Multibic with potassium 2 mmol/l solution for hemodialysis/for hemofiltration

Patient Information Leaflet

multiBic with potassium 2 mmol/l solution for haemodialysis/for haemofiltration
Please read all of this leaflet carefully before this medicine is used, as it contains
important information for the patient.

• Keep this leaflet, as you may need to read it again.
• If you have any further questions, please consult your doctor or nurse.
• If the patient experiences any adverse reactions, including any adverse reactions not listed in this leaflet, inform the doctor or nurse immediately. See section 4.

Table of contents:

1. What multiBic with potassium 2 mmol/l is and what it is used for
2. Important information before using multiBic with potassium 2 mmol/l
3. How to use multiBic with potassium 2 mmol/l
4. Possible side effects
5. How to store multiBic with potassium 2 mmol/l
6. Contents of the pack and other information

1. What multiBic with potassium 2 mmol/l is and what it is used for

multiBic with potassium 2 mmol/l is a solution for continuous renal replacement therapy, used to remove metabolic waste products from the body of patients with kidney disease. It is used in patients with kidney impairment, as well as in the treatment of poisonings. The type of solution administered to the patient depends on the level of potassium (salt) in the blood. The attending physician will regularly monitor the patient's blood potassium concentration.

2. Information before using multiBic with potassium 2 mmol/l solution for hemodialysis/hemofiltration

When not to use multiBic with potassium 2 mmol/l

• if you are hypersensitive to any active substance or any of the other ingredients of the medicine (listed in section 6)
• if you have hypokalemia (very low blood potassium levels);
• if you have metabolic alkalosis (a condition in which there is too much bicarbonate in the blood);
• if adequate blood flow through the hemofilter (the filter used for blood filtration) cannot be achieved;
• if there is a high risk of bleeding related to medications necessary to prevent clotting in the hemofilter.

Warnings and precautions
Before starting treatment with multiBic with potassium 2 mmol/l, discuss this with your doctor.

• Do not use until the solutions in both chambers of the bag are completely mixed.
• The solution must not be used if its temperature is below room temperature.
• The set of infusion lines used for administering the ready-to-use solution should be inspected every 30 minutes. If precipitate (solid deposit) is observed in the lines, the bag and lines must be replaced immediately and the patient should be closely monitored.
• Your treating physician will monitor your hydration status (amount of water in the patient's body), blood concentrations of potassium, sodium, other salts, certain metabolic products, and glucose. The doctor may also provide dietary recommendations.

Children
There are no established guidelines for the use of multiBic with potassium 2 mmol/l in children.
multiBic with potassium 2 mmol/l and other medicines
You must inform your doctor about all medicines you are currently taking or have recently taken, as well as any medicines you plan to take.
The following interactions may occur:

• increased risk of toxic effects of cardiac glycosides (used in heart disease);
• electrolyte supplementation, parenteral nutrition (intravenous feeding), and other infusion therapies. Consider their impact on serum concentrations and fluid status during this treatment;
• this therapy may reduce blood concentrations of certain medicinal products. Dose adjustments may be required.

Pregnancy and breastfeeding:
If you are pregnant or breastfeeding, suspect you may be pregnant, or are planning to have a child, you should consult your doctor before using this medicine.
There are no data or only limited data available on the use of multiBic with potassium 2 mmol/l during pregnancy and breastfeeding.
This medicine should be used during pregnancy only if the treating physician considers it necessary.
Breastfeeding is not recommended during treatment with multiBic with potassium 2 mmol/l.

3. How to use multiBic with potassium 2 mmol/l

multiBic with potassium 2 mmol/l solution for hemodialysis/hemofiltration is administered in a hospital or other medical facility. The attending physician has the knowledge on how to use this medicine.
In case of doubts, consult your doctor.

4. Possible adverse reactions

Like all medicines, this medicine can cause adverse reactions, although not everyone will experience them.
Adverse reactions of multiBic with potassium 2 mmol/l:

• nausea
• vomiting
• muscle cramps
• changes in blood pressure

Some adverse reactions may be caused by too much or too little fluid in the
body. These include:

• shortness of breath
• swelling of ankles and legs
• dehydration (e.g. dizziness, muscle cramps, feeling thirsty)
• blood disorders (e.g. abnormal blood salt levels)

The exact frequency of these events is unknown (cannot be estimated from available data).
Reporting suspected adverse reactions
If any adverse reactions occur, including any adverse reactions not listed in this leaflet, inform a doctor or nurse. Adverse reactions can be reported directly to the "national reporting system" listed in Annex V.*
Adverse reactions can also be reported to the marketing authorization holder.
Reporting adverse reactions helps provide more information on the safety of the medicine.

5. How to store multiBic with potassium 2 mmol/l

Keep the medicine out of the sight and reach of children.
Do not store below 4 °C.
Storage conditions after mixing both chambers of the bag:
The ready-to-use solution should not be stored above 30 °C and must be used within 48 hours.
Do not use this medicine after the expiry date stated on the label following the term "Expiry date". The expiry date refers to the last day of the stated month.

6. Contents of the pack and other information

What multiBic with potassium 2 mmol/l contains

• The active substances are: potassium chloride, sodium chloride, sodium hydrogen carbonate, calcium chloride dihydrate, magnesium chloride hexahydrate and glucose monohydrate.
• Other components of the medicine are: water for injections, hydrochloric acid (25%), carbon dioxide and disodium hydrogen phosphate dihydrate.

What multiBic with potassium 2 mmol/l looks like and contents of the pack:
multiBic with potassium 2 mmol/l is supplied in a dual-chamber bag (two chambers containing different solutions). After mixing the solutions from both chambers, a ready-to-use solution is obtained.
Each bag contains a total of 5000 ml of solution. The ready-to-use solution is clear and colourless.
Each bag is equipped with an HF connector, Luer lock connector and an injection port, and is covered with a protective foil.
Pack size:
2 bags of 5000 ml each
Marketing Authorisation Holder and Manufacturer
Marketing Authorisation Holder
Fresenius Medical Care Deutschland GmbH, Else-Kröner-Straße 1,
61352 Bad Homburg v.d.H., Germany
Manufacturer
Fresenius Medical Care Deutschland GmbH, Frankfurter Strasse 6-8, 66606 St. Wendel, Germany
Distributor:
Fresenius Medical Care Polska S.A.
tel.: +48 61 83 92 600
Information intended for medical personnel only – see end of this leaflet.
The following information is intended for medical personnel only:
1000 ml of ready-to-use solution contains:

pH ≈ 7.4
Theoretical osmolarity (Osmolar. teoret.) 296 mOsm/l
Use only if the ready-to-use solution is clear and colourless, and the bag and bag connectors are undamaged.
The solution is intended for single use only. Any unused portion of the solution must be discarded.
Use exclusively via a pump integrated with a device for extracorporeal blood purification.

Instructions for use
The haemodialysis/haemofiltration solution should be administered in three steps:

1. Removal of the protective film and careful inspection of the bag

The protective film should be removed immediately before use. Plastic packaging may occasionally become damaged during transport from the manufacturer to the clinic (dialysis station) or within the clinic itself. This may lead to contamination and bacterial or fungal growth in the solutions. For this reason, the bag must be carefully inspected before mixing. Particular attention should be paid to even the smallest damage to the closure, the seal separating the two chambers, and the corners of the bag, in search of possible contamination.

2. Mixing the contents of both chambers

Both solutions must be mixed immediately before use, thus obtaining a ready-to-use solution.
A) B) C)

Unfold the small …..until the seal
chamber. Roll up the bag with the solution, between both chambers
starting from the corner opens along its entire length, and
opposite the small the solutions from both chambers mix
chamber… together.

After mixing the solutions from both chambers, check whether the seal line is fully open, the mixed solution is clear and colourless, and the bag does not leak.

3. Use of the ready-to-use solution

The ready-to-use solution should be used immediately after mixing or within 48 hours after mixing.
Any additives to the ready-to-use solution may be introduced only after thorough mixing. After adding any substance, the ready-to-use solution should be carefully mixed again before use.
Additions of sodium chloride solution (up to 30%) or alternatively water for injections are compatible with this medicinal product and may, if necessary, be administered to adjust the sodium concentration, in order to limit the rate of sodium concentration changes in cases of severe hyper- or hyponatraemia.
Detailed information is provided in the Product Characteristics.
Unless otherwise advised, the ready-to-use solution should be warmed immediately before use to a temperature of 36.5°C – 38.0°C. The exact temperature is determined according to clinical requirements and the technical equipment used.