General: Substitution by any other biological medicinal product requires the consent of the prescribing physician.
Treatment should be initiated under the supervision of a physician experienced in the treatment of hemophilia and/or bleeding disorders.
Treatment with bypassing agents should be discontinued the day before starting HEMLIBRA therapy (see Precautions). FVIII prophylaxis may be continued for the first 7 days of HEMLIBRA treatment.
Recommended dosage (all patients): The recommended loading dose is 3 mg/kg administered as a subcutaneous injection once weekly for the first 4 weeks, followed by a maintenance dose of either: 1.5 mg/kg once weekly, or 3 mg/kg every two weeks, or 6 mg/kg every four weeks.
The maintenance dose regimen should be selected based on physician and patient/caregiver dosing regimen preference to support adherence.
Method of administration: HEMLIBRA is for subcutaneous use only. HEMLIBRA should be administered using appropriate aseptic technique (see Special Instructions for Use, Handling and Disposal under Cautions for Usage).
The injection should be restricted to the recommended injection sites: the abdomen, the upper outer arms and the thighs (see Pharmacology: Pharmacokinetics: Absorption under Actions). No data are available on injection at other sites of the body.
Administration of HEMLIBRA subcutaneous injection in the upper outer arm should be performed by a caregiver or healthcare professional.
Alternating the site of injection may help prevent or reduce injection site reactions (see Clinical Trials under Adverse Reactions). HEMLIBRA subcutaneous injection should not be administered into areas where the skin is red, bruised, tender or hard, or areas where there are moles or scars.
During treatment with HEMLIBRA, other medicinal products for subcutaneous administration should, preferably, be injected at different anatomical sites.
Administration by the patient and/or caregiver: HEMLIBRA is intended for use under the guidance of a healthcare professional. After proper training in subcutaneous injection technique, a patient may self-inject HEMLIBRA, or the patient's caregiver may administer HEMLIBRA, if their physician determines that it is appropriate.
The physician and the caregiver should determine the appropriateness of a child self-injecting HEMLIBRA. However, self-administration is not recommended for children below 7 years of age.
Duration of treatment: HEMLIBRA is intended for long-term prophylactic treatment.
Dosage adjustments during treatment: No dosage adjustments of HEMLIBRA are recommended.
Delayed or missed doses: If a patient misses a scheduled subcutaneous injection of HEMLIBRA, the patient should be instructed to take the missed dose as soon as possible, before the day of the next scheduled dose. The patient should then administer the next dose on the usual scheduled dosing day. The patient should not take two doses on the same day to make up for a missed dose.
Special Dosage Instructions: Pediatric use: No dose adjustments are recommended in pediatric patients. Currently available data are described in Pharmacology: Pharmacodynamics: Clinical/Efficacy Studies and Pharmacokinetics: Pharmacokinetics in Special Populations under Actions.
Geriatric use: No dose adjustments are recommended in patients ≥ 65 years of age (see Pharmacology: Pharmacokinetics: Pharmacokinetics in Special Populations under Actions).
Renal impairment: No dose adjustments are recommended in patients with renal impairment (see Pharmacology: Pharmacokinetics: Pharmacokinetics in Special Populations under Actions).
Hepatic impairment: No dose adjustments are recommended in patients with hepatic impairment (see Pharmacology: Pharmacokinetics: Pharmacokinetics in Special Populations under Actions).