MONOVER Solution for injection / infusion Ref.[49847] Active ingredients:

Source: Health Products Regulatory Authority (IE)  Revision Year: 2020  Publisher: Pharmacosmos A/S, Roervangsvej 30, DK-4300 Holbaek, Denmark

4.3. Contraindications

  • Hypersensitivity to the active substance, to Monover or any of its excipients listed in section 6.1.
  • Known serious hypersensitivity to other parenteral iron products.
  • Non-iron deficiency anaemia (e.g. haemolytic anaemia).
  • Iron overload or disturbances in utilisation of iron (e.g. haemochromatosis, haemosiderosis).
  • Decompensated liver disease.

4.4. Special warnings and precautions for use

Parenterally administered iron preparations can cause hypersensitivity reactions including serious and potentially fatal anaphylactic/anaphylactoid reactions. Hypersensitivity reactions have also been reported after previously uneventful doses of parenteral iron complexes. There have been reports of hypersensitivity reactions which progressed to Kounis syndrome (acute allergic coronary arteriospasm that can result in myocardial infarction, see section 4.8).

The risk is enhanced for patients with known allergies including drug allergies, including patients with a history of severe asthma, eczema or other atopic allergy.

There is also an increased risk of hypersensitivity reactions to parenteral iron complexes in patients with immune or inflammatory conditions (e.g. systemic lupus erythematosus, rheumatoid arthritis).

Monover should only be administered when staff trained to evaluate and manage anaphylactic reactions is immediately available, in an environment where full resuscitation facilities can be assured. Each patient should be observed for adverse effects for at least 30 minutes following each Monover injection. If hypersensitivity reactions or signs of intolerance occur during administration, the treatment must be stopped immediately. Facilities for cardio respiratory resuscitation and equipment for handling acute anaphylactic/anaphylactoid reactions should be available, including an injectable 1:1000 adrenaline solution. Additional treatment with antihistamines and/or corticosteroids should be given as appropriate.

In patients with compensated liver dysfunction, parenteral iron should only be administered after careful benefit/risk assessment. Parenteral iron administration should be avoided in patients with hepatic dysfunction (alanine aminotransferase and/or aspartate aminotransferase >3 times upper limit of normal) where iron overload is a precipitating factor, in particular Porphyria Cutanea Tarda (PCT). Careful monitoring of iron status is recommended to avoid iron overload.

Parenteral iron should be used with caution in case of acute or chronic infection.

Monover should not be used in patients with ongoing bacteraemia.

Hypotensive episodes may occur if intravenous injection is administered too rapidly.

Caution should be exercised to avoid paravenous leakage when administrating Monover. Paravenous leakage of Monover at the injection site may lead to irritation of the skin and potentially long lasting brown discolouration at the site of injection. In case of paravenous leakage, the administration of Monover must be stopped immediately.

4.5. Interaction with other medicinal products and other forms of interaction

As with all parenteral iron preparations the absorption of oral iron is reduced when administered concomitantly.

Large doses of parenteral iron (5 ml or more) have been reported to give a brown colour to serum from a blood sample drawn four hours after administration.

Parenteral iron may cause falsely elevated values of serum bilirubin and falsely decreased values of serum calcium.

4.6. Fertility, pregnancy and lactation

Pregnancy

There are no adequate and well-controlled trials of Monover in pregnant women. A careful risk/benefit evaluation is therefore required before use during pregnancy and Monover should not be used during pregnancy unless clearly necessary.

Iron deficiency anaemia occurring in the first trimester of pregnancy can in many cases be treated with oral iron. Treatment with Monover should be confined to second and third trimester if the benefit is judged to outweigh the potential risk for both the mother and the foetus.

Foetal bradycardia may occur following administration of parenteral irons. It is usually transient and a consequence of a hypersensitivity reaction in the mother. The unborn baby should be carefully monitored during intravenous administration of parenteral irons to pregnant women.

Breast-feeding

A clinical study showed that transfer of iron from Monover to human milk was very low. At therapeutic doses of Monover no effects on the breastfeed newborns/infants are anticipated.

Fertility

There are no data on the effect of Monover on human fertility. Fertility was unaffected following Monover treatment in animal studies (see section 5.3).

4.7. Effects on ability to drive and use machines

No studies on the effects on the ability to drive and use machines have been performed.

4.8. Undesirable effects

The table presents the adverse drug reactions (ADRs) reported during Monover treatment in clinical trials and in-market experience.

Acute severe hypersensitivity reactions may occur with parenteral iron preparations. They usually occur within the first few minutes of administration and are generally characterised by the sudden onset of respiratory difficulty and/or cardiovascular collapse; fatalities have been reported. Other less severe manifestations of immediate hypersensitivity, such as urticaria and itching may also occur. In pregnancy, associated foetal bradycardia may occur with parenteral iron preparations.

Fishbane reaction characterised by flushing in the face, acute chest and/or back pain and tightness sometimes with dyspnea in association with IV iron treatment may occur (frequency uncommon). This may mimic the early symptoms of an anaphylactoid/anaphylactic reaction. The infusion should be stopped and the patient’s vital signs should be assessed. These symptoms disappear shortly after the iron administration is stopped. They typically do not reoccur if the administration is restarted at a lower infusion rate.

Distant skin discolouration has also been reported post marketing following IV iron administration.

Adverse drug reactions observed during clinical trials and post-marketing experience:

System Organ
Class
Common
(≥1/100 to <1/10)
Uncommon
(≥1/1000 to <1/100)
Rare
(≥1/10000 to <1/1000)
Not known
Immune system
disorders
 Hypersensitivity, including
severe reactions
Anaphylactoid/
anaphylactic
reactions
 
Nervous system
disorders
 Headache, paraesthesia,
dysgeusia, blurred
vision, loss of
consciousness,
dizziness, fatigue
Dysphonia, seizure,
tremor, altered
mental status
 
Cardiac disorders  Tachycardia Arrhythmia Kounis syndrome
Vascular disorders  Hypotension, hypertension  
Respiratory, thoracic and
mediastinal disorders
 Chest pain,
dyspnoea,
bronchospasm
  
Gastrointestinal
disorders
Nausea Abdominal pain, vomiting,
dyspepsia, constipation,
diarrhoea
  
Skin and
subcutaneous
tissue disorders
Rash Pruritus, urticaria,
flushing, sweating,
dermatitis
AngioedemaDistant skin
discolouration
Metabolism and
nutritional
disorders
 Hypophosphataemia  
Musculoskeletal
and connective
tissue disorders
 Back pain, myalgia,
arthralgia, muscle spasms
  
General
disorders and
administration
site conditions
Injection site
reactions*
Pyrexia,
chills/shivering,
infection, local
phlebitic reaction,
skin exfoliation
Malaise,
influenza like
illness**
 
Investigations  Hepatic enzyme
increased
  

* Includes the following preferred terms, i.e. injection site erythema, -swelling, -burning, -pain, -bruising, -discolouration, -extravasation, -irritation, -reaction.
** Influenza like illness whose onset may vary from a few hours to several days.

Description of selected adverse reactions

Delayed reactions may also occur with parenteral iron preparations and can be severe. They are characterised by arthralgia, myalgia and sometimes fever. The onset varies from several hours up to four days after administration. Symptoms usually last two to four days and settle spontaneously or following the use of simple analgesics.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system: HPRA Pharmacovigilance Website: www.hpra.ie.

6.2. Incompatibilities

This medicinal product must not be mixed with other medicinal products except those mentioned in section 6.6.

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