сангера

Overdose

No case of overdose has been reported.

Signs and symptoms may include dizziness, headache, hypotension, and convulsions. It has been shown that convulsions tend to occur at higher frequency with increasing dose.

Management of overdose should be supportive.

Contraindications

Acute venous or arterial thrombosis.

Fibrinolytic conditions following consumption coagulopathy except in those with predominant activation of the fibrinolytic system with acute severe bleeding.

Severe renal impairment (risk of accumulation).

History of convulsions

Intrathecal and intraventricular injection, intracerebral application (risk of cerebral oedema and convulsions)

Incompatibilities

Solution for intravenous administration; Substance; Substance-powderFilm-coated tablet

Сангера solution for injection should not be added to blood for transfusion, or to injections containing penicillin.

Сангераic acid solution for injection should not be added to blood for transfusion, or to injections containing penicillin.

Pharmaceutical form

Emulsion for injection

Undesirable effects

The ADRs reported from clinical studies and post-marketing experience are listed below according to system organ class.

Tabulated list of adverse reactions

Adverse reactions reported are presented in table below. Adverse reactions are listed according to MedDRA primary system organ class. Within each system organ class, adverse reactions are ranked by frequency. Within each frequency grouping, adverse reactions are presented in the order of decreasing seriousness. Frequencies were defined as follows: Very common (>1/10); common (>1/100 to <1/10); uncommon (>1/1,000 to <1/100), not known (cannot be estimated from the available data).

MedDRA System Organ Class

Frequency

Undesirable Effects

Immune system disorders

Not known

- Hypersensitivity reactions including anaphylaxis

Nervous system disorders

Not known

4)

Eye disorders

Not known

- Visual disturbances including impaired colour vision

Vascular disorders

Not known

- Malaise with hypotension with or without loss of consciousness (generally following a too fast intravenous injection, exceptionally after oral administration)

- Arterial or venous embolism at any sites

Gastrointestinal disorders

Common

- Diarrhoea

- Vomiting

- Nausea

Skin and subcutaneous tissue disorders

Uncommon

- Dermatitis allergic

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard.

Сангера price

We have no data on the cost of the drug.
However, we will provide data for each active ingredient

Preclinical safety data

Solution for intravenous administration; Substance; Substance-powderFilm-coated tablet

Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential and toxicity to reproduction.

Epileptogenic activity has been observed in animals with intrathecal use of Сангера.

Non-clinical data reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity, carcinogenic potential and toxicity to reproduction.

Epileptogenic activity has been observed in animals with intrathecal use of Сангераic acid.

Therapeutic indications

Prevention and treatment of haemorrhages due to general or local fibrinolysis in adults and children from one year.

Specific indications include:

- Haemorrhage caused by general or local fibrinolysis such as:

- Menorrhagia and metrorrhagia,

- Gastrointestinal bleeding,

- Haemorrhagic urinary disorders, further to prostate surgery or surgical procedures affecting the urinary tract,

- Ear Nose Throat surgery (adenoidectomy, tonsillectomy, dental extractions),

- Gynaecological surgery or disorders of obstetric origin,

- Thoracic and abdominal surgery and other major surgical intervention such as cardiovascular surgery,

- Management of haemorrhage due to the administration of a fibrinolytic agent.

Pharmacotherapeutic group

Antihemorrhagics, Antifibrinolytics, Aminoacids

Pharmacodynamic properties

Solution for intravenous administration; Substance; Substance-powderFilm-coated tablet

Pharmacotherapeutic group: Antihemorrhagics, Antifibrinolytics, Aminoacids

ATC code: B02AA02

Сангера exerts an anti haemorrhagic activity by inhibiting the fibrinolytic properties of plasmin.

A complex involving Сангера, plasminogen is constituted; the Сангера being linked to plasminogen when transformed into plasmin.

The activity of the Сангера-plasmin complex on the activity on fibrin is lower than the activity of free plasmin alone.

In vitro studies showed that high tranexamic dosages decreased the activity of complement.

Paediatric population

In children over one year old:

Literature review identified 12 efficacy studies in paediatric cardiac surgery which have included 1073 children, 631 having received Сангера. Most of them were controlled versus placebo. Studied population was heterogenic in terms of age, surgery types, dosing schedules. Study results with Сангера suggest reduced blood loss and reduced blood product requirements in paediatric cardiac surgery under cardiopulmonary bypass (CPB) where there is a high risk of haemorrhage, especially in cyanotic patients or patients undergoing repeat surgery.The most adapted dosing schedule appeared to be:

- first bolus of 10 mg/kg after induction of anaesthesia and prior to skin incision,

- continuous infusion of 10 mg/kg/h or injection into the CPB pump prime at a dose adapted on the CPB procedure, either according to a patient weight with a dose of 10 mg/kg dose, either according to CPB pump prime volume, last injection of 10 mg/kg at the end of CPB.

While studied in very few patients, the limited data suggest that continuous infusion is preferable, since it would maintain therapeutic plasma concentration throughout surgery.

No specific dose-effect study or PK study has been conducted in children.

Pharmacotherapeutic group: Antihemorrhagics, Antifibrinolytics, Aminoacids

ATC code: B02AA02

Сангераic acid exerts an anti haemorrhagic activity by inhibiting the fibrinolytic properties of plasmin.

A complex involving Сангераic acid, plasminogen is constituted; the Сангераic acid being linked to plasminogen when transformed into plasmin.

The activity of the Сангераic acid-plasmin complex on the activity on fibrin is lower than the activity of free plasmin alone.

In vitro studies showed that high Сангераic dosages decreased the activity of complement.

Paediatric population

In children over one year old:

Literature review identified 12 efficacy studies in paediatric cardiac surgery which have included 1073 children, 631 having received Сангераic acid. Most of them were controlled versus placebo. Studied population was heterogenic in terms of age, surgery types, dosing schedules. Study results with Сангераic acid suggest reduced blood loss and reduced blood product requirements in paediatric cardiac surgery under cardiopulmonary bypass (CPB) where there is a high risk of haemorrhage, especially in cyanotic patients or patients undergoing repeat surgery.The most adapted dosing schedule appeared to be:

- first bolus of 10 mg/kg after induction of anaesthesia and prior to skin incision,

- continuous infusion of 10 mg/kg/h or injection into the CPB pump prime at a dose adapted on the CPB procedure, either according to a patient weight with a dose of 10 mg/kg dose, either according to CPB pump prime volume, last injection of 10 mg/kg at the end of CPB.

While studied in very few patients, the limited data suggest that continuous infusion is preferable, since it would maintain therapeutic plasma concentration throughout surgery.

No specific dose-effect study or PK study has been conducted in children.

Pharmacokinetic properties

Solution for intravenous administration; Substance; Substance-powderFilm-coated tablet

Absorption

Peak plasma concentrations of Сангера are obtained rapidly after a short intravenous infusion after which plasma concentrations decline in a multi-exponential manner.

Distribution

The plasma protein binding of Сангера is about 3% at therapeutic plasma levels and seems to be fully accounted for by its binding to plasminogen. Сангера does not bind to serum albumin. The initial volume of distribution is about 9 to 12 litres.

Сангера passes through the placenta. Following administration of an intravenous injection of 10 mg/kg to 12 pregnant women, the concentration of Сангера in serum ranged 10-53 μg/mL while that in cord blood ranged 4-31 μg/mL. Сангера diffuses rapidly into joint fluid and the synovial membrane. Following administration of an intravenous injection of 10 mg/kg to 17 patients undergoing knee surgery, concentrations in the joint fluids were similar to those seen in corresponding serum samples. The concentration of Сангера in a number of other tissues is a fraction of that observed in the blood (breast milk, one hundredth; cerebrospinal fluid, one tenth; aqueous humor, one tenth). Сангера has been detected in semen where it inhibits fibrinolytic activity but does not influence sperm migration.

Excretion

It is excreted mainly in the urine as unchanged drug. Urinary excretion via glomerular filtration is the main route of elimination. Renal clearance is equal to plasma clearance (110 to 116 mL/min). Excretion of Сангера is about 90% within the first 24 hours after intravenous administration of 10 mg/kg body weight. Elimination half-life of Сангера is approximately 3 hours.

Special populations

Plasma concentrations increase in patients with renal failure.

No specific PK study has been conducted in children.

Absorption

Peak plasma concentrations of Сангераic acid are obtained rapidly after a short intravenous infusion after which plasma concentrations decline in a multi-exponential manner.

Distribution

The plasma protein binding of Сангераic acid is about 3% at therapeutic plasma levels and seems to be fully accounted for by its binding to plasminogen. Сангераic acid does not bind to serum albumin. The initial volume of distribution is about 9 to 12 litres.

Сангераic acid passes through the placenta. Following administration of an intravenous injection of 10 mg/kg to 12 pregnant women, the concentration of Сангераic acid in serum ranged 10-53 μg/mL while that in cord blood ranged 4-31 μg/mL. Сангераic acid diffuses rapidly into joint fluid and the synovial membrane. Following administration of an intravenous injection of 10 mg/kg to 17 patients undergoing knee surgery, concentrations in the joint fluids were similar to those seen in corresponding serum samples. The concentration of Сангераic acid in a number of other tissues is a fraction of that observed in the blood (breast milk, one hundredth; cerebrospinal fluid, one tenth; aqueous humor, one tenth). Сангераic acid has been detected in semen where it inhibits fibrinolytic activity but does not influence sperm migration.

Excretion

It is excreted mainly in the urine as unchanged drug. Urinary excretion via glomerular filtration is the main route of elimination. Renal clearance is equal to plasma clearance (110 to 116 mL/min). Excretion of Сангераic acid is about 90% within the first 24 hours after intravenous administration of 10 mg/kg body weight. Elimination half-life of Сангераic acid is approximately 3 hours.

Special populations

Plasma concentrations increase in patients with renal failure.

No specific PK study has been conducted in children.

Name of the medicinal product

Сангера

Qualitative and quantitative composition

Tranexamic Acid

Special warnings and precautions for use

Solution for intravenous administration; Substance; Substance-powderFilm-coated tablet

The indications and method of administration indicated above should be followed strictly:

- Intravenous injections should be given very slowly.

- Сангера should not be administered by the intramuscular route.

Convulsions

Cases of convulsions have been reported in association with Сангера treatment.In coronary artery bypass graft (CABG) surgery, most of these cases were reported following intravenous (i.v.) injection of Сангера in high doses. With the use of the recommended lower doses of TXA, the incidence of post-operative seizures was the same as that in untreated patients.

Visual disturbances

Attention should be paid to possible visual disturbances including visual impairment, vision blurred, impaired colour vision and if necessary the treatment should be discontinued. With continuous long-term use of TXA solution for injection, regular ophthalmologic examinations (eye examinations including visual acuity, colour vision, fundus, visual field etc.) are indicated. With pathological ophthalmic changes, particularly with diseases of the retina, the physician must decide after consulting a specialist on the necessity for the long-term use of TXA solution for injection in each individual case.

Haematuria

In case of haematuria from the upper urinary tract, there is a risk for urethral obstruction.

Thromboembolic events

Before use of TXA, risk factors of thromboembolic disease should be considered. In patients with a history of thromboembolic diseases or in those with increased incidence of thromboembolic events in their family history (patients with a high risk of thrombophilia), Сангера solution for injection should only be administered if there is a strong medical indication after consulting a physician experienced in hemostaseology and under strict medical supervision.

Сангера should be administered with care in patients receiving oral contraceptives because of the increased risk of thrombosis.

Disseminated intravascular coagulation

Patients with disseminated intravascular coagulation (DIC) should in most cases not be treated with Сангера. If Сангера is given it must be restricted to those in whom there is predominant activation of the fibrinolytic system with acute severe bleeding. Characteristically, the haematological profile approximates to the following: reduced euglobulin clot lysis time; prolonged prothrombin time; reduced plasma levels of fibrinogen, factors V and VIII, plasminogen fibrinolysin and alpha-2 macroglobulin; normal plasma levels of P and P complex; i.e. factors II (prothrombin), VIII and X; increased plasma levels of fibrinogen degradation products; a normal platelet count. The foregoing presumes that the underlying disease state does not of itself modify the various elements in this profile. In such acute cases a single dose of 1 g Сангера is frequently sufficient to control bleeding. Administration of Сангера in DIC should be considered only when appropriate haematological laboratory facilities and expertise are available.

The indications and method of administration indicated above should be followed strictly:

- Intravenous injections should be given very slowly.

- Сангераic acid should not be administered by the intramuscular route.

Convulsions

Cases of convulsions have been reported in association with Сангераic acid treatment.In coronary artery bypass graft (CABG) surgery, most of these cases were reported following intravenous (i.v.) injection of Сангераic acid in high doses. With the use of the recommended lower doses of TXA, the incidence of post-operative seizures was the same as that in untreated patients.

Visual disturbances

Attention should be paid to possible visual disturbances including visual impairment, vision blurred, impaired colour vision and if necessary the treatment should be discontinued. With continuous long-term use of TXA solution for injection, regular ophthalmologic examinations (eye examinations including visual acuity, colour vision, fundus, visual field etc.) are indicated. With pathological ophthalmic changes, particularly with diseases of the retina, the physician must decide after consulting a specialist on the necessity for the long-term use of TXA solution for injection in each individual case.

Haematuria

In case of haematuria from the upper urinary tract, there is a risk for urethral obstruction.

Thromboembolic events

Before use of TXA, risk factors of thromboembolic disease should be considered. In patients with a history of thromboembolic diseases or in those with increased incidence of thromboembolic events in their family history (patients with a high risk of thrombophilia), Сангераic acid solution for injection should only be administered if there is a strong medical indication after consulting a physician experienced in hemostaseology and under strict medical supervision.

Сангераic acid should be administered with care in patients receiving oral contraceptives because of the increased risk of thrombosis.

Disseminated intravascular coagulation

Patients with disseminated intravascular coagulation (DIC) should in most cases not be treated with Сангераic acid. If Сангераic acid is given it must be restricted to those in whom there is predominant activation of the fibrinolytic system with acute severe bleeding. Characteristically, the haematological profile approximates to the following: reduced euglobulin clot lysis time; prolonged prothrombin time; reduced plasma levels of fibrinogen, factors V and VIII, plasminogen fibrinolysin and alpha-2 macroglobulin; normal plasma levels of P and P complex; i.e. factors II (prothrombin), VIII and X; increased plasma levels of fibrinogen degradation products; a normal platelet count. The foregoing presumes that the underlying disease state does not of itself modify the various elements in this profile. In such acute cases a single dose of 1 g Сангераic acid is frequently sufficient to control bleeding. Administration of Сангераic acid in DIC should be considered only when appropriate haematological laboratory facilities and expertise are available.

Effects on ability to drive and use machines

No studies have been performed on the ability to drive and use machines.

Dosage (Posology) and method of administration

Solution for intravenous administration; Substance; Substance-powderFilm-coated tablet

Posology

Adults

Unless otherwise prescribed, the following doses are recommended:

1. Standard treatment of local fibrinolysis:

0.5 g (1 ampoule of 5 ml) to 1 g (1 ampoule of 10 ml or 2 ampoules of 5 ml) Сангера by slow intravenous injection (= 1 ml/minute) two to three times daily

2. Standard treatment of general fibrinolysis:

1 g (1 ampoule of 10 ml or 2 ampoules of 5 ml) Сангера by slow intravenous injection (= 1 ml/minute) every 6 to 8 hours, equivalent to 15 mg/kg BW

Renal impairment

In renal insufficiency leading to a risk of accumulation, the use of Сангера is contraindicated in patients with severe renal impairment. For patients with mild to moderate renal impairment, the dosage of Сангера should be reduced according to the serum creatinine level:

Serum creatinine

Dose IV

Administration

μmol/l

mg/10 ml

120 to 249

1.35 to 2.82

10 mg/kg BW

Every 12 hours

250 to 500

2.82 to 5.65

10 mg/kg BW

Every 24 hours

> 500

> 5.65

5 mg/kg BW

Every 24 hours

Hepatic impairment

No dose adjustment is required in patients with hepatic impairment.

Paediatric Population:

The efficacy, posology and safety of Сангера in children undergoing cardiac surgery have not been fully established.

Elderly:

No reduction in dosage is necessary unless there is evidence of renal failure.

Method of administration

The administration is strictly limited to slow intravenous injection.

Posology

Adults

Unless otherwise prescribed, the following doses are recommended:

1. Standard treatment of local fibrinolysis:

0.5 g (1 ampoule of 5 ml) to 1 g (1 ampoule of 10 ml or 2 ampoules of 5 ml) Сангераic acid by slow intravenous injection (= 1 ml/minute) two to three times daily

2. Standard treatment of general fibrinolysis:

1 g (1 ampoule of 10 ml or 2 ampoules of 5 ml) Сангераic acid by slow intravenous injection (= 1 ml/minute) every 6 to 8 hours, equivalent to 15 mg/kg BW

Renal impairment

In renal insufficiency leading to a risk of accumulation, the use of Сангераic acid is contraindicated in patients with severe renal impairment. For patients with mild to moderate renal impairment, the dosage of Сангераic acid should be reduced according to the serum creatinine level:

Serum creatinine

Dose IV

Administration

μmol/l

mg/10 ml

120 to 249

1.35 to 2.82

10 mg/kg BW

Every 12 hours

250 to 500

2.82 to 5.65

10 mg/kg BW

Every 24 hours

> 500

> 5.65

5 mg/kg BW

Every 24 hours

Hepatic impairment

No dose adjustment is required in patients with hepatic impairment.

Paediatric Population:

The efficacy, posology and safety of Сангераic acid in children undergoing cardiac surgery have not been fully established.

Elderly:

No reduction in dosage is necessary unless there is evidence of renal failure.

Method of administration

The administration is strictly limited to slow intravenous injection.

Special precautions for disposal and other handling

The product is for single use only. Any unused medicinal product or waste material should be disposed of in accordance with local requirements.