Anticoagulant Sodium Citrate - Trisodium Citrate Dihydrate solution prescribing information
INDICATIONS AND USAGE
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP is intended for use only for the anticoagulation of whole blood as part of automated apheresis procedures. [See Dosage and Administration (2) .]
DOSAGE AND ADMINISTRATION
- ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP is added to tubing sets during apheresis procedures. (2 )
- ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP may only be used with apheresis devices. For instructions on the use of the solution see the apheresis device operator's manual. (2.1 )
- Follow the directions for connecting the ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP bag to the apheresis system. (2.2 )
General Dosing Information
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP is added to tubing sets during apheresis procedures. The solution bag is connected to the tubing set in an apheresis collection. The recommended dose is determined by the apheresis device and metered into the tubing set by the apheresis device. It is not intended for direct intravenous infusion.
For instructions on the use of the solution with the apheresis device and tubing set, see the device operator's manual.
Administration
- Ensure solution is the ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP and is within the expiration date
- Inspect the bag. Do not use if the container is damaged, leaking, or if there is any visible sign of deterioration
- Use only if solution is clear and free of particulate matter
- Protect from sharp objects.
Directions for connecting the ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP bag to the apheresis device.
At the prompt to connect anticoagulant to the apheresis device tubing set:
- Remove the overwrap by pulling down at the notch, and remove the ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP bag.
- Before use, perform the following checks [see Warnings and Precautions (5) ] :
- Check for leaks by gently squeezing the bag. If leaks are found, discard the bag
- Ensure that the solution is the ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP and is within the expiration date
- Inspect the solution in good light. Bags showing cloudiness, haze, or particulate matter should not be used
- Remove the twist off port on the bag
- Connect the bag to the apheresis device tubing set using aseptic technique and hang the solution
- Proceed according to the apheresis device operator's manual
Drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever the solution and container permit.
DOSAGE FORMS AND STRENGTHS
250 mL ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP is a sterile solution in a PVC bag. Each 100 mL contains: Sodium Citrate (dihydrate) 4.0 g; Water for Injection to 100 mL, (pH adjusted with citric acid). Approximate millimoles of Sodium Citrate: 13.6.
USE IN SPECIFIC POPULATIONS
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP has not been adequately studied in controlled clinical trials with specific populations.
CONTRAINDICATIONS
DO NOT INFUSE ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP DIRECTLY TO THE DONOR.
WARNINGS AND PRECAUTIONS
- Verify that the ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP has been securely attached to the anticoagulant (AC) line on the system tubing set. Use aseptic technique throughout all procedures to ensure donor safety and quality.
- Single-use container. Do not reuse. Discard any unused or partially used product.
- Rx only
ADVERSE REACTIONS
Citrate reactions or toxicity may occur with the infusion of blood products to patient and return of blood containing citrate anticoagulant to donors. The recipient of the blood containing citrate should be monitored for the signs and symptoms of citrate toxicity. The signs and symptoms of citrate toxicity begin with paresthesia, a "tingling" sensation around the mouth or in the extremities, followed by severe reactions that are characterized by hypotension and possible cardiac arrhythmia. Citrate toxicity may occur more frequently in patients who are hypothermic, have impaired liver or renal function, or have low calcium levels because of an underlying disease.
DESCRIPTION
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP is designed to be metered by an apheresis device in apheresis procedures, to prevent platelet activation and coagulation as blood moves throughout the extracorporeal unit (tubing set) in an apheresis procedure.
The solution is sterile and non-pyrogenic, and it contains no bacteriostatic or antimicrobial agents. Sterilized with steam.
The formulas of the active ingredients are provided in Table 1.
| Ingredients | Molecular Formula | Molecular Weight |
|---|---|---|
| Sodium Citrate Dihydrate | C 6 H 9 Na 3 O 9 | 294.10 |
| Water for Injection | H 2 O | 18.00 |
Each 100 mL of ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP contains:
Sodium Citrate (dihydrate) 4.0 g; and Water for Injection to 100 mL (pH adjusted with citric acid). Approximate millimoles of sodium citrate: 13.6.
The PVC bag is not made with natural rubber latex.
The bag contains materials that have been tested to demonstrate the suitability of the container for storing pharmaceutical solutions. The bag is nontoxic and biologically inert. The bag-solution unit is a closed system and is not dependent upon entry of external air during administration. The bag is overwrapped to provide protection from the physical environment and to provide an additional moisture barrier when necessary.
CLINICAL PHARMACOLOGY
Mechanism of Action
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP acts as an extracorporeal anticoagulant by binding the free calcium in the blood. Calcium is a necessary co-factor to several steps in the clotting cascade. The following ingredients are key components of the solution:
- Citric acid for pH regulation
- Sodium Citrate anticoagulant
This solution has no pharmacological effect.
HOW SUPPLIED/STORAGE AND HANDLING
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP is a clear solution supplied in sterile and non-pyrogenic PVC bags. The bags are packaged 30 bags per case.
| SIZE | CATALOG NUMBER | NDC NUMBER |
|---|---|---|
| 250 mL | 1000782 | Bag: 81839-782-01 Case: 81839-782-02 |
Store at 20° to 25°C (68°to 77°F); excursions permitted between 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature]. Brief exposure up to 40°C (104°F) does not adversely affect the product.
Protect from freezing.
Mechanism of Action
ANTICOAGULANT SODIUM CITRATE 4% W/V SOLUTION USP acts as an extracorporeal anticoagulant by binding the free calcium in the blood. Calcium is a necessary co-factor to several steps in the clotting cascade. The following ingredients are key components of the solution:
- Citric acid for pH regulation
- Sodium Citrate anticoagulant
This solution has no pharmacological effect.
