Bebulin
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Questions & Answers
Side Effects & Adverse Reactions
Thromboembolic events (deep vein thrombosis, pulmonary embolism, thrombotic stroke) as well as disseminated intravascular coagulation (DIC) have been reported with BEBULIN. The risk of thromboembolic complications including DIC and hyperfibrinolysis is higher in patients with congenital or acquired coagulation disorders, with repeated dosing or high doses of BEBULIN. Because of the risk of thromboembolic complications, closely monitor patients when administering BEBULIN:
- Monitor patients closely for signs and symptoms of intravascular coagulation or thrombosis.
- Monitor Factor IX level in patients predisposed to thromboembolic complications including patients with a history of coronary artery disease, patients with liver disease, pre- or postoperative patients, and neonates.
- Stop the infusion immediately and initiate appropriate diagnostic and therapeutic measures at the first signs or symptoms of thrombosis or embolism.
Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions have been reported with BEBULIN. Manifestations of hypersensitivity or allergic reactions include anaphylactic shock, hypotension, hypertension, chest tightness, dizziness, paresthesia, lethargy, restlessness, vomiting, urticaria, erythema, pyrexia, chills, and rash. In the event of an anaphylactic/anaphylactoid reaction, stop the infusion immediately and administer appropriate emergency treatment. Evaluate patients experiencing allergic reactions for the presence of an inhibitor.
Formation of circulating antibodies inhibiting Factor IX has been reported with the administration of BEBULIN. If such an inhibitor occurs, the condition will manifest itself as a poor clinical response. Nephrotic syndrome has been reported following attempted immune tolerance induction in hemophilia B with Factor IX inhibitor receiving factor IX products including BEBULIN.4 The safety and efficacy of using factor IX products including BEBULIN for immune tolerance induction have not been established.
Because BEBULIN is made from human plasma, it may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and theoretically, the classic Creutzfeldt-Jakob disease agent. This also applies to unknown or emerging viruses and other pathogens. No cases of transmission of viral diseases or vCJD have been associated with BEBULIN.
ALL infections thought by a physician to possibly have been transmitted by this product should be reported by the physician or other healthcare provider to Baxter Healthcare Corporation, at 1-800-423-2862 (in the U.S.).
Thromboembolic events (deep vein thrombosis, pulmonary embolism, thrombotic stroke) as well as disseminated intravascular coagulation (DIC) have been reported with BEBULIN. The risk of thromboembolic complications including DIC and hyperfibrinolysis is higher in patients with congenital or acquired coagulation disorders, with repeated dosing or high doses of BEBULIN. Because of the risk of thromboembolic complications, closely monitor patients when administering BEBULIN:
- Monitor patients closely for signs and symptoms of intravascular coagulation or thrombosis.
- Monitor Factor IX level in patients predisposed to thromboembolic complications including patients with a history of coronary artery disease, patients with liver disease, pre- or postoperative patients, and neonates.
- Stop the infusion immediately and initiate appropriate diagnostic and therapeutic measures at the first signs or symptoms of thrombosis or embolism.
Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions have been reported with BEBULIN. Manifestations of hypersensitivity or allergic reactions include anaphylactic shock, hypotension, hypertension, chest tightness, dizziness, paresthesia, lethargy, restlessness, vomiting, urticaria, erythema, pyrexia, chills, and rash. In the event of an anaphylactic/anaphylactoid reaction, stop the infusion immediately and administer appropriate emergency treatment. Evaluate patients experiencing allergic reactions for the presence of an inhibitor.
Development of InhibitorFormation of circulating antibodies inhibiting Factor IX has been reported with the administration of BEBULIN. If such an inhibitor occurs, the condition will manifest itself as a poor clinical response. Nephrotic syndrome has been reported following attempted immune tolerance induction in hemophilia B with Factor IX inhibitor receiving factor IX products including BEBULIN.4 The safety and efficacy of using factor IX products including BEBULIN for immune tolerance induction have not been established.
Transmission of Infectious AgentsBecause BEBULIN is made from human plasma, it may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and theoretically, the classic Creutzfeldt-Jakob disease agent. This also applies to unknown or emerging viruses and other pathogens. No cases of transmission of viral diseases or vCJD have been associated with BEBULIN.
ALL infections thought by a physician to possibly have been transmitted by this product should be reported by the physician or other healthcare provider to Baxter Healthcare Corporation, at 1-800-423-2862 (in the U.S.).
Legal Issues
There is currently no legal information available for this drug.
FDA Safety Alerts
There are currently no FDA safety alerts available for this drug.
Manufacturer Warnings
There is currently no manufacturer warning information available for this drug.
FDA Labeling Changes
There are currently no FDA labeling changes available for this drug.
Uses
BEBULIN is indicated for the prevention and control of bleeding episodes in adult patients with hemophilia B (congenital Factor IX deficiency or Christmas disease).
BEBULIN is not indicated for use in the treatment of Factor VII deficiency. No clinical studies have been conducted to show benefit from this product for treating deficiencies other than Factor IX deficiency.
History
There is currently no drug history available for this drug.
Other Information
BEBULIN (Factor IX Complex), Nanofiltered and Vapor Heated is a purified, sterile, freeze-dried concentrate of the Coagulation Factor IX (Christmas Factor) as well as Factor II (Prothrombin) and Factor X (Stuart-Prower Factor) and low amounts of Factor VII. In addition, the product contains small amounts of heparin (≤ 0.15 IU heparin per IU Factor IX).
BEBULIN is standardized in terms of Factor IX content and each vial is labeled for the Factor IX content indicated in International Units (IU). One International Unit of Factor IX (according to the current International Standard for Human Blood Coagulation Factors II, IX, and X in concentrates) corresponds to the activity of Factor IX in 1 mL of fresh normal human plasma.
BEBULIN is manufactured from large plasma pools of human plasma. Screening against potentially infectious agents begins with the donor selection process and continues throughout plasma collection and plasma preparation. Each individual plasma donation used in the manufacture of BEBULIN is collected only at FDA approved blood establishments and is tested by FDA licensed serological tests for Hepatitis B Surface Antigen (HBsAg), for antibodies to Human Immunodeficiency Virus (HIV-1/HIV-2) and Hepatitis C Virus (HCV) in accordance with U.S. regulatory requirements. As an additional safety measure, mini-pools of the plasma are tested for the presence of HIV-1 and HCV by FDA licensed Nucleic Acid Testing (NAT) and found negative. Validated virus removal/inactivation steps have been integrated into the manufacturing process, namely 35 nm nanofiltration1 and a vapor heat treatment process2 [10 hours at 60°C and subsequent 1 hour at 80°C under the condition of 7-8% (w/v) residual moisture]. In addition DEAE-Sephadex adsorption contributes to the virus safety profile of BEBULIN. Despite these measures, this product can still potentially transmit disease3 [see Warnings].
In vitro spiking studies have been used to validate the capability of the manufacturing process to remove and inactivate viruses. To establish virus clearance capacity of the manufacturing process, these virus clearance studies were performed in accordance with good laboratory practices under extreme conditions (e.g. at minimum incubation times and temperatures below specifications for vapor-heat treatment). The in vitro viral reduction studies performed on nanofiltered BEBULIN are summarized in Table 1 .
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| Virus Type | Enveloped RNA | Enveloped DNA | Non-enveloped RNA | Non-enveloped DNA | |
| Virus Family | Retroviridae | Flaviviridae | Herpesviridae | Picornaviridae | Parvoviridae† |
| Virus‡ | HIV-1 | BVDV | PRV | HAV | MMV |
| DEAE Sephadex Adsorption | n.d§ | n.d | n.d | 1.4 | 1.3 |
| 35 nm Nanofiltration¶ | > 6.4 | 2.0 | > 6.0 | 1.7 | ≤1.0 |
| Vapor-Heat Treatment | > 6.8 | > 7.1 | > 7.4 | > 4.5 | ≤1.0 |
| Overall log reduction factor (ORF) | > 13.2 | > 9.1 | > 13.4 | > 7.6 | 1.3 |
Sources
Bebulin Manufacturers
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Baxter Healthcare Corporation
![Bebulin (Coagulation Factor Ix Human) Kit [Baxter Healthcare Corporation]](/wp-content/themes/bootstrap/assets/img/loading2.gif)
Bebulin | Baxter Healthcare Corporation
For intravenous administration only
One International Unit (IU) of Factor IX activity/kg will increase the plasma level of Factor IX by 0.8%. Accordingly, the following formula is provided for dosage calculations:
Number of Factor IX IU required = bodyweight (kg) x desired Factor IX increase (% of normal) x 1.2.
The response to treatment will vary from patient to patient. Exact dosage determination should be based on localization and extent of hemorrhage, and the level of Factor IX to be achieved. Close laboratory monitoring of the Factor IX level is required to determine proper dosage, particularly with severe hemorrhage and major surgery. Larger doses than those derived from the above formula may be required; particularly if treatment is delayed.
Management of Bleeding 7-11Approximate desired Factor IX levels, typical initial doses, and the average duration of treatment are suggested in Table 3. For minor bleeding, a single dose will usually be sufficient; otherwise a second dose may be given after 24 hours. More severe hemorrhage will require several doses at approximately 24-hours intervals. For maintenance therapy, usually two thirds of the initial dose is infused.
Table 3 Management of Specific Types of Bleeding * For patients predisposing to thrombosis see Precautions section. Type of BleedingApproximateDesired Factor IX Level
(% Normal)Typical InitialDose
(International Units/kg)Average Durationof Treatment
(Days)Minor
and gingival bleeding, mild hematuria 20 25-35 1
Early hemarthrosis,
minor epistaxis,Moderate
hematemesis,
Severe joint bleeding,
early hematoma, major open bleeding, minor trauma, minor hemoptysis,
and melena,
major hematuria 40 50-652 or until adequate
wound healing
Major
hematemesis, and
Severe hematoma major trauma, Severe hemoptysis,
melena ≥60* 75-902-3 or until adequate
wound healing Management of Surgical Procedures 7-11Dosage guidelines for surgical procedures are suggested in Table 4. Administer preoperative loading dose one hour prior to surgery. Depending on the type of surgery, continue replacement therapy over one to several weeks until adequate wound healing is achieved. The average treatment interval will initially be 12 hours, while in the later postoperative period, 24 hours is adequate.
Table 4 Management of Surgical Procedures * N/A– Not Applicable. † For patients predisposing to thrombosis see Precautions section.Type ofSurgery
Day of OperationInit. Postop. Period
(1st to 2nd Week)Late Postop. Period(from 3rd Week Onwards)
Approx. Level Factor IX
(% Normal)
Dose
(IU/kg)Approx. Level Factor IX
(% Normal)Dose
(IU/kg)Approx. Level Factor IX
(% Normal)
Dose
(IU/kg)
Minor 40-60 50-7520-40
25-65
N/A* N/A* Major≥60†
75-90 20-60 25-75 20 25-35For tooth extraction, the same initial dose as for minor surgery is recommended and one infusion should be sufficient. In case of extraction of several teeth, replacement therapy for up to one week may be necessary using the same doses as for minor surgery8-11.
Reconstitution Do not mix BEBULIN with other medicinal products or solvents, other than the enclosed sterilized water for injection. Administer BEBULIN within 3 hours after reconstitution as the solution does not contain a preservative. Do not refrigerate after reconstitution. Warm unopened vials of both diluent and concentrate to room temperature (not to exceed 37°C, 98°F). Remove caps from both vials to expose central portions of the rubber stoppers. Cleanse exposed surface of the rubber stoppers with germicidal solution and allow to dry. Using aseptic technique, remove protective covering from one end of the double-ended needle and insert the exposed end through the diluent vial stopper. Remove protective covering from the other end of the double-ended needle. Do not touch the exposed end. Invert diluent vial over the concentrate vial, then insert free end of the needle through the concentrate vial stopper. Diluent will be drawn into the concentrate vial by vacuum. Disconnect the two vials by removing needle from the concentrate vial stopper.
Gently agitate or rotate the concentrate vial until all material is dissolved. AdministrationFor Intravenous Administration Only.
Parenteral drug products should be inspected for particulate matter and discoloration prior to administration. The reconstituted product should be colorless to slightly yellowish and clear to slightly turbid solution. Do not administer if particulate matter or discoloration is found and notify Baxter immediately. Record the name of the patient and batch number of the product in order to maintain a link between the patient and the batch of the product. After reconstituting the concentrate as described above, attach the enclosed filter needle to a sterile disposable syringe using aseptic technique. Insert filter needle through the concentrate vial stopper. Inject air and withdraw solution into the syringe. Remove and discard filter needle. Attach a suitable intravenous needle or infusion set with winged adapter. Administer the solution intravenously at a rate comfortable to the patient. The infusion rate should not exceed 2 mL per minute.
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