Albuminex

Patient Information

Ensure that patients to be treated with ALBUMINEX 5% are informed of the potential risks and benefits of its use for their clinical condition [see WARNINGS AND PRECAUTIONS].

Check that they are not known to be allergic to the product or its excipients [see CONTRAINDICATIONS and DESCRIPTION].

Make them aware of the symptoms of anaphylaxis [see Hypersensitivity].

Make them aware of the symptoms of potential circulatory overload [see Hypervolemia].

Inform patients that because ALBUMINEX 5% is derived from human blood plasma it may contain infectious agents that cause disease (e.g. viruses and, theoretically CJD agents) although the risk of infection from ALBUMINEX 5% has been reduced by the procedures used in donor selection and during manufacture [see Infectious Diseases and DESCRIPTION].

Description

ALBUMINEX 5% is a sterile, ready-for-use, clear, slightly viscous, almost colorless, yellow, amber or slightly green aqueous solution of human albumin for single-dose intravenous infusion. It is prepared from the pooled plasma of US donors in FDA-licensed facilities in the US. The product also contains 130-160 mmol/L of sodium, and less than 200 micrograms/L of aluminum and is stabilized with caprylate (0.08 mmol/g albumin) and acetyltryptophanate (0.08 mmol/g albumin) but does not contain any preservative.

12.5 g (250 mL) of ALBUMINEX 5% is oncotically equivalent to 250 mL plasma.

25 g (500 mL) of ALBUMINEX 5% is oncotically equivalent to 500 mL plasma.

The vials are closed with a synthetic rubber stopper. The stopper is not made with natural rubber latex.

The viral risk from human plasma is minimized by the fractionation process and pasteurization of the albumin solution for 10 hours at 60°C (140°F) in its final container. These processes are effective for both enveloped and non-enveloped viruses. There have been no reports of virus transmission with products manufactured using this combination of processes.

Typical reductions of experimental viral loads are shown in Table 1.

Table 1: Virus Reduction for Albumin (Human) 5%

Indications

Hypovolemia

ALBUMINEX 5% is indicated for restoration and maintenance of circulating blood volume where volume deficiency has been demonstrated, and use of a colloid is appropriate e.g. hypovolemia following shock due to trauma or sepsis, in surgical patients and in other similar conditions with volume deficiency when restoration and maintenance of circulating blood volume is required in both adult and pediatric patients. In pediatric patients to reverse hypovolemia and achieve normal capillary refill time.^{1,2,3,4,5,6,7,8}

Ascites

ALBUMINEX 5% is indicated for prevention of central volume depletion and maintenance of cardiovascular function after large volume parencentesis in patients with liver cirrhosis or other chronic liver disease in adults and children.^9,10,11,12

ALBUMINEX 5% infusion plus administration of vasoactive drugs is indicated in the treatment of type I hepatorenal syndrome.⁶

For patients with spontaneous bacterial peritonitis, ALBUMINEX 5% is indicated as adjuvant treatment to antibiotic therapy.^9,10,13

Hypoalbuminemia Including From Burns

ALBUMINEX 5% is indicated in patients with severe burn injury (> 20% total body surface area), but not until at least 12 to 24 hours after the burn, in order to correct protein loss, decrease overall fluid requirements, decrease systemic edema and stabilize cardiovascular hemodynamics without fluid overload (initial resuscitation should be with crystalloids).^8,14 ALBUMINEX 5% is also indicated in patients with pre- or post-operative hypoproteinemia and for third space protein loss due to infection or burns.

Acute Nephrosis

ALBUMINEX 5% is indicated in patients with acute nephrosis in combination with loop diuretics to reinforce the diuretic therapeutic effect, which is reduced by hypoalbuminemia, and for the correction of reduced oncotic pressure. ^{15, 16}

Acute Respiratory Distress Syndrome (ARDS)

ALBUMINEX 5% is indicated in conjunction with diuretics to correct fluid volume overload associated with ARDS. ^{17, 18, 19}

Cardiopulmonary Bypass

ALBUMINEX 5% is indicated in cardiopulmonary bypass procedures as part of the priming fluids to passivate the synthetic surfaces of the extracorporeal circuit and maintain the patient’s colloid oncotic pressure. ^{20, 21, 22, 23, 24, 25}

Dosage And Administration

For intravenous administration only.

Dosage

The concentration of ALBUMINEX 5% used, its dosage, and infusion rate should be adjusted to the patient’s individual requirements and clinical indication.

Administration

• Visually inspect the solution for particulate matter and discoloration prior to administration, whenever solution and container permit.
• Do not use if there are any particulates seen or if the solution is discolored.
• If a large volume is infused, ensure that the vial is at room temperature before infusion.
• Do not dilute with Sterile Water for Injection as hemolysis may occur. ALBUMINEX 5% may be diluted with 0.9% saline or 5% dextrose.
• Begin the infusion within 4 hours of piercing the vial stopper (the product does not contain any preservative).
• Adjust the rate of infusion according to the individual patient’s hemodynamic and other physiological responses, using appropriate clinical monitoring.

How Supplied

Dosage Forms And Strengths

ALBUMINEX 5% is a sterile, aqueous solution of human albumin (5% w/v i.e. 5 g/dL) for intravenous administration available as:

• 250 mL (12.5 g) single dose vial
• 500 mL (25 g) single dose vial

How ALBUMINEX 5% Is Supplied

ALBUMINEX 5%, 5 g/dL in clear Type II glass vials.

Not all pack sizes may be marketed.

Storage And Handling

Do not store above 30°C (86°F).

Keep the vial stored in the outer carton in order to protect from light.

Do not freeze.

Do not use ALBUMINEX 5% after the expiration date which is stated on the carton and label after “EXP.” The expiration date refers to the last day of that month.

ALBUMINEX 5% should be inspected visually for particulate matter and discoloration prior to administration.

REFERENCES

1. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;3650:2247-2256

2. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD001319. DOI: 10.1002/14651858.CD001319.pub3

3. Powell-Tuck J, Gosling P, Lobo DN, et al. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients. BAPEN; 2011. Available from: http://www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf (Guideline Ref ID GIFTASUP2011)

4. Rochwerg B, Alhazzani W, Sindi A, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med 2014;161(5):347-355

5. Wiedermann CJ, Joannidis M. Albumin replacement in severe sepsis or septic shock. N Engl J Med 2014;371:83-84

6. Akech S, Gwer S, Idro R, et al. Volume expansion with albumin compared to gelofusine in children with severe malaria: results of a controlled trial. PLoS Clin Trials 2006; 5:0001-0011

7. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Critical Care Medicine, 2013; 41(2):580–637

8. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systemic Reviews 2013, Issue 2.Art. No.CD000567. DOI:10.1002/14651858.CD000567.pub6.

9. Runyon BA. Management of Adult Patients with Ascites Due to Cirrhosis: Update 2012. The American Association for the Study of Liver Diseases 2012. http://www.aasld.org/publications/practice-guidelines-0 [accessed 15 April 2016]

10. EASL clinical practise guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397–417

11. Bernardi M, Carceni P, Navickis RJ, et al. Albumin infusion in patients undergoing large-volume paracentesis: a meta-analysis of randomized trials. Hepatology 2012;55:1172-1181

12. Sarma MS, Yachha SK, Bhatia V, et al. Safety, complications and outcome of large volume paracentesis with or without albumin therapy in children with severe ascites due to liver disease. J Hepatol 2015:63;1126-1132

13. Wiest R, Krag A, Gerbes A. Spontaneous Bacterial Peritonitis. Recent Guidelines and Beyond. Gut 2012; 61(2):297-310

14. Pham TN, Cancio LC, Gibran NS. American Burn Association Practice Guidelines Burn Shock Resuscitation. J Burn Care Res 2008; 29(1):257-266

15. Bircan Z, Kervancioglu M. Does albumin and furosemide therapy affect plasma volume in nephrotic children? Pediatr Nephrol 2001;16:497- 499

16. Dharmaraj R, Hari P, Bagga A. Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome. Pediatr Nephrol 2009; 24(4):775-782

17. Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med 2005;33(8):1681-1687

18. Uhlig C, Pedro L, Silva PL, et al. Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care 2014, 18:R10 http://ccforum.com/content/18/1/R10 [accessed 02 November 2016]

19. Quinlan GJ, Mumby S, Martin GS, et al. Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury. Crit Care Med 2004;32:755–759

20. Wilkes MM, Navickis RJ, Sibbald WJ. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg 2001;72(2):527-534

21. Golab HD, Scohy TV, de Jong PL, et al. Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study. Eur J Cardio-Thor Surg 2011; 39(6):886-891

22. Hanart C, Khalife M, De Villé A, et al. Perioperative volume replacement in children undergoing cardiac surgery: Albumin versus hydroxyethyl starch 130/0.4. Crit Care Med 2009;37 (2): 696-701 DOI: 10.1097/CCM.0b013e3181958c81

23. Loeffelbein F, Zirell U, Benk C, et al. High colloid oncotic pressure priming of cardiopulmonary bypass in neonates and infants: implications on haemofiltration, weight gain and renal function. Eur J Cardio-Thor Surg 2008; 34(3):648-652

24. Oliver WC Jr, Beynen FM, Nuttall GA, et al. Blood loss in infants and children for open heart operations: albumin 5% versus fresh-frozen plasma in the prime. Ann Thor Surg 2003;75(5):1506-1512

25. Yu K, Liu Y, Hei F, et al. Effect of different albumin concentrations in extracorporeal circuit prime on perioperative fluid status in young children. ASAIO Journal 2008; 54(5):463-466

Manufactured by: Bio Products Laboratory Ltd., Elstree, WD6 3BX.United Kingdom, Bircan Z, Kervancioglu M. Does albumin and furosemide therapy affect plasma volume in nephrotic children? Pediatr Nephrol 2001;16:497- 499. Revised: Aug 2018

General

In general, human albumin solutions are well-tolerated and no specific, clinically relevant alterations in organ function or coagulopathy have been substantiated.²⁶

The most common adverse reactions associated with infusion of human albumin solutions are rigors, hypotension/decreased BP, tachycardia/increased heart rate, pyrexia, feeling cold (chills), nausea, vomiting, dyspnea/bronchospasm, rash/pruritus. Reactions usually resolve when the infusion is slowed or stopped.

Anaphylaxis, with or without shock, may occur and in this situation, stop the infusion.

Clinical Trials Experience

No clinical studies were done using ALBUMINEX 5%.

Drug Interactions

Do not mix ALBUMINEX 5% with blood, blood components, protein hydrolysates, alcoholic solutions or other medicinal products. Although it is not usually necessary to dilute Albuminex 5%, if it should be necessary, it may be diluted with 0.9% saline or 5% dextrose. However, it can be administered, via a separate IV line, concomitantly with other parenterals.

REFERENCES

26. German Medical Association. Cross-Sectional Guidelines for Therapy with Blood Components and Plasma Derivatives. 4th revised and updated edition 2014. http://www.bundesaerztekammer.de/aerzte/ medizin-ethik/wissenschaftlicher-beirat/veroeffentlichungen/ haemotherapietransfusionsmedizin/english/ [accessed 15 April 2016]

Included as part of the PRECAUTIONS section.

Precautions

Hypersensitivity Reactions

Suspicion of allergic or anaphylactic reactions require immediate discontinuation of the infusion and implementation of appropriate medical treatment.

Hypervolemia

Hypervolemia may occur if the dosage and rate of infusion are not adjusted to the patient’s volume status. At the first clinical signs of cardiovascular overload (headache, dyspnea, jugular venous distention, increased blood pressure), the infusion must be slowed or stopped immediately.

Use albumin with caution in conditions where hypervolemia and its consequences or hemodilution could represent a special risk to the patient. Examples of such conditions are:

• Decompensated heart failure
• Hypertension
• Esophageal varices
• Pulmonary edema
• Hemorrhagic diathesis
• Severe anemia
• Renal and post-renal anuria

Laboratory Parameters

When large volumes of albumin are being infused, control of coagulation parameters and hematocrit value is essential. Also, ensure adequate substitution of other blood constituents such as coagulation factors, electrolytes, platelets and erythrocytes, as appropriate.

Clinical Hemodynamics Parameters

The colloid osmotic pressure of ALBUMINEX 5% is about the same as plasma.

The following parameters should be assessed during administration of ALBUMINEX 5%:

• Arterial blood pressure and pulse rate
• Central venous pressure
• Pulmonary artery occlusion pressure
• Urine output
• Electrolytes
• Hematocrit/hemoglobin

Pre-infusion Preparation

ALBUMINEX 5% must not be diluted with sterile water for injection as this may cause hemolysis in recipients. The product can be diluted in an isotonic solution (e.g., 5% dextrose in water or 0.9% sodium chloride) [see DOSAGE AND ADMINISTRATION].

Infectious Diseases

Albumin is a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. A theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD) is also considered extremely remote. No cases of transmission of viral diseases or CJD have ever been identified for ALBUMINEX 5%.

Use In Specific Populations

Pregnancy

Risk Summary

There are no data with ALBUMINEX 5% use in pregnant women to inform on drug-associated risk. Animal reproduction studies have not been conducted using ALBUMINEX 5%. It is not known whether ALBUMINEX 5% can cause fetal harm when administered to a pregnant woman or can affect fertility. ALBUMINEX 5% should be given to a pregnant woman only if clearly needed. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

Lactation

Risk Summary

There is no information regarding the presence of ALBUMINEX 5% in human milk, the effects on the breast-fed infant, or the effects on milk production. The developmental and health benefits of breast-feeding should be considered along with the mother’s clinical need for ALBUMINEX 5% and any potential adverse effects on the breast-fed infant from ALBUMINEX 5% or from the underlying maternal condition.

Pediatric Use

No human or animal data. Use only if clearly needed.

Geriatric Use

No human or animal data. Use only if clearly needed.

No Information provided

Contraindications

ALBUMINEX 5% is contraindicated in patients with:

• Hypersensitivity to human albumin or any of the excipients
• Severe anemia or cardiac failure with normal or increased intravascular volume

Mechanism Of Action

Human albumin accounts for more than half of the total protein in the plasma and represents about 10% of protein synthesis activity by the liver.

The primary physiological function of albumin results from its contribution to plasma colloid oncotic pressure and transport function. Albumin stabilizes circulating blood volume and is a carrier of hormones, enzymes, medicinal products and toxins. Other physiological functions include antioxidant properties, free radical scavenging, and capillary membrane integrity.

Pharmacokinetics

Albumin is distributed throughout the extracellular space and more than 60% of the body albumin pool is located in the extravascular fluid compartment. Albumin has a circulating life span of 15-20 days, with a turnover of approximately 15 g per day. The balance between synthesis and breakdown is normally achieved by feedback regulation. Elimination is predominantly intracellular and due to lysosome proteases.

In healthy subjects, less than 10% of infused albumin leaves the intravascular compartment during the first 2 hours following infusion. There is considerable individual variation in the effect of albumin on plasma volume.

In some patients, the plasma volume can remain elevated for several hours. In critically ill patients, however, albumin can leak out of the vascular space in substantial amounts at an unpredictable rate.