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Intravenous Dilution Guidelines

HEMATIN (PANHEMATIN ®)

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

Sterile water

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

313 mg vial/ 43 ml
[Prescribed dose] [10-15 min]  (See comments)

Update: July 2014


Albumin should be considered the primary diluent based on comments in various specialized references:

"We recommend that lyophilized hemin be reconstituted with human albumin to enhance stability (60). Degradation products form rapidly in vitro when lyophilized hemin is reconstituted with sterile water, as recommended in product labeling. These degradation products adhere to endothelial cells, platelets, and coagulation factors and cause a transient anticoagulant effect and often phlebitis at the site of infusion. Phlebitis can be severe and can compromise venous access with repeated administration. In our experience, reconstitution with albumin enhances stability of lyophilized hemin, decreases the incidence of phlebitis, prevents the anticoagulant effect, and may enhance efficacy(60)."

60. Bonkovsky HL, Healey JF, Lourie AN, Gerron GG. Intravenous hemealbumin
in acute intermittent porphyria: evidence for repletion of hepatic hemoproteins
and regulatory heme pools. Am J Gastroenterol. 1991;86:1050-6.


[Source: Anderson KE, Bloomer JR, Bonkovsky HL, et al. Recommendations for the Diagnosis and Treatment of the Acute Porphyrias. Ann Intern Med. 2005;142:439-450.]

Similar comments were also found here:
Rimoin DL, Pyeritz RE, Korf B. Inherited Porphyrias - IN: Emery and Rimoin's Principles and Practice of Medical Genetics. Academic Press, Mar 20, 2013. Chapter 99 (pg.13).


Stability / Miscellaneous

Mix just before use / Must use 0.22 micron filter.
Final concentration: 7 mg/ml or @ 301 mg/ 43 ml per manufacturer.

Remove entire volume with a syringe and add the "amount ordered" back into the vial.

Mix just before use (undergoes rapid decomposition).
Usual dose: 1 to 4 mg/kg/day. Maximum dose: 6 mg/kg.

Mechanism of action:
Heme acts to limit the hepatic and/or marrow synthesis of porphyrin (likely due to inhibition of aminolevulonic acid synthetase-the enzyme which limits the rate of porphyrin synthesis.)

Nursing instruction: (1) flush the line with normal saline (2) Add a 0.22 micron filter to the line-must be used because the solution is not transparent and any undissolved particulate matter is difficult to see. (3) Infuse Hematin over 10 to 15 minutes. (4) Use normal saline as a backflush to complete the infusion. Note: the filter will be stained dark brown.
Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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