Beriate 250

LEAFLET INCLUDED IN THE PACKAGE: INFORMATION FOR

THE USER

Beriate

Beriate 250, 250 IU Powder and solvent for solution for injection or infusion
Beriate 500, 500 IU Powder and solvent for solution for injection or infusion
Beriate 1000, 1000 IU Powder and solvent for solution for injection or infusion
Beriate 2000, 2000 IU Powder and solvent for solution for injection or infusion
Human coagulation factor VIII

You should carefully read the contents of this leaflet before using the medicine, as it contains important information for the patient.

• You should keep this leaflet, so that you can read it again if you need to.
• If you have any doubts, you should consult your doctor or pharmacist.
• This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm them, even if their symptoms are the same as yours.
• If the patient experiences any side effects, including any not listed in this leaflet, they should tell their doctor or pharmacist. See section 4.

Table of contents of the leaflet:

• 1. What is Beriate and what is it used for
• 2. Important information before using Beriate
• 3. How to use Beriate
• 4. Possible side effects
• 5. How to store Beriate
• 6. Contents of the package and other information

1. What is Beriate and what is it used for

What is Beriate?
Beriate consists of powder and solvent. The prepared solution is for intravenous administration by injection or infusion.
Beriate is produced from human plasma (the liquid part of the blood) and contains human coagulation factor VIII. It is used for the prevention and treatment of bleeding caused by a lack of factor VIII (hemophilia type A) in the blood. It can also be used to treat acquired factor VIII deficiency.
What is Beriate used for?
Factor VIII is involved in the blood clotting process. A lack of factor VIII means that the blood does not clot as quickly as it should, resulting in an increased tendency to bleed. Supplementing factor VIII with Beriate temporarily improves the blood clotting mechanism.

2. Important information before using Beriate

The following sections contain information that should be considered before using Beriate.

When not to use Beriate

• If the patient is allergic (hypersensitive) to the active substance (human coagulation factor VIII) or any of the other ingredients of this medicine (listed in section 6).

Warnings and precautions

Identifiability
It is strongly recommended that each administration of Beriate to the patient be recorded in the treatment diary, including the date of administration, batch number, and volume injected.
Before starting treatment with Beriate, this should be discussed with the doctor or pharmacist.

• It is possible to have allergic reactions. Patients should be informed by the doctor about early signs of allergic reactions,such as hives, generalized rash, chest tightness, wheezing, low blood pressure, and anaphylaxis (a severe allergic reaction that can cause serious breathing difficulties or dizziness). If such symptoms occur, patients should immediately stop using the product and contact their treating doctor.
• The formation of inhibitors(antibodies) is a known complication that can occur during treatment with all factor VIII medicines. These inhibitors, especially at high levels, disrupt proper treatment, and the patient will be closely monitored for the production of these inhibitors. If the patient's bleeding is not properly controlled with Beriate, they should immediately tell their doctor.
• In the case of existing heart disease or the risk of its occurrence, the doctor or pharmacist should be informed.
• If the administration of Beriate requires a central venous access device (CVAD), the doctor should consider the risk of complications associated with CVAD, including local infections, the appearance of bacteria in the blood (bacteremia), and the formation of blood clots in the blood vessels (thrombosis) at the site of catheter insertion.

The doctor should carefully weigh the benefits of treatment with Beriate against the risk of these complications.

Safety of use in terms of the possibility of transmitting viruses

In the case of medicines produced from human blood or plasma, appropriate preventive measures are taken to prevent the transmission of infection to patients.
These measures include careful selection of blood and plasma donors to exclude carriers of infectious diseases and testing each donation and plasma pool for viruses/infections.
Manufacturers of these products also include procedures in the production process that inactivate or remove viruses or other pathogens. Despite the use of these measures, when administering medicines derived from human blood or plasma, it is not possible to completely exclude the possibility of transmitting infectious agents. This also applies to unknown or newly discovered viruses and other types of infections.
The safety measures used are considered effective against enveloped viruses, such as human immunodeficiency virus (HIV, the virus that causes AIDS), hepatitis B and C viruses, as well as against non-enveloped viruses, such as hepatitis A virus and parvovirus B19.
In the case of regular or repeated administration of products derived from human plasma (e.g., factor VIII), the doctor may recommend vaccination against hepatitis A and B.

Beriate and other medicines

• The doctor or pharmacist should be informed about all medicines the patient is currently taking or has recently taken, as well as any medicines the patient plans to take.
• Beriate should not be mixed with other medicinal products, diluents, and solvents, except those recommended by the manufacturer (see section 6).

Pregnancy, breastfeeding, and fertility

• If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor or pharmacist before using this medicine.
• Beriate should be used during pregnancy and breastfeeding only if clearly necessary.
• Data on fertility are not available.

Driving and using machines

Beriate does not affect the ability to drive or use machines.

Beriate contains sodium

Beriate 250 IU and 500 IU contain less than 1 mmol of sodium (23 mg) per vial, so it can be considered "essentially sodium-free".
Beriate 1000 IU and 2000 IU contain 27.55 mg of sodium (the main component of table salt) per vial. This is equivalent to 1.4% of the recommended maximum daily intake of sodium for an adult.

3. How to use Beriate

This medicine should always be used as directed by the doctor or pharmacist. In case of doubts, the doctor or pharmacist should be consulted.
Treatment of hemophilia A should be initiated and maintained under the supervision of a doctor experienced in the treatment of this type of disease.

Recommended dose

The required amount of factor VIII and the duration of treatment depend on several factors, such as body weight, disease severity, location, and intensity of bleeding or the need to prevent bleeding during surgery or examination.
If the doctor has recommended using Beriate at home, they should inform the patient about how to inject the medicine and what dose to use.
Instructions received from the doctor or nurse at the hemophilia treatment center must be followed.
Follow the instructions of the hemophilia treatment center.

Use in children and adolescents

The dose is determined based on body weight, using the same principle as for adults.

Overdose of Beriate

No symptoms of factor VIII overdose have been reported.

Missed dose of Beriate

The next dose should be administered immediately and continued at regular intervals as directed by the doctor. A double dose should not be administered to make up for a missed dose.

Reconstitution and administration method General recommendations:

• The powder should be mixed (reconstituted) with the solvent (liquid part) and drawn from the vial under aseptic conditions.
• The reconstituted solution should be clear or slightly opalescent, i.e., it may shine when observed in light. Sometimes, single fibers or particles may appear in the vial. The filter, which is part of the Mix2Vial device, removes solid particles. Filtration does not affect dose calculation. Before administration, after filtration and drawing the product into the syringe (see below), the solution should be visually inspected for the presence of small particles and discoloration. Do not use the solution if it is cloudy or contains sediment or particles in the syringe.
• After transferring to the syringe, the product should be used immediately. Do not store the product in the syringe.
• Any unused product or waste should be disposed of in accordance with local regulations and the doctor's instructions.

Reconstitution:
Without opening the vials, warm the Beriate powder and solvent to room temperature or body temperature. This can be achieved by leaving the vials at room temperature for about an hour or by holding them in your hands for a few minutes.
DO NOT expose the vials to direct heat sources. The vial should not be heated to a temperature above body temperature (37°C).
Carefully remove the protective caps from the vials with the powder and solvent, wipe the surface of the rubber stoppers with an alcohol swab, and let them dry before opening the Mix2Vial package, then follow the instructions below.

• 1. Open the Mix2Vial package by removing the cap. Do notremove the Mix2Vial from the blister!

• 2. Place the vial with the solventon a flat and clean surface and hold it firmly. Do not remove the Mix2Vial from the blister. Pressing the tip of the blue connector vertically down, pierce the cork of the solvent vial.

• 3. Carefully remove the blister from the Mix2Vial by holding the edge and pulling verticallyupwards. Note that only the blister should be removed, not the entire Mix2Vial.

4 .Place the vial with the product on a flat and hard surface.
Turn the vial with the solvent and the attached Mix2Vial set upside down and, pressing the tip of the transparent connector vertically down, pierce the cork of the vial with the product. The solvent will flow into the vial with the product.

• 5. Holding the vial with the medicinal product attached to the Mix2Vial with one hand and the vial with the solvent also attached to the Mix2Vial with the other hand, carefully unscrew the Mix2Vial into two parts by turning it counterclockwise. Remove the vial with the solvent with the attached blue connector of the Mix2Vial.

• 6. Bring the substance to complete dissolution by gently rotating the vial with the product with the attached transparent connector. Do not shake.

7	7. Draw air into an empty, sterile syringe. Holding the vial with the product vertically, attach the syringe to the Luer Lock connection of the Mix2Vial, turning it clockwise. Inject air into the vial with the product.

Withdrawal and administration:

• 8. Holding the plunger of the syringe pressed, turn the entire set upside down and fill the syringe with the solution, slowly pulling the plunger of the syringe.

• 9. The solution is now in the syringe. Holding the syringe cylinder (with the plunger facing down) firmly, detach the transparent connector of the Mix2Vial from the syringe by turning it counterclockwise.

Insert the needle into a vein using the provided venipuncture set. Allow blood to flow into the end of the tube. Attach the syringe to the threaded, securing end of the venipuncture set. According to the doctor's instructions, slowly injectthe reconstituted solution intravenously. The injection or infusion rate should not exceed 2 ml per minute. Care should be taken to ensure that blood does not enter the syringe containing the product.
If it is necessary to administer a larger volume, this can also be done by infusion. To do this, transfer the product after reconstitution to an approved infusion set. Perform the infusion as directed by the doctor.
Attention should be paid to the occurrence of any side effects. If such an effect may be related to the administration of Beriate, the injection or infusion should be discontinued (see also section 2).
In case of further doubts about the use of this medicine, the doctor or pharmacist should be consulted.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If any of the following symptoms occur, the doctor or emergency services or the hemophilia treatment center at the nearest hospital should be notified immediately:

• Symptoms of angioedema, such as
• swelling of the face, tongue, or throat
• difficulty swallowing
• hives and difficulty breathing The above side effects are very rare (may occur in less than 1 in 10,000 patients) and in some cases may lead to severe allergic reactions (anaphylaxis), including shock.
• Loss of treatment effectiveness (persistent bleeding). In the case of previously untreated children with factor VIII medicines, inhibitory antibodies (see section 2) may occur very frequently (more than 1 in 10 patients). However, in patients who have previously been treated with factor VIII (more than 150 days of treatment), the risk is not very common (less than 1 in 100 patients). If this happens, the patient's medicines may stop working properly, and the patient may experience persistent bleeding. If this happens, the doctor should be notified immediately.

Other side effects:

• Allergic reactions (hypersensitivity), which may include:
• burning and stinging at the injection or infusion site
• chills, fever, generalized rash, blisters
• headache
• low blood pressure, anxiety, rapid heartbeat, chest tightness, wheezing
• feeling of fatigue (lethargy)
• nausea, vomiting
• tingling The above side effects are very rare and in some cases may lead to severe allergic reactions (anaphylaxis), including shock.
• Very rarely, an increased body temperature has been observed.

Side effects in children and adolescents

The frequency, type, and severity of adverse reactions in children are comparable to those in adults.

Reporting side effects

If side effects occur, including any not listed in the leaflet, the doctor or pharmacist or nurse should be informed.
Side effects can be reported directly to the Department of Adverse Reaction Monitoring of Medicinal Products, Medical Devices, and Biocidal Products
Al. Jerozolimskie 181C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl
Side effects can also be reported to the marketing authorization holder.
By reporting side effects, more information can be collected on the safety of the medicine.

5. How to store Beriate

Do not use this medicine after the expiry date stated on the label and carton after "EXP". The expiry date refers to the last day of that month.
The batch number is stated on the label and carton after "Lot".

• Store in a refrigerator (2°C - 8°C).
• During the shelf life, Beriate may be stored at a temperature not exceeding 25°C for a total of 1 month. Individual periods of storage at room temperature should be recorded in the treatment documentation so that the total storage time at this temperature does not exceed one month.
• Beriate does not contain a preservative, and it is desirable to administer it immediately after reconstitution.
• If the reconstituted product is not administered immediately, its storage time in the vial should not exceed 8 hours at room temperature. After transfer to a syringe, the product should be used immediately.
• Do not freeze.
• Store the container in the outer packaging to protect it from light.
• The medicine should be stored out of sight and reach of children.

6. Contents of the package and other information

What Beriate contains The active substance of the medicine is:

Beriate is available in powder form (containing nominally 250 IU, 500 IU, 1000 IU, or 2000 IU of human coagulation factor VIII per vial) and liquid part (solvent). The solution after reconstitution is for injection or infusion.
Beriate 250/500/1000 reconstituted with 2.5 ml, 5 ml, and 10 ml of water for injection, respectively, contains approximately 100 IU/ml of human coagulation factor VIII.
Beriate 2000 should be reconstituted with 10 ml of water for injection, and the resulting solution contains approximately 200 IU/ml of human coagulation factor VIII.
Other ingredients are:
Glycine, calcium chloride, sodium hydroxide (in small amounts) to adjust pH, sucrose, sodium chloride. Solvent:water for injection 2.5 ml, 5 ml, and 10 ml, respectively.

What Beriate looks like and what the package contains

Beriate is available as a white powder and is supplied with water for injection.
The reconstituted solution should be clear to slightly opalescent, i.e., it may shine when held in light, but it must not contain any visible particles.
Available packages
Package with 250 IU containing:
1 vial with powder
1 vial with water for injection 2.5 ml
1 20/20 transfer system with filter
Administration set (inner packaging):
1 single-use syringe 5 ml
1 venipuncture set
2 alcohol swabs
1 non-sterile plaster
Package with 500 IU containing:
1 vial with powder
1 vial with water for injection 5 ml
1 20/20 transfer system with filter
Administration set (inner packaging):
1 single-use syringe 5 ml
1 venipuncture set
2 alcohol swabs
1 non-sterile plaster.
Package with 1000 IU containing:
1 vial with powder
1 vial with water for injection 10 ml
1 20/20 transfer system with filter
Administration set (inner packaging):
1 single-use syringe 10 ml
1 venipuncture set
2 alcohol swabs
1 non-sterile plaster.
Package with 2000 IU containing:
1 vial with powder
1 vial with water for injection 10 ml
1 20/20 transfer system with filter
Administration set (inner packaging):
1 single-use syringe 10 ml
1 venipuncture set
2 alcohol swabs
1 non-sterile plaster.
Not all package sizes may be marketed.

Marketing authorization holder and manufacturer

CSL Behring GmbH
Emil-von-Behring-Str. 76
35041 Marburg
Germany

This medicinal product is authorized in the Member States of the European Economic Area under the following names

Austria:
Beriate 100 IU/ml Powder and solvent for solution for injection or infusion (250 IU, 500 IU, 1000 IU)
Beriate 200 IU/ml Powder and solvent for solution for injection or infusion (2000 IU)
Bulgaria:
Beriate 250 IU Powder and solvent for solution for injection or infusion
Beriate 500 IU Powder and solvent for solution for injection or infusion
Beriate 1000 IU Powder and solvent for solution for injection or infusion
Beriate 2000 IU Powder and solvent for solution for injection or infusion
Croatia:
Beriate 250 IU powder and solvent for solution for injection or infusion
Beriate 500 IU powder and solvent for solution for injection or infusion
Beriate 1000 IU powder and solvent for solution for injection or infusion
Beriate 2000 IU powder and solvent for solution for injection or infusion
Czech Republic:
Beriate 250 IU, Beriate 500 IU, Beriate 1000 IU, Beriate 2000 IU
Estonia:
Beriate
Latvia:
Beriate 250 IU powder and solvent for solution for injection or infusion
Beriate 500 IU powder and solvent for solution for injection or infusion
Beriate 1000 IU powder and solvent for solution for injection or infusion
Beriate 2000 IU powder and solvent for solution for injection or infusion
Lithuania:
Beriate 250 IU powder and solvent for solution for injection or infusion
Beriate 500 IU powder and solvent for solution for injection or infusion
Beriate 1000 IU powder and solvent for solution for injection or infusion
Beriate 2000 IU powder and solvent for solution for injection or infusion
Germany:
Beriate 250, Beriate 500, Beriate 1000, Beriate 2000
Hungary:
Presentations of Beriate 250, 500 and 1000:
BERIATE 100 NE/ml powder and solvent for solution for injection or infusion (250 IU, 500 IU, 1000 IU)
Presentation 2000:
BERIATE 200 NE/ml powder and solvent for solution for injection or infusion (2000 IU)
Italy:
Beriate
Poland:
Beriate 250
Beriate 500
Beriate 1000
Beriate 2000
Portugal:
Beriate
Romania:
Beriate 250 IU powder and solvent for solution for injection or infusion
Beriate 500 IU powder and solvent for solution for injection or infusion
Beriate 1000 IU powder and solvent for solution for injection or infusion
Beriate 2000 IU powder and solvent for solution for injection or infusion
Spain:
Beriate 250 IU powder and solvent for solution for injection or infusion
Beriate 500 IU powder and solvent for solution for injection or infusion
Beriate 1000 IU powder and solvent for solution for injection or infusion
Beriate 2000 IU powder and solvent for solution for injection or infusion
Slovakia:
Beriate 250 IU
Beriate 500 IU
Beriate 1000 IU
Beriate 2000 IU
Slovenia:
Beriate 250 IU powder and solvent for solution for injection or infusion
Beriate 500 IU powder and solvent for solution for injection or infusion
Beriate 1000 IU powder and solvent for solution for injection or infusion
Beriate 2000 IU powder and solvent for solution for injection or infusion

Date of last revision of the leaflet: September 2021

Information intended for healthcare professionals only:

Dosage

Monitoring of treatment
During treatment, it is necessary to properly determine the levels of factor VIII to measure the appropriate dose to be administered to the patient and the frequency of repeated infusions.
Patient responses to factor VIII may vary, due to different recovery levels and half-lives. Dosing based on body weight may need to be adjusted in patients who are overweight or underweight. In particular, for major surgical procedures, it is necessary to closely monitor substitution therapy through coagulation control (factor VIII activity level in plasma).
Patients should be monitored for the development of factor VIII inhibitors. See also section 2.
The number of factor VIII units administered to the patient is expressed in international units (IU), which refer to the current WHO standards for factor VIII concentrates. Factor VIII activity in plasma is expressed as a percentage (relative to normal human plasma) or preferably in IU (relative to the international standard for factor VIII in plasma).
One international unit of factor VIII activity is equal to the activity of factor VIII contained in 1 ml of normal human plasma.
Treatment on demand
The calculation of the required factor VIII dose is based on the empirical finding that 1 IU of factor VIII per kilogram of body weight increases the activity of factor VIII in plasma by about 2% of normal activity (2 IU/dl). The required dose is calculated using the following formula:
Required dose (in IU) = body weight (in kg) x desired increase in factor VIII level (in % or IU/dl) x 0.5.
The dose of the product and its administration frequency should always be individually tailored, depending on the clinical effectiveness in individual patients.
In the following cases of bleeding, factor VIII activity should not fall below the specified values for activity in plasma (as a percentage of normal or IU/dl) during the corresponding period. The following table presents possible dosing for bleeding and surgical procedures:

Prophylaxis
In long-term prophylactic treatment of bleeding in patients with severe hemophilia A, 20-40 IU of factor VIII per kilogram of body weight are usually administered at intervals of 2 to 3 days. In some cases, especially in younger patients, more frequent administration of factor VIII or the use of higher doses may be necessary.
Children and adolescents
Dosing in children is based on body weight, using the same principle as for adults. The administration frequency should always be individually tailored, depending on clinical effectiveness. Cases of treatment of children under the age of 6 have been reported.

Information on the pharmacological properties of VWF

In addition to its role as a protective protein for factor VIII, von Willebrand factor mediates platelet adhesion to the site of vascular injury and plays a role in platelet aggregation.