1. Name Of The Medicinal Product
Human Varicella-Zoster Immunoglobulin 250 mg solution for injection
2. Qualitative And Quantitative Composition
Human Varicella-Zoster Immunoglobulin Ph.Eur. contains human protein, 40-180 g/L of which at least 95% is IgG. The concentration of specific IgG to Varicella Zoster is at least 100 IU/mL in nominal 250 mg vials. The correct volume to give 250 mg is overprinted on the label.
This product is prepared from plasma from screened donors. Donors are selected from the USA.
For excipients, see section 6.1.
3. Pharmaceutical Form
Solution for injection.
4. Clinical Particulars
4.1 Therapeutic Indications
Prophylaxis against varicella-zoster virus (VZV) infection in at risk patients exposed to varicella (chickenpox) or herpes zoster:
1. pregnant women with negative VZV immune status especially up to early in the third trimester
2. neonates whose mothers develop varicella infection within 7 days before and 7 days after delivery
3. neonates whose mothers have no history of varicella and/or a negative immune status
4. premature infants <28 weeks of gestation or newborns with low birth weight
5. adults and children with no history of varicella and/or a negative immune status, receiving immunosuppressive therapy including steroids, cytostatic agents, radiotherapy, recent stem cell transplantation, or who have congenital or acquired immunodeficiency disorders and are not receiving replacement therapy with immunoglobulin.
Notes on use of Human Varicella-Zoster Immunoglobulin
Whenever possible, contacts without a definite history of chickenpox should be screened for antibody by a sensitive test (e.g. ELISA, radioimmunoassay or immunofluorescence). There is no need to test neonates for antibody.
If antibodies to VZV are detectable, Human Varicella-Zoster Immunoglobulin is generally NOT needed. The following infants will possess maternal antibody and do NOT require Human Varicella-Zoster Immunoglobulin.
(i) Infants born more than seven days after the onset of maternal chickenpox.
(ii) Infants whose mothers have a positive history of chickenpox and/or a positive antibody result.
(iii) Infants whose mothers develop zoster (shingles) before or after delivery.
4.2 Posology And Method Of Administration
Posology
Alternative dose levels for treatment are as follows:
0 - 5 years | 250 mg (1 vial) |
6 - 10 years | 500 mg (2 vials) |
11 - 14 years | 750 mg (3 vials) |
15 years and older | 1000 mg (4 vials) |
The correct volume of solution to give a dose of 250 mg is overprinted on the label.
If a second exposure to chickenpox occurs three weeks or more after the first dose of Human Varicella-Zoster Immunoglobulin, a second dose is required.
Method of administration
Human Varicella-Zoster Immunoglobulin should be administered via the intramuscular route. The usually recommended sites for adults are the buttock, thigh or deltoid; for infants the lateral aspect of the thigh is preferable. If a large volume (>2 mL for children or>5 mL for adults) is required, it is recommended to administer this in divided doses at different sites.
If intramuscular administration is contraindicated (bleeding disorders), the injection can be administered subcutaneously. However, it should be noted that there are no clinical efficacy data to support administration by the subcutaneous route.
4.3 Contraindications
Hypersensitivity to any of the components.
Hypersensitivity to human immunoglobulins.
4.4 Special Warnings And Precautions For Use
Ensure that Human Varicella-Zoster Immunoglobulin is not administered into a blood vessel, because of the risk of shock.
True hypersensitivity reactions are rare.
Human Varicella-Zoster Immunoglobulin contains a small quantity of IgA. Individuals who are deficient in IgA have the potential for developing IgA antibodies and may have anaphylactic reactions after administration of blood components containing IgA. The physician must therefore weigh the benefit of treatment with Human Varicella-Zoster Immunoglobulin against the potential risks of hypersensitivity reactions.
Rarely, Human Varicella-Zoster Immunoglobulin can induce a fall in blood pressure with anaphylactic reaction, even in patients who have tolerated previous treatment with human immunoglobulin.
Suspicion of allergic or anaphylactic type reactions requires immediate discontinuation of the injection. In case of shock, standard medical treatment for shock should be implemented.
Standard measures to prevent infections resulting from the use of medicinal products prepared from human blood or plasma include selection of donors, screening of individual donations and plasma pools for specific markers of infection and the inclusion of effective manufacturing steps for the inactivation/removal of viruses. Despite this, when medicinal products prepared from human blood or plasma are administered, the possibility of transmitting infective agents cannot be totally excluded. This also applies to unknown or emerging viruses and other pathogens.
The measures taken are considered effective for enveloped viruses such as HIV, HBV and HCV. The measures taken may be of limited value against non-enveloped viruses such as HAV and parvovirus B19.
There is reassuring clinical experience regarding the lack of hepatitis A or parvovirus B19 transmission with immunoglobulins and it is also assumed that the antibody content makes an important contribution to the viral safety.
It is strongly recommended that every time that Human Varicella-Zoster Immunoglobulin is administered to a patient, the name and batch number of the product are recorded in order to maintain a link between the patient and the batch of the product.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Live attenuated virus vaccines
Immunoglobulin administration may interfere with the development of an immune response to live attenuated virus vaccines, such as rubella, mumps and varicella, for a period of up to 3 months. After administration of this product, an interval of at least 3 months should elapse before vaccination with live attenuated virus vaccines. In the case of measles, this impairment may persist for up to 5 months.
Interference with serological testing
After injection of immunoglobulin, the transitory rise of the various passively transferred antibodies in the patient's blood may result in misleading positive results in serological tests.
Passive transmission of antibodies to erythrocyte antigens, e.g. A, B, D may interfere with some serological tests for red cell antibodies, for example the antiglobulin test (Coomb's test).
4.6 Pregnancy And Lactation
The safety of this medicinal product for use in human pregnancy has not been established in controlled clinical trials. Clinical experience with immunoglobulins suggests that no harmful effects on the course of pregnancy, or on the foetus and the neonate are to be expected.
4.7 Effects On Ability To Drive And Use Machines
No effects on ability to drive and use machines have been observed.
4.8 Undesirable Effects
There are no robust data on the frequency of undesirable effects from clinical trials. The following undesirable effects have been reported with intramuscular immunoglobulins.
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For safety with respect to transmissible agents, see Section 4.4.
4.9 Overdose
Consequences of an overdose are not known.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Pharmacotherapeutic group: immune sera and immunoglobulins:
Human varicella immunoglobulin ATC code: J06B B03.
Human Varicella-Zoster Immunoglobulin contains mainly immunoglobulin G (IgG) with a specifically high content of antibodies against varicella-zoster virus.
5.2 Pharmacokinetic Properties
Human Varicella-Zoster Immunoglobulin for intramuscular administration is bioavailable in the recipient's circulation after a delay of 2-3 days.
Human Varicella-Zoster Immunoglobulin has a half-life of about 3-4 weeks. This half-life may vary from patient to patient.
IgG and IgG-complexes are broken down in cells of the reticuloendothelial system.
5.3 Preclinical Safety Data
Human Varicella-Zoster Immunoglobulin is a preparation of human plasma proteins, so safety testing in animals is not particularly relevant to the safety of use in man. Acute toxicity studies in rat and mouse showed species specific reactions which bear no relevance to administration in humans. Repeated dose toxicity testing and embryo-foetal toxicity studies are impracticable due to induction of, and interference with antibodies to human protein.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Sodium chloride
Glycine
Sodium acetate trihydrate
Sodium hydroxide
6.2 Incompatibilities
This medicinal product must not be mixed with other medicinal products.
6.3 Shelf Life
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6.4 Special Precautions For Storage
Human Varicella-Zoster Immunoglobulin should be stored in the original vial at 2°C to 8°C. Keep vial in the outer carton in order to protect from light.
Storage for up to one week at ambient temperatures (25°C) in the original container is not detrimental.
DO NOT FREEZE.
6.5 Nature And Contents Of Container
Neutral borosilicate glass vial (Type I Ph.Eur.) with overseal consisting of a halobutyl rubber wad (Type I Ph.Eur.), clear lacquered aluminium skirt and flip-off polypropylene cap.
6.6 Special Precautions For Disposal And Other Handling
The product should be brought to room or body temperature before use.
The colour can vary from colourless to pale-yellow and is either clear or slightly opalescent. Do not use solutions which are cloudy or have deposits.
Any used product or waste material should be disposed of in accordance with local requirements.
7. Marketing Authorisation Holder
Bio Products Laboratory
Dagger Lane
Elstree
Hertfordshire
WD6 3BX
United Kingdom.
Tel: +44 (0)20 8258 2200
Fax: +44 (0)20 8258 2608
Email: info@bpl.co.uk
8. Marketing Authorisation Number(S)
PL 08801/0013
9. Date Of First Authorisation/Renewal Of The Authorisation
July 1995
10. Date Of Revision Of The Text
February 2009
Version Code: GZS7
POM
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