- Approval Id
- 7b3644ff86ede913
- Drug Approval Emc Name
- Intratect 100g/l, solution for infusion
- Drug Name
- Intratect 100g/l, solution for infusion
- Company Name
- Grifols UK Ltd
- Company Address
- 3980 - 3990 Enterprise, Cambridge Research Park, Beach Drive, Waterbeach, Cambridge, Cambridgeshire, CB25 9PE, UK
- Company Website
- http://www.grifols.com
- Company Telephone
- 0808 1756 992 (free from mobiles and landlines)
- Company Medical Info Email
- medinfo.uk@grifols.com
- Atc Code
- J06BA02
- Legal Category
- Prescription only medicine
- Authorisation Holder
- Biotest Pharma GmbH
Landsteinerstrasse 5
63303 Dreieich, Germany
Tel.: (49) 6103 801 0
Fax: (49) 6103 801 150
Email: [[email protected]](/cdn-cgi/l/email-protection)
- Authorisation Number
- PL 04500/0013
- Authorisation Date
- 09/11/2012
- Instruction Authorisation Holder
- Biotest Pharma GmbH
Landsteinerstrasse 5
63303 Dreieich, Germany
Tel.: (49) 6103 801 0
Fax: (49) 6103 801 150
Email: [[email protected]](/cdn-cgi/l/email-protection)
- Instruction Authorisation Number
- PL 04500/0013
- Instruction Authorisation Date
- 09/11/2012
- Instruction Composition
- \*\*2.1 General description\*\*
Human normal immunoglobulin (IVIg)
\*\*2.2 Qualitative and quantitative composition\*\*
One ml contains:
Human normal immunoglobulin 100 mg (purity of at least 96% IgG)
Each vial of 10 ml contains: 1 g of human normal immunoglobulin
Each vial of 25 ml contains: 2.5 g of human normal immunoglobulin
Each vial of 50 ml contains: 5 g of human normal immunoglobulin
Each vial of 100 ml contains: 10 g of human normal immunoglobulin
Each vial of 200 ml contains: 20 g of human normal immunoglobulin
Distribution of the IgG subclasses (approx. values):
IgG1 57%
IgG2 37%
IgG3 3%
IgG4 3%
The maximum IgA content is 1800 micrograms/ml.
Produced from the plasma of human donors.
For a full list of excipients, see section 6.1.
- Instruction Dosage Form
- Solution for infusion.
The solution is clear to slightly opalescent and colourless to pale yellow.
Intratect 100 g/l has a pH of 5.0–5.6 and an osmolality of 280–380 mOsmol/kg.
- Instruction Clinical Particulars
- 4.1 Therapeutic indications
\*\*Replacement therapy in adults, children, and adolescents (0–18 years) in:\*\*
• Primary immunodeficiency syndromes (PID) with impaired antibody production
• Secondary immunodeficiencies (SID) in patients who suffer from severe or recurrent infections, ineffective antimicrobial treatment and either \*\*proven specific antibody failure (PSAF)\\*\*\* or serum IgG level of <4 g/l
\\* PSAF= failure to mount at least a 2-fold rise in IgG antibody titre to pneumococcal polysaccharide and polypeptide antigen vaccines
\*\*Immunomodulation in adults, children, and adolescents (0–18 years) in:\*\*
• Primary immune thrombocytopenia (ITP), in patients at high risk of bleeding or prior to surgery to correct the platelet count
• Guillain Barré syndrome
• Kawasaki disease (in conjunction with acetylsalicylic acid; see section 4.2)
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• Multifocal motor neuropathy (MMN)4.2 Posology and method of administration
IVIg therapy should be initiated and monitored under the supervision of a physician experienced in the treatment of immune system disorders.
\*\*Posology\*\*
The dose and dose regimen are dependent on the indication.
The dose may need to be individualised for each patient dependent on the clinical response. Dose based on body weight may require adjustment in underweight or overweight patients.
The following dose regimens are given as a guidance.
\*Replacement therapy in primary immunodeficiency syndromes\*
The dose regimen should achieve a trough level of IgG (measured before the next infusion) of at least 6 g/l or within the normal reference range for the population age. 3–6 months are required after the initiation of therapy for equilibration (steady-state IgG levels) to occur. The recommended starting dose is 0.4–0.8 g/kg given once, followed by at least 0.2 g/kg given every 3–4 weeks.
The dose required to achieve a trough level of IgG of 6 g/l is of the order of 0.2–0.8 g/kg/month. The dosage interval when steady state has been reached varies from 3–4 weeks.
IgG trough levels should be measured and assessed in conjunction with the incidence of infection. To reduce the rate of bacterial infections, it may be necessary to increase the dosage and aim for higher trough levels.
\*Replacement therapy in secondary immunodeficiencies (as defined in section 4.1)\*
The recommended dose is 0.2–0.4 g/kg every three to four weeks.
IgG trough levels should be measured and assessed in conjunction with the incidence of infection. Dose should be adjusted as necessary to achieve optimal protection against infections, an increase may be necessary in patients with persisting infection; a dose decrease can be considered when the patient remains infection free.
\*\*\*Immunomodulation in:\*\*\*
\*Primary immune thrombocytopenia\*
There are two alternative treatment schedules:
- 0.8–1 g/kg given on day 1; this dose may be repeated once within 3 days
- 0.4 g/kg given daily for 2–5 days.
The treatment can be repeated if relapse occurs.
\*Guillain Barré syndrome\*
0.4 g/kg/day over 5 days (possible repeat of dosing in case of relapse).
\*Kawasaki disease\*
2.0 g/kg should be administered as a single dose. Patients should receive concomitant treatment with acetylsalicylic acid.
\*Chronic inflammatory demyelinating polyneuropathy (CIDP)\*
Starting dose: 2 g/kg divided over 2–5 consecutive days
Maintenance doses: 1 g/kg divided over 1–2 consecutive days every 3 weeks.
The treatment effect should be evaluated after each cycle; if no treatment effect is seen after 6 months, the treatment should be discontinued.
If the treatment is effective, long-term treatment should be subject to the physician's discretion based upon the patient response and maintenance response. The dosing and intervals may have to be adapted according to the individual course of the disease.
\*Multifocal Motor Neuropathy (MMN)\*
Starting dose: 2 g/kg divided over 2–5 consecutive days.
Maintenance dose: 1 g/kg every 2 to 4 weeks or 2 g/kg every 4 to 8 weeks.
The treatment effect should be evaluated after each cycle; if no treatment effect is seen after 6 months, the treatment should be discontinued.
If the treatment is effective, long-term treatment should be subject to the physician's discretion based upon the patient response and maintenance response. The dosing and intervals may have to be adapted according to the individual course of the disease.
The dosage recommendations are summarised in the following table:
| | | |
| --- | --- | --- |
| \*\*Indication\*\* | \*\*Dose\*\* | \*\*Frequency of infusions\*\* |
| \*\*Replacement therapy\*\*: | | |
| Primary immunodeficiency syndromes | Starting dose: 0.4–0.8 g/kg | |
| Maintenance dose: 0.2–0.8 g/kg | every 3–4 weeks |
| Secondary immunodeficiencies (as defined in section 4.1) | 0.2–0.4 g/kg | every 3–4 weeks |
| \*\*Immunomodulation:\*\* | | |
| Primary immune thrombocytopenia | 0.8–1 g/kg or 0.4 g/kg/d | on day 1, possibly repeated once within 3 days for 2–5 days |
| Guillain Barré syndrome | 0.4 g/kg/d | for 5 days |
| Kawasaki disease | 2 g/kg | in one dose in association with acetylsalicylic acid |
| Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) | Starting dose: 2 g/kg | in divided doses over 2–5 days |
| Maintenance dose: 1 g/kg | every 3 weeks in divided doses over 1–2 days |
| Multifocal Motor Neuropathy (MMN) | Starting dose: 2 g/kg Maintenance dose: 1 g/kg or 2 g/kg | in divided doses over 2–5 consecutive days every 2–4 weeks or every 4–8 weeks in divided doses over 2–5 days |
\*Paediatric population\*
The posology in children and adolescents (0–18 years) is not different to that of adults as the posology for each indication is given by body weight and must be adjusted to the clinical outcome of the above mentioned conditions.
\*Hepatic impairment\*
No evidence is available to require a dose adjustment.
\*Renal impairment\*
No dose adjustment unless clinically warranted, see section 4.4.
\*Elderly\*
No dose adjustment unless clinically warranted, see section 4.4.
\*\*Method of administration\*\*
Intravenous use.
Intratect 100 g/l should be infused intravenously at an initial rate of not more than 0.3 ml/kg/h for 30 minutes. See section 4.4. In case of adverse reaction, either the rate of administration must be reduced or the infusion stopped. If well tolerated, the rate of administration may gradually be increased to a maximum of 1.9 ml/kg/h.
\*\*Replacement Therapy:\*\*
In patients who have tolerated the infusion rate of 1.9 ml/kg/h well, the rate may be gradually increased to 6 ml/kg/h and if still tolerated well, it may be further increased gradually to a maximum of 8 ml/kg/h.
In general, dosage and infusion rates have to be individually tailored according to the patient's needs (see also section 4.4).4.3 Contraindications
• Hypersensitivity to the active substance (human immunoglobulins) or to any of the excipients (see section 4.4 and 6.1).
• Patients with selective IgA deficiency who developed antibodies to IgA, as administering an IgA-containing product can result in anaphylaxis.4.4 Special warnings and precautions for use
\*Traceability\*
In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.
\*Precautions for use\*
Potential complications can often be avoided by ensuring that patients:
• are not sensitive to human normal immunoglobulin by initially administering the product slowly (0.3 ml/kg/h corresponding to 0.005 ml/kg/min),
• are carefully monitored for any symptoms throughout the infusion period. In particular, patients naive to human normal immunoglobulin, patients switched from an alternative IVIg product or when there has been a long interval since the previous infusion should be monitored during the first infusion and for the first hour after the first infusion in a controlled healthcare setting in order to detect potential adverse signs and to ensure that emergency treatment can be administered immediately should problems occur. All other patients should be observed for at least 20 minutes after administration.
In all patients, IVIg administration requires:
• adequate hydration prior to the initiation of the IVIg infusion
• monitoring of urine output
• monitoring of serum creatinine levels
• avoidance of concomitant use of loop diuretics (see section 4.5)
In case of adverse reaction, either the infusion rate must be reduced or the infusion stopped. The treatment required depends on the nature and severity of the adverse reaction.
\*\*Infusion-related reaction\*\*
Certain adverse reactions (e.g. headache, flushing, chills, myalgia, wheezing, tachycardia, lower back pain, nausea, and hypotension) may be related to the rate of infusion. The recommended infusion rate given under section 4.2 must be closely followed. Patients must be closely monitored and carefully observed for any symptoms throughout the infusion period.
Adverse reactions may occur more frequently
• in patients who receive human normal immunoglobulin for the first time or, in rare cases, when the human normal immunoglobulin product is switched or when there has been a long interval since the previous infusion
• in patients with an active infection or underlying chronic inflammation
\*\*Hypersensitivity\*\*
Hypersensitivity reactions are rare.
Anaphylaxis can develop in patients:
• with undetectable IgA who have anti-IgA antibodies
• who had tolerated previous treatment with human normal immunoglobulin
In case of shock, standard medical treatment for shock should be implemented.
\*\*Thromboembolism\*\*
There is clinical evidence of an association between IVIg administration and thromboembolic events such as myocardial infarction, cerebral vascular accident (including stroke), pulmonary embolism and deep vein thromboses which is assumed to be related to a relative increase in blood viscosity through the high influx of immunoglobulin in at-risk patients. Caution should be exercised in prescribing and infusing IVIg in obese patients and in patients with pre-existing risk factors for thrombotic events (such as advanced age, hypertension, diabetes mellitus and a history of vascular disease or thrombotic episodes, patients with acquired or inherited thrombophilic disorders, patients with prolonged periods of immobilisation, severely hypovolemic patients, patients with diseases which increase blood viscosity).
In patients at risk for thromboembolic adverse reactions, IVIg products should be administered at the minimum rate of infusion and dose practicable.
\*\*Acute renal failure\*\*
Cases of acute renal failure have been reported in patients receiving IVIg therapy. In most cases, risk factors have been identified, such as pre-existing renal insufficiency, diabetes mellitus, hypovolemia, overweight, concomitant nephrotoxic medicinal products or age over 65.
Renal parameters should be assessed prior to infusion of IVIg, particularly in patients judged to have a potential increased risk for developing acute renal failure, and again at appropriate intervals. In patients at risk for acute renal failure, IVIg products should be administered at the minimum rate of infusion and dose practicable. In case of renal impairment, IVIg discontinuation should be considered.
While reports of renal dysfunction and acute renal failure have been associated with the use of many of the licensed IVIg products containing various excipients such as sucrose, glucose and maltose, those containing sucrose as a stabiliser accounted for a disproportionate share of the total number. In patients at risk, the use of IVIg products that do not contain these excipients may be considered. Intratect 100 g/l does not contain sucrose, maltose or glucose.
\*\*Aseptic meningitis syndrome (AMS)\*\*
AMS has been reported to occur in association with IVIg treatment.
The syndrome usually begins within several hours to 2 days following IVIg treatment. Cerebrospinal fluid (CSF) studies are frequently positive with pleocytosis up to several thousand cells per mm3, predominantly from the granulocytic series, and elevated protein levels up to several hundred mg/dl.
AMS may occur more frequently in association with high-dose (2 g/kg) IVIg treatment.
Patients exhibiting such signs and symptoms should receive a thorough neurological examination, including CSF studies, to rule out other causes of meningitis.
Discontinuation of IVIg treatment has resulted in remission of AMS within several days without sequelae.
\*\*Haemolytic anaemia\*\*
IVIg products can contain blood group antibodies which may act as haemolysins and induce \*in vivo\* coating of red blood cells (RBC) with immunoglobulin, causing a positive direct antiglobulin reaction (Coombs' test) and, rarely, haemolysis. Haemolytic anaemia can develop subsequent to IVIg therapy due to enhanced RBC sequestration. IVIg recipients should be monitored for clinical signs and symptoms of haemolysis. (See section 4.8.)
\*\*Neutropenia/Leukopenia\*\*
A transient decrease in neutrophil count and/or episodes of neutropenia, sometimes severe, have been reported after treatment with IVIg. This typically occurs within hours or days after IVIg administration and resolves spontaneously within 7 to 14 days.
\*\*Transfusion-related acute lung injury (TRALI)\*\*
In patients receiving IVIg, there have been some reports of acute non-cardiogenic pulmonary oedema [Transfusion-related acute lung injury (TRALI)]. TRALI is characterised by severe hypoxia, dyspnoea, tachypnoea, cyanosis, fever and hypotension. Symptoms of TRALI typically develop during or within 6 hours after a transfusion, often within 1–2 hours. Therefore, IVIg recipients must be monitored for and IVIg infusion must be immediately stopped in case of pulmonary adverse reactions. TRALI is a potentially life-threatening condition requiring immediate intensive-care-unit management.
\*\*Interference with serological testing\*\*
After the administration of immunoglobulin the transitory rise of the various passively transferred antibodies in the patient's blood may result in misleading positive results in serological testing.
Passive transmission of antibodies to erythrocyte antigens, e.g. A, B, D may interfere with some serological tests for red blood cell antibodies for example the direct antiglobulin test (DAT, direct Coombs' test).
\*\*Transmissible agents\*\*
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). The measures taken may be of limited value against non-enveloped viruses such as hepatitis A virus (HAV) and parvovirus B19.
There is reassuring clinical experience regarding the lack of HAV or parvovirus B19 transmission with immunoglobulins and it is also assumed that the antibody content makes an important contribution to the viral safety.
\*Paediatric population\*
The special warnings and precautions for use mentioned for the adults should also be considered for the paediatric population.4.5 Interaction with other medicinal products and other forms of interaction
\*\*Live attenuated virus vaccines\*\*
Immunoglobulin administration may impair for a period of at least 6 weeks and up to 3 months the efficacy of live attenuated virus vaccines such as measles, rubella, mumps and varicella. After administration of this medicinal product, an interval of 3 months should elapse before vaccination with live attenuated virus vaccines. In the case of measles, this impairment may persist for up to 1 year. Therefore patients receiving measles vaccine should have their antibody status checked.
\*\*Loop diuretics\*\*
Avoidance of concomitant use of loop diuretics.
\*Paediatric population\*
It is expected that the same interaction mentioned for the adults may also occur in the paediatric population.4.6 Fertility, pregnancy and lactation
\*\*Pregnancy\*\*
The safety of this medicinal product for use in human pregnancy has not been established in controlled clinical trials and therefore should only be given with caution to pregnant women. IVIg products have been shown to cross the placenta, increasingly during the third trimester. Clinical experience with immunoglobulins suggests that no harmful effects on the course of pregnancy, or on the foetus and the neonate are expected.
\*\*Breast-feeding\*\*
The safety of this medicinal product for use in human pregnancy has not been established in controlled clinical trials and therefore should only be given with caution to breast-feeding mothers. Immunoglobulins are excreted into human milk. No negative effects on the breastfed newborns/infants are anticipated.
\*\*Fertility\*\*
Clinical experience with immunoglobulins suggests that no harmful effects on fertility are to be expected.4.7 Effects on ability to drive and use machines
Intratect 100 g/l has minor influence on the ability to drive and use machines. Patients who experience adverse reactions during treatment should wait for these to resolve before driving or operating machines.4.8 Undesirable effects
\*\*Summary of the safety profile\*\*
Adverse reactions caused by human normal immunoglobulins (in decreasing frequency) encompass (see also section 4.4):
• chills, headache, dizziness, fever, vomiting, allergic reactions, nausea, arthralgia, low blood pressure and moderate low back pain
• reversible haemolytic reactions; especially in those patients with blood groups A, B, and AB and (rarely) haemolytic anaemia requiring transfusion
• (rarely) a sudden fall in blood pressure and, in isolated cases, anaphylactic shock, even when the patient has shown no hypersensitivity to previous administration
• (rarely) transient cutaneous reactions (including cutaneous lupus erythematosus - frequency unknown)
• (very rarely) thromboembolic reactions such as myocardial infarction, stroke, pulmonary embolism, deep vein thromboses
• cases of reversible aseptic meningitis
• cases of increased serum creatinine level and/or occurrence of acute renal failure
• cases of Transfusion Related Acute Lung Injury (TRALI)
For safety information with respect to transmissible agents, see section 4.4.
\*\*Tabulated list of adverse reactions\*\*
\*Suspected Adverse Drug Reactions reported in completed clinical trials:\*
Three clinical studies have been performed with Intratect (50 g/l): two in patients with primary immunodeficiencies (PID) and one in patients with immune thrombocytopenic purpura (ITP). In the two PID studies overall 68 patients were treated with Intratect (50 g/l) and evaluated for safety. Treatment period was 6 and 12 months respectively. The ITP study was performed in 24 patients.
These 92 patients received a total of 830 infusions of Intratect (50 g/l), whereby a total of 51 adverse drug reactions (ADRs) were recorded.
With Intratect 100 g/l one clinical study has been performed in patients with PID. 30 patients were treated with Intratect 100 g/l over 3 to 6 months and evaluated for safety. These 30 patients received a total of 165 infusions of Intratect 100 g/l, whereof a total of 19 infusions (11.5%) were associated with adverse drug reactions (ADRs).
The majority of these ADRs was mild to moderate and self-limiting. No serious ADRs were observed during the studies.
The table presented below is according to the MedDRA system organ classification (SOC and Preferred Term Level).
Frequencies have been evaluated according to the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); not known (cannot be estimated from the available data).
\*\*Frequency of Adverse Drug Reactions (ADRs) in clinical studies with Intratect (50 g/l), indications PID and ITP\*\* \*(Frequencies are calculated per infusions administered (n=830) and patients treated (n=92) respectively.)\*
| | | | |
| --- | --- | --- | --- |
| \*\*MedDRA\*\* \*\*System Organ Class (SOC)\*\* | \*\*Adverse reaction\*\* \*\*(MedDRA preferred term (PT))\*\* | \*\*Frequency\*\* \*based on infusions administered\* (n=\*830\*) | \*\*Frequency\*\* \*based on patients treated\* (n=\*92\*) |
| Blood and lymphatic system disorders | Haemolysis (mild) | Uncommon | Common |
| Nervous system disorders | Headache | Common | Very Common |
| Dysgeusia | Uncommon | Common |
| Vascular disorders | Hypertension, thrombophlebitis superficial | Uncommon | Common |
| Gastrointestinal disorders | Nausea, vomiting, gastrointestinal pain | Uncommon | Common |
| Skin and subcutaneous tissue disorders | Papular rash | Uncommon | Common |
| General disorders and administration site conditions | Pyrexia | Common | Very Common |
| Chills, feeling hot | Uncommon | Common |
| Investigations | Body temperature increased, Coombs test (indirect and direct) positive | Uncommon | Common |
\*\*Frequency of Adverse Drug Reactions (ADRs) in a clinical study with Intratect 100 g/l, indication PID\*\* \*(Frequencies are calculated per infusions administered (n=165 and patients treated (n=30) respectively.)\*
| | | | |
| --- | --- | --- | --- |
| \*\*MedDRA\*\* \*\*System Organ Class (SOC)\*\* | \*\*Adverse reaction\*\* \*\*(MedDRA preferred term (PT))\*\* | \*\*Frequency\*\* \*based on infusions administered (n=165)\* | \*\*Frequency\*\* \*based on patients treated (n=30)\* |
| Immune system disorders | Infusion related reaction | Common | Common |
| Hypersensitivity | Uncommon | Common |
| Nervous system disorders | Headache | Common | Common |
| Sensory disturbance | Uncommon | Common |
| Cardiac disorders | Palpitations | Common | Common |
| Vascular disorders | Hyperaemia, hypertension | Uncommon | Common |
| Gastrointestinal disorders | Diarrhoea, abdominal pain | Uncommon | Common |
| Skin and subcutaneous tissue disorders | Pain of skin, rash | Uncommon | Common |
| Musculoskeletal and connective tissue disorders | Arthralgia, back pain, bone pain | Common | Common |
| Myalgia | Uncommon | Common |
| General disorders and administration site conditions | Discomfort | Common | Very Common |
| Fatigue, chills, hypothermia | Uncommon | Uncommon |
\*Details of further spontaneously reported adverse reactions:\*
\*Frequency: not known (cannot be estimated from the available data)\*
Cardiac disorders: Angina pectoris
General disorders and administrations site conditions: Rigors
Immune system disorders: Anaphylactic shock, allergic reaction
Investigations: Blood pressure decreased
Musculoskeletal and connective tissue disorders: Back pain
Respiratory, thoracic and mediastinal disorders: Dyspnoea NOS
Vascular disorders: Shock
Blood and lymphatic system disorders: leukopenia
\*\*Description of selected adverse reactions\*\*
The reported adverse reactions for Intratect are in the expected profile for human normal immunoglobulins.
\*Paediatric population\*
Frequency, type and severity of adverse reactions in the paediatric population are expected to be the same as in adults.
\*\*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 Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose
Overdose may lead to fluid overload and hyperviscosity, particularly in patients at risk, including infants, elderly patients or patients with cardiac or renal impairment (see section 4.4).
- Instruction Pharmacology
- 5.1 Pharmacodynamic properties
Pharmacotherapeutic group: immune sera and immunoglobulins: immunoglobulins, normal human, for intravascular administration, ATC code: J06BA02
Human normal immunoglobulin contains mainly immunoglobulin G (IgG) with a broad spectrum of antibodies against infectious agents.
Human normal immunoglobulin contains the IgG antibodies present in the normal population. It is usually prepared from pooled plasma from not fewer than 1000 donors. It has a distribution of immunoglobulin G subclasses closely proportional to that in native human plasma. Adequate doses of this medicinal product may restore abnormally low immunoglobulin G levels to the normal range.
The mechanism of action in indications other than replacement therapy is not fully elucidated, but includes immunomodulatory effects.
\*Paediatric population\*
The pharmacodynamic properties in the paediatric population are expected to be the same as in adults.5.2 Pharmacokinetic properties
\*\*Absorption\*\*
Human normal immunoglobulin is immediately and completely bioavailable in the recipient's circulation after intravenous administration.
\*\*Distribution\*\*
It is distributed relatively rapidly between plasma and extravascular fluid, after approximately 3–5 days equilibrium is reached between the intra- and extravascular compartments.
\*\*Elimination\*\*
Intratect 100 g/l has a half-life of about 34 days. This half-life may vary from patient to patient, in particular in primary immunodeficiency.
IgG and IgG-complexes are broken down in cells of the reticuloendothelial system.5.3 Preclinical safety data
Immunoglobulins are normal constituents of the human body. Repeated dose toxicity testing and embryo-foetal toxicity studies are impracticable due to induction of, and interference with antibodies. Effects of the product on the immune system of the newborn have not been studied.
Since clinical experience provides no hint for tumorigenic and mutagenic effects of immunoglobulins, experimental studies, particularly in heterologous species, are not considered necessary.
- Instruction Pharmaceutical Particulars
- 6.1 List of excipients
Glycine, water for injections.6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products, nor with any other IVIg products.6.3 Shelf life
3 years.
After first opening, an immediate use is recommended.6.4 Special precautions for storage
Do not store above 25°C. Do not freeze.
Keep the vial in the outer carton in order to protect from light.6.5 Nature and contents of container
10 ml, 25 ml, 50 ml, 100 ml or 200 ml of solution in a vial (Type II glass) with a stopper (bromobutyl) and a cap (aluminium).
Pack with 1 vial with 10 ml, 25 ml, 50 ml, 100 ml or 200 ml solution.
Pack with 3 vials with 100 ml or 200 ml solution.
Not all pack sizes may be marketed.6.6 Special precautions for disposal and other handling
The product should be brought to room or body temperature before use.
The solution should be clear or slightly opalescent and colourless to pale yellow. Solutions that are cloudy or have deposits should not be used.
Any unused product or waste material should be disposed of in accordance with local requirements.
- Instruction Content
- ## Composition
\*\*2.1 General description\*\*
Human normal immunoglobulin (IVIg)
\*\*2.2 Qualitative and quantitative composition\*\*
One ml contains:
Human normal immunoglobulin 100 mg (purity of at least 96% IgG)
Each vial of 10 ml contains: 1 g of human normal immunoglobulin
Each vial of 25 ml contains: 2.5 g of human normal immunoglobulin
Each vial of 50 ml contains: 5 g of human normal immunoglobulin
Each vial of 100 ml contains: 10 g of human normal immunoglobulin
Each vial of 200 ml contains: 20 g of human normal immunoglobulin
Distribution of the IgG subclasses (approx. values):
IgG1 57%
IgG2 37%
IgG3 3%
IgG4 3%
The maximum IgA content is 1800 micrograms/ml.
Produced from the plasma of human donors.
For a full list of excipients, see section 6.1.
## Pharmaceutical Form
Solution for infusion.
The solution is clear to slightly opalescent and colourless to pale yellow.
Intratect 100 g/l has a pH of 5.0–5.6 and an osmolality of 280–380 mOsmol/kg.
## Clinical Particulars
4.1 Therapeutic indications
\*\*Replacement therapy in adults, children, and adolescents (0–18 years) in:\*\*
• Primary immunodeficiency syndromes (PID) with impaired antibody production
• Secondary immunodeficiencies (SID) in patients who suffer from severe or recurrent infections, ineffective antimicrobial treatment and either \*\*proven specific antibody failure (PSAF)\\*\*\* or serum IgG level of <4 g/l
\\* PSAF= failure to mount at least a 2-fold rise in IgG antibody titre to pneumococcal polysaccharide and polypeptide antigen vaccines
\*\*Immunomodulation in adults, children, and adolescents (0–18 years) in:\*\*
• Primary immune thrombocytopenia (ITP), in patients at high risk of bleeding or prior to surgery to correct the platelet count
• Guillain Barré syndrome
• Kawasaki disease (in conjunction with acetylsalicylic acid; see section 4.2)
• Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
• Multifocal motor neuropathy (MMN)4.2 Posology and method of administration
IVIg therapy should be initiated and monitored under the supervision of a physician experienced in the treatment of immune system disorders.
\*\*Posology\*\*
The dose and dose regimen are dependent on the indication.
The dose may need to be individualised for each patient dependent on the clinical response. Dose based on body weight may require adjustment in underweight or overweight patients.
The following dose regimens are given as a guidance.
\*Replacement therapy in primary immunodeficiency syndromes\*
The dose regimen should achieve a trough level of IgG (measured before the next infusion) of at least 6 g/l or within the normal reference range for the population age. 3–6 months are required after the initiation of therapy for equilibration (steady-state IgG levels) to occur. The recommended starting dose is 0.4–0.8 g/kg given once, followed by at least 0.2 g/kg given every 3–4 weeks.
The dose required to achieve a trough level of IgG of 6 g/l is of the order of 0.2–0.8 g/kg/month. The dosage interval when steady state has been reached varies from 3–4 weeks.
IgG trough levels should be measured and assessed in conjunction with the incidence of infection. To reduce the rate of bacterial infections, it may be necessary to increase the dosage and aim for higher trough levels.
\*Replacement therapy in secondary immunodeficiencies (as defined in section 4.1)\*
The recommended dose is 0.2–0.4 g/kg every three to four weeks.
IgG trough levels should be measured and assessed in conjunction with the incidence of infection. Dose should be adjusted as necessary to achieve optimal protection against infections, an increase may be necessary in patients with persisting infection; a dose decrease can be considered when the patient remains infection free.
\*\*\*Immunomodulation in:\*\*\*
\*Primary immune thrombocytopenia\*
There are two alternative treatment schedules:
- 0.8–1 g/kg given on day 1; this dose may be repeated once within 3 days
- 0.4 g/kg given daily for 2–5 days.
The treatment can be repeated if relapse occurs.
\*Guillain Barré syndrome\*
0.4 g/kg/day over 5 days (possible repeat of dosing in case of relapse).
\*Kawasaki disease\*
2.0 g/kg should be administered as a single dose. Patients should receive concomitant treatment with acetylsalicylic acid.
\*Chronic inflammatory demyelinating polyneuropathy (CIDP)\*
Starting dose: 2 g/kg divided over 2–5 consecutive days
Maintenance doses: 1 g/kg divided over 1–2 consecutive days every 3 weeks.
The treatment effect should be evaluated after each cycle; if no treatment effect is seen after 6 months, the treatment should be discontinued.
If the treatment is effective, long-term treatment should be subject to the physician's discretion based upon the patient response and maintenance response. The dosing and intervals may have to be adapted according to the individual course of the disease.
\*Multifocal Motor Neuropathy (MMN)\*
Starting dose: 2 g/kg divided over 2–5 consecutive days.
Maintenance dose: 1 g/kg every 2 to 4 weeks or 2 g/kg every 4 to 8 weeks.
The treatment effect should be evaluated after each cycle; if no treatment effect is seen after 6 months, the treatment should be discontinued.
If the treatment is effective, long-term treatment should be subject to the physician's discretion based upon the patient response and maintenance response. The dosing and intervals may have to be adapted according to the individual course of the disease.
The dosage recommendations are summarised in the following table:
| | | |
| --- | --- | --- |
| \*\*Indication\*\* | \*\*Dose\*\* | \*\*Frequency of infusions\*\* |
| \*\*Replacement therapy\*\*: | | |
| Primary immunodeficiency syndromes | Starting dose: 0.4–0.8 g/kg | |
| Maintenance dose: 0.2–0.8 g/kg | every 3–4 weeks |
| Secondary immunodeficiencies (as defined in section 4.1) | 0.2–0.4 g/kg | every 3–4 weeks |
| \*\*Immunomodulation:\*\* | | |
| Primary immune thrombocytopenia | 0.8–1 g/kg or 0.4 g/kg/d | on day 1, possibly repeated once within 3 days for 2–5 days |
| Guillain Barré syndrome | 0.4 g/kg/d | for 5 days |
| Kawasaki disease | 2 g/kg | in one dose in association with acetylsalicylic acid |
| Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) | Starting dose: 2 g/kg | in divided doses over 2–5 days |
| Maintenance dose: 1 g/kg | every 3 weeks in divided doses over 1–2 days |
| Multifocal Motor Neuropathy (MMN) | Starting dose: 2 g/kg Maintenance dose: 1 g/kg or 2 g/kg | in divided doses over 2–5 consecutive days every 2–4 weeks or every 4–8 weeks in divided doses over 2–5 days |
\*Paediatric population\*
The posology in children and adolescents (0–18 years) is not different to that of adults as the posology for each indication is given by body weight and must be adjusted to the clinical outcome of the above mentioned conditions.
\*Hepatic impairment\*
No evidence is available to require a dose adjustment.
\*Renal impairment\*
No dose adjustment unless clinically warranted, see section 4.4.
\*Elderly\*
No dose adjustment unless clinically warranted, see section 4.4.
\*\*Method of administration\*\*
Intravenous use.
Intratect 100 g/l should be infused intravenously at an initial rate of not more than 0.3 ml/kg/h for 30 minutes. See section 4.4. In case of adverse reaction, either the rate of administration must be reduced or the infusion stopped. If well tolerated, the rate of administration may gradually be increased to a maximum of 1.9 ml/kg/h.
\*\*Replacement Therapy:\*\*
In patients who have tolerated the infusion rate of 1.9 ml/kg/h well, the rate may be gradually increased to 6 ml/kg/h and if still tolerated well, it may be further increased gradually to a maximum of 8 ml/kg/h.
In general, dosage and infusion rates have to be individually tailored according to the patient's needs (see also section 4.4).4.3 Contraindications
• Hypersensitivity to the active substance (human immunoglobulins) or to any of the excipients (see section 4.4 and 6.1).
• Patients with selective IgA deficiency who developed antibodies to IgA, as administering an IgA-containing product can result in anaphylaxis.4.4 Special warnings and precautions for use
\*Traceability\*
In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.
\*Precautions for use\*
Potential complications can often be avoided by ensuring that patients:
• are not sensitive to human normal immunoglobulin by initially administering the product slowly (0.3 ml/kg/h corresponding to 0.005 ml/kg/min),
• are carefully monitored for any symptoms throughout the infusion period. In particular, patients naive to human normal immunoglobulin, patients switched from an alternative IVIg product or when there has been a long interval since the previous infusion should be monitored during the first infusion and for the first hour after the first infusion in a controlled healthcare setting in order to detect potential adverse signs and to ensure that emergency treatment can be administered immediately should problems occur. All other patients should be observed for at least 20 minutes after administration.
In all patients, IVIg administration requires:
• adequate hydration prior to the initiation of the IVIg infusion
• monitoring of urine output
• monitoring of serum creatinine levels
• avoidance of concomitant use of loop diuretics (see section 4.5)
In case of adverse reaction, either the infusion rate must be reduced or the infusion stopped. The treatment required depends on the nature and severity of the adverse reaction.
\*\*Infusion-related reaction\*\*
Certain adverse reactions (e.g. headache, flushing, chills, myalgia, wheezing, tachycardia, lower back pain, nausea, and hypotension) may be related to the rate of infusion. The recommended infusion rate given under section 4.2 must be closely followed. Patients must be closely monitored and carefully observed for any symptoms throughout the infusion period.
Adverse reactions may occur more frequently
• in patients who receive human normal immunoglobulin for the first time or, in rare cases, when the human normal immunoglobulin product is switched or when there has been a long interval since the previous infusion
• in patients with an active infection or underlying chronic inflammation
\*\*Hypersensitivity\*\*
Hypersensitivity reactions are rare.
Anaphylaxis can develop in patients:
• with undetectable IgA who have anti-IgA antibodies
• who had tolerated previous treatment with human normal immunoglobulin
In case of shock, standard medical treatment for shock should be implemented.
\*\*Thromboembolism\*\*
There is clinical evidence of an association between IVIg administration and thromboembolic events such as myocardial infarction, cerebral vascular accident (including stroke), pulmonary embolism and deep vein thromboses which is assumed to be related to a relative increase in blood viscosity through the high influx of immunoglobulin in at-risk patients. Caution should be exercised in prescribing and infusing IVIg in obese patients and in patients with pre-existing risk factors for thrombotic events (such as advanced age, hypertension, diabetes mellitus and a history of vascular disease or thrombotic episodes, patients with acquired or inherited thrombophilic disorders, patients with prolonged periods of immobilisation, severely hypovolemic patients, patients with diseases which increase blood viscosity).
In patients at risk for thromboembolic adverse reactions, IVIg products should be administered at the minimum rate of infusion and dose practicable.
\*\*Acute renal failure\*\*
Cases of acute renal failure have been reported in patients receiving IVIg therapy. In most cases, risk factors have been identified, such as pre-existing renal insufficiency, diabetes mellitus, hypovolemia, overweight, concomitant nephrotoxic medicinal products or age over 65.
Renal parameters should be assessed prior to infusion of IVIg, particularly in patients judged to have a potential increased risk for developing acute renal failure, and again at appropriate intervals. In patients at risk for acute renal failure, IVIg products should be administered at the minimum rate of infusion and dose practicable. In case of renal impairment, IVIg discontinuation should be considered.
While reports of renal dysfunction and acute renal failure have been associated with the use of many of the licensed IVIg products containing various excipients such as sucrose, glucose and maltose, those containing sucrose as a stabiliser accounted for a disproportionate share of the total number. In patients at risk, the use of IVIg products that do not contain these excipients may be considered. Intratect 100 g/l does not contain sucrose, maltose or glucose.
\*\*Aseptic meningitis syndrome (AMS)\*\*
AMS has been reported to occur in association with IVIg treatment.
The syndrome usually begins within several hours to 2 days following IVIg treatment. Cerebrospinal fluid (CSF) studies are frequently positive with pleocytosis up to several thousand cells per mm3, predominantly from the granulocytic series, and elevated protein levels up to several hundred mg/dl.
AMS may occur more frequently in association with high-dose (2 g/kg) IVIg treatment.
Patients exhibiting such signs and symptoms should receive a thorough neurological examination, including CSF studies, to rule out other causes of meningitis.
Discontinuation of IVIg treatment has resulted in remission of AMS within several days without sequelae.
\*\*Haemolytic anaemia\*\*
IVIg products can contain blood group antibodies which may act as haemolysins and induce \*in vivo\* coating of red blood cells (RBC) with immunoglobulin, causing a positive direct antiglobulin reaction (Coombs' test) and, rarely, haemolysis. Haemolytic anaemia can develop subsequent to IVIg therapy due to enhanced RBC sequestration. IVIg recipients should be monitored for clinical signs and symptoms of haemolysis. (See section 4.8.)
\*\*Neutropenia/Leukopenia\*\*
A transient decrease in neutrophil count and/or episodes of neutropenia, sometimes severe, have been reported after treatment with IVIg. This typically occurs within hours or days after IVIg administration and resolves spontaneously within 7 to 14 days.
\*\*Transfusion-related acute lung injury (TRALI)\*\*
In patients receiving IVIg, there have been some reports of acute non-cardiogenic pulmonary oedema [Transfusion-related acute lung injury (TRALI)]. TRALI is characterised by severe hypoxia, dyspnoea, tachypnoea, cyanosis, fever and hypotension. Symptoms of TRALI typically develop during or within 6 hours after a transfusion, often within 1–2 hours. Therefore, IVIg recipients must be monitored for and IVIg infusion must be immediately stopped in case of pulmonary adverse reactions. TRALI is a potentially life-threatening condition requiring immediate intensive-care-unit management.
\*\*Interference with serological testing\*\*
After the administration of immunoglobulin the transitory rise of the various passively transferred antibodies in the patient's blood may result in misleading positive results in serological testing.
Passive transmission of antibodies to erythrocyte antigens, e.g. A, B, D may interfere with some serological tests for red blood cell antibodies for example the direct antiglobulin test (DAT, direct Coombs' test).
\*\*Transmissible agents\*\*
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). The measures taken may be of limited value against non-enveloped viruses such as hepatitis A virus (HAV) and parvovirus B19.
There is reassuring clinical experience regarding the lack of HAV or parvovirus B19 transmission with immunoglobulins and it is also assumed that the antibody content makes an important contribution to the viral safety.
\*Paediatric population\*
The special warnings and precautions for use mentioned for the adults should also be considered for the paediatric population.4.5 Interaction with other medicinal products and other forms of interaction
\*\*Live attenuated virus vaccines\*\*
Immunoglobulin administration may impair for a period of at least 6 weeks and up to 3 months the efficacy of live attenuated virus vaccines such as measles, rubella, mumps and varicella. After administration of this medicinal product, an interval of 3 months should elapse before vaccination with live attenuated virus vaccines. In the case of measles, this impairment may persist for up to 1 year. Therefore patients receiving measles vaccine should have their antibody status checked.
\*\*Loop diuretics\*\*
Avoidance of concomitant use of loop diuretics.
\*Paediatric population\*
It is expected that the same interaction mentioned for the adults may also occur in the paediatric population.4.6 Fertility, pregnancy and lactation
\*\*Pregnancy\*\*
The safety of this medicinal product for use in human pregnancy has not been established in controlled clinical trials and therefore should only be given with caution to pregnant women. IVIg products have been shown to cross the placenta, increasingly during the third trimester. Clinical experience with immunoglobulins suggests that no harmful effects on the course of pregnancy, or on the foetus and the neonate are expected.
\*\*Breast-feeding\*\*
The safety of this medicinal product for use in human pregnancy has not been established in controlled clinical trials and therefore should only be given with caution to breast-feeding mothers. Immunoglobulins are excreted into human milk. No negative effects on the breastfed newborns/infants are anticipated.
\*\*Fertility\*\*
Clinical experience with immunoglobulins suggests that no harmful effects on fertility are to be expected.4.7 Effects on ability to drive and use machines
Intratect 100 g/l has minor influence on the ability to drive and use machines. Patients who experience adverse reactions during treatment should wait for these to resolve before driving or operating machines.4.8 Undesirable effects
\*\*Summary of the safety profile\*\*
Adverse reactions caused by human normal immunoglobulins (in decreasing frequency) encompass (see also section 4.4):
• chills, headache, dizziness, fever, vomiting, allergic reactions, nausea, arthralgia, low blood pressure and moderate low back pain
• reversible haemolytic reactions; especially in those patients with blood groups A, B, and AB and (rarely) haemolytic anaemia requiring transfusion
• (rarely) a sudden fall in blood pressure and, in isolated cases, anaphylactic shock, even when the patient has shown no hypersensitivity to previous administration
• (rarely) transient cutaneous reactions (including cutaneous lupus erythematosus - frequency unknown)
• (very rarely) thromboembolic reactions such as myocardial infarction, stroke, pulmonary embolism, deep vein thromboses
• cases of reversible aseptic meningitis
• cases of increased serum creatinine level and/or occurrence of acute renal failure
• cases of Transfusion Related Acute Lung Injury (TRALI)
For safety information with respect to transmissible agents, see section 4.4.
\*\*Tabulated list of adverse reactions\*\*
\*Suspected Adverse Drug Reactions reported in completed clinical trials:\*
Three clinical studies have been performed with Intratect (50 g/l): two in patients with primary immunodeficiencies (PID) and one in patients with immune thrombocytopenic purpura (ITP). In the two PID studies overall 68 patients were treated with Intratect (50 g/l) and evaluated for safety. Treatment period was 6 and 12 months respectively. The ITP study was performed in 24 patients.
These 92 patients received a total of 830 infusions of Intratect (50 g/l), whereby a total of 51 adverse drug reactions (ADRs) were recorded.
With Intratect 100 g/l one clinical study has been performed in patients with PID. 30 patients were treated with Intratect 100 g/l over 3 to 6 months and evaluated for safety. These 30 patients received a total of 165 infusions of Intratect 100 g/l, whereof a total of 19 infusions (11.5%) were associated with adverse drug reactions (ADRs).
The majority of these ADRs was mild to moderate and self-limiting. No serious ADRs were observed during the studies.
The table presented below is according to the MedDRA system organ classification (SOC and Preferred Term Level).
Frequencies have been evaluated according to the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); not known (cannot be estimated from the available data).
\*\*Frequency of Adverse Drug Reactions (ADRs) in clinical studies with Intratect (50 g/l), indications PID and ITP\*\* \*(Frequencies are calculated per infusions administered (n=830) and patients treated (n=92) respectively.)\*
| | | | |
| --- | --- | --- | --- |
| \*\*MedDRA\*\* \*\*System Organ Class (SOC)\*\* | \*\*Adverse reaction\*\* \*\*(MedDRA preferred term (PT))\*\* | \*\*Frequency\*\* \*based on infusions administered\* (n=\*830\*) | \*\*Frequency\*\* \*based on patients treated\* (n=\*92\*) |
| Blood and lymphatic system disorders | Haemolysis (mild) | Uncommon | Common |
| Nervous system disorders | Headache | Common | Very Common |
| Dysgeusia | Uncommon | Common |
| Vascular disorders | Hypertension, thrombophlebitis superficial | Uncommon | Common |
| Gastrointestinal disorders | Nausea, vomiting, gastrointestinal pain | Uncommon | Common |
| Skin and subcutaneous tissue disorders | Papular rash | Uncommon | Common |
| General disorders and administration site conditions | Pyrexia | Common | Very Common |
| Chills, feeling hot | Uncommon | Common |
| Investigations | Body temperature increased, Coombs test (indirect and direct) positive | Uncommon | Common |
\*\*Frequency of Adverse Drug Reactions (ADRs) in a clinical study with Intratect 100 g/l, indication PID\*\* \*(Frequencies are calculated per infusions administered (n=165 and patients treated (n=30) respectively.)\*
| | | | |
| --- | --- | --- | --- |
| \*\*MedDRA\*\* \*\*System Organ Class (SOC)\*\* | \*\*Adverse reaction\*\* \*\*(MedDRA preferred term (PT))\*\* | \*\*Frequency\*\* \*based on infusions administered (n=165)\* | \*\*Frequency\*\* \*based on patients treated (n=30)\* |
| Immune system disorders | Infusion related reaction | Common | Common |
| Hypersensitivity | Uncommon | Common |
| Nervous system disorders | Headache | Common | Common |
| Sensory disturbance | Uncommon | Common |
| Cardiac disorders | Palpitations | Common | Common |
| Vascular disorders | Hyperaemia, hypertension | Uncommon | Common |
| Gastrointestinal disorders | Diarrhoea, abdominal pain | Uncommon | Common |
| Skin and subcutaneous tissue disorders | Pain of skin, rash | Uncommon | Common |
| Musculoskeletal and connective tissue disorders | Arthralgia, back pain, bone pain | Common | Common |
| Myalgia | Uncommon | Common |
| General disorders and administration site conditions | Discomfort | Common | Very Common |
| Fatigue, chills, hypothermia | Uncommon | Uncommon |
\*Details of further spontaneously reported adverse reactions:\*
\*Frequency: not known (cannot be estimated from the available data)\*
Cardiac disorders: Angina pectoris
General disorders and administrations site conditions: Rigors
Immune system disorders: Anaphylactic shock, allergic reaction
Investigations: Blood pressure decreased
Musculoskeletal and connective tissue disorders: Back pain
Respiratory, thoracic and mediastinal disorders: Dyspnoea NOS
Vascular disorders: Shock
Blood and lymphatic system disorders: leukopenia
\*\*Description of selected adverse reactions\*\*
The reported adverse reactions for Intratect are in the expected profile for human normal immunoglobulins.
\*Paediatric population\*
Frequency, type and severity of adverse reactions in the paediatric population are expected to be the same as in adults.
\*\*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 Yellow Card Scheme, Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.4.9 Overdose
Overdose may lead to fluid overload and hyperviscosity, particularly in patients at risk, including infants, elderly patients or patients with cardiac or renal impairment (see section 4.4).
## Pharmacological Properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: immune sera and immunoglobulins: immunoglobulins, normal human, for intravascular administration, ATC code: J06BA02
Human normal immunoglobulin contains mainly immunoglobulin G (IgG) with a broad spectrum of antibodies against infectious agents.
Human normal immunoglobulin contains the IgG antibodies present in the normal population. It is usually prepared from pooled plasma from not fewer than 1000 donors. It has a distribution of immunoglobulin G subclasses closely proportional to that in native human plasma. Adequate doses of this medicinal product may restore abnormally low immunoglobulin G levels to the normal range.
The mechanism of action in indications other than replacement therapy is not fully elucidated, but includes immunomodulatory effects.
\*Paediatric population\*
The pharmacodynamic properties in the paediatric population are expected to be the same as in adults.5.2 Pharmacokinetic properties
\*\*Absorption\*\*
Human normal immunoglobulin is immediately and completely bioavailable in the recipient's circulation after intravenous administration.
\*\*Distribution\*\*
It is distributed relatively rapidly between plasma and extravascular fluid, after approximately 3–5 days equilibrium is reached between the intra- and extravascular compartments.
\*\*Elimination\*\*
Intratect 100 g/l has a half-life of about 34 days. This half-life may vary from patient to patient, in particular in primary immunodeficiency.
IgG and IgG-complexes are broken down in cells of the reticuloendothelial system.5.3 Preclinical safety data
Immunoglobulins are normal constituents of the human body. Repeated dose toxicity testing and embryo-foetal toxicity studies are impracticable due to induction of, and interference with antibodies. Effects of the product on the immune system of the newborn have not been studied.
Since clinical experience provides no hint for tumorigenic and mutagenic effects of immunoglobulins, experimental studies, particularly in heterologous species, are not considered necessary.
## Pharmaceutical Particulars
6.1 List of excipients
Glycine, water for injections.6.2 Incompatibilities
In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products, nor with any other IVIg products.6.3 Shelf life
3 years.
After first opening, an immediate use is recommended.6.4 Special precautions for storage
Do not store above 25°C. Do not freeze.
Keep the vial in the outer carton in order to protect from light.6.5 Nature and contents of container
10 ml, 25 ml, 50 ml, 100 ml or 200 ml of solution in a vial (Type II glass) with a stopper (bromobutyl) and a cap (aluminium).
Pack with 1 vial with 10 ml, 25 ml, 50 ml, 100 ml or 200 ml solution.
Pack with 3 vials with 100 ml or 200 ml solution.
Not all pack sizes may be marketed.6.6 Special precautions for disposal and other handling
The product should be brought to room or body temperature before use.
The solution should be clear or slightly opalescent and colourless to pale yellow. Solutions that are cloudy or have deposits should not be used.
Any unused product or waste material should be disposed of in accordance with local requirements.
