood transfusion needs in patients with surgery:

erythropoietin is indicated to treat anemia patient (hemoglobin 10 -13 g/decolide) preparing selective surgery (not heart or blood vessels) to reduce the need for genetic blood transfusion, or patients with high blood loss need to be transferred before, during and after surgery. The recommended dose is 300 IU/kg/day, subcutaneously 10 days before surgery, during the surgery day and 4 days after surgery. Another way is to injection under the skin 600 IU/kg, once a week before surgery 21, 14, and 7 days) add the fourth dose on the surgery day. Need to add iron. Erythropoietin subcutaneous or vein (300 IU/kg/day until there is an appropriate response, then 150 IU/kg, a day) for 3-10 days, combined with folat, cyanocobalamin, oral or iron injection can cause hemoglobin or hematocrite to increase every day 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 IU/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 - 100 IU for each 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 blood extract may be extracted if the concentration of hemoglobin is too high.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when forgetting a dose? If you forget a dose, contact your doctor for additional immediately.

Side Effects

When using nanokine 4000 IU/0.5 ml, you may experience unwanted effects (ADR).

Common, ADR> 1/100

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

Circulation: Hypertension, thrombosis in intravenous, blood clots in the machine, platelets increased temporarily.

blood: changes too quickly in hematocrit, hyperkalemia.

Neurological: cramps, whole epilepsy.

Skin: local irritation, acne, pain in the subcutaneous injection site.

Rare, 1/10,000

Blood: Soldier property (prca).

circulating: platelet increase, angina.

Body: 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, it is immediately injected with 10 ml of the isothermal saline solution and increases heparin during dialysis to prevent thrombosis.

When hypertension is dangerous, anti -hypertension therapy has no results. It is possible to perform veins when hemoglobin (HB) concentration increases excessively.

Warnings

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

Contraindicated

Nanokine 4000 IU/0.5 ml of contraindications in the following cases:

uncontrolled hypertension.

Hypersensitivity to erythropoietin or any ingredient of the drug.

Patients have progressed simply red blood cell property (PRCA) after treatment with preparations containing erythropoietin.

Be cautious when using

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

Be cautious when prescribing the nanokine for the following objects:

Patients with myocardial ischemia.

The patient starts hypertension, or goes 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 platelet growth.

Use erythropoietin for athletes who are considered to use stimulants, if the physician's lack of supervision and do not monitor dehydration while competing requires toughness, the serious consequences of blood change, can be fatal.

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 phenomenon of sudden loss of effectiveness of the drug, severe anemia, hemoglobin decrease (1 - 2 g/dl or 0.62 - 1.25 mmol/l per month), 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, testing antibody antibody Erythropoietin and bone marrow. Other Erythropoietin should not be switched because antibodies are likely to react cross -reactions between erythropoietin. Other causes should be eliminated and applied appropriate management measures.

In patients with chronic renal impairment, the treatment of anemia increases the appetite of the patient, and the amount of potassium is eaten. 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 increased blood clotting, if there is increased blood clotting, increased heparin.

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 a temperature of 2 - 8 ° C (refrigerator) in the original packaging packaging. Do not let freezing. Avoid light.

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