Alphanate Antihemophilic Factor/von Willebrand Factor Complex (Human) Kit
🆔 Identity & classification
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🏭 Manufacturer & labeler
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🩺 Clinical
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🧪 Inactive Ingredients / Excipients
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per each | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
| Medicare Part B allowsASP · J7186 | $1.269 / J7186 unit | — |
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🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Alphanate 68516-4612-01 | GRIFOLS | 1 kit | — | — | Discontinued | — |
| Alphanate 68516-4613-02 | GRIFOLS | 1 kit | — | — | Discontinued | — |
| Alphanatethis 68516-4616-01 | GRIFOLS | 1 kit | — | — | FDA listed | — |
| Alphanate 68516-4611-01 | GRIFOLS | 1 kit | — | — | Discontinued | — |
| Alphanate 68516-4614-02 | GRIFOLS | 1 kit | — | — | Discontinued | — |
| Alphanate 68516-4618-02 | GRIFOLS | 1 kit | — | — | FDA listed | — |
| Alphanate 68516-4619-02 | GRIFOLS | 1 kit | — | — | FDA listed | — |
| Alphanate 68516-4615-02 | GRIFOLS | 1 kit | — | — | Discontinued | — |
| Alphanate 68516-4620-02 | GRIFOLS | 1 kit | — | — | FDA listed | — |
| Alphanate 68516-4617-01 | GRIFOLS | 1 kit | — | — | FDA listed | — |
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⏳ Availability & biosimilar status
Biologics have no small-molecule generics; biosimilar competition is tracked in the FDA Purple Book.
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📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 68516-4616-01 You're viewing this | 1 KIT in 1 CARTON (68516-4616-1) * 5 mL in 1 VIAL (68516-4605-1) * 5 mL in 1 VIAL, GLASS (76297-002-02) | 1978-08-15 | Active |
🧭 About this NDC listing & data coverage
Kit / multi-component package
This NDC identifies a kit — a package containing more than one component. Structured data (pricing, ingredients, equivalents) is often reported per component rather than for the kit NDC itself, which can make this page look thinner than the components' own pages.
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| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | — Not published for this NDC The labeler did not submit a structured excipient list, or no SPL is available. |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | — Not published for this NDC Applies only to products approved under an NDA/ANDA; many listings are out of scope. |
| HCPCS J-code billing crosswalk | ✓ Available |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |
Questions about this listing
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📄 Full FDA label FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Alphanate is an Antihemophilic Factor/von Willebrand Factor Complex (Human) indicated for: Control and prevention of bleeding in patients with hemophilia A ( 1.1 ) Surgical and/or invasive procedures in adult and pediatric patients with von Willebrand Disease in whom desmopressin (DDAVP) is either ineffective or contraindicated. It is not indicated for patients with severe VWD (Type 3) undergoing major surgery ( 1.2 ).
1.1Hemophilia A Alphanate ® , Antihemophilic Factor/von Willebrand Factor Complex (Human), is indicated for the control and prevention of bleeding in patients with Factor VIII (FVIII) deficiency due to hemophilia A. 1 1.2 von Willebrand Disease Alphanate is indicated for surgical and/or invasive procedures in adult and pediatric patients with von Willebrand Disease (VWD) in whom desmopressin (DDAVP ® ) is either ineffective or contraindicated. It is not indicated for patients with severe VWD (Type 3) undergoing major surgery.
1.1Hemophilia A Alphanate ® , Antihemophilic Factor/von Willebrand Factor Complex (Human), is indicated for the control and prevention of bleeding in patients with Factor VIII (FVIII) deficiency due to hemophilia A. 1
1.2von Willebrand Disease Alphanate is indicated for surgical and/or invasive procedures in adult and pediatric patients with von Willebrand Disease (VWD) in whom desmopressin (DDAVP ® ) is either ineffective or contraindicated. It is not indicated for patients with severe VWD (Type 3) undergoing major surgery.
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION For Intravenous Use Only Antihemophilic Factor (AHF) potency (FVIII:C activity) is expressed in International Units (IU) FVIII/vial on the product label. Additionally, Alphanate contains von Willebrand Factor:Ristocetin Cofactor (VWF:RCo), which is expressed in IU VWF:RCo/vial for the treatment of VWD. For Intravenous use only.
Alphanate contains the labeled amount of Factor VIII expressed in International Units (IU) FVIII/vial and Willebrand Factor:Ristocetin Cofactor activity in IU VWF:RCo/vial ( 2 ). Hemophilia A: Control and prevention of bleeding episodes ( 2.1 ) Dose (units) = body weight (kg) x desired FVIII rise (IU/dL or % of normal) x 0.5 (IU/kg per IU/dL) Frequency of intravenous injection of the reconstituted product is determined by the type of bleeding episode and the recommendation of the treating physician von Willebrand Disease: Surgical and/or invasive procedure in adult and pediatric patients except Type 3 undergoing major surgery ( 2.2 ) Adults: Pre-operative dose of 60 IU VWF:RCo/kg body weight; subsequent doses of 40-60 IU VWF:RCo/kg/body weight at 8-12 hour intervals post-operative as clinically needed Pediatric: Pre-operative dose of 75 IU VWF:RCo/kg/body weight; subsequent doses of 50-75 IU VWF:RCo/kg body weight at 8-12 hour intervals post-operative as clinically needed Dosage based on protocol used in the Alphanate prospective clinical trial according to judgment of the investigator
2.1Hemophilia A Treatment with Alphanate should be initiated under the supervision of a physician experienced in the treatment of hemophilia. Dosage and duration of treatment depend on the severity of the FVIII deficiency, the location and extent of bleeding, presence of inhibitors, and the patient’s clinical condition. Careful control of replacement therapy is especially important in cases of major surgery or life-threatening bleeding episodes.
Dosing requirements and frequency of dosing is calculated on the basis of an expected initial response of 2% of normal FVIII:C increase per IU FVIII:C/kg body weight administered. 2,3 The expected in vivo peak increase in FVIII level expressed as IU/dL (or % normal) can be estimated using the following formulas: Dosage (units) = body weight (kg) x desired FVIII rise (IU/dL or % normal) x 0.5 (IU/kg per IU/dL) OR IU/dL (or % normal) = Total Dose (IU)/body weight (kg) x 2 Thus, an administered AHF dose of 50 IU/kg will be expected to increase the circulating FVIII level to 100% of normal (100 IU/dL).
Doses administered should be titrated to the patient’s clinical response, including individualized needs, severity of the deficiency, severity of the hemorrhage, presence of inhibitors, and FVIII level desired. Patients may vary in their pharmacokinetic (e.g., half-life, in vivo recovery) and clinical responses to Alphanate. Although the dose can be estimated by the calculations above, it is highly recommended that, whenever possible, appropriate laboratory tests including serial FVIII activity assays be performed.
Table 1: Dosage Guidelines for the Treatment of Hemophilia A Hemorrhagic event Dosage (IU FVIII:C/kg Body Weight) Minor hemorrhage: Large bruises Significant cuts or scrapes Uncomplicated joint hemorrhage FVIII:C levels should be brought to 30% of normal (15 IU FVIII/kg twice daily) until hemorrhage stops and healing has been achieved (1–2 days). Moderate hemorrhage: Nose, mouth and gum bleeds Dental extractions Hematuria FVIII:C levels should be brought to 50% (25 IU FVIII/kg twice daily). Treatment should continue until healing has been achieved (2–7 days, on average).
Major hemorrhage: Joint hemorrhage Muscle hemorrhage Major trauma Hematuria Intracranial and intraperitoneal bleeding FVIII:C levels should be brought to 80–100% for at least 3–5 days (40–50 IU FVIII/kg twice daily). Following this treatment period, FVIII levels should be maintained at 50% (25 IU FVIII/kg twice daily) until healing has been achieved. Major hemorrhages may require…
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Alphanate is a sterile, lyophilized powder for intravenous injection after reconstitution. It is available in the following potencies: 250 IU FVIII/5 mL single dose vial 500 IU FVIII/5 mL single dose vial 1000 IU FVIII/10 mL single dose vial 1500 IU FVIII/10 mL single dose vial Alphanate is a sterile, lyophilized powder for intravenous injection after reconstitution, available as 250, 500, 1000, and 1500 IU FVIII in single dose vials ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS Alphanate is contraindicated in patients who have manifested life-threatening immediate hypersensitivity reactions, including anaphylaxis, to the product or its components. Patients who have manifested life-threatening immediate hypersensitivity reactions, including anaphylaxis, to the product or its components ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Anaphylaxis and severe hypersensitivity reactions are possible. Should symptoms occur, treatment with Alphanate should be discontinued, and emergency treatment should be sought ( 5.1 ) Development of activity-neutralizing antibodies has been detected in patients receiving FVIII containing products. Development of alloantibodies to VWF in Type 3 VWD patients have been occasionally reported in the literature ( 5.2 ) Thromboembolic events may be associated with AHF/VWF Complex (Human) in VWD patients, especially in the setting of known risk factors ( 5.3 ) Intravascular hemolysis may be associated with infusion of massive doses of AHF/VWF Complex (Human) ( 5.4 ) Rapid administration of a FVIII concentrate may result in vasomotor reactions ( 5.5 ) Plasma products carry a risk of transmitting infectious agents, such as viruses, and theoretically, the Creutzfeldt-Jakob disease (CJD) agent, despite steps designed to reduce this risk ( 5.6 )
5.1Anaphylaxis and Severe Hypersensitivity Reactions Anaphylaxis and severe hypersensitivity reactions are possible. Should symptoms occur, treatment with Alphanate should be discontinued, and emergency treatment should be administered.
5.2Neutralizing Antibodies Development of procoagulant activity-neutralizing antibodies (inhibitors) has been detected in patients receiving FVIII-containing products. Carefully monitor patients treated with AHF products for the development of FVIII inhibitors by appropriate clinical observations and laboratory tests. No studies have been conducted with Alphanate to evaluate inhibitor formation.
Therefore, it is not known whether there are greater, lesser or the same risks of developing inhibitors due to the use of this product than there are with other FVIII preparations. If expected plasma FVIII activity levels are not attained, or if bleeding is not controlled with an appropriate dose, an assay that measures FVIII inhibitor concentration should be performed. Patients with these inhibitors may not respond to treatment with Antihemophilic Factor/von Willebrand Factor Complex (Human), or the response may be much less than would otherwise be expected; therefore, larger doses of Antihemophilic Factor/von Willebrand Factor Complex (Human) are often required.
The management of bleeding in patients with inhibitors requires careful monitoring, especially if surgical procedures are indicated. 4-6 Depending on the level of the inhibitor and/or clinical response, it may be appropriate to use an alternative ‘bypass’ therapeutic agent. Reports in the literature suggest that patients with Type 3, severe von Willebrand Disease, may develop alloantibodies to von Willebrand factor (VWF) after replacement therapy.
13 The risk of developing alloantibodies in patients with von Willebrand disease due to the use of this product is not known.
5.3Thromboembolic Events Thromboembolic events have been reported in von Willebrand Disease patients receiving AHF/VWF Complex (Human) replacement therapy, especially in the setting of known risk factors for thrombosis. 14-16 In addition, endogenous high levels of FVIII have also been associated with thrombosis but no causal relationship has been established. In all VWD patients in situations of high thrombotic risk receiving coagulation factor replacement therapy, caution should be exercised and antithrombotic measures should be considered.
See also ADVERSE REACTIONS ( 6 ) .
5.4Intravascular Hemolysis Massive doses of AHF/VWF Complex (Human) have rarely resulted in acute hemolytic anemia, increased bleeding tendency or hyperfibrinogenemia. 17 Alphanate contains blood group specific isoagglutinins and, when large and/or frequent doses are required in patients of blood groups A, B, or AB, the patient should be monitored for signs of intravascular hemolysis and falling hematocrit. Should this condition occur, thus leading to progressive hemolytic anemia, the administration of serologically compatible Type O red blood c…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS Serious adverse reactions observed in patients receiving Alphanate are anaphylaxis/hypersensitivity reactions. Thomboembolic events have also been observed in patients receiving Alphanate for VWD. See also WARNINGS AND PRECAUTIONS ( 5.3 ) .
The most frequent adverse events reported with Alphanate in > 5% of patients are respiratory distress, pruritus, rash, urticaria, face edema, paresthesia, pain, fever, chills, joint pain and fatigue. The most frequent adverse events reported with Alphanate in > 5% of patients are respiratory distress, pruritus, rash, urticaria, face edema, paresthesia, pain, fever, chills, joint pain and fatigue ( 6 ). To report SUSPECTED ADVERSE REACTIONS , contact Grifols Biologicals Inc. at 1-888-GRIFOLS (1-888-474-3657) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch .
6.1Clinical Trial Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in clinical trials of another drug and may not reflect the rates observed in clinical practice. Hemophilia A In a clinical study with Alphanate, regardless of causality, 14 of 23 (60.9%) patients experienced a total of 47 adverse events. Twenty-three (48.9%) of the AEs were mild, 19 (40.4%) were moderate and 5 (10.6%) were severe.
Two of 23 (8.7%) patients experienced 10 serious AEs during the study. None of the SAEs were considered to be related to study drug. The most common AEs were pain (combined terms), with 14 episodes occurring in 7 patients, and headache, with 3 episodes occurring in 2 patients.
None of the symptoms were judged to be related to treatment (see Table 3 ). Table 3. Most Commonly Reported AEs irrespective of relationship to study drug Adverse Event Number of Episodes Number of Subjects with signs/symptoms % Body as a whole 23 11 47.8% Pain (combined terms) 14 Headache 3 Accidental injury 2 Asthenia 1 Cellulitis 1 Chest pain 1 Flu syndrome 1 Digestive system 6 4 17.4% Dyspepsia 1 GI disorder 1 Hepatitis 1 Nausea 1 Tooth disorder 1 Vomiting 1 Respiratory system 5 4 17.4% Cough increased 1 Lung disorder 1 Pharyngitis 1 Respiratory disorder 1 Rhinitis 1 Musculoskeletal system 3 3 13.0% Bone disorder 2 Bone necrosis 1 Skin and appendages 3 3 13.0% Acne 1 Dry skin 1 Sweating 1 Nervous system 2 2 8.7% Insomnia 1 Somnolence 1 Hemic and lymphatic system 2 2 8.7% Anemia 1 Ecchymosis 1 Urogenital system 2 2 8.7% Abnormal ejaculation 1 Cutaneous moniliasis 1 Special senses 1 1 4.3% Eye disorder 1 VWD In the prospective clinical study of Alphanate (A-SD/HT)** in patients with von Willebrand Disease, adverse events occurred in 18 of 36 (50.0%) subjects (irrespective of causality) and 53 of 204 (26.0%) infusions.
Most of the AEs were unrelated to study drug, however, and the proportion of subjects experiencing an AE possibly, probably, or definitely related to study drug was 5 of 36 subjects (13.9%) treated with Alphanate. The proportion of subjects with at least one serious AE, regardless of causality was 3 of 36 subjects (8.3%). There were no subjects who reported at least one serious AE possibly, probably, or definitely related to study drug.
Overall, AEs, regardless of causality, were observed in association with 53 of 204 (26.0%) infusions of Alphanate across all parts of these studies. Most AEs were unrelated to study drug, however, and the proportion of infusions associated with AEs possibly, probably, or definitely related to study drug was 14 of 204 infusions (6.9%). The proportion of infusions associated with serious AEs, regardless of causality, was only 5 of 204 (2.5%) infusions of Alphanate.
There were no observed serious AEs possibly, probably or definitely related to study drug. **Alphanate, Solvent Detergent, non heat-treated (A-SD), is the previous formulation and Alphanate, Solvent Detergent/Heat Treated (A-SD/HT), is the current formulation. Both products are biochemically equivalent and demons…
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS None known.
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Pregnancy: No human or animal data. Use only if clearly needed ( 8.1 ). Labor and Delivery: No human or animal data.
Use only if clearly needed ( 8.2 ). Nursing Mothers: No human or animal data. Use only if clearly needed ( 8.3 ).
Pediatric Use: Clinical trials for safety and effectiveness in pediatric hemophilia A patients have not been conducted. The hemostatic efficacy of Alphanate has been studied in 20 pediatric subjects with VWD 18 years of age and under. Based on the data from a subset of these subjects, age had no effect on the pharmacokinetics of VWF:RCo ( 8.4 ).
Geriatric Use: No human or animal data. Use only if clearly needed ( 8.5 ).
8.1Pregnancy Pregnancy Category C. Animal reproduction studies have not been conducted with Alphanate. It is also not known whether Alphanate can cause fetal harm when administered to a pregnant woman or affect reproductive capacity. Alphanate should be given to a pregnant woman only if clearly needed.
8.2Labor and Delivery No human or animal data. Use only if clearly needed.
8.3Nursing Mothers No human or animal data. Use only if clearly needed.
8.4Pediatric Use 8.4.1 Hemophilia A Indication Clinical trials for safety and effectiveness in pediatric hemophilia A patients 16 years of age and younger have not been conducted. 8.4.2 VWD Indication The hemostatic efficacy of Alphanate has been studied in 20 pediatric subjects with VWD 18 years of age and under. Based on the data from a subset of these subjects, age had no effect on the pharmacokinetics of VWF:RCo.
There were no clinically important differences between pediatric patients and adults.
8.5Geriatric Use No human or animal data. Use only if clearly needed.
🤰 Pregnancy ▾
8.1Pregnancy Pregnancy Category C. Animal reproduction studies have not been conducted with Alphanate. It is also not known whether Alphanate can cause fetal harm when administered to a pregnant woman or affect reproductive capacity. Alphanate should be given to a pregnant woman only if clearly needed.
🧒 Pediatric Use ▾
8.4Pediatric Use 8.4.1 Hemophilia A Indication Clinical trials for safety and effectiveness in pediatric hemophilia A patients 16 years of age and younger have not been conducted. 8.4.2 VWD Indication The hemostatic efficacy of Alphanate has been studied in 20 pediatric subjects with VWD 18 years of age and under. Based on the data from a subset of these subjects, age had no effect on the pharmacokinetics of VWF:RCo.
There were no clinically important differences between pediatric patients and adults.
8.4.1Hemophilia A Indication Clinical trials for safety and effectiveness in pediatric hemophilia A patients 16 years of age and younger have not been conducted.
8.4.2VWD Indication The hemostatic efficacy of Alphanate has been studied in 20 pediatric subjects with VWD 18 years of age and under. Based on the data from a subset of these subjects, age had no effect on the pharmacokinetics of VWF:RCo. There were no clinically important differences between pediatric patients and adults.
🧓 Geriatric Use ▾
8.5Geriatric Use No human or animal data. Use only if clearly needed.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Antihemophilic Factor/von Willebrand Factor Complex (Human) contains Antihemophilic Factor (FVIII) and von Willebrand Factor (VWF), constituents of normal plasma, which are required for clotting. The administration of Alphanate temporarily increases the plasma level of FVIII, thus minimizing the hazard of hemorrhage in patients with hemophilia A. 23,24 FVIII is an essential cofactor in activation of factor X leading to formation of thrombin and fibrin.
VWF promotes platelet aggregation and platelet adhesion on damaged vascular endothelium; it also serves as a stabilizing carrier protein for the procoagulant protein FVIII. 25,26
12.3Pharmacokinetics 12.3.1 Pharmacokinetics in Hemophilia A Following the administration of Alphanate during clinical trials, the mean in vivo half-life of FVIII observed in 12 adult subjects with severe hemophilia A was 17.9 ± 9.6 hours. In this same study, the in vivo recovery was 96.7 ± 14.5% at 10 minutes postinfusion. Recovery at 10 minutes post-infusion was also determined as 2.4 ±
0.4IU FVIII rise/dL plasma per IU FVIII infused/kg body weight. 12.3.2 Pharmacokinetics in von Willebrand Disease (VWD) A pharmacokinetic crossover study was conducted in 14 non-bleeding subjects with VWD (1 type 1, 2 type 2A, and 11 type 3) comparing the pharmacokinetics of Alphanate (A-SD/HT) and an earlier formulation, Alphanate (A-SD). Subjects received, in random order at least seven days apart, a single intravenous dose of each product, 60 IU VWF:RCo/kg (75 IU VWF:RCo/kg in subjects younger than 18 years of age).
Pharmacokinetic parameters were similar for the two products and indicated that they were biochemically equivalent. Pharmacokinetic analysis of Alphanate (A-SD/HT) in the 14 subjects revealed the following results: the median plasma levels (% normal) of VWF:RCo rose from
10.00IU/dL [mean, 11.86 ±
4.97IU/dL; range: 10.00 to
27.00IU/dL] at baseline to 206.00 IU/dL [mean, 215.50 ± 101.70 IU/dL; range: 87.00 to 440.00 IU/dL] 15 minutes post-infusion; median plasma levels of FVIII:C rose from
5.00IU/dL [mean, 21.00 ±
33.83IU/dL; range: 2.00 to 114.00 IU/dL] to 206.00 IU/dL [mean, 215.29 ±
94.26IU/dL; range: 110.00 to 421.00 IU/dL]. The median bleeding time (BT) prior to infusion was 30 minutes (mean, 28.8 ± 4.41 minutes; range: 13.5 to 30 minutes), which shortened to 10.38 minutes (mean, 10.4 ± 3.20 minutes; range: 6 to 16 minutes) 1 hour post-infusion. Following infusion of Alphanate (A-SD/HT), the median half-lives for VWF:RCo, FVIII:C and VWF:Ag were 6.91 hours (mean, 7.67 ± 3.32 hours, range, 3.80 to 16.22 hours), 20.92 hours (mean, 21.58 ± 7.79 hours; range: 7.19 to 32.20 hours), and 12.80 hours (mean, 13.06 ± 2.20 hours: range: 10.34 to 17.45 hours), respectively.
The median incremental in vivo recoveries of VWF:RCo and FVIII:C were 3.12 (IU/dL)/(IU/kg) [mean, 3.29 ± 1.46 (IU/dL)/(IU/kg); range: 1.28 to 5.73 (IU/dL)/(IU/kg)] for VWF:RCo and 1.95 (IU/dL)/(IU/kg) [mean, 2.13 ± 0.58 (IU/dL)/(IU/kg); range: 1.33 to 3.32 (IU/dL)/(IU/kg)] for FVIII:C. The pharmacokinetic data in VWD are summarized in Table 6 . Table 6.
Pharmacokinetic data in VWD Parameter Plasma VWF:RCo (Mean ± SD) Plasma FVIII:C (Mean ± SD) Plasma VWF:Ag (Mean ± SD) Number of patients 14 14 14 Mean plasma levels (IU/dL) Baseline 11.86 ± 4.97 21.00 ± 33.83 - 15 minutes post infusion 215.50 ± 101.70 215.29 ± 94.26 - T½ (Half-life in hours) 7.67 ± 3.32 21.58 ± 7.79 13.06 ±
2.20Incremental in vivo recovery in (IU/dL)/(IU/kg) 3.29 ± 1.46 2.13 ± 0.58 - Following infusion of both Alphanate (A-SD) and Alphanate (A-SD/HT), an increase in the size of VWF multimers was seen and persisted for at least 24 hours. The shortening of the BT was transient, lasting less than 6 hours following treatment and did not correlate with the presence of large and intermediate size VWF multimers. 27
🧬 Mechanism of Action ▾
12.1Mechanism of Action Antihemophilic Factor/von Willebrand Factor Complex (Human) contains Antihemophilic Factor (FVIII) and von Willebrand Factor (VWF), constituents of normal plasma, which are required for clotting. The administration of Alphanate temporarily increases the plasma level of FVIII, thus minimizing the hazard of hemorrhage in patients with hemophilia A. 23,24 FVIII is an essential cofactor in activation of factor X leading to formation of thrombin and fibrin.
VWF promotes platelet aggregation and platelet adhesion on damaged vascular endothelium; it also serves as a stabilizing carrier protein for the procoagulant protein FVIII. 25,26
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Alphanate is supplied in sterile, lyophilized form in a single dose vial with a vial of diluent (Sterile Water for Injection, USP) and a Mix2Vial filter transfer set. IU activity of FVIII and VWF:RCo are stated on the carton and label of each vial. Alphanate is available in the following potencies and color coded based upon assay on the carton and label as follows: Potency NDC Assay Color Code 250 IU FVIII/5 mL single dose vial 68516-4601-1 250 IU FVIII Range - grey box 500 IU FVIII/5 mL single dose vial 68516-4602-1 500 IU FVIII Range - blue box 1000 IU FVIII/10 mL single dose vial 68516-4603-2 1000 IU FVIII Range - red box 1500 IU FVIII/10 mL single dose vial 68516-4604-2 1500 IU FVIII Range - black box Storage Store under refrigeration at temperatures between 2 and 8 °C (34 to 46 °F).
Do not freeze to prevent damage to diluent vial. May be stored at room temperature not to exceed 30 ºC for up to 2 months. If stored outside the refrigerator, record the date removed on the space provided on the carton.
📋 Description ▾
11 DESCRIPTION Alphanate is a sterile, lyophilized concentrate of FVIII (AHF) and von Willebrand Factor (VWF). Alphanate is prepared from pooled human plasma by cryoprecipitation of FVIII, fractional solubilization, and further purification employing heparin-coupled, cross-linked agarose which has an affinity to the heparin binding domain of VWF/FVIII:C complex. 20 The product is treated with a mixture of tri-n-butyl phosphate (TNBP) and polysorbate 80 to inactivate enveloped viruses.
The product is also subjected to an 80 °C heat treatment step for 72 hours to inactivate enveloped and non-enveloped viruses. However, no procedure has been shown to be totally effective in removing viral infectivity from coagulation factor products. Alphanate is labeled with the antihemophilic factor potency (FVIII:C activity) in International Units (IU) FVIII/vial and with VWF:RCo activity expressed in IU VWF:RCo/vial.
The activities are referenced to their respective international standards established by the World Health Organization. One IU of FVIII or one IU of VWF:RCo is approximately equal to the amount of FVIII or VWF:RCo activity in 1 mL of freshly-pooled human plasma. Alphanate contains Albumin (Human) as a stabilizer, resulting in a final container concentrate with a specific activity of at least 5 FVIII:C IU/mg total protein.
Prior to the addition of the Albumin (Human) stabilizer, the specific activity is significantly higher. When reconstituted as directed, the composition of Alphanate is as follows: Component Concentration FVIII:C activity 40 – 180 IU/mL VWF:RCo activity NLT
0.4VWF:RCo IU per 1 IU of FVIII:C Albumin (Human) 0.3 – 0.9 g/100 mL Calcium NMT 5 mmol/L Glycine NMT 750 μg per FVIII:C IU Heparin NMT
1.0U/mL Histidine 10 – 40 mmol/L Imidazole NMT 0.1 mg/mL Arginine 50 – 200 mmol/L Polyethylene Glycol and Polysorbate 80 NMT 1.0 μg per FVIII:C IU Sodium NMT 10 mEq/vial Tri-n-butyl Phosphate (TNBP) NMT 0.1 μg per FVIII:C IU NMT= not more than NLT= not less than Viral Reduction Capacity The solvent detergent treatment process has been shown by Horowitz, et al., to provide a high level of viral inactivation without compromising protein structure and function. 21 The susceptibility of human pathogenic viruses such as Human Immunodeficiency viruses (HIV), hepatitis viruses, as well as marker viruses such as Sindbis virus (SIN, a model for Hepatitis C virus) and Vesicular Stomatitis virus (VSV, a model for large, enveloped RNA virus), to inactivation by organic solvent detergent treatment has been discussed in the literature.
22 In vitro inactivation studies to evaluate the solvent detergent treatment (0.3% Tri-n-butyl Phosphate and 1.0% Polysorbate 80) step in the manufacture of Alphanate demonstrated a log inactivation of ≥ 11.1 for HIV-1, ≥ 6.1 for HIV-2, ≥ 4.1 for VSV and ≥ 4.7 for SIN. No residual virus was detected after solvent detergent treatment in any of these studies. Additional steps in the manufacturing process of Alphanate were evaluated for virus elimination capability.
The dry heat cycle of 80 °C for 72 hours was shown to inactivate greater than 5.8 logs of Hepatitis A virus (HAV). Precipitation with 3.5% polyethylene glycol (PEG) and heparin-actigel-ALD chromatography are additional steps studied using Bovine Herpes virus (BHV, a model for Hepatitis B virus), Bovine Viral Diarrhea virus (BVD, a second model for Hepatitis C virus), human Poliovirus Sabin type 2 (POL, a model for Hepatitis A virus), Canine Parvovirus (CPV, a model for Parvovirus B19) and HIV-1. Table 5 summarizes the reduction factors for each virus validation study performed for the manufacturing process of Alphanate.
Table 5: Virus Log Reduction Virus (Model Virus for) 3.5% PEG Precipitation Solvent–Detergent Column Chromatography Lyophilization Dry Heat Cycle (80 °C, 72 h) Total Log Removal BHV (HBV) < 1.0 ≥ 8.0 7.6 1.3 2.1 ≥
19.0BVD (HCV) < 1.0 ≥ 4.5 < 1.0 < 1.0 ≥ 4.9 ≥
9.4POL (HAV) 3.3 – < 1.0 3.4 ≥ 2.5 ≥
9.2CPV (B19) 1.2 – < 1.0 < 1.0 4.1…
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Inform patients of the early signs of hypersensitivity reaction, including hives, generalized urticaria, chest tightness, dyspnea, wheezing, faintness, hypotension, and anaphylaxis. Have epinephrine available in case of severe immediate hypersensitivity reactions. If allergic symptoms occur, discontinue treatment immediately and seek emergency treatment.
See WARNINGS AND PRECAUTIONS ( 5.1 ). Inform patients that inhibitors to FVIII and VWF have been detected in patients receiving FVIII or AHF/VWF Complex (Human). If expected levels are not obtained or if bleeding is not controlled with adequate dose, contact your physician.
See WARNINGS AND PRECAUTIONS ( 5.2 ). Inform patients that thromboembolic events may be associated with AHF/VWF Complex (Human). For patients with high thrombotic risk, antithrombotic measures should be considered.
See WARNINGS AND PRECAUTIONS ( 5.3 ). Inform patients that despite stringent procedures designed to reduce risk, the risk of transmitting infectious agents cannot be totally eliminated. Ask patients, especially pregnant women and immunocompromised individuals, to report any signs and symptoms of fever, rash, joint pain, or sore throat, to their physician immediately.
See WARNINGS AND PRECAUTIONS ( 5.6 ). Manufactured and Distributed by: Grifols Biologicals Inc. Los Angeles, CA 90032, U.S.A.
U. S. License No.
1694 3031638