Dienol

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Dienol uses

Dienol consists of Iron (Ferrous Oxides), Manganese Oxides.

Iron (Ferrous Oxides):


1 INDICATIONS AND USAGE

Dienol (Iron (Ferrous Oxides)) is indicated for the treatment of Dienol (Iron (Ferrous Oxides)) deficiency anemia in patients with chronic kidney disease (CKD).

Dienol (Iron (Ferrous Oxides)) is an Dienol (Iron (Ferrous Oxides)) replacement product indicated for the treatment of Dienol (Iron (Ferrous Oxides)) deficiency anemia in patients with chronic kidney disease (CKD). (1)

2 DOSAGE AND ADMINISTRATION

Dienol ) must only be administered intravenously either by slow injection or by infusion. The dosage of Dienol (Iron (Ferrous Oxides)) is expressed in mg of elemental Dienol (Iron (Ferrous Oxides)). Each mL contains 20 mg of elemental Dienol (Iron (Ferrous Oxides)).

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

2.1 Adult Patients with Hemodialysis Dependent-Chronic Kidney Disease (HDD-CKD)

Administer Dienol (Iron (Ferrous Oxides)) 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. Dienol (Iron (Ferrous Oxides)) should be administered early during the dialysis session. The usual total treatment course of Dienol (Iron (Ferrous Oxides)) is 1000 mg. Dienol (Iron (Ferrous Oxides)) treatment may be repeated if Dienol (Iron (Ferrous Oxides)) deficiency reoccurs.

2.2 Adult Patients with Non-Dialysis Dependent-Chronic Kidney Disease

Administer Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)), 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. Dienol (Iron (Ferrous Oxides)) treatment may be repeated if Dienol (Iron (Ferrous Oxides)) deficiency reoccurs.

2.3 Adult Patients with Peritoneal Dialysis Dependent-Chronic Kidney Disease

Administer Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) in a maximum of 250 mL of 0.9% NaCl. Dienol (Iron (Ferrous Oxides)) treatment may be repeated if Dienol (Iron (Ferrous Oxides)) deficiency reoccurs.

2.4 Pediatric Patients with HDD-CKD for Dienol (Iron (Ferrous Oxides)) maintenance treatment

The dosing for Dienol (Iron (Ferrous Oxides)) replacement treatment in pediatric patients with HDD-CKD has not been established.

For Dienol (Iron (Ferrous Oxides)) maintenance treatment: Administer Dienol (Iron (Ferrous Oxides)) 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. Dienol (Iron (Ferrous Oxides)) treatment may be repeated if necessary.

2.5 Pediatric Patients with NDD-CKD or PDD-CKD who are on erythropoietin therapy for Dienol (Iron (Ferrous Oxides)) maintenance treatment

The dosing for Dienol (Iron (Ferrous Oxides)) replacement treatment in pediatric patients with NDD-CKD or PDD-CKD has not been established.

For Dienol (Iron (Ferrous Oxides)) maintenance treatment: Administer Dienol (Iron (Ferrous Oxides)) 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. Dienol (Iron (Ferrous Oxides)) treatment may be repeated if necessary.

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3 DOSAGE FORMS AND STRENGTHS

  • 10 mL single-use vial / 200 mg elemental Dienol (Iron (Ferrous Oxides)) (20 mg/mL)
  • 5 mL single-use vial / 100 mg elemental Dienol (Iron (Ferrous Oxides)) (20 mg/mL)
  • 2.5 mL single-use vial / 50 mg elemental Dienol (Iron (Ferrous Oxides)) (20 mg/mL)
  • 10 mL single-use vial / 200 mg elemental Dienol (Iron (Ferrous Oxides)) (20 mg/mL) (3)
  • 5 mL single-use vial / 100 mg elemental Dienol (Iron (Ferrous Oxides)) (20 mg/mL) (3)
  • 2.5 mL single-use vial / 50 mg elemental Dienol (Iron (Ferrous Oxides)) (20 mg/mL) (3)

4 CONTRAINDICATIONS

  • Known hypersensitivity to Dienol (Iron (Ferrous Oxides))
  • Known hypersensitivity to Dienol (Iron (Ferrous Oxides)) (4)

5 WARNINGS AND PRECAUTIONS

  • Hypersensitivity Reactions: Observe for signs and symptoms of hypersensitivity during and after Dienol ) administration for at least 30 minutes and until clinically stable following completion of each administration. Only administer Dienol (Iron (Ferrous Oxides)) when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. (5.1)
  • Hypotension: Dienol (Iron (Ferrous Oxides)) may cause hypotension. Monitor for signs and symptoms of hypotension during and following each administration of Dienol (Iron (Ferrous Oxides)). (5.2)
  • Dienol (Iron (Ferrous Oxides)) Overload: Regularly monitor hematologic responses during Dienol (Iron (Ferrous Oxides)) therapy. Do not administer Dienol (Iron (Ferrous Oxides)) to patients with Dienol (Iron (Ferrous Oxides)) overload. (5.3)

5.1 Hypersensitivity Reactions

Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening and fatal, have been reported in patients receiving Dienol (Iron (Ferrous Oxides)). 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 Dienol (Iron (Ferrous Oxides)) immediately. Monitor patients for signs and symptoms of hypersensitivity during and after Dienol (Iron (Ferrous Oxides)) administration for at least 30 minutes and until clinically stable following completion of the infusion. Only administer Dienol (Iron (Ferrous Oxides)) when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. Most reactions associated with intravenous Dienol (Iron (Ferrous Oxides)) preparations occur within 30 minutes of the completion of the infusion .

5.2 Hypotension

Dienol ) may cause clinically significant hypotension. Monitor for signs and symptoms of hypotension following each administration of Dienol (Iron (Ferrous Oxides)). Hypotension following administration of Dienol (Iron (Ferrous Oxides)) may be related to the rate of administration and/or total dose administered .

5.3 Dienol (Iron (Ferrous Oxides)) Overload

Excessive therapy with parenteral Dienol (Iron (Ferrous Oxides)) can lead to excess storage of Dienol (Iron (Ferrous Oxides)) with the possibility of iatrogenic hemosiderosis. All adult and pediatric patients receiving Dienol (Iron (Ferrous Oxides)) require periodic monitoring of hematologic and Dienol (Iron (Ferrous Oxides)) parameters (hemoglobin, hematocrit, serum ferritin and transferrin saturation). Do not administer Dienol (Iron (Ferrous Oxides)) to patients with evidence of Dienol (Iron (Ferrous Oxides)) overload. Transferrin saturation (TSAT) values increase rapidly after intravenous administration of Dienol (Iron (Ferrous Oxides)) sucrose; do not perform serum Dienol (Iron (Ferrous Oxides)) measurements for at least 48 hours after intravenous dosing .

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6 ADVERSE REACTIONS

The following serious adverse reactions associated with Dienol ) are described in other sections .

  • The most common adverse reactions (≥2%) following the administration of Dienol (Iron (Ferrous Oxides)) are diarrhea, nausea, vomiting, headache, dizziness, hypotension, pruritus, pain in extremity, arthralgia, back pain, muscle cramp, injection site reactions, chest pain, and peripheral edema. (6.1)

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 .

6.1 Adverse Reactions in Clinical Trials

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 Adults Patients with CKD

Adverse Reactions in Adult Patients with CKD

The frequency of adverse reactions associated with the use of Dienol ) 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 Dienol (Iron (Ferrous Oxides)) 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
Dienol (Iron (Ferrous Oxides)) Dienol (Iron (Ferrous Oxides)) Oral Dienol (Iron (Ferrous Oxides)) Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) therapy and were reported to be intolerant (defined as precluding further use of that Dienol (Iron (Ferrous Oxides)) product). When these patients were treated with Dienol (Iron (Ferrous Oxides)) there were no occurrences of adverse reactions that precluded further use of Dienol (Iron (Ferrous Oxides)) .

Adverse Reactions in Pediatric Patients with CKD (ages 2 years and older)

Adverse Reactions in Pediatric Patients with CKD (ages 2 years and older)

In a randomized, open-label, dose-ranging trial for Dienol (Iron (Ferrous Oxides)) maintenance treatment with Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) 0.5 mg/kg, 53% (25/47) of the patients receiving Dienol (Iron (Ferrous Oxides)) 1.0 mg/kg, and 55% (26/47) of the patients receiving Dienol (Iron (Ferrous Oxides)) 2.0 mg/kg.

A total of 5 (11%) subjects in the Dienol (Iron (Ferrous Oxides)) 0.5 mg/kg group, 10 (21%) patients in the Dienol (Iron (Ferrous Oxides)) 1.0 mg/kg group, and 10 (21%) patients in the Dienol (Iron (Ferrous Oxides)) 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%).

6.2 Adverse Reactions from Post-Marketing Experience

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 Dienol (Iron (Ferrous Oxides)). 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 Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) injection. Reactions have occurred following the first dose or subsequent doses of Dienol (Iron (Ferrous Oxides)). 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.

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7 DRUG INTERACTIONS

Drug interactions involving Dienol (Iron (Ferrous Oxides)) have not been studied. However, Dienol (Iron (Ferrous Oxides)) may reduce the absorption of concomitantly administered oral Dienol (Iron (Ferrous Oxides)) preparations.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category B

Pregnancy Category B

There are no adequate and well-controlled studies in pregnant women. In animal reproduction studies, Dienol ) sucrose was administered intravenously to rats and rabbits during the period of organogenesis at doses up to 13 mg/kg/day of elemental Dienol (Iron (Ferrous Oxides)) (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 Dienol (Iron (Ferrous Oxides)) sucrose. Because animal reproductive studies are not always predictive of human response, Dienol (Iron (Ferrous Oxides)) should be used during pregnancy only if clearly needed.

8.3 Nursing Mothers

It is not known whether Dienol (Iron (Ferrous Oxides)) sucrose is excreted in human milk. Dienol (Iron (Ferrous Oxides)) sucrose is secreted into the milk of lactating rats. Because many drugs are excreted in human milk, caution should be exercised when Dienol (Iron (Ferrous Oxides)) is administered to a nursing woman.

8.4 Pediatric Use

Safety and effectiveness of Dienol ) for Dienol (Iron (Ferrous Oxides)) replacement treatment in pediatric patients with dialysis-dependent or non-dialysis-dependent CKD have not been established.

Safety and effectiveness of Dienol (Iron (Ferrous Oxides)) for Dienol (Iron (Ferrous Oxides)) maintenance treatment in pediatric patients 2 years of age and older with dialysis-dependent or non-dialysis-dependent CKD receiving erythropoietin therapy were studied. Dienol (Iron (Ferrous Oxides)) 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)]

Dienol (Iron (Ferrous Oxides)) has not been studied in patients younger than 2 years of age.

In a country where Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)), several other medications and erythropoietin. Necrotizing enterocolitis may be a complication of prematurity in very low birth weight infants. No causal relationship to Dienol (Iron (Ferrous Oxides)) or any other drugs could be established.

8.5 Geriatric Use

Clinical studies of Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)), 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.

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10 OVERDOSAGE

No data are available regarding overdosage of Dienol (Iron (Ferrous Oxides)) in humans. Excessive dosages of Dienol (Iron (Ferrous Oxides)) may lead to accumulation of Dienol (Iron (Ferrous Oxides)) in storage sites potentially leading to hemosiderosis. Do not administer Dienol (Iron (Ferrous Oxides)) to patients with Dienol (Iron (Ferrous Oxides)) overload.

Toxicities in single-dose studies in mice and rats, at intravenous Dienol (Iron (Ferrous Oxides)) 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.

11 DESCRIPTION

Dienol (Iron (Ferrous Oxides)) (iron sucrose injection, USP), an Dienol (Iron (Ferrous Oxides)) replacement product, is a brown, sterile, aqueous, complex of polynuclear Dienol (Iron (Ferrous Oxides)) (III)-hydroxide in sucrose for intravenous use. Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) polymerization and m is the number of sucrose molecules associated with the Dienol (Iron (Ferrous Oxides)) (III)-hydroxide.

Each mL contains 20 mg elemental Dienol (Iron (Ferrous Oxides)) as Dienol (Iron (Ferrous Oxides)) sucrose in water for injection. Dienol (Iron (Ferrous Oxides)) is available in 10 mL single-use vials (200 mg elemental Dienol (Iron (Ferrous Oxides)) per 10 mL), 5 mL single-use vials (100 mg elemental Dienol (Iron (Ferrous Oxides)) per 5 mL), and 2.5 mL single-use vials (50 mg elemental Dienol (Iron (Ferrous Oxides)) 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.

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

Dienol ) is an aqueous complex of poly-nuclear Dienol (Iron (Ferrous Oxides)) (III)-hydroxide in sucrose. Following intravenous administration, Dienol (Iron (Ferrous Oxides)) is dissociated into Dienol (Iron (Ferrous Oxides)) and sucrose and the Dienol (Iron (Ferrous Oxides)) is transported as a complex with transferrin to target cells including erythroid precursor cells. The Dienol (Iron (Ferrous Oxides)) in the precursor cells is incorporated into hemoglobin as the cells mature into red blood cells.

12.2 Pharmacodynamics

Following intravenous administration, Dienol (Iron (Ferrous Oxides)) is dissociated into Dienol (Iron (Ferrous Oxides)) and sucrose. In 22 patients undergoing hemodialysis and receiving erythropoietin (recombinant human erythropoietin) therapy treated with Dienol (Iron (Ferrous Oxides)) sucrose containing 100 mg of Dienol (Iron (Ferrous Oxides)), three times weekly for three weeks, significant increases in serum Dienol (Iron (Ferrous Oxides)) and serum ferritin and significant decreases in total Dienol (Iron (Ferrous Oxides)) binding capacity occurred four weeks from the initiation of Dienol (Iron (Ferrous Oxides)) sucrose treatment.

12.3 Pharmacokinetics

In healthy adults administered intravenous doses of Dienol ), its Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) component appeared to distribute mainly in blood and to some extent in extravascular fluid. A study evaluating Dienol (Iron (Ferrous Oxides)) containing 100 mg of Dienol (Iron (Ferrous Oxides)) labeled with 52Fe/59Fe in patients with Dienol (Iron (Ferrous Oxides)) deficiency showed that a significant amount of the administered Dienol (Iron (Ferrous Oxides)) is distributed to the liver, spleen and bone marrow and that the bone marrow is an irreversible Dienol (Iron (Ferrous Oxides)) trapping compartment.

Following intravenous administration of Dienol (Iron (Ferrous Oxides)), Dienol (Iron (Ferrous Oxides)) sucrose is dissociated into Dienol (Iron (Ferrous Oxides)) and sucrose. The sucrose component is eliminated mainly by urinary excretion. In a study evaluating a single intravenous dose of Dienol (Iron (Ferrous Oxides)) containing 1,510 mg of sucrose and 100 mg of Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) sucrose containing 500 to 700 mg of Dienol (Iron (Ferrous Oxides)) in 26 patients with anemia on erythropoietin therapy (23 female, 3 male; age range 16 to 60), approximately 5% of the Dienol (Iron (Ferrous Oxides)) was eliminated in urine in 24 h at each dose level. The effects of age and gender on the pharmacokinetics of Dienol (Iron (Ferrous Oxides)) have not been studied.

Pharmacokinetics in Pediatric Patients

Pharmacokinetics in Pediatric Patients

In a single-dose PK study of Dienol (Iron (Ferrous Oxides)), patients with NDD-CDK ages 12 to 16 (N=11) received intravenous bolus doses of Dienol (Iron (Ferrous Oxides)) at 7 mg/kg (maximum 200 mg) administered over 5 minutes. Following single dose Dienol (Iron (Ferrous Oxides)), the half-life of total serum Dienol (Iron (Ferrous Oxides)) 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.

Dienol (Iron (Ferrous Oxides)) is not dialyzable through CA210 (Baxter) High Efficiency or Fresenius F80A High Flux dialysis membranes. In in vitro studies, the amount of Dienol (Iron (Ferrous Oxides)) sucrose in the dialysate fluid was below the levels of detection of the assay (less than 2 parts per million).

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenicity studies have not been performed with Dienol (Iron (Ferrous Oxides)) sucrose.

Dienol (Iron (Ferrous Oxides)) sucrose was not mutagenic in vitro in the bacterial reverse mutation assay (Ames test) or the mouse lymphoma assay. Dienol (Iron (Ferrous Oxides)) sucrose was not clastogenic in the in vitro chromosome aberration assay using human lymphocytes or in the in vivo mouse micronucleus assay.

Dienol (Iron (Ferrous Oxides)) sucrose at intravenous doses up to 15 mg/kg/day of elemental Dienol (Iron (Ferrous Oxides)) (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.

14 CLINICAL STUDIES

Five clinical trials involving 647 adult patients and one clinical trial involving 131 pediatric patients were conducted to assess the safety and efficacy of Dienol ).

14.1 Study A: Hemodialysis Dependent-Chronic Kidney Disease (HDD–CKD)

Study A was a multicenter, open-label, historically-controlled study in 101 patients with HDD-CKD (77 patients with Dienol (Iron (Ferrous Oxides)) treatment and 24 in the historical control group) with Dienol (Iron (Ferrous Oxides)) deficiency anemia. Eligibility criteria for Dienol (Iron (Ferrous Oxides)) 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.

Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)), who were off intravenous Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) 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
Dienol (Iron (Ferrous Oxides)) (n=69 Historical Control (n=18) Dienol (Iron (Ferrous Oxides))

(n=73)

Historical Control

(n=18)

Dienol (Iron (Ferrous Oxides))

(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%).

14.2 Study B: Hemodialysis Dependent-Chronic Kidney Disease

Study B was a multicenter, open label study of Dienol (Iron (Ferrous Oxides)) in 23 patients with Dienol (Iron (Ferrous Oxides)) deficiency and HDD-CKD who had been discontinued from Dienol (Iron (Ferrous Oxides)) 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.

14.3 Study C: Hemodialysis Dependent-Chronic Kidney Disease

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 Dienol (Iron (Ferrous Oxides)). Exclusion criteria were similar to those in studies A and B. Dienol (Iron (Ferrous Oxides)) was administered in doses of 100 mg during sequential dialysis sessions until a pre-determined (calculated) total dose of Dienol (Iron (Ferrous Oxides)) 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.

14.4 Study D: Non-Dialysis Dependent-Chronic Kidney Disease

Study D was a randomized, open-label, multicenter, active-controlled study of the safety and efficacy of oral Dienol (Iron (Ferrous Oxides)) versus Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) (325 mg ferrous sulfate three times daily for 56 days); or Dienol (Iron (Ferrous Oxides)) (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 Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) group.

A statistically significantly greater proportion of Dienol (Iron (Ferrous Oxides)) subjects (35/79; 44.3%) compared to oral Dienol (Iron (Ferrous Oxides)) subjects (23/82; 28%) had an increase in hemoglobin ≥ 1 g/dL at anytime during the study (p = 0.03).

14.5 Study E: Peritoneal Dialysis Dependent-Chronic Kidney Disease

Study E was a randomized, open-label, multicenter study comparing patients with PDD-CKD receiving an erythropoietin and intravenous Dienol (Iron (Ferrous Oxides)) to patients with PDD-CKD receiving an erythropoietin alone without Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) or Dienol (Iron (Ferrous Oxides)) (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 Dienol (Iron (Ferrous Oxides)) / 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 Dienol (Iron (Ferrous Oxides)) / 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 Dienol (Iron (Ferrous Oxides)) / 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%).

14.6 Study F: Dienol ) Maintenance Treatment Dosing in Pediatric Patients Ages 2 years and Older with Chronic Kidney Disease

Study F was a randomized, open-label, dose-ranging study for Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) (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 Dienol (Iron (Ferrous Oxides)) once every other week for 6 doses. Patients with PDD-CKD or NDD-CKD received Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) 0.5 mg/kg, 1.0 mg/kg, and 2.0 mg/kg groups, respectively. A dose-response relationship was not demonstrated.

16 HOW SUPPLIED/storage and handling

16.1 How Supplied

Dienol ) is supplied sterile in 10 mL, 5 mL, and 2.5 mL single-use vials. Each 10 mL vial contains 200 mg elemental Dienol (Iron (Ferrous Oxides)), each 5 mL vial contains 100 mg elemental Dienol (Iron (Ferrous Oxides)), and each 2.5 mL vial contains 50 mg elemental Dienol (Iron (Ferrous Oxides)) (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

16.2 Stability and Storage

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: Dienol (Iron (Ferrous Oxides)), when diluted with 0.9% NaCl at concentrations ranging from 2 mg to 10 mg of elemental Dienol (Iron (Ferrous Oxides)) per mL, or undiluted (20 mg elemental Dienol (Iron (Ferrous Oxides)) 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: Dienol (Iron (Ferrous Oxides)), 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 Dienol (Iron (Ferrous Oxides)) 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 Dienol (Iron (Ferrous Oxides)) 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.

17 PATIENT COUNSELING INFORMATION

Prior to Dienol (Iron (Ferrous Oxides)) administration:

  • Question patients regarding any prior history of reactions to parenteral Dienol (Iron (Ferrous Oxides)) products
  • Advise patients of the risks associated with Dienol (Iron (Ferrous Oxides))
  • Advise patients to report any symptoms of hypersensitivity that may develop during and following Dienol (Iron (Ferrous Oxides)) administration, such as rash, itching, dizziness, light-headedness, swelling, and breathing problems [see Warnings and Precautions (5)]

AMERICAN

REGENT, INC.

SHIRLEY, NY 11967

Dienol (Iron (Ferrous Oxides)) is manufactured under license from Vifor (International) Inc., Switzerland.

PremierProRx® is a trademark of Premier, Inc., used under license.

PREMIERProRx®

IN2340

MG #15727

Dienol pharmaceutical active ingredients containing related brand and generic drugs:

Active ingredient is the part of the drug or medicine which is biologically active. This portion of the drug is responsible for the main action of the drug which is intended to cure or reduce the symptom or disease. The other portions of the drug which are inactive are called excipients; there role is to act as vehicle or binder. In contrast to active ingredient, the inactive ingredient's role is not significant in the cure or treatment of the disease. There can be one or more active ingredients in a drug.


Dienol available forms, composition, doses:

Form of the medicine is the form in which the medicine is marketed in the market, for example, a medicine X can be in the form of capsule or the form of chewable tablet or the form of tablet. Sometimes same medicine can be available as injection form. Each medicine cannot be in all forms but can be marketed in 1, 2, or 3 forms which the pharmaceutical company decided based on various background research results.
Composition is the list of ingredients which combinedly form a medicine. Both active ingredients and inactive ingredients form the composition. The active ingredient gives the desired therapeutic effect whereas the inactive ingredient helps in making the medicine stable.
Doses are various strengths of the medicine like 10mg, 20mg, 30mg and so on. Each medicine comes in various doses which is decided by the manufacturer, that is, pharmaceutical company. The dose is decided on the severity of the symptom or disease.


Dienol destination | category:

Destination is defined as the organism to which the drug or medicine is targeted. For most of the drugs what we discuss, human is the drug destination.
Drug category can be defined as major classification of the drug. For example, an antihistaminic or an antipyretic or anti anginal or pain killer, anti-inflammatory or so.


Dienol Anatomical Therapeutic Chemical codes:

A medicine is classified depending on the organ or system it acts [Anatomical], based on what result it gives on what disease, symptom [Therapeutical], based on chemical composition [Chemical]. It is called as ATC code. The code is based on Active ingredients of the medicine. A medicine can have different codes as sometimes it acts on different organs for different indications. Same way, different brands with same active ingredients and same indications can have same ATC code.


Dienol pharmaceutical companies:

Pharmaceutical companies are drug manufacturing companies that help in complete development of the drug from the background research to formation, clinical trials, release of the drug into the market and marketing of the drug.
Researchers are the persons who are responsible for the scientific research and is responsible for all the background clinical trials that resulted in the development of the drug.


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References

  1. "Iron". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).
  2. "Iron". http://www.drugbank.ca/drugs/DB0159... (accessed August 28, 2018).
  3. "E1UOL152H7: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Dat... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Dienol?

Depending on the reaction of the Dienol after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Dienol 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 Dienol 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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Review

sdrugs.com conducted a study on Dienol, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Dienol consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.

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The information was verified by Dr. Arunabha Ray, MD Pharmacology

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