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重症低血压静脉注射液angiotensin II(商标名 Giapreza)获FDA批准

2017-12-22 06:41:06  作者:新特药房  来源:互联网  浏览次数:33  文字大小:【】【】【
简介:2017年12月21日,美国食品和药品监管局今天批准Giapreza (血管紧张素angiotensin II) 注射为成年中有败血症或其他分配性休克静脉输注增加血压。FDA的药品评价和研究中心中心血管和肾产品部主任Norman Stockbrid ...

2017年12月21日,美国食品和药品监管局今天批准血管紧张素angiotensin II(商标名 Giapreza,La Jolla制药) 注射为成年中有败血症或其他分配性休克静脉输注增加血压。
FDA的药品评价和研究中心中心血管和肾产品部主任Norman Stockbridge,M.D.,Ph.D.说:"休克,不能维持血流至生命组织,可能导致器官衰竭和死亡,"  "对危重地生病不能对可得到的治疗适当反应的低血压患者这是一个需求的治疗选择。"
血压是当心脏泵出血液时推向动脉的血管壁的一种力量。低血压是异常地低血压。休克是一种危重情况其中血压掉至如此低,使大脑,肾脏和其他生命器官不能接受足够血流至适当地功能。
在一项321例有休克和一个危重低血压患者临床试验,与用安慰剂治疗患者比较显著地更多患者对用Giapreza治疗反应。Giapreza有效地增加血压当加入至用于升高血压的常用治疗。
Giapreza可能致危险的血凝块有严重的后果(凝块在动脉和静脉,包括深部静脉血栓形成);应被使用对血液凝固预防性治疗。
这个申请接受一个优先审评,在它下FDA的目的是采取行动用一个申请在6个月内当监管局决定该药物,如被批准,将显著地改善治疗,诊断或预防一种严重情况安全或有效。
FDA授予La Jolla制药公司Giapreza的批准。
GIAPREZA™ (angiotensin II) increases blood pressure in adults with septic or other distributive shock.
Standard dilution:
[2.5mg] [500mL] [Titrate-see comments.]
Fluid restricted:
[2.5mg] [250mL]  [Titrate-see comments.]
[5mg] [500mL]  [Titrate -see comments.]
Use the drip rate calculator - final option - ng/kg/min
[Dilution Data]
Preparation:  GIAPREZA must be administered as an intravenous infusion. GIAPREZA must be diluted in 0.9% sodium chloride prior to use. Dilute the contents of one vial of GIAPREZA in 0.9% saline to achieve a final concentration of 5,000 ng/mL or 10,000 ng/mL.
Discard vial and any unused portion of the drug product after use.
Table 1: Preparation of Diluted Solution

Fluid Restricted? Vial Strength Withdraw Amount (mL) Infusion Bag Size (mL) Final Concentration (ng/mL)
No 2.5 mg/mL 1 500 5,000
Yes 2.5 mg/mL 1 250 10,000
5 mg/2 mL 2 500 10,000

Diluted solution may be stored at room temperature or under refrigeration. Discard prepared solution after 24 hours at room temperature or under refrigeration.
Administration
The recommended starting dosage of GIAPREZA is 20 nanograms (ng)/kg/min via continuous intravenous infusion. Administration through a central venous line is recommended.
Monitor blood pressure response and titrate GIAPREZA every 5 minutes by increments of up to 15 ng/kg/min as needed to achieve or maintain target blood pressure. Do not exceed 80 ng/kg/min during the first 3 hours of treatment. Maintenance doses should not exceed 40 ng/kg/min. Doses as low as 1.25 ng/kg/min may be used.
Once the underlying shock has sufficiently improved, down-titrate every 5 to 15 minutes by increments of up to 15 ng/kg/min based on blood pressure.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Stability data:
GIAPREZA vials should be stored in the refrigerator (36-46°F, 2-8°C).
Discard prepared diluted solution after 24 hours at room temperature or under refrigeration.
Diluted solution may be stored at room temperature or under refrigeration. Discard prepared solution after 24 hours at room temperature or under refrigeration.
Discard vial and any unused portion of the drug product after use.
WARNINGS
See warnings and precautions below.
DESCRIPTION  
Description:
Angiotensin II is a naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and an increase in blood pressure. GIAPREZA is a sterile, aqueous solution of synthetic human angiotensin II for intravenous administration by infusion. Each 1 mL of GIAPREZA contains 2.5 mg angiotensin II equivalent to an average of 2.9 mg angiotensin II acetate, 25 mg mannitol, and Water for Injection adjusted with sodium hydroxide and/or hydrochloric acid to pH of 5.5.
The chemical name of the synthetic angiotensin II acetate is L-Aspartyl-L-arginyl-L-valyl-Ltyrosyl-L-isoleucyl-L-histidyl-L-prolyl-L-phenylalanine, acetate salt. The counter ion acetate is present in a non-stoichiometric ratio. It is a white to off-white powder, soluble in water.
CLINICAL PHARMACOLOGY: 
Mechanism of Action:
Angiotensin II raises blood pressure by vasoconstriction and increased aldosterone release. Direct action of angiotensin II on the vessel wall is mediated by binding to the G-protein-coupled angiotensin II receptor type 1 on vascular smooth muscle cells, which stimulates Ca2+/calmodulin-dependent phosphorylation of myosin and causes smooth muscle contraction.   
INDICATIONS AND USAGE:
GIAPREZA increases blood pressure in adults with septic or other distributive shock.
USE IN SPECIFIC POPULATIONS
8.1. Pregnancy
Risk Summary
The published data on angiotensin II use in pregnant women are not sufficient to determine a drug-associated risk of adverse developmental outcomes. Animal reproduction studies have not been conducted with GIAPREZA.
All pregnancies have a background risk of birth defects, loss, or other adverse outcomes. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinical Considerations
Disease-associated maternal and/or embryo/fetal risk
Septic or other distributive shock is a medical emergency that can be fatal if left untreated. Delaying treatment in pregnant women with hypotension associated with septic or other distributive shock is likely to increase the risk of maternal and fetal morbidity and mortality.
8.2. Lactation
Risk Summary
It is not known whether GIAPREZA is present in human milk. No data are available on the effects of angiotensin II on the breastfed child or the effects on milk production.
8.4. Pediatric Use
The safety and efficacy of GIAPREZA in pediatric patients have not been established.
8.5. Geriatric Use
In ATHOS-3, 48% of the total patient population was aged 65 years and older. There was no significant difference in safety or efficacy between patients less than 65 and those 65 years or older when treated with GIAPREZA.
CONTRAINDICATIONS 
Contraindications:
None
PRECAUTIONS 
WARNINGS AND PRECAUTIONS:
5.1 Risk for Thrombosis
The safety of GIAPREZA was evaluated in 321 adults with septic or other distributive shock in a randomized, double-blind, placebo-controlled study, ATHOS-3. There was a higher incidence of arterial and venous thrombotic and thromboembolic events in patients who received GIAPREZA compared to placebo-treated patients in the ATHOS-3 study (13% vs. 5%). The major imbalance was in deep venous thromboses. Use concurrent venous thromboembolism (VTE) prophylaxis. 
ADVERSE REACTIONS:
•The most common adverse reactions reported in greater than 10% in GIAPREZA treated patients were thromboembolic events. (6.1)
To report SUSPECTED ADVERSE REACTIONS, contact La Jolla Pharmaceutical Company at 1-800-651-3861 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
See PACKAGE INSERT for PATIENT COUNSELING INFORMATION and Medication Guide. 
DOSAGE AND ADMINISTRATION:
2.1. Preparation
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
GIAPREZA must be administered as an intravenous infusion. GIAPREZA must be diluted in 0.9% sodium chloride prior to use. Dilute the contents of one vial of GIAPREZA in 0.9% saline to achieve a final concentration of 5,000 ng/mL or 10,000 ng/mL.
Discard vial and any unused portion of the drug product after use.
Table 1: Preparation of Diluted Solution

Fluid Restricted? Vial Strength Withdraw Amount (mL) Infusion Bag Size (mL) Final Concentration (ng/mL)
No 2.5 mg/mL 1 500 5,000
Yes 2.5 mg/mL 1 250 10,000
5 mg/2 mL 2 500 10,000

Diluted solution may be stored at room temperature or under refrigeration. Discard prepared solution after 24 hours at room temperature or under refrigeration.
2.2. Administration
The recommended starting dosage of GIAPREZA is 20 nanograms (ng)/kg/min via continuous intravenous infusion. Administration through a central venous line is recommended.
Monitor blood pressure response and titrate GIAPREZA every 5 minutes by increments of up to 15 ng/kg/min as needed to achieve or maintain target blood pressure. Do not exceed 80 ng/kg/min during the first 3 hours of treatment. Maintenance doses should not exceed 40 ng/kg/min. Doses as low as 1.25 ng/kg/min may be used.
Once the underlying shock has sufficiently improved, down-titrate every 5 to 15 minutes by increments of up to 15 ng/kg/min based on blood pressure.
HOW SUPPLIED  
DOSAGE FORMS AND STRENGTHS:
Injection: 2.5 mg/mL angiotensin II and 5 mg/2 mL angiotensin II (2.5 mg/mL) in a vial.
GIAPREZA is a clear, aqueous solution.
Storage and Stability 
How Supplied
GIAPREZA (angiotensin II) Injection is a clear, aqueous solution for administration by intravenous infusion supplied as a single dose vial in two strengths:
2.5mg/mL vial: NDC 68547-501-02: A carton of one 1 mL single dose vial containing 2.5 mg angiotensin II (as a sterile liquid).
5mg/2 mL vial: NDC 68547-002-05: A carton of one 2 mL single dose vial containing 5 mg (2.5 mg/mL) angiotensin II (as a sterile liquid).
Storage and Handling
GIAPREZA vials should be stored in the refrigerator (36-46°F, 2-8°C).
Discard prepared diluted solution after 24 hours at room temperature or under refrigeration.
Reference:
GIAPREZA (angiotensin II) Injection for Intravenous Infusion
Initial U.S. Approval: 2017
Manufactured for:
La Jolla Pharmaceutical Company
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm590249.htm

责任编辑:p53


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