Nepofer

Nepofer is indicated for the replacement of iron to maintain hemoglobin in adult patients with hemodialysis-dependent chronic kidney disease (HDD-CKD).

Dosage & Administration

Inspect Ferric Pyrophosphate Citrate ampoule for signs of precipitation prior to mixing with the bicarbonate concentrate. Ferric Pyrophosphate Citrate should only be added to the bicarbonate concentrate and should not be added to acid concentrate mixtures. Add Ferric Pyrophosphate Citrate to bicarbonate concentrate used for generation of hemodialysate. The final concentration of iron (III) in the final hemodialysate is 2 micromolar (110 mcg/L). Multiple ampoules can be added to the master bicarbonate mix at each center at a ratio of one ampoule to each 2.5 gallons of bicarbonate concentrate.
Administer Ferric Pyrophosphate Citrate to patients at each dialysis procedure for as long as patients are receiving maintenance hemodialysis therapy for CKD.
Hemodialysis solutions should be used within 24 hours of the preparation of the Ferric Pyrophosphate Citrate /bicarbonate concentrate mixture.

The most common side effects are headache, peripheral edema, asthenia, AV fistula thrombosis, urinary tract infection, AV fistula site hemorrhage, pyrexia, fatigue, hypotension, muscle spasms, pain in extremity, back pain, and dyspnea.

Hypersensitivity Reactions
: Anaphylactic-type reactions, shock, hypotension, loss of consciousness and collapse can occur. Monitor patients for signs and symptoms of hypersensitivity during and after hemodialysis until he/she is clinically stable. Personnel and therapies should be immediately available for the treatment of serious hypersensitivity reactions.
Iron laboratory testing
: Iron status should be determined on pre-dialysis blood samples. Post dialysis serum iron parameters may overestimate serum iron and transferrin saturation.