Multi-Sanosvit mit Eisen

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Multi-Sanosvit mit Eisen uses

Multi-Sanosvit mit Eisen consists of Iron, Multiminerals, Multivitamins.

Iron:


1 INDICATIONS AND USAGE

Multi-Sanosvit mit Eisen (Iron) is indicated for the treatment of Multi-Sanosvit mit Eisen (Iron) deficiency anemia in patients with chronic kidney disease (CKD).

Multi-Sanosvit mit Eisen (Iron) is an Multi-Sanosvit mit Eisen (Iron) replacement product indicated for the treatment of Multi-Sanosvit mit Eisen (Iron) deficiency anemia in patients with chronic kidney disease (CKD). (1)

2 DOSAGE AND ADMINISTRATION

Multi-Sanosvit mit Eisen must only be administered intravenously either by slow injection or by infusion. The dosage of Multi-Sanosvit mit Eisen (Iron) is expressed in mg of elemental Multi-Sanosvit mit Eisen (Iron). Each mL contains 20 mg of elemental Multi-Sanosvit mit Eisen (Iron).

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 Multi-Sanosvit mit Eisen (Iron) 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. Multi-Sanosvit mit Eisen (Iron) should be administered early during the dialysis session. The usual total treatment course of Multi-Sanosvit mit Eisen (Iron) is 1000 mg. Multi-Sanosvit mit Eisen (Iron) treatment may be repeated if Multi-Sanosvit mit Eisen (Iron) deficiency reoccurs.

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

Administer Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron), 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. Multi-Sanosvit mit Eisen (Iron) treatment may be repeated if Multi-Sanosvit mit Eisen (Iron) deficiency reoccurs.

2.3 Adult Patients with Peritoneal Dialysis Dependent-Chronic Kidney Disease

Administer Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) in a maximum of 250 mL of 0.9% NaCl. Multi-Sanosvit mit Eisen (Iron) treatment may be repeated if Multi-Sanosvit mit Eisen (Iron) deficiency reoccurs.

2.4 Pediatric Patients with HDD-CKD for Multi-Sanosvit mit Eisen (Iron) maintenance treatment

The dosing for Multi-Sanosvit mit Eisen (Iron) replacement treatment in pediatric patients with HDD-CKD has not been established.

For Multi-Sanosvit mit Eisen (Iron) maintenance treatment: Administer Multi-Sanosvit mit Eisen (Iron) 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. Multi-Sanosvit mit Eisen (Iron) treatment may be repeated if necessary.

2.5 Pediatric Patients with NDD-CKD or PDD-CKD who are on erythropoietin therapy for Multi-Sanosvit mit Eisen (Iron) maintenance treatment

The dosing for Multi-Sanosvit mit Eisen (Iron) replacement treatment in pediatric patients with NDD-CKD or PDD-CKD has not been established.

For Multi-Sanosvit mit Eisen (Iron) maintenance treatment: Administer Multi-Sanosvit mit Eisen (Iron) 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. Multi-Sanosvit mit Eisen (Iron) treatment may be repeated if necessary.

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3 DOSAGE FORMS AND STRENGTHS

  • 10 mL single-use vial / 200 mg elemental Multi-Sanosvit mit Eisen (Iron) (20 mg/mL)
  • 5 mL single-use vial / 100 mg elemental Multi-Sanosvit mit Eisen (Iron) (20 mg/mL)
  • 2.5 mL single-use vial / 50 mg elemental Multi-Sanosvit mit Eisen (Iron) (20 mg/mL)
  • 10 mL single-use vial / 200 mg elemental Multi-Sanosvit mit Eisen (Iron) (20 mg/mL) (3)
  • 5 mL single-use vial / 100 mg elemental Multi-Sanosvit mit Eisen (Iron) (20 mg/mL) (3)
  • 2.5 mL single-use vial / 50 mg elemental Multi-Sanosvit mit Eisen (Iron) (20 mg/mL) (3)

4 CONTRAINDICATIONS

  • Known hypersensitivity to Multi-Sanosvit mit Eisen (Iron)
  • Known hypersensitivity to Multi-Sanosvit mit Eisen (Iron) (4)

5 WARNINGS AND PRECAUTIONS

  • Hypersensitivity Reactions: Observe for signs and symptoms of hypersensitivity during and after Multi-Sanosvit mit Eisen administration for at least 30 minutes and until clinically stable following completion of each administration. Only administer Multi-Sanosvit mit Eisen (Iron) when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. (5.1)
  • Hypotension: Multi-Sanosvit mit Eisen (Iron) may cause hypotension. Monitor for signs and symptoms of hypotension during and following each administration of Multi-Sanosvit mit Eisen (Iron). (5.2)
  • Multi-Sanosvit mit Eisen (Iron) Overload: Regularly monitor hematologic responses during Multi-Sanosvit mit Eisen (Iron) therapy. Do not administer Multi-Sanosvit mit Eisen (Iron) to patients with Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron). 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 Multi-Sanosvit mit Eisen (Iron) immediately. Monitor patients for signs and symptoms of hypersensitivity during and after Multi-Sanosvit mit Eisen (Iron) administration for at least 30 minutes and until clinically stable following completion of the infusion. Only administer Multi-Sanosvit mit Eisen (Iron) when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. Most reactions associated with intravenous Multi-Sanosvit mit Eisen (Iron) preparations occur within 30 minutes of the completion of the infusion .

5.2 Hypotension

Multi-Sanosvit mit Eisen may cause clinically significant hypotension. Monitor for signs and symptoms of hypotension following each administration of Multi-Sanosvit mit Eisen (Iron). Hypotension following administration of Multi-Sanosvit mit Eisen (Iron) may be related to the rate of administration and/or total dose administered .

5.3 Multi-Sanosvit mit Eisen (Iron) Overload

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

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6 ADVERSE REACTIONS

The following serious adverse reactions associated with Multi-Sanosvit mit Eisen are described in other sections .

  • The most common adverse reactions (≥2%) following the administration of Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen 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 Multi-Sanosvit mit Eisen (Iron) 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
Multi-Sanosvit mit Eisen (Iron) Multi-Sanosvit mit Eisen (Iron) Oral Multi-Sanosvit mit Eisen (Iron) Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) therapy and were reported to be intolerant (defined as precluding further use of that Multi-Sanosvit mit Eisen (Iron) product). When these patients were treated with Multi-Sanosvit mit Eisen (Iron) there were no occurrences of adverse reactions that precluded further use of Multi-Sanosvit mit Eisen (Iron) .

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 Multi-Sanosvit mit Eisen (Iron) maintenance treatment with Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) 0.5 mg/kg, 53% (25/47) of the patients receiving Multi-Sanosvit mit Eisen (Iron) 1.0 mg/kg, and 55% (26/47) of the patients receiving Multi-Sanosvit mit Eisen (Iron) 2.0 mg/kg.

A total of 5 (11%) subjects in the Multi-Sanosvit mit Eisen (Iron) 0.5 mg/kg group, 10 (21%) patients in the Multi-Sanosvit mit Eisen (Iron) 1.0 mg/kg group, and 10 (21%) patients in the Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron). 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 Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) injection. Reactions have occurred following the first dose or subsequent doses of Multi-Sanosvit mit Eisen (Iron). 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 Multi-Sanosvit mit Eisen (Iron) have not been studied. However, Multi-Sanosvit mit Eisen (Iron) may reduce the absorption of concomitantly administered oral Multi-Sanosvit mit Eisen (Iron) 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, Multi-Sanosvit mit Eisen sucrose was administered intravenously to rats and rabbits during the period of organogenesis at doses up to 13 mg/kg/day of elemental Multi-Sanosvit mit Eisen (Iron) (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 Multi-Sanosvit mit Eisen (Iron) sucrose. Because animal reproductive studies are not always predictive of human response, Multi-Sanosvit mit Eisen (Iron) should be used during pregnancy only if clearly needed.

8.3 Nursing Mothers

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

8.4 Pediatric Use

Safety and effectiveness of Multi-Sanosvit mit Eisen for Multi-Sanosvit mit Eisen (Iron) replacement treatment in pediatric patients with dialysis-dependent or non-dialysis-dependent CKD have not been established.

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

Multi-Sanosvit mit Eisen (Iron) has not been studied in patients younger than 2 years of age.

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

8.5 Geriatric Use

Clinical studies of Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron), 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 Multi-Sanosvit mit Eisen (Iron) in humans. Excessive dosages of Multi-Sanosvit mit Eisen (Iron) may lead to accumulation of Multi-Sanosvit mit Eisen (Iron) in storage sites potentially leading to hemosiderosis. Do not administer Multi-Sanosvit mit Eisen (Iron) to patients with Multi-Sanosvit mit Eisen (Iron) overload.

Toxicities in single-dose studies in mice and rats, at intravenous Multi-Sanosvit mit Eisen (Iron) 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

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

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

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

12.2 Pharmacodynamics

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

12.3 Pharmacokinetics

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

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

Pharmacokinetics in Pediatric Patients

Pharmacokinetics in Pediatric Patients

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

Multi-Sanosvit mit Eisen (Iron) is not dialyzable through CA210 (Baxter) High Efficiency or Fresenius F80A High Flux dialysis membranes. In in vitro studies, the amount of Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) sucrose.

Multi-Sanosvit mit Eisen (Iron) sucrose was not mutagenic in vitro in the bacterial reverse mutation assay (Ames test) or the mouse lymphoma assay. Multi-Sanosvit mit Eisen (Iron) sucrose was not clastogenic in the in vitro chromosome aberration assay using human lymphocytes or in the in vivo mouse micronucleus assay.

Multi-Sanosvit mit Eisen (Iron) sucrose at intravenous doses up to 15 mg/kg/day of elemental Multi-Sanosvit mit Eisen (Iron) (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 Multi-Sanosvit mit Eisen.

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 Multi-Sanosvit mit Eisen (Iron) treatment and 24 in the historical control group) with Multi-Sanosvit mit Eisen (Iron) deficiency anemia. Eligibility criteria for Multi-Sanosvit mit Eisen (Iron) 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.

Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron), who were off intravenous Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) 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
Multi-Sanosvit mit Eisen (Iron) (n=69 Historical Control (n=18) Multi-Sanosvit mit Eisen (Iron)

(n=73)

Historical Control

(n=18)

Multi-Sanosvit mit Eisen (Iron)

(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 Multi-Sanosvit mit Eisen (Iron) in 23 patients with Multi-Sanosvit mit Eisen (Iron) deficiency and HDD-CKD who had been discontinued from Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron). Exclusion criteria were similar to those in studies A and B. Multi-Sanosvit mit Eisen (Iron) was administered in doses of 100 mg during sequential dialysis sessions until a pre-determined (calculated) total dose of Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) versus Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) (325 mg ferrous sulfate three times daily for 56 days); or Multi-Sanosvit mit Eisen (Iron) (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 Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) group.

A statistically significantly greater proportion of Multi-Sanosvit mit Eisen (Iron) subjects (35/79; 44.3%) compared to oral Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) to patients with PDD-CKD receiving an erythropoietin alone without Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) or Multi-Sanosvit mit Eisen (Iron) (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 Multi-Sanosvit mit Eisen (Iron) / 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 Multi-Sanosvit mit Eisen (Iron) / 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 Multi-Sanosvit mit Eisen (Iron) / 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: Multi-Sanosvit mit Eisen 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 Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) (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 Multi-Sanosvit mit Eisen (Iron) once every other week for 6 doses. Patients with PDD-CKD or NDD-CKD received Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) 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

Multi-Sanosvit mit Eisen is supplied sterile in 10 mL, 5 mL, and 2.5 mL single-use vials. Each 10 mL vial contains 200 mg elemental Multi-Sanosvit mit Eisen (Iron), each 5 mL vial contains 100 mg elemental Multi-Sanosvit mit Eisen (Iron), and each 2.5 mL vial contains 50 mg elemental Multi-Sanosvit mit Eisen (Iron) (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: Multi-Sanosvit mit Eisen (Iron), when diluted with 0.9% NaCl at concentrations ranging from 2 mg to 10 mg of elemental Multi-Sanosvit mit Eisen (Iron) per mL, or undiluted (20 mg elemental Multi-Sanosvit mit Eisen (Iron) 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: Multi-Sanosvit mit Eisen (Iron), 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 Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) 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 Multi-Sanosvit mit Eisen (Iron) administration:

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

AMERICAN

REGENT, INC.

SHIRLEY, NY 11967

Multi-Sanosvit mit Eisen (Iron) is manufactured under license from Vifor (International) Inc., Switzerland.

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

PREMIERProRx®

IN2340

MG #15727

Multi-Sanosvit mit Eisen 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.


Multi-Sanosvit mit Eisen 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.


Multi-Sanosvit mit Eisen 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.


Multi-Sanosvit mit Eisen 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.


Multi-Sanosvit mit Eisen 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. Dailymed."NOVAFERRUM PEDIATRIC DROPS (IRON) LIQUID [GENSAVIS PHARMACEUTICALS, LLC]". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
  2. "Iron". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).
  3. "Iron". http://www.drugbank.ca/drugs/DB0159... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Multi-Sanosvit mit Eisen?

Depending on the reaction of the Multi-Sanosvit mit Eisen after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Multi-Sanosvit mit Eisen 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 Multi-Sanosvit mit Eisen 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 Multi-Sanosvit mit Eisen, 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 Multi-Sanosvit mit Eisen 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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