Dosing for hemophilia A1
|Hemorrhagic event||Dosage (IU FVIII:C/kg body weight)|
|Minor hemorrhage Large bruises, significant cuts or scrapes, uncomplicated joint hemorrhage||Bring FVIII:C to 30% (15 IU FVIII/kg BID) until hemorrhage stops and healing is achieved (1 to 2 days)|
|Moderate hemorrhage Nose, mouth, and gum bleeds; dental extractions; hematuria||Bring FVIII:C to 50% (25 IU FVIII/kg BID) until healing is achieved (2 to 7 days on average)|
|Major hemorrhage Joint hemorrhage, muscle hemorrhage, major trauma, hematuria, intracranial and intraperitoneal bleeding||Bring FVIII:C to 80% to 100% for at least 3 to 5 days(40 to 50 IU FVIII/kg BID).Maintain at 50% (25 IU FVIII/kg BID) until healing is achieved. Major bleeds may require treatment for up to 10 days. Intracranial bleeds up to 6 months|
|Surgery||Prior to surgery, bring level of FVIII:C to 80% to 100%(40 to 50 IU FVIII/kg).Maintain at 60% to 100% (30 to 50 IU FVIII/kg BID) for the next 7 to 10 days or until healing is achieved|
Dosing requirements and frequency of dosing are calculated on the basis of an expected initial response of 2% FVIII:C increase per IU FVIII:C/kg body weight (ie, 2% per IU/kg) and an average half-life for FVIII:C of 17.9 hours. If dosing studies have determined that a particular patient exhibits a lower-than-expected response and the medication has a shorter half-life, the dose and the frequency of dosing should be adjusted accordingly.1
Plasma FVIII levels should be monitored periodically to evaluate individual patient response to the dosage regimen. Depending on the level of the inhibitor and/or clinical response, it may be appropriate to use an alternative "bypass" therapeutic agent.
FVIII=factor FVIII; VWF=von Willebrand factor.