Your browser does not support JavaScript! BEBULIN (COAGULATION FACTOR IX HUMAN) KIT [BAXTER HEALTHCARE CORPORATION]
DailyMed Logo Header image

Daily Med

Current Medication Information

Options

RxNorm Names

BEBULIN (coagulation factor ix human) kit
[Baxter Healthcare Corporation]


Category DEA Schedule Marketing Status
PLASMA DERIVATIVE Biologic Licensing Application
Drug Label Sections

DESCRIPTION

BEBULIN (Factor IX Complex), Nanofiltered and Vapor Heated is a purified, sterile, freeze-dried concentrate of the Coagulation Factor IX (Christmas Factor) as well as Factor II (Prothrombin) and Factor X (Stuart-Prower Factor) and low amounts of Factor VII. In addition, the product contains small amounts of heparin (≤ 0.15 IU heparin per IU Factor IX).

BEBULIN is standardized in terms of Factor IX content and each vial is labeled for the Factor IX content indicated in International Units (IU). One International Unit of Factor IX (according to the current International Standard for Human Blood Coagulation Factors II, IX, and X in concentrates) corresponds to the activity of Factor IX in 1 mL of fresh normal human plasma.

BEBULIN is manufactured from large plasma pools of human plasma. Screening against potentially infectious agents begins with the donor selection process and continues throughout plasma collection and plasma preparation. Each individual plasma donation used in the manufacture of BEBULIN is collected only at FDA approved blood establishments and is tested by FDA licensed serological tests for Hepatitis B Surface Antigen (HBsAg), for antibodies to Human Immunodeficiency Virus (HIV-1/HIV-2) and Hepatitis C Virus (HCV) in accordance with U.S. regulatory requirements. As an additional safety measure, mini-pools of the plasma are tested for the presence of HIV-1 and HCV by FDA licensed Nucleic Acid Testing (NAT) and found negative. Validated virus removal/inactivation steps have been integrated into the manufacturing process, namely 35 nm nanofiltration1 and a vapor heat treatment process2 [10 hours at 60°C and subsequent 1 hour at 80°C under the condition of 7-8% (w/v) residual moisture]. In addition DEAE-Sephadex adsorption contributes to the virus safety profile of BEBULIN. Despite these measures, this product can still potentially transmit disease3 [see Warnings].

In vitro spiking studies have been used to validate the capability of the manufacturing process to remove and inactivate viruses. To establish virus clearance capacity of the manufacturing process, these virus clearance studies were performed in accordance with good laboratory practices under extreme conditions (e.g. at minimum incubation times and temperatures below specifications for vapor-heat treatment). The in vitro viral reduction studies performed on nanofiltered BEBULIN are summarized in Table 1 .

Table 1 Mean log10 Reduction Factors (RFs) For Each Virus and Manufacturing Step*  
*
Reduction factors < 1 log are not used for calculation of the overall reduction factor.
Studies on B19V, which are considered experimental in nature, have demonstrated a virus reduction factor of not more than 3.6 log10 and 4.6 log10 by DEAE-Sephadex adsorption and vapor -heat treatment, respectively.
HIV-1, Human Immunodeficiency Virus Type 1
BVDV, Bovine Viral Diarrhea Virus (model for Hepatitis C Virus and other lipid enveloped RNA viruses)
PRV, Pseudorabies Virus (model for lipid enveloped DNA viruses including Hepatitis B Virus)
HAV, Hepatitis A Virus
MMV, Mice Minute Virus (model for non-lipid enveloped DNA viruses, including human parvovirus B19 [B19V])
§
n.d.: Not done
Studies on West Nile Virus (WNV), have demonstrated a virus reduction factor of 3.1 log10 by the 35 nm nanofiltration step.
Virus TypeEnveloped RNAEnveloped DNANon-enveloped RNANon-enveloped DNA
Virus FamilyRetroviridaeFlaviviridaeHerpesviridaePicornaviridaeParvoviridae
VirusHIV-1BVDVPRVHAVMMV
DEAE Sephadex Adsorptionn.d§n.dn.d1.41.3
35 nm Nanofiltration> 6.42.0> 6.01.7≤1.0
Vapor-Heat Treatment> 6.8> 7.1 > 7.4> 4.5≤1.0
Overall log reduction factor (ORF)> 13.2> 9.1> 13.4> 7.61.3

CLINICAL PHARMACOLOGY

BEBULIN is a combination of vitamin K-dependent clotting factors (Factor IX, II, X) and found in normal plasma. The administration of BEBULIN provides an increase in plasma levels of Factor IX and can temporarily correct the coagulation defect of patients with Factor IX deficiency. Plasma levels of Factors II and X will also be increased. However, no clinical studies have been conducted to show benefit from this product for treating deficiencies other than Factor IX deficiency.

In vivo recovery of BEBULIN was determined using the former International Standard, WHO 72/32 and was found to be 53.3% ±9.6%, 57.5% ±21.8%, and 53.24% ±16.95%, respectively. In the same studies, using different methodologies, half-lives were determined to be 19.4 hrs ±3.8 hrs, 24.6 hrs ±3.2 hrs, and 19.97 hrs ±8.24 hrs, respectively1.

INDICATIONS AND USAGE

BEBULIN is indicated for the prevention and control of bleeding episodes in adult patients with hemophilia B (congenital Factor IX deficiency or Christmas disease).

BEBULIN is not indicated for use in the treatment of Factor VII deficiency. No clinical studies have been conducted to show benefit from this product for treating deficiencies other than Factor IX deficiency.

CONTRAINDICATIONS

BEBULIN is contraindicated in patients with

  • Known history of hypersensitivity reactions to the product
  • Known allergy to heparin
  • Known history of heparin-induced thrombocytopenia

WARNINGS

Thrombosis

Thromboembolic events (deep vein thrombosis, pulmonary embolism, thrombotic stroke) as well as disseminated intravascular coagulation (DIC) have been reported with BEBULIN. The risk of thromboembolic complications including DIC and hyperfibrinolysis is higher in patients with congenital or acquired coagulation disorders, with repeated dosing or high doses of BEBULIN. Because of the risk of thromboembolic complications, closely monitor patients when administering BEBULIN:

  • Monitor patients closely for signs and symptoms of intravascular coagulation or thrombosis.
  • Monitor Factor IX level in patients predisposed to thromboembolic complications including patients with a history of coronary artery disease, patients with liver disease, pre- or postoperative patients, and neonates.
  • Stop the infusion immediately and initiate appropriate diagnostic and therapeutic measures at the first signs or symptoms of thrombosis or embolism.

Anaphylaxis and Hypersensitivity Reactions

Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions have been reported with BEBULIN. Manifestations of hypersensitivity or allergic reactions include anaphylactic shock, hypotension, hypertension, chest tightness, dizziness, paresthesia, lethargy, restlessness, vomiting, urticaria, erythema, pyrexia, chills, and rash. In the event of an anaphylactic/anaphylactoid reaction, stop the infusion immediately and administer appropriate emergency treatment. Evaluate patients experiencing allergic reactions for the presence of an inhibitor.

Development of Inhibitor

Formation of circulating antibodies inhibiting Factor IX has been reported with the administration of BEBULIN. If such an inhibitor occurs, the condition will manifest itself as a poor clinical response. Nephrotic syndrome has been reported following attempted immune tolerance induction in hemophilia B with Factor IX inhibitor receiving factor IX products including BEBULIN.4 The safety and efficacy of using factor IX products including BEBULIN for immune tolerance induction have not been established.

Transmission of Infectious Agents

Because BEBULIN is made from human plasma, it may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and theoretically, the classic Creutzfeldt-Jakob disease agent. This also applies to unknown or emerging viruses and other pathogens. No cases of transmission of viral diseases or vCJD have been associated with BEBULIN.

ALL infections thought by a physician to possibly have been transmitted by this product should be reported by the physician or other healthcare provider to Baxter Healthcare Corporation, at 1-800-423-2862 (in the U.S.).

PRECAUTIONS

Interference with Heparin Sensitivity Laboratory Testing

BEBULIN contains heparin. Take heparin content into account when performing clotting tests sensitive to heparin.

Information for Patients

Inform patients of all signs and symptoms of immediate hypersensitivity reactions such as fever, urticaria/hives, rashes, nausea, retching, angioedema/swelling of face or other body areas, laryngeal edema, stridor, dysphonia, bronchospasm/wheezing, hypotension, dizziness, lightheadedness, or loss of consciousness. Advise patients to discontinue use of the product and contact their physician if these symptoms occur and seek emergency care immediately for serious symptoms.

Inform patients of all signs and symptoms of parvovirus B19 infection, which is especially serious in pregnant women or immune-compromised individuals. Symptoms of parvovirus B19 infection include fever, drowsiness, chills, and runny nose followed about two weeks later by a rash and joint pain.

Drug Interactions

No drug interaction studies were performed. The effect of vitamin K antagonists (e.g. warfarin) can be temporarily overcome by the administration of human prothrombin complex products, including BEBULIN, which provides increased plasma levels of functional vitamin-K dependent coagulation Factors (II, IX and X)6.

Pregnancy

Pregnancy Category C - Animal reproduction studies have not been conducted with BEBULIN. It is also not known whether BEBULIN can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.

Pediatric Use

The safety and efficacy of the use of BEBULIN in pediatric patients have not been established.

ADVERSE REACTIONS

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

The following adverse reactions were reported in clinical studies with a previous formulation of BEBULIN:

Hypotension, Dizziness, Urticaria, Erythema, Pyrexia, and Chills.

The formation of inhibitor antibodies to Factor IX has been observed with the administration of BEBULIN.

Postmarketing Experience

Because postmarketing reporting of adverse reactions is voluntary and from a population of uncertain size, it is not always possible to reliably estimate the frequency of these reactions or establish a causal relationship to product exposure.

Table 2 lists the adverse reactions reported during postmarketing use of BEBULIN.

Table 2 Postmarketing Adverse Reactions
Blood and Lymphatic System Disorders

Disseminated intravascular coagulation

Immune System Disorders

Anaphylactic/Anaphylactoid reactions,

Hypersensitivity
Nervous System DisordersHeadache
Cardiac DisordersTachycardia
Vascular Disorders

Thromboembolic events (including Deep vein

thrombosis, Pulmonary embolism, Thrombotic stroke), Flushing
Respiratory, Thoracic, and Mediastinal Disorders

Dyspnea, Bronchospasm, Wheezing, Cough

Gastrointestinal Disorders

Abdominal pain, Nausea

Skin and Subcutaneous Tissue Disorders

Angioedema, Facial edema, Rash, Pruritus

Renal and Urinary Disorders

Nephrotic syndrome (following attempted

immune tolerance induction)
General Disorders and Administration Site ConditionsInfusion site reactions, including Infusion site pain

In addition to reactions listed above, myocardial infarction has been identified in the published literature with other Factor IX products.

DOSAGE AND ADMINISTRATION

For intravenous administration only

One International Unit (IU) of Factor IX activity/kg will increase the plasma level of Factor IX by 0.8%. Accordingly, the following formula is provided for dosage calculations:

Number of Factor IX IU required = bodyweight (kg) x desired Factor IX increase (% of normal) x 1.2.

The response to treatment will vary from patient to patient. Exact dosage determination should be based on localization and extent of hemorrhage, and the level of Factor IX to be achieved. Close laboratory monitoring of the Factor IX level is required to determine proper dosage, particularly with severe hemorrhage and major surgery. Larger doses than those derived from the above formula may be required; particularly if treatment is delayed.

Management of Bleeding 7-11

Approximate desired Factor IX levels, typical initial doses, and the average duration of treatment are suggested in Table 3. For minor bleeding, a single dose will usually be sufficient; otherwise a second dose may be given after 24 hours. More severe hemorrhage will require several doses at approximately 24-hours intervals. For maintenance therapy, usually two thirds of the initial dose is infused.

Table 3 Management of Specific Types of Bleeding
*
For patients predisposing to thrombosis see Precautions section.
Type of Bleeding

ApproximateDesired Factor IX Level

(% Normal)

Typical InitialDose

(International Units/kg)

Average Durationof Treatment

(Days)

Minor
Early hemarthrosis,
minor epistaxis,

and gingival bleeding, mild hematuria
2025-351

Moderate
Severe joint bleeding,
early hematoma, major open bleeding, minor trauma, minor hemoptysis,

hematemesis,
and melena,
major hematuria
4050-65

2 or until adequate

wound healing

Major
Severe hematoma major trauma, Severe hemoptysis,

hematemesis, and
melena
≥60*75-90

2-3 or until adequate

wound healing

Management of Surgical Procedures 7-11

Dosage guidelines for surgical procedures are suggested in Table 4. Administer preoperative loading dose one hour prior to surgery. Depending on the type of surgery, continue replacement therapy over one to several weeks until adequate wound healing is achieved. The average treatment interval will initially be 12 hours, while in the later postoperative period, 24 hours is adequate.

Table 4 Management of Surgical Procedures
*
N/A– Not Applicable.
For patients predisposing to thrombosis see Precautions section.

Type ofSurgery

Day of Operation

Init. Postop. Period

(1st to 2nd Week)

Late Postop. Period(from 3rd Week Onwards)

Approx. Level Factor IX

(% Normal)

Dose

(IU/kg)

Approx. Level Factor IX

(% Normal)

Dose

(IU/kg)

Approx. Level Factor IX

(% Normal)

Dose

(IU/kg)
Minor 40-60 50-75

20-40

25-65

N/A*N/A*
Major

≥60

75-9020-60 25-75 20 25-35

For tooth extraction, the same initial dose as for minor surgery is recommended and one infusion should be sufficient. In case of extraction of several teeth, replacement therapy for up to one week may be necessary using the same doses as for minor surgery8-11.


Reconstitution

  • Do not mix BEBULIN with other medicinal products or solvents, other than the enclosed sterilized water for injection.
  • Administer BEBULIN within 3 hours after reconstitution as the solution does not contain a preservative. Do not refrigerate after reconstitution.
  1. Warm unopened vials of both diluent and concentrate to room temperature (not to exceed 37°C, 98°F).
  2. Remove caps from both vials to expose central portions of the rubber stoppers.
  3. Cleanse exposed surface of the rubber stoppers with germicidal solution and allow to dry.
  4. Using aseptic technique, remove protective covering from one end of the double-ended needle and insert the exposed end through the diluent vial stopper.
  5. Remove protective covering from the other end of the double-ended needle. Do not touch the exposed end. Invert diluent vial over the concentrate vial, then insert free end of the needle through the concentrate vial stopper. Diluent will be drawn into the concentrate vial by vacuum.
  6. Disconnect the two vials by removing needle from the concentrate vial stopper.
    Gently agitate or rotate the concentrate vial until all material is dissolved.

Administration

For Intravenous Administration Only.

  • Parenteral drug products should be inspected for particulate matter and discoloration prior to administration.
  • The reconstituted product should be colorless to slightly yellowish and clear to slightly turbid solution. Do not administer if particulate matter or discoloration is found and notify Baxter immediately.
  • Record the name of the patient and batch number of the product in order to maintain a link between the patient and the batch of the product.
  1. After reconstituting the concentrate as described above, attach the enclosed filter needle to a sterile disposable syringe using aseptic technique. Insert filter needle through the concentrate vial stopper.
  2. Inject air and withdraw solution into the syringe.
  3. Remove and discard filter needle. Attach a suitable intravenous needle or infusion set with winged adapter.
  4. Administer the solution intravenously at a rate comfortable to the patient. The infusion rate should not exceed 2 mL per minute.

HOW SUPPLIED

BEBULIN is supplied in single dose vials (NDC 64193-445-02) with Sterile Water for Injection, U.S.P., double-ended needle, and filter needle for reconstitution and withdrawal. Factor IX activity in international units is stated on the label of each vial.

STORAGE

Store at refrigerated temperature (2°C-8°C, 35°F-46°F). Do not use BEBULIN past the expiration date printed on the unit carton. Do not freeze.

REFERENCES

  1. T. Abe et al.: Clinical Study with BENOBIL TIM 4, Steam-Treated Factor IX Complex, Single Administration. Jap. Pharm. & Ther., 14, 1986, 1, pp. 19-31.
  2. Vapor Heating is described in: World Health Organization (WHO) Technical Report, Series No. 924, 2004, Annex 4, Guidelines on viral inactivation and removal, procedures intended to assure the viral safety, of human blood plasma products.
  3. D.U. Preiss, B. Eberspächer, D. Abdullah, I. Rosner: Safety of Vapour Heated Prothrombin Complex Concentrate (PCC) Prothromplex S-TIM4. Thrombosis Research, 63, 1991, pp. 651-659.
  4. I. Warrier: Management of haemophilia B patients with inhibitors and anaphylaxis. Haemophilia, 4 (4), pp.574-576.
  5. A. Shapiro, T. Abe, L. M. Aledort, K. Anderle, M. W. Hilgartner, M. Kunschak,
    F. E. Preston, G. E. Rivard, K. Schimpf and International Factor Safety Study Group: Transfusion, 35, 1995, pp 204-208.
  6. Ansell J, Hirsch J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed). Chest 2008, 133:160S-198S.
  7. P. H. Levine: Clinical Manifestations and Therapy of Hemophilias A and B. In: R. W. Colman, J. Hirsh, V. J. Marder, E.W. Salzman (Eds.): Hemostasis and Thrombosis. Philadelphia: J. B. Lippincott Company, 1987, pp. 97-111.
  8. C. R. Rizza, P. Jones: Management of patients with inherited blood coagulation defects. In: A.L. Bloom, D.P. Thomas (Eds.): Hemostasis and Thrombosis. Edinburgh: Churchill Livingstone, 1987, pp. 465-493.
  9. T. Abe, M. Kazama: An International Survey on the Appropriate Dosage of Hemophilias and Related Congenital Coagulopathies. In: Proceedings of the 3rd International Symposium on Haemostasis and Thrombosis, 1982, pp. 273-304.
  10. I. M. Nilsson, Å. Ahlberg, G. Björlin: Clinical Experience with a Swedish Factor IX Concentrate. Acta Med. Scand., 190, 1971, pp. 257-266.
  11. J. N. George, R. T. Breckenridge: The Use of Factor VIII and Factor IX Concentrates During Surgery. JAMA, 214, 1970, 9, pp. 1673-1676.

To enroll in the confidential, Industry-wide Patient Notification System, call 1 888-873-2838.

Baxter and Bebulin are trademarks of Baxter International Inc., its subsidiaries or affiliates.

Baxter Healthcare Corporation

Westlake Village, CA-91362

USA

U.S. License No. 140                                            Revised: Jul 2012

Principle Display Panel

 BEBULIN unit carton for 200-1200 potency ranges

BEBULIN unit carton for 200-1200 potency ranges

20 mL size, dried

NDC 64193-445-02

Factor IX Complex

BEBULIN

Nanofiltered and Vapor Heated

BAXTER

For Intravenous Use Only

WARNING: Human plasma product. Human blood and its components may transmit infectious agents. The physician and patient should discuss the risks and benefits of this product.

Some components of the packaging material contain Dry Natural Rubber Latex.

Rx Only

BEBULIN is a trademark of Baxter AG, Vienna, Austria: Baxter is a trademark of Baxter International Inc., registered in the U.S. Patent and Trademark Office.

Bebulin Vial Label

BEBULIN vial label for 200-1200 potency ranges

20 mL size, dried

NDC 64193-345-01

Factor IX Complex

BEBULIN

Nanofiltered and Vapor Heated

BAXTER

For Intravenous Use Only

Rx Only

Directions for use: see package insert

Store between 2º and 8ºC (35º and 46ºF).

Reconstitute with 20 mL of Sterile Water for Injection

Baxter and Bebulin are trademarks of Baxter International Inc, Its subsidiaries or affiliates

Baxter Healthcare Corporation

Westlake Village, CA 91362 USA

U.S. License No. 140

20 mL Sterile Water for Injection vial label

20 mL Sterile Water for Injection vial label

NDC 0338-0764-62

Nonpyrogenic

Single-Dose Container

20 mL

Sterile Water for Injection, USP for reconstitution of accompanying product

Do not use unless clear. No antimicrobial agent or other substances has been added. Do not use for intravascular injection without making approximately isotonic by addition of suitable solute. Discard unused portion. Rx Only.

BAXTER

Manufactured by

Baxter Healthcare Corporation

Deerfield, IL 60015 USA

BEBULIN 
coagulation factor ix human kit
Product Information
Product TypePLASMA DERIVATIVEItem Code (Source)NDC:64193-445
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:64193-445-021 in 1 CARTON
Quantity of Parts
Part #Package QuantityTotal Product Quantity
Part 11 VIAL, GLASS 20 mL
Part 21 VIAL, GLASS 20 mL
Part 1 of 2
BEBULIN 
coagulation factor ix human injection, powder, lyophilized, for solution
Product Information
Item Code (Source)NDC:64193-345
Route of AdministrationINTRAVENOUSDEA Schedule    
Active Ingredient/Active Moiety
Ingredient NameBasis of StrengthStrength
COAGULATION FACTOR IX HUMAN (COAGULATION FACTOR IX HUMAN) COAGULATION FACTOR IX HUMAN300 [iU]  in 1 mL
Inactive Ingredients
Ingredient NameStrength
SODIUM CITRATE 
SODIUM CHLORIDE 
HEPARIN 
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:64193-345-0120 mL in 1 VIAL, GLASS
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
BLABLA10311208/19/1992
Part 2 of 2
STERILE WATER 
water liquid
Product Information
Item Code (Source)NDC:0338-0764
Route of AdministrationINTRAVENOUSDEA Schedule    
Inactive Ingredients
Ingredient NameStrength
WATER20 mL  in 20 mL
Packaging
#Item CodePackage DescriptionMarketing Start DateMarketing End Date
1NDC:0338-0764-6220 mL in 1 VIAL, GLASS
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
BLABLA10311208/19/1992
Marketing Information
Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
BLABLA10311208/19/1992
Labeler - Baxter Healthcare Corporation (085206634)
Establishment
NameAddressID/FEIBusiness Operations
Baxter Healthcare Corporation001728059MANUFACTURE

Revised: 7/2012
 
Baxter Healthcare Corporation

Visit The National Library of Medicine Copyright, Privacy, Accessibility
U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894
National Institutes of Health, Health & Human Services