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Gammanorm (Human normal immunoglobulin)

What Gammanorm is and what it is used for

Gammanorm is an immunoglobulin and contains antibodies against bacteria and viruses. Antibodies protect the body and increase its resistance to infections. The purpose of this treatment is to attain normal antibody levels.

Gammanorm is used as replacement therapy in adults and children to treat primary immunodeficiency syndromes such as:

  • congenital agammaglobulinaemia and hypogammaglobulinaemia
  • common variable immunodeficiency (CVID)
  • severe combined immunodeficiency
  • IgG subclass deficiencies with recurrent infections
  • myeloma or chronic lymphatic leukaemia with severe secondary hypogammaglobulinaemia and recurrent infections.

Before you use Gammanorm

Do not use Gammanorm

  • if you are hypersensitive to human normal immunoglobulin or any of the other ingredients of Gammanorm.
  • intravenously (Gammanorm must not be administered into a vein).
  • intramuscularly (into a muscle) by yourself. Gammanorm must not be given into a muscle if you have any bleeding disorders.

Take special care with Gammanorm

  • Tell your doctor if you have any other illnesses.
  • If Gammanorm is accidentally administered into a blood vessel you could develop shock.
  • True hypersensitivity reactions are rare. They can particularly occur in the very rare cases of IgA deficiency with anti-lgA antibodies and these patients should be treated with caution.

Virus safety:

When medicines are made from human blood or plasma, certain measures are put in place to prevent infections being passed on to patients. These include careful selection of the blood and plasma donors to make sure those at risk of carrying infections are excluded, and the testing of each donation and pools of plasma for signs of virus/infections.

Manufacturers of these products also include steps in the processing of the blood or plasma that can inactivate or remove the viruses.

Despite these measures, when medicines prepared from human blood or plasma are administered, the possibility of passing on infection cannot be totally excluded.

This also applies to any unknown or emerging viruses or other types of infections.

The measures taken are considered effective for enveloped viruses such as human immunodeficiency virus (HIV), hepatitis B virus and hepatitis C virus.

The measures taken may be of limited value against non-enveloped viruses such as hepatitis A virus and parvovirus B19.

Immunoglobulins have not been associated with hepatitis A or parvovirus B19 infections possibly because the antibodies against these infections, which are contained in the product, are protective.

Note: Every time you receive a dose of Gammanorm you should record the name and batch number of the product in order to maintain a record of the batch used.

Using other medicines

Inform your doctor or pharmacist if you are taking, or have recently taken any other medicines, even over-the-counter ones, or if you have received a vaccination in the last three months.

Gammanorm may weaken the effect of all vaccines containing live viruses such as measles, rubella, mumps, and chicken pox. Following treatment with Gammanorm, three months should have elapsed before you are vaccinated with any of these vaccines. Where measles vaccine is concerned, you may need to wait up to a year following treatment with Gammanorm. It is therefore important that the doctor carrying out the vaccination is aware that you are having, or have had treatment with Gammanorm.

Inform your doctor that you are taking immunoglobulin when you give a blood sample, as this treatment may affect the results.

Pregnancy and breast-feeding

There is limited experience of usage of Gammanorm during pregnancy and breastfeeding. You should therefore consult your doctor before use of Gammanorm when you are pregnant or breast-feeding.

Driving and using machines

No effect has been observed upon the ability to drive or operate machinery.

Important information about some of the ingredients of Gammanorm

This medicinal product contains 4.35 mmol (or 100 mg) sodium per dose (40 ml). Please take this into consideration if you are on a controlled sodium diet.

How to use Gammanorm

The treatment will be started off by your doctor who will ensure that you receive training and precise information on using the pump, injection technique, keeping a treatment diary, and what action to take in the event of serious side effects. As soon as you are able to treat yourself, and if no side effects have arisen during treatment, your doctor may allow you to continue treatment at home.

The dosage and infusion speed will be determined by your doctor, who will adapt the dose especially for you. Always follow your doctor’s instructions.

This product should be administered subcutaneously (under the skin). In special cases where Gammanorm cannot be given subcutaneously, it may be administered intramuscularly (into muscle). An intramuscular injection must be given by a doctor or nurse.

Instructions

Always use Gammanorm exactly as your doctor has told you. You should check with your doctor if you are not sure.

The product should be at room or body temperature prior to use.

The solution should be clear or semi-translucent. Do not use solution that is cloudy, contains particles, or has deposits.

Handling instructions:

Remove the protective cap from the vial and wipe the rubber stopper with alcohol.

To withdraw Gammanorm, use a sterile syringe and needle or transfer device (e.g. Minispike or Medimop vial adapter).

Inject air into the vial that is equivalent to the amount of Gammanorm to be withdrawn. Then withdraw Gammanorm from the vial. If multiple vials are required to achieve the desired dose, repeat this step.

Follow the manufacturer’s instructions for preparing the syringe driver. Prime the administration tubing to ensure that no air is left in the tubing by filling the tubing/needle with Gammanorm.

Clean the injection site(s) with antiseptic solution.

Grasp the skin between two fingers.

Insert the needle under the skin.

Gammanorm must not be injected into a blood vessel. To test that no blood vessel has been accidentally hit, gently pull back on the syringe plunger and look to see if any blood is flowing back into the tubing (Fig. 5). If you see any blood, remove and discard the needle and tubing, gently applying pressure with cotton wool or gauze to where the needle was inserted. Repeat priming and needle insertion steps using a new needle, tubing and a new injection site.

Secure the needle in place by applying sterile gauze or a transparent dressing.

Inject Gammanorm following the manufacturer’s instructions for the syringe driver.

The injection site should be changed after 5 – 15 ml.

Multiple injection sites can be used at the same time. Injection sites should be at least 5 cm apart.

Remove the peel-off label from the Gammanorm vial and use this to complete the patient diary.

If you use more Gammanorm than you should

The risks of overdosing with Gammanorm are not known. Contact your doctor or Poison Information Centre if you have taken more Gammanorm than prescribed.

If you forget to use Gammanorm

If you forget to inject one dose of Gammanorm do not use a double dose or multiple doses at the same time to make up for the forgotten dose. Instead, inject one dose as soon as possible, then go on injecting Gammanorm as prescribed by your doctor.

If you stop using Gammanorm

If you stop injecting Gammanorm the success of your treatment may be at risk. Do not stop your treatment without consulting your doctor before.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

Possible side effects

Like all medicines, Gammanorm can cause side effects, although not everybody gets them.

Certain side effects may occur more often in people who are receiving Gammanorm for the first time or, in rare cases, when changing human normal immunoglobulin products, or when treatment is suspended for more than eight weeks.

In rare cases, Gammanorm may cause a fall in blood pressure and a severe hypersensitivity reaction (anaphylactic reaction), even in people who previously tolerated treatment with human normal immunoglobulin.

In case of a suspected allergy or anaphylactic reaction, which may cause such things as dizziness, pounding heart, falling blood pressure, breathlessness, itching, and rash, seek medical attention immediately and follow your doctor’s instructions.

Common side effects (affect 1 to 10 patients of 100):

  • local reactions at the injection site such as swelling, tenderness, pain, redness,
  • hardening, a sensation of heat, itching, bruising, or rashes

Rare side effects (affect 1 to 10 patients of 10,000):

  • low blood pressure
  • allergic reactions

Very rare side effects (affect less than 1 of 10,000 patients):

  • headache, dizziness, nausea, vomiting, back pain, joint pains, fever, shaking,
  • tiredness, anaphylactic shock (severe allergic reaction)

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

How to store Gammanorm

Keep out of the reach and sight of children.

Do not use Gammanorm after the expiry date which is stated on the label and carton after EXP. The expiry date refers to the last day of that month.

Store in a refrigerator (2 °C – 8 °C). Keep the vial in the outer carton.

Within its shelf-life, the product may be stored below 25 °C for up to 2 months. The date of transfer from the refrigerator and the end of the 2 month period should be recorded on the outer carton. The product must not be returned to the refrigerator and must be discarded if not used after the 2-month period.

After first opening, the product should be used immediately.

Do not use Gammanorm if the solution is cloudy or contains particles.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Never discard used syringes with ordinary household waste.

Further information

What Gammanorm contains

The active substance is:

  • human normal immunoglobulin 165 mg/ml (at least 95% is immunoglobulin G)

The other ingredients are:

  • glycine, sodium chloride, and sodium acetate equivalent to 2.5 mg of sodium per ml, water for injections.

What Gammanorm looks like and contents of the pack

Gammanorm is a clear or slightly opalescent and pale-yellow to light-brown solution for injection and is available as:

  • 10 ml or 20 ml of solution in a vial (Type I glass) – pack size of 1, 10 or 20.
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