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DRUGS & SUPPLEMENTS
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Copper (Copper HVP Chelate):
Water-Resistant Protection Without Bandaging
Recommended as an Aid in Treating Horses and Ponies With Thrush Due to Organisms Susceptible to Copper plus Iron and Zinc (Copper (Copper HVP Chelate)) Naphthenate.
For Animal Use Only.
ThrushTox® is indicated in the treatment of thrush in horses and ponies.
Clean the hoof thoroughly, removing debris and necrotic material prior to application of Copper plus Iron and Zinc (Copper (Copper HVP Chelate))®. Apply daily to affected hoofs with a narrow paint brush (about 1”) until fully healed. Caution: Do not allow runoff of excess Copper plus Iron and Zinc (Copper (Copper HVP Chelate))® onto hair since contact with Copper plus Iron and Zinc (Copper (Copper HVP Chelate))® may cause some hair loss. Do not contaminate feed.
NOTE: Copper plus Iron and Zinc (Copper (Copper HVP Chelate))® is easily removed from hands, clothing and surfaces with light grade fuel oil or any type of lighter fluid.
CONTAINS FOIL SEAL – REMOVE BEFORE USE.
SHAKE WELL BEFORE USE.
To report suspected adverse reactions or to obtain technical assistance, call 1-800-650-4899.
Copper plus Iron and Zinc (Copper (Copper HVP Chelate)) Naphthenate...37.5% w/w
Inert Ingredients...62.5% w/w
Total... 100.0%
Do not use in horses intended for human consumption.
CAUTION: COMBUSTIBLE MIXTURE.
Use in a well-ventilated place. Avoid fire, flame, sparks or heaters.
If swallowed, do not induce vomiting, call physician immediately. Avoid breathing vapor. Avoid contact with skin and eyes.
KEEP OUT OF REACH OF CHILDREN AND PETS.
Store at controlled room temperature 15º to 30ºC (59º to 86ºF). Keep container tightly closed when not in use.
Manufactured for:
Aspen Veterinary Resources,® Ltd.
Liberty, MO 64068, USA
FC163FP 11/13
Manufactured by:
First Priority, Inc.
Elgin, IL 60123-1146, USA
16 OZ (473 mL)
ANADA 200-304, Approved by FDA
Image of 473 mL bottle/case label
Iron (Ferrous HVP Chelate):
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is indicated for the treatment of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency anemia in patients with chronic kidney disease (CKD).
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is an Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) replacement product indicated for the treatment of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency anemia in patients with chronic kidney disease (CKD). (1)
Copper plus Iron and Zinc ) must only be administered intravenously either by slow injection or by infusion. The dosage of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is expressed in mg of elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)). Each mL contains 20 mg of elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)).
Population | Dose | |
Adult patients | Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD) (2.1) | 100 mg slow intravenous injection or infusion |
Non-Dialysis Dependent-Chronic Kidney Disease (NDD-CKD) (2.2) | 200 mg slow intravenous injection or infusion | |
Peritoneal Dialysis Dependent-Chronic Kidney Disease (PDD-CKD) (2.3) | 300 mg or 400 mg intravenous infusion | |
Pediatric patients | HDD-CKD (2.4), PDD-CKD or NDD-CKD (2.5) | 0.5 mg/kg slow intravenous injection or infusion |
Administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 100 mg undiluted as a slow intravenous injection over 2 to 5 minutes, or as an infusion of 100 mg diluted in a maximum of 100 mL of 0.9% NaCl over a period of at least 15 minutes, per consecutive hemodialysis session. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) should be administered early during the dialysis session. The usual total treatment course of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is 1000 mg. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment may be repeated if Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency reoccurs.
Administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 200 mg undiluted as a slow intravenous injection over 2 to 5 minutes or as an infusion of 200 mg in a maximum of 100 mL of 0.9% NaCl over a period of 15 minutes. Administer on 5 different occasions over a 14 day period. There is limited experience with administration of an infusion of 500 mg of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), diluted in a maximum of 250 mL of 0.9% NaCl, over a period of 3.5 to 4 hours on Day 1 and Day 14. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment may be repeated if Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency reoccurs.
Administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in 3 divided doses, given by slow intravenous infusion, within a 28 day period: 2 infusions each of 300 mg over 1.5 hours 14 days apart followed by one 400 mg infusion over 2.5 hours 14 days later. Dilute Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in a maximum of 250 mL of 0.9% NaCl. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment may be repeated if Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency reoccurs.
The dosing for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) replacement treatment in pediatric patients with HDD-CKD has not been established.
For Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) maintenance treatment: Administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every two weeks for 12 weeks given undiluted by slow intravenous injection over 5 minutes or diluted in 25 mL of 0.9% NaCl and administered over 5 to 60 minutes. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment may be repeated if necessary.
The dosing for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) replacement treatment in pediatric patients with NDD-CKD or PDD-CKD has not been established.
For Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) maintenance treatment: Administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) at a dose of 0.5 mg/kg, not to exceed 100 mg per dose, every four weeks for 12 weeks given undiluted by slow intravenous injection over 5 minutes or diluted in 25 mL of 0.9% NaCl and administered over 5 to 60 minutes. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment may be repeated if necessary.
Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening and fatal, have been reported in patients receiving Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)). Patients may present with shock, clinically significant hypotension, loss of consciousness, and/or collapse. If hypersensitivity reactions or signs of intolerance occur during administration, stop Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) immediately. Monitor patients for signs and symptoms of hypersensitivity during and after Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) administration for at least 30 minutes and until clinically stable following completion of the infusion. Only administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. Most reactions associated with intravenous Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) preparations occur within 30 minutes of the completion of the infusion .
Copper plus Iron and Zinc ) may cause clinically significant hypotension. Monitor for signs and symptoms of hypotension following each administration of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)). Hypotension following administration of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) may be related to the rate of administration and/or total dose administered .
Excessive therapy with parenteral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) can lead to excess storage of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) with the possibility of iatrogenic hemosiderosis. All adult and pediatric patients receiving Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) require periodic monitoring of hematologic and Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) parameters (hemoglobin, hematocrit, serum ferritin and transferrin saturation). Do not administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) to patients with evidence of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) overload. Transferrin saturation (TSAT) values increase rapidly after intravenous administration of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose; do not perform serum Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) measurements for at least 48 hours after intravenous dosing .
The following serious adverse reactions associated with Copper plus Iron and Zinc ) are described in other sections .
To report SUSPECTED ADVERSE REACTIONS, contact American Regent, Inc. at 1-800-734-9236 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch .
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug may not reflect the rates observed in practice.
Adverse Reactions in Adult Patients with CKD
The frequency of adverse reactions associated with the use of Copper plus Iron and Zinc ) has been documented in six clinical trials involving 231 patients with HDD-CKD, 139 patients with NDD-CKD and 75 patients with PDD-CKD. Treatment-emergent adverse reactions reported by ≥ 2% of treated patients in the six clinical trials for which the rate for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) exceeds the rate for comparator are listed by indication in Table 1. Patients with HDD-CKD received 100 mg doses at 10 consecutive dialysis sessions until a cumulative dose of 1000 mg was administered. Patients with NDD-CKD received either 5 doses of 200 mg over 2 weeks or 2 doses of 500 mg separated by fourteen days, and patients with PDD-CKD received 2 doses of 300 mg followed by a dose of 400 mg over a period of 4 weeks.
* EPO=Erythropoietin | |||||
Adverse Reactions (Preferred Term) | HDD-CKD | NDD-CKD | PDD-CKD | ||
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) | Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) | Oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) | Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) | EPO* Only | |
(N=231) | (N=139) | (N=139) | (N=75) | (N=46) | |
% | % | % | % | % | |
Subjects with any adverse reaction | 78.8 | 76.3 | 73.4 | 72.0 | 65.2 |
Ear and Labyrinth Disorders | |||||
Ear Pain | 0 | 2.2 | 0.7 | 0 | 0 |
Eye Disorders | |||||
Conjunctivitis | 0.4 | 0 | 0 | 2.7 | 0 |
Gastrointestinal Disorders | |||||
Abdominal pain | 3.5 | 1.4 | 2.9 | 4.0 | 6.5 |
Diarrhea | 5.2 | 7.2 | 10.1 | 8.0 | 4.3 |
Dysgeusia | 0.9 | 7.9 | 0 | 0 | 0 |
Nausea | 14.7 | 8.6 | 12.2 | 5.3 | 4.3 |
Vomiting | 9.1 | 5.0 | 8.6 | 8.0 | 2.2 |
General Disorders and | |||||
Administration Site Conditions | |||||
Asthenia | 2.2 | 0.7 | 2.2 | 2.7 | 0 |
Chest pain | 6.1 | 1.4 | 0 | 2.7 | 0 |
Feeling abnormal | 3.0 | 0 | 0 | 0 | 0 |
Infusion site pain or burning | 0 | 5.8 | 0 | 0 | 0 |
Injection site extravasation | 0 | 2.2 | 0 | 0 | 0 |
Peripheral edema | 2.6 | 7.2 | 5.0 | 5.3 | 10.9 |
Pyrexia | 3.0 | 0.7 | 0.7 | 1.3 | 0 |
Infections and Infestations | |||||
Nasopharyngitis, Sinusitis, Upper respiratory tract infections, Pharyngitis | 2.6 | 2.2 | 4.3 | 16.0 | 4.3 |
Injury, Poisoning and Procedural | |||||
Complications | |||||
Graft complication | 9.5 | 1.4 | 0 | 0 | 0 |
Metabolism and Nutrition Disorders | |||||
Fluid overload | 3.0 | 1.4 | 0.7 | 1.3 | 0 |
Gout | 0 | 2.9 | 1.4 | 0 | 0 |
Hyperglycemia | 0 | 2.9 | 0 | 0 | 2.2 |
Hypoglycemia | 0.4 | 0.7 | 0.7 | 4.0 | 0 |
Musculoskeletal and Connective | |||||
Tissue Disorders | |||||
Arthralgia | 3.5 | 1.4 | 2.2 | 4.0 | 4.3 |
Back pain | 2.2 | 2.2 | 3.6 | 1.3 | 4.3 |
Muscle cramp | 29.4 | 0.7 | 0.7 | 2.7 | 0 |
Myalgia | 0 | 3.6 | 0 | 1.3 | 0 |
Pain in extremity | 5.6 | 4.3 | 0 | 2.7 | 6.5 |
Nervous System Disorders | |||||
Dizziness | 6.5 | 6.5 | 1.4 | 1.3 | 4.3 |
Headache | 12.6 | 2.9 | 0.7 | 4.0 | 0 |
Respiratory, Thoracic and | |||||
Mediastinal Disorders | |||||
Cough | 3.0 | 2.2 | 0.7 | 1.3 | 0 |
Dyspnea | 3.5 | 5.8 | 1.4 | 1.3 | 2.2 |
Nasal congestion | 0 | 1.4 | 2.2 | 1.3 | 0 |
Skin and Subcutaneous | |||||
Tissue Disorders | |||||
Pruritus | 3.9 | 2.2 | 4.3 | 2.7 | 0 |
Vascular Disorders | |||||
Hypertension | 6.5 | 6.5 | 4.3 | 8.0 | 6.5 |
Hypotension | 39.4 | 2.2 | 0.7 | 2.7 | 2.2 |
One hundred thirty (11%) of the 1,151 patients evaluated in the 4 U.S. trials in HDD-CKD patients (studies A, B and the two post marketing studies) had prior other intravenous Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) therapy and were reported to be intolerant (defined as precluding further use of that Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) product). When these patients were treated with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) there were no occurrences of adverse reactions that precluded further use of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) .
Adverse Reactions in Pediatric Patients with CKD (ages 2 years and older)
In a randomized, open-label, dose-ranging trial for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) maintenance treatment with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in pediatric patients with CKD on stable erythropoietin therapy , at least one treatment-emergent adverse reaction was experienced by 57% (27/47) of the patients receiving Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 0.5 mg/kg, 53% (25/47) of the patients receiving Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 1.0 mg/kg, and 55% (26/47) of the patients receiving Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 2.0 mg/kg.
A total of 5 (11%) subjects in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 0.5 mg/kg group, 10 (21%) patients in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 1.0 mg/kg group, and 10 (21%) patients in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 2.0 mg/kg group experienced at least 1 serious adverse reaction during the study. The most common treatment-emergent adverse reactions (> 2% of patients) in all patients were headache (6%), respiratory tract viral infection (4%), peritonitis (4%), vomiting (4%), pyrexia (4%), dizziness (4%), cough (4%), renal transplant (4%), nausea (3%), arteriovenous fistula thrombosis (2%), hypotension (2%), and hypertension (2.1%).
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
In the post-marketing safety studies in 1,051 treated patients with HDD-CKD, the adverse reactions reported by > 1% were: cardiac failure congestive, sepsis and dysgeusia.
The following adverse reactions have been identified during post-approval use of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)). Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure: Anaphylactic-type reactions, shock, loss of consciousness, collapse, bronchospasm, dyspnea, convulsions, light-headedness, confusion, angioedema, swelling of the joints, hyperhidrosis, back pain, bradycardia, and chromaturia.
Symptoms associated with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) total dosage or infusing too rapidly included hypotension, dyspnea, headache, vomiting, nausea, dizziness, joint aches, paresthesia, abdominal and muscle pain, edema, and cardiovascular collapse. These adverse reactions have occurred up to 30 minutes after the administration of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) injection. Reactions have occurred following the first dose or subsequent doses of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)). Symptoms may respond to intravenous fluids, hydrocortisone, and/or antihistamines. Slowing the infusion rate may alleviate symptoms.
Injection site discoloration has been reported following extravasation. Assure stable intravenous access to avoid extravasation.
Drug interactions involving Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) have not been studied. However, Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) may reduce the absorption of concomitantly administered oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) preparations.
Pregnancy Category B
There are no adequate and well-controlled studies in pregnant women. In animal reproduction studies, Copper plus Iron and Zinc ) sucrose was administered intravenously to rats and rabbits during the period of organogenesis at doses up to 13 mg/kg/day of elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (half or equivalent to the maximum recommended human dose based on body surface area, respectively) and revealed no evidence of harm to the fetus due to Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose. Because animal reproductive studies are not always predictive of human response, Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) should be used during pregnancy only if clearly needed.
It is not known whether Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose is excreted in human milk. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose is secreted into the milk of lactating rats. Because many drugs are excreted in human milk, caution should be exercised when Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is administered to a nursing woman.
Safety and effectiveness of Copper plus Iron and Zinc ) for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) replacement treatment in pediatric patients with dialysis-dependent or non-dialysis-dependent CKD have not been established.
Safety and effectiveness of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) maintenance treatment in pediatric patients 2 years of age and older with dialysis-dependent or non-dialysis-dependent CKD receiving erythropoietin therapy were studied. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) at doses of 0.5 mg/kg, 1.0 mg/kg, and 2.0 mg/kg was administered. All three doses maintained hemoglobin between 10.5 g/dL and 14.0 g/dL in about 50% of subjects over the 12-week treatment period with stable EPO dosing. [See Clinical Studies (14.6)]
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) has not been studied in patients younger than 2 years of age.
In a country where Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is available for use in children, at a single site, five premature infants (weight less than 1,250 g) developed necrotizing enterocolitis and two of the five died during or following a period when they received Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), several other medications and erythropoietin. Necrotizing enterocolitis may be a complication of prematurity in very low birth weight infants. No causal relationship to Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) or any other drugs could be established.
Clinical studies of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) did not include sufficient numbers of subjects aged 65 years and older to determine whether they respond differently from younger subjects. Of the 1,051 patients in two post-marketing safety studies of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), 40% were 65 years and older. No overall differences in safety were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. In general, dose administration to an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
No data are available regarding overdosage of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in humans. Excessive dosages of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) may lead to accumulation of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in storage sites potentially leading to hemosiderosis. Do not administer Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) to patients with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) overload.
Toxicities in single-dose studies in mice and rats, at intravenous Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose doses up to 8 times the maximum recommended human dose based on body surface area, included sedation, hypoactivity, pale eyes, bleeding in the gastrointestinal tract and lungs, and mortality.
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (iron sucrose injection, USP), an Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) replacement product, is a brown, sterile, aqueous, complex of polynuclear Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (III)-hydroxide in sucrose for intravenous use. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose injection has a molecular weight of approximately 34,000 to 60,000 daltons and a proposed structural formula:
[Na2Fe5O8(OH) ·3(H2O)]n ·m(C12H22O11)
where: n is the degree of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) polymerization and m is the number of sucrose molecules associated with the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (III)-hydroxide.
Each mL contains 20 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) as Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose in water for injection. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is available in 10 mL single-use vials (200 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) per 10 mL), 5 mL single-use vials (100 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) per 5 mL), and 2.5 mL single-use vials (50 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) per 2.5 mL). The drug product contains approximately 30% sucrose w/v (300 mg/mL) and has a pH of 10.5 to 11.1. The product contains no preservatives. The osmolarity of the injection is 1,250 mOsmol/L.
Copper plus Iron and Zinc ) is an aqueous complex of poly-nuclear Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (III)-hydroxide in sucrose. Following intravenous administration, Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is dissociated into Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) and sucrose and the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is transported as a complex with transferrin to target cells including erythroid precursor cells. The Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in the precursor cells is incorporated into hemoglobin as the cells mature into red blood cells.
Following intravenous administration, Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is dissociated into Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) and sucrose. In 22 patients undergoing hemodialysis and receiving erythropoietin (recombinant human erythropoietin) therapy treated with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose containing 100 mg of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), three times weekly for three weeks, significant increases in serum Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) and serum ferritin and significant decreases in total Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) binding capacity occurred four weeks from the initiation of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose treatment.
In healthy adults administered intravenous doses of Copper plus Iron and Zinc ), its Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) component exhibited first order kinetics with an elimination half-life of 6 h, total clearance of 1.2 L/h, and steady state apparent volume of distribution of 7.9 L. The Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) component appeared to distribute mainly in blood and to some extent in extravascular fluid. A study evaluating Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) containing 100 mg of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) labeled with 52Fe/59Fe in patients with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency showed that a significant amount of the administered Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is distributed to the liver, spleen and bone marrow and that the bone marrow is an irreversible Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) trapping compartment.
Following intravenous administration of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose is dissociated into Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) and sucrose. The sucrose component is eliminated mainly by urinary excretion. In a study evaluating a single intravenous dose of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) containing 1,510 mg of sucrose and 100 mg of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in 12 healthy adults (9 female, 3 male: age range 32 to 52), 68.3% of the sucrose was eliminated in urine in 4 h and 75.4% in 24 h. Some Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) was also eliminated in the urine. Neither transferrin nor transferrin receptor levels changed immediately after the dose administration. In this study and another study evaluating a single intravenous dose of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose containing 500 to 700 mg of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in 26 patients with anemia on erythropoietin therapy (23 female, 3 male; age range 16 to 60), approximately 5% of the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) was eliminated in urine in 24 h at each dose level. The effects of age and gender on the pharmacokinetics of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) have not been studied.
Pharmacokinetics in Pediatric Patients
In a single-dose PK study of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), patients with NDD-CDK ages 12 to 16 (N=11) received intravenous bolus doses of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) at 7 mg/kg (maximum 200 mg) administered over 5 minutes. Following single dose Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), the half-life of total serum Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) was 8 hours. The mean Cmax and AUC values were 8545 μg/dl and 31305 hr-μg/dL, respectively, which were 1.42- and 1.67-fold higher than dose adjusted adult Cmax and AUC values.
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is not dialyzable through CA210 (Baxter) High Efficiency or Fresenius F80A High Flux dialysis membranes. In in vitro studies, the amount of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose in the dialysate fluid was below the levels of detection of the assay (less than 2 parts per million).
Carcinogenicity studies have not been performed with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose.
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose was not mutagenic in vitro in the bacterial reverse mutation assay (Ames test) or the mouse lymphoma assay. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose was not clastogenic in the in vitro chromosome aberration assay using human lymphocytes or in the in vivo mouse micronucleus assay.
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) sucrose at intravenous doses up to 15 mg/kg/day of elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (1.2 times the maximum recommended human dose based on body surface area) had no effect on fertility and reproductive function of male and female rats.
Five clinical trials involving 647 adult patients and one clinical trial involving 131 pediatric patients were conducted to assess the safety and efficacy of Copper plus Iron and Zinc ).
Study A was a multicenter, open-label, historically-controlled study in 101 patients with HDD-CKD (77 patients with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment and 24 in the historical control group) with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency anemia. Eligibility criteria for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treatment included patients undergoing chronic hemodialysis, receiving erythropoietin, hemoglobin level between 8.0 and 11.0 g/dL, transferrin saturation < 20%, and serum ferritin < 300 ng/mL. The mean age of the patients was 65 years with the age range of 31 to 85 years. Of the 77 patients, 44 (57%) were male and 33 (43%) were female.
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 100 mg was administered at 10 consecutive dialysis sessions either as slow injection or a slow infusion. The historical control population consisted of 24 patients with similar ferritin levels as patients treated with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), who were off intravenous Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) for at least 2 weeks and who had received erythropoietin therapy with hematocrit averaging 31 to 36 for at least two months prior to study entry. The mean age of patients in the historical control group was 56 years, with an age range of 29 to 80 years. Patient age and serum ferritin level were similar between treatment and historical control patients.
Patients in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) treated population showed a greater increase in hemoglobin and hematocrit than did patients in the historical control population. See Table 2.
**p < 0.01 and *p < 0.05 compared to historical control from ANCOVA analysis with baseline hemoglobin, serum ferritin and erythropoietin dose as covariates. | ||||||
Efficacy parameters | End of treatment | 2 week follow-up | 5 week follow-up | |||
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (n=69 | Historical Control (n=18) | Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (n=73) | Historical Control (n=18) | Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (n=71) | Historical Control (n=15) | |
Hemoglobin (g/dL) | 1.0 ± 0.12** | 0.0 ± 0.21 | 1.3 ± 0.14** | -0.6 ± 0.24 | 1.2 ± 0.17* | -0.1 ± 0.23 |
Hematocrit (%) | 3.1 ± 0.37** | -0.3 ± 0.65 | 3.6 ± 0.44** | -1.2 ± 0.76 | 3.3 ± 0.54 | 0.2 ± 0.86 |
Serum ferritin increased at endpoint of study from baseline in the Venofer-treated population (165.3 ± 24.2 ng/mL) compared to the historical control population (-27.6 ± 9.5 ng/mL). Transferrin saturation also increased at endpoint of study from baseline in the Venofer-treated population (8.8 ± 1.6%) compared to this historical control population (-5.1 ± 4.3%).
Study B was a multicenter, open label study of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in 23 patients with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) deficiency and HDD-CKD who had been discontinued from Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) dextran due to intolerance. Eligibility criteria were otherwise identical to Study A. The mean age of the patients in this study was 53 years, with ages ranging from 21 to 79 years. Of the 23 patients enrolled in the study, 10 (44%) were male and 13 (56%) were female.
All 23 enrolled patients were evaluated for efficacy. Increases in mean hemoglobin (1.1 ± 0.2 g/dL), hematocrit (3.6 ± 0.6%), serum ferritin (266.3 ± 30.3 ng/mL) and transferrin saturation (8.7 ± 2.0%) were observed from baseline to end of treatment.
Study C was a multicenter, open-label study in patients with HDD-CKD. This study enrolled patients with a hemoglobin ≤ 10 g/dL, a serum transferrin saturation ≤ 20%, and a serum ferritin ≤ 200 ng/mL, who were undergoing maintenance hemodialysis 2 to 3 times weekly. The mean age of the patients enrolled in this study was 41 years, with ages ranging from 16 to 70 years. Of 130 patients evaluated for efficacy in this study, 68 (52%) were male and 62 (48%) were female. Forty-eight percent of the patients had previously been treated with oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)). Exclusion criteria were similar to those in studies A and B. Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) was administered in doses of 100 mg during sequential dialysis sessions until a pre-determined (calculated) total dose of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) was administered. A 50 mg dose (2.5 mL) was given to patients within two weeks of study entry as a test dose. Twenty-seven patients (20%) were receiving erythropoietin treatment at study entry and they continued to receive the same erythropoietin dose for the duration of the study.
The modified intention-to-treat (mITT) population consisted of 131 patients. Increases from baseline in mean hemoglobin (1.7 g/dL), hematocrit (5%), serum ferritin (434.6 ng/mL), and serum transferrin saturation (14%) were observed at week 2 of the observation period and these values remained increased at week 4 of the observation period.
Study D was a randomized, open-label, multicenter, active-controlled study of the safety and efficacy of oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) versus Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) in patients with NDD-CKD with or without erythropoietin therapy. Erythropoietin therapy was stable for 8 weeks prior to randomization. In the study 188 patients with NDD-CKD, hemoglobin of ≤ 11.0 g/dL, transferrin saturation ≤ 25%, ferritin ≤ 300 ng/mL were randomized to receive oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (325 mg ferrous sulfate three times daily for 56 days); or Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (either 200 mg over 2 to 5 minutes 5 times within 14 days or two 500 mg infusions on Day 1 and Day 14, administered over 3.5 to 4 hours). The mean age of the 91 treated patients in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) group was 61.6 years (range 25 to 86 years) and 64 years (range 21 to 86 years) for the 91 patients in the oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) group.
A statistically significantly greater proportion of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) subjects (35/79; 44.3%) compared to oral Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) subjects (23/82; 28%) had an increase in hemoglobin ≥ 1 g/dL at anytime during the study (p = 0.03).
Study E was a randomized, open-label, multicenter study comparing patients with PDD-CKD receiving an erythropoietin and intravenous Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) to patients with PDD-CKD receiving an erythropoietin alone without Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) supplementation. Patients with PDD-CKD, stable erythropoietin for 8 weeks, hemoglobin of ≤ 11.5 g/dL, TSAT ≤ 25%, ferritin ≤ 500 ng/mL were randomized to receive either no Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) or Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (300 mg in 250 mL 0.9% NaCl over 1.5 hours on Day 1 and 15 and 400 mg in 250 mL 0.9% NaCl over 2.5 hours on Day 29). The mean age of the 75 treated patients in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) / erythropoietin group was 51.9 years (range 21 to 81 years) vs. 52.8 years (range 23 to 77 years) for 46 patients in the erythropoietin alone group.
Patients in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) / erythropoietin group had statistically significantly greater mean change from baseline to the highest hemoglobin value (1.3 g/dL), compared to subjects who received erythropoietin alone (0.6 g/dL) (p < 0.01). A greater proportion of subjects treated with Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) / erythropoietin (59.1 %) had an increase in hemoglobin of ≥ 1 g/dL at any time during the study compared to the subjects who received erythropoietin only (33.3%).
Study F was a randomized, open-label, dose-ranging study for Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) maintenance treatment in pediatric patients with dialysis-dependent or non-dialysis-dependent CKD on stable erythropoietin therapy. The study randomized patients to one of three doses of Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (0.5 mg/kg, 1.0 mg/kg or 2.0 mg/kg). The mean age was 13 years (range 2 to 20 years). Over 70% of patients were 12 years or older in all three groups. There were 84 males and 61 females. About 60% of patients underwent hemodialysis and 25% underwent peritoneal dialysis in all three dose groups. At baseline, the mean hemoglobin was 12 g/dL, the mean TSAT was 33% and the mean ferritin was 300 ng/mL. Patients with HDD-CKD received Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) once every other week for 6 doses. Patients with PDD-CKD or NDD-CKD received Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) once every 4 weeks for 3 doses. Among 131 evaluable patients with stable erythropoietin dosing, the proportion of patients who maintained hemoglobin between 10.5 g/dL and 14.0 g/dL during the 12-week treatment period was 58.7%, 46.7%, and 45.0% in the Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) 0.5 mg/kg, 1.0 mg/kg, and 2.0 mg/kg groups, respectively. A dose-response relationship was not demonstrated.
Copper plus Iron and Zinc ) is supplied sterile in 10 mL, 5 mL, and 2.5 mL single-use vials. Each 10 mL vial contains 200 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), each 5 mL vial contains 100 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), and each 2.5 mL vial contains 50 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) (20 mg/mL).
NDC-0517-2310-05 | 200 mg/10 mL Single-Use Vial | Packages of 5 |
NDC-0517-2310-10 | 200 mg/10 mL Single-Use Vial | Packages of 10 |
NDC-0517-2340-01 | 100 mg/5 mL Single-Use Vial | Individually Boxed |
NDC-0517-2340-10 | 100 mg/5 mL Single-Use Vial | Packages of 10 |
NDC-0517-2340-25 | 100 mg/5 mL Single-Use Vial | Packages of 25 |
NDC-0517-2340-99 | 100 mg/5 mL Single-Use Vial | Packages of 10 |
NDC-0517-2325-10 | 50 mg/2.5 mL Single-Use Vial | Packages of 10 |
NDC-0517-2325-25 | 50 mg/2.5 mL Single-Use Vial | Packages of 25 |
Contains no preservatives. Store in original carton at 20°C to 25°C (68° F to 77° F); excursions permitted to 15° to 30°C (59° to 86°F).. Do not freeze.
Syringe Stability: Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), when diluted with 0.9% NaCl at concentrations ranging from 2 mg to 10 mg of elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) per mL, or undiluted (20 mg elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) per mL) and stored in a plastic syringe, was found to be physically and chemically stable for 7 days at controlled room temperature (25°C ± 2°C) and under refrigeration (4°C ± 2°C).
Intravenous Admixture Stability: Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)), when added to intravenous infusion bags (PVC or non-PVC) containing 0.9% NaCl at concentrations ranging from 1 mg to 2 mg of elemental Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) per mL, has been found to be physically and chemically stable for 7 days at controlled room temperature (25°C ± 2°C).
Do not dilute to concentrations below 1 mg/mL.
Do not mix Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) with other medications or add to parenteral nutrition solutions for intravenous infusion.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to infusion.
Prior to Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) administration:
AMERICAN
REGENT, INC.
SHIRLEY, NY 11967
Copper plus Iron and Zinc (Iron (Ferrous HVP Chelate)) is manufactured under license from Vifor (International) Inc., Switzerland.
PremierProRx® is a trademark of Premier, Inc., used under license.
PREMIERProRx®
IN2340
MG #15727
Zinc (Zinc HVP Chelate):
Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) 1 mg/mL (Zinc Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for TPN. Administration helps to maintain Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) serum levels and to prevent depletion of endogenous stores, and subsequent deficiency symptoms.
None known.
Direct intramuscular or intravenous injection of Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) 1 mg/mL (Zinc Chloride Injection, USP) is contraindicated as the acidic pH of the solution (2) may cause considerable tissue irritation.
Severe kidney disease may make it necessary to reduce or omit chromium and Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) doses because these elements are primarily eliminated in the urine.
WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.
Do not use unless the solution is clear and the seal is intact.
Zinc 1 mg/mL should only be used in conjunction with a pharmacy directed admixture program using aseptic technique in a laminar flow environment; it should be used promptly and in a single operation without any repeated penetrations. Solution contains no preservatives; discard unused portion immediately after admixture procedure is completed.
Zinc should not be given undiluted by direct injection into a peripheral vein because of the likelihood of infusion phlebitis and the potential for increased excretory loss of Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) from a bolus injection. Administration of Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) in the absence of copper may cause a decrease in serum copper levels.
Periodic determinations of serum copper as well as Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) are suggested as a guideline for subsequent Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) administration.
Long-term animal studies to evaluate the carcinogenic potential of Copper plus Iron and Zinc ) 1 mg/mL (Zinc Chloride Injection, USP) have not been performed, nor have studies been done to assess mutagenesis or impairment of fertility.
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) 1 mg/mL (Zinc Chloride Injection, USP) is administered to a nursing woman.
Pregnancy Category C. Animal reproduction studies have not been conducted with Copper plus Iron and Zinc ) chloride. It is also not known whether Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) chloride can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) chloride should be given to a pregnant woman only if clearly needed.
An evaluation of current literature revealed no clinical experience identifying differences in response between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
None known.
None known.
Single intravenous doses of 1 to 2 mg zinc/kg body weight have been given to adult leukemic patients without toxic manifestations. However, acute toxicity was reported in an adult when 10 mg Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) was infused over a period of one hour on each of four consecutive days. Profuse sweating, decreased level of consciousness, blurred vision, tachycardia (140/min), and marked hypothermia (94.2° F) on the fourth day were accompanied by a serum Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) concentration of 207 mcg/dl. Symptoms abated within three hours.
Hyperamylasemia may be a sign of impending Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) overdosage; patients receiving an inadvertent overdose (25 mg zinc/liter of TPN solution, equivalent to 50 to 70 mg zinc/day) developed hyperamylasemia (557 to 1850 Klein units; normal: 130 to 310).
Death resulted from an overdosage in which 1683 mg Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) was delivered intravenously over the course of 60 hours to a 72 year old patient.
Symptoms of Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) toxicity included hypotension (80/40 mm Hg), pulmonary edema, diarrhea, vomiting, jaundice, and oliguria, with a serum Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) level of 4184 mcg/dl.
Calcium supplements may confer a protective effect against Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) toxicity.
Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) 1 mg/mL (Zinc Chloride Injection, USP) contains 1 mg zinc/mL and is administered intravenously only after dilution. The additive should be diluted prior to administration in a volume of fluid not less than 100 mL. For the metabolically stable adult receiving TPN, the suggested intravenous dosage is 2.5 to 4 mg zinc/day (2.5 to 4 mL/day). An additional 2 mg zinc/day (2 mL/day) is suggested for acute catabolic states. For the stable adult with fluid loss from the small bowel, an additional 12.2 mg zinc/liter of small bowel fluid lost (12.2 mL/liter of small bowel fluid lost), or an additional 17.1 mg zinc/kg of stool or ileostomy output (17.1 mL/kg of stool or ileostomy output) is recommended. Frequent monitoring of Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) blood levels is suggested for patients receiving more than the usual maintenance dosage level of Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)).
For full term infants and children up to 5 years of age, 100 mcg zinc/kg/day (0.1 mL/kg/day) is recommended. For premature infants (birth weight less than 1500 g) up to 3 kg in body weight, 300 mcg zinc/kg/day (0.3 mL/kg/day) is suggested.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.
Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) 1 mg/mL (Zinc Chloride Injection, USP) is supplied in 10 mL Plastic Vials (List No. 4090).
Store at 20 to 25°C (68 to 77°F).
Revised: October, 2004
© Hospira 2004 EN-0488 Printed in USA
HOSPIRA, INC., LAKE FOREST, IL 60045 USA
10 mL Vial
Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate))
1 mg/mL
Copper plus Iron and Zinc (Zinc (Zinc HVP Chelate)) Chloride Inj., USP
Rx only
FOR I.V. USE ONLY AFTER DILUTION.
HOSPIRA, INC., LAKE FOREST, IL 60045 USA
Depending on the reaction of the Copper plus Iron and Zinc after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Copper plus Iron and Zinc not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Copper plus Iron and Zinc addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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The information was verified by Dr. Rachana Salvi, MD Pharmacology