Treatment of anemia in patients with chronic kidney disease
Subcutaneously or intravenously (within 2 minutes). Patients on hemodialysis - through the arteriovenous shunt at the end of the dialysis session. Patients who do not receive hemodialysis, preferably administer the drug subcutaneously, to avoid puncture of peripheral veins. The goal of the treatment is a hemoglobin (Hb) value of 100-120 g / l. Hb should not exceed 120 g / l. With an increase in Hb by more than 20 g / l (1.3 mmol / L) in 4 weeks, the dose of the drug should be reduced. In patients with hypertension, cardiovascular and cerebrovascular diseases, weekly increase in Hb and its targets should be determined individually, depending on the clinical picture. Careful observation of the patient should be carried out in order to select the minimum dose sufficient to ensure the maximum effect of the drug.
Treatment Rekormon is carried out in 2 stages.
Correction stage
Subcutaneously - The initial dose is 20 IU / kg 3 times a week.With an insufficient increase in Hb (less than 2.5 g / L per week), the dose can be increased every 4 weeks by 20 IU / kg 3 times a week. The total weekly dose of the drug can also be divided into daily injections.
Intravenously - The initial dose is 40 IU / kg 3 times a week. With an insufficient increase in Hb in a month, the dose can be increased to 80 IU / kg 3 times a week. If necessary, in the future, the dose should be increased by 20 IU / kg 3 times a week, with a monthly interval. Regardless of the route of administration, the maximum dose should not exceed 720 IU / kg per week.
Supportive therapy.
To maintain the target Hb value (100-120 g / l), the dose should first be reduced 2 times from the previous one. Subsequently, the maintenance dose is selected individually, with an interval of 2 or 4 weeks. With subcutaneous administration, a weekly dose can be administered in 1 dose or divided into 3 or 7 administrations per week. When the condition stabilizes against a background of a single injection per week, you can switch to a single injection at a two-week interval, in which case an increase in dose may be necessary.
Treatment Rekormon, as a rule, is long. If necessary, it can be interrupted at any time.
Treatment of symptomatic anemia in patients with solid and hematological non-myeloid tumors receiving chemotherapy
The drug is administered subcutaneously, in an initial dose of 30000 ME per week (450 IU / kg per week), a single or weekly dose can be divided into 3 or 7 injections.
Rekormon therapy is indicated for Hb <110 g / l (6.83 mmol / l). The Hb should not exceed 130 g / l (8.07 mmol / l).
When Hb is increased by 10 g / l (0.62 mmol / L) after 4 weeks, therapy should be continued at the same dose.
With a rise in Hb of less than 10 g / L (0.62 mmol / L) after 4 weeks - the dose should be doubled. In the absence of an increase in Hb by 10 g / l (0.62 mmol / l) after 8 weeks - treatment should be interrupted, as. response to therapy Rekormon unlikely.
Treatment should continue for 4 weeks after the end of chemotherapy. The maximum dose should not exceed 60,000 ME in Week.
When the target Hb for a particular patient is reached, the dose of the drug should be reduced by 25-50%.
To prevent an increase in Hb greater than 130 g / L, a further dose reduction may be required.
When Hb increases by more than 20 g / l (1.3 mmol / L) per month, the dose of Rekormon should be reduced by 25-50%.
Preparation of patients for the collection of donor blood for subsequent autohemotransfusion. Intravenously (for 2 minutes) or subcutaneously, 2 times a week for 4 weeks. In those cases where the hematocrit value of the patient (> 33%) allows blood sampling, the Recormon should be entered at the end of the procedure.
Throughout the course of treatment, the hematocrit should not exceed 48%.
The dose of the drug is determined by the transfusiologist and the surgeon individually, depending on how much blood is taken from the patient and from his erythrocyte reserve:
1. The amount of blood that will be taken from the patient depends on the estimated blood loss, the available methods of blood preservation and the general condition of the patient; it should be sufficient to avoid transfusion of blood from another donor.
2. The volume of blood that will be taken from the patient is expressed in units (one unit is equivalent to 180 ml of erythrocytes).
3. The possibility of donation depends mainly on the volume of blood in this patient and the initial hematocrit. Both indices determine the endogenous red blood cell, which is calculated by the following formula:
Endogenous erythrocyte reserve = blood volume [ml] x (hematocrit 33): 100 Women: blood volume [ml] = 41 [ml / kg] x body weight [kg] + 1200 [ml]
Men: blood volume [ml] - 44 [ml / kg] x body weight [kg] + 1600 [ml] (with body weight> 45 kg).
Indication for the use of Recormon and its single dose are determined from nomograms, based on the required volume of donor blood and the endogenous red blood cell. The maximum dose should not exceed 1600 IU / kg per week with intravenous administration and 1200 IU / kg per week with subcutaneous injection.
Prevention of anemia in premature newborns (only syringe-Tubics with the drug Recormon).
Subcutaneously, 250 IU / kg 3 times a week, as early as possible, preferably from the 3rd day of life, for 6 weeks.
Dosing in special patient groups
Children and teens
In children and adolescents, the dose of the drug depends on age: as a rule, the smaller the age, the higher the dose of Recormon is required. But, since it is impossible to predict the individual response to a drug, it is advisable to start with the standard dosage regimen (see "Treatment of anemia in patients with chronic kidney disease" and "Prevention of anemia in premature infants").
When treating anemia associated with chronic kidney disease, Rekormon should not be prescribed to children under 2 years of age.
Elderly age
In clinical trials, the need for dose changes is not defined.
Mode of application
Syringe tube with the drug Recormon is ready for use. The solution contained in it is sterile and does not contain preservatives. Apply only light clear or slightly opalescent solution that does not contain visible inclusions. If after the injection in the syringe tube a certain amount of the drug remains, the repeated administration of it is unacceptable.
Instructions for the use of a syringe tube
Before injection, wash hands
1. Remove one syringe from the package and make sure that the solution is clear, colorless and contains no visible inclusions. Remove the cap from the syringe.
2. Remove one needle from the package, put it on the syringe and remove the protective cap from the needle.
3.Remove air from the syringe and needle, holding the syringe upright, gently pushing the piston upward. Press the plunger until the required dose of Recormon is left in the syringe.
4.Wipe the skin at the injection site with alcohol moistened with cotton wool. With a thumb and forefinger, take the skin into a crease. Holding the syringe body closer to the needle, insert the needle under the skin. Introduce the solution of Rekormon. Quickly remove the needle and squeeze the injection site with a sterile dry cotton wool.
Cartridge with the Recormon for the syringe handle Reco-Pen is a two-section cartridge containing lyophilizate for the preparation of a solution for subcutaneous administration and a solvent with preservatives. The prepared solution is obtained by inserting the cartridge into the Reco-Pen syringe-pen in accordance with the instructions for Reco-Pen. Cartridges with Recormon should only be used in the Reco Pen syringe pen. It is recommended to use needles for the Reco Pen syringe (for example, the Penfine needle). The solution prepared in the cartridge is stored for 1 month at a temperature of 2-8 ° C. After installing the cartridge, the Reco-Pen syringe pen is removed from the refrigerator only at the time of the injection.