“As orthopedic surgeons, we look very critically at safety; we look very critically at efficacy. I think it is fair to say, if we consider those to be equal and the dosing schedule is equal, (and) they are both once-a-day, then it comes down to cost,” Richard J. Friedman, M.D., was quoted in the publication. “But we are looking (at) safety first and efficacy afterward.”

The topic, spurred by positive Food and Drug Administration (FDA) advisory committee reviews of rivaroxaban, was discussed recently at the 76th annual meeting of the American Academy of Orthopaedic Surgeons. Rivaroxaban, made by Bayer and marketed in other countries as Xarelto, is just one of many anticoagulants in development and expected to be on the market in the next one to three years.

Heparin is an injectible used in hospitals because it is easier to control than Coumadin, also known as warfarin, which requires close monitoring and frequent blood tests. Rivaroxaban is an attractive alternative because it comes in a pill and doesn’t require constant monitoring. If approved by the FDA, Rivaroxaban will be marketed by Ortho-McNeil Pharmaceuticals.

“Often in orthopedics, even the best of folks take a long time to incorporate and change practice patterns,” said Fred D. Cushner, M.D. “The big question is, who is going to switch? … This is debatable, but my personal opinion is the injectables will probably be the first to go.”

SOURCE: Heparin Recall › Surgeons hopeful about new alternatives to heparin

Baxter Healthcare Corp.

Announcement of the deaths and illness at Beebe Medical Center in Lewes, Delaware, raised immediate concern at the hospital, which promptly notified the FDA and Baxter. The incidents were far too similar to the 2007 heparin scandal in which more than 80 Americans died and hundreds more became ill after receiving doses of Baxter’s heparin. An investigation found some lots of heparin manufactured in Baxter’s China factory were contaminated with a heparin-like substance called over-sulfated chondroitin sulfate, or OSCS.

Both Baxter and the FDA investigated the Beebe incidents. Earlier this week Baxter announced its investigation found no OSCS contaminate in the heparin supplied to Beebe. It also said the heparin used by Beebe was manufactured in its Ohio plant, not the China facility.

But the mystery about the deaths and illness at Beebe still remains. A Baxter spokesperson said that following the national guidelines for drugs like heparin does not guarantee that there will be no problems with the medication.

“Even when those protocols are followed, bleeding at a site, including intercranial bleeding, can occur – especially in high-risk patients, which is an established side effect of all anticoagulant therapies,” said Erin Gardiner with Baxter. “Our responsibility is for the safety of the product.”

Source: Delmarva Media Group

SOURCE: Heparin Recall › FDA clears Baxter in deaths following heparin injections

She already has Senator Edward M. Kennedy’s support. “Her expertise is valuable for problems we now face, such as combating food-borne illness, cooperating with other agencies to address the new flu outbreak and drug-resistant diseases, and protecting our food and drug supplies,” Sen. Kennedy said in a statement for the Health, Education, Labor, and Pensions Committee hearing.

If confirmed, one of Dr. Hamburg’s many priorities will be to detangle the mess left behind from last year’s contaminated heparin scandal, in which batches of tainted heparin manufactured in China made their way into the United States. Those bad batches killed more than 80 people and sickened hundreds more. An investigation resulted in the FDA’s admission that it did not have the resources or the funding to adequately inspect foreign food and drug manufacturing companies.

The agency’s handling of the heparin scandal is currently under review by the Government Accountability Office, and congressional leaders are not letting up on their insistence that the FDA make better provisions to ensure the food and drugs imported into the US are safe.

“It is abundantly clear that the agency needs strong, new leadership to improve morale and make it once again the world class agency that Americans can trust to protect the health of their families,” Sen. Kennedy wrote. “I’m very pleased, therefore, that President Obama has nominated Dr. Margaret Hamburg to lead the FDA as its new Commissioner.”

SOURCE: Heparin Recall › Obama’s pick for FDA commissioner wants to restore trust in agency

Anticoagulants are often administered to patients before undergoing some surgeries and medical procedures to reduce the risk of life-threatening blood clots. Lovenox has been touted as an effective replacement for the blood thinner heparin in patients undergoing abdominal surgery.

Heparin carries a laundry list of side effects such as nausea, vomiting, abdominal pain, diarrhea and low blood pressure. Concerns about heparin flooded the media last year with cases of accidental overdoes and shipments of tainted batches of the blood thinner imported from China. Both incidences caused patients serious injury or death.

The contaminated heparin scandal in particular created an urgency among consumers, the medical community and pharmaceutical companies to find safer alternatives to the commonly used blood thinner.

Momenta chief executive officer Craig A. Wheeler said in the conference call that the FDA continues to review its Abbreviated New Drug Application (ANDA) process for M-Enoxaprin. ANDA is the FDA’s Center for Drug Evaluation and Research Office of Generic Drugs review and ultimate approval process of a generic drug.

Once approved, an applicant may manufacture and market the generic drug product to provide a safe, effective, low cost alternative to the American public. “We are in regular communication with the agency and responding to their questions as they arise,” Wheeler said.

Wheeler referred to the “global contamination issue” with the heparin supply and the FDA’s plant inspections of Chinese suppliers of heparin, adding that the companies who supply heparin to Momenta’s partner distributor Sandoz for the manufacture of M-Enoxaprin have all been inspected by the FDA.

While the company has no indication that the inspections raised concerns with the FDA, Wheeler said “Any disruption in the heparin supply has the potential to impact our supply chain.” As a result, the company will diversify its sources of heparin and closely monitor the supply chain.

Momenta hopes to launch M-Enoxaparin in 2009 provided the ANDA is readily approved by the FDA.

Source:
Seeking Alpha

SOURCE: Heparin Recall › FDA approval for marketing generic Lovenox expected

Blood tends to pool in the atrial chamber of individuals with atrial fibrillation, which can lead to clotting and an increased risk for strokes. Patients with atrial fibrillation are generally treated with blood thinners to help prevent blood clots from forming.

However, blood thinners like heparin can cause serious bleeding episodes and allergic reactions. Alternatives to long-term use of blood thinners has many cardiologists taking notice.

“The findings from this clinical trial are very impressive,” said Dr. Gregg C. Fonarow, professor of cardiology at the University of California, Los Angeles. “Treatment with this novel device will be very attractive and provide patients with atrial fibrillation effective, long-term protection from stroke and systemic embolization without the bleeding risks associated with (blood thinners).”

The PROTECT-AF Trial, which involved 707 patients with a type of atrial fibrillation, showed that patients who had the device had a 32 percent lower risk of stroke and cardiovascular death compared with those on blood thinners. The study also found fewer complications with the implanted device compared to the use of blood thinners.

A Food and Drug Administration (FDA) advisory panel will meet in April to consider the sale of the device in the United States.

Source:
Eflux Media News

SOURCE: Heparin Recall › Heart device may eliminate need for heparin, warfarin

Rivaroxaban, a pill marketed in Europe as Xarelto, showed to be more effective than the anticoagulant heparin, while presenting no more side effects than heparin. Side effects of heparin and rivaroxaban include the risk of internal bleeding. Another benefit of rivaroxaban is that it does not need constant monitoring like another popular blood thinner, warfarin. Heparin is administered intravenously while warfarin is a pill taken orally.

Pharmaceutical companies have long been working on safer and easier alternatives to heparin and warfarin, especially since the tainted heparin scandal last year where more than 80 Americans died and hundreds more were made sick after receiving injections of batches of heparin that had been laced with oversulfated chondroitin sulfate (OSCS), a contaminant that mimics heparin but can cause serious allergic reactions in humans.

The FDA is expected to make a decision whether to approve rivaroxaban by May 28. If approved, rivaroxaban would be the first oral blood thinner approved since the FDA approved warfarin in 1954, according to Forbes.

“We appreciate the thoroughness of the advisory committee’s review, and we will continue to work with the FDA as they finalize their review,” Dr. Peter DiBattiste, vice president of Johnson & Johnson Pharmaceutical Research and Development, said in a prepared statement.

SOURCE: Heparin Recall › FDA panel recommends agency approval of heparin alternative

Even on the campaign trail, Obama’s camp said it would support the plan but that there would have to be measures in place to ensure the FDA was properly inspecting the plants where drugs are being manufactured.

After all, it was just one year ago that hundreds of people became ill and more than 80 died after receiving injections of the blood thinner heparin that was later found to have been contaminated at pharmaceutical giant Baxter International’s manufacturing plant in China.

The FDA later admitted that it simply didn’t have the manpower to inspect all foreign food and drug manufacturing plants and thus couldn’t ensure the safety of those products. Late last year, the agency began placing food and drug inspectors to oversee the safety of foods and drugs imported into the U.S. The first three offices were opened in China.

Allowing Americans to purchase their drugs from foreign countries can provide a tremendous savings to consumers, but some lawmakers say that it is too risky a gamble. At a hearing of the Senate Finance Committee, Kansas Republican Pat Roberts asked the White House if it was in favor of first establishing some controls before moving forward with the importation plans. “Would you also agree that, if such a proposal were to move forward, we should demand that any drug imported into the U.S. meet the same high safety and efficacy standards of our FDA including bioequivalency standards?” he asked.

White House budget director Peter Orszag answered by simply saying, “Yes.”

SOURCE: Heparin Recall › Lawmakers debate safety of importing drugs

However, an FDA spokesperson says no details were available on those “new efforts” the agency will undertake to ensure quality control, though a spokesperson with the Department of Health and Human Services, which oversees the FDA, says more information will be available when Obama releases the more detailed budget in April.

The Bush administration largely opposed the idea because of safety concerns. One cannot soon forget the toll tainted heparin took on the U.S. just last year. More than 80 people died and hundreds more were sickened when vials heparin imported from a China manufacturing plant were found to have been contaminated. FDA admitted then that it didn’t have sufficient staff to properly inspect all food and drug manufacturing plants on foreign soil.

Countries such as Canada sell medicines for much less than in the United States because the government helps control prices. Critics of importation say that buying drugs from foreign countries would leach vital funds from the U.S. drug industry that otherwise would be used to research new therapies and innovations.

In the past several months, the FDA has stepped up quality control measures by setting up offices overseas to inspect food and drugs being imported into the U.S. The first offices were placed in China.

SOURCE: Heparin Recall › New budget supports plan for importation of drugs

American Capital purchased 87 percent of Scientific Protein Laboratories in 2006. Scientific Protein Laboratories has a fair market value of $186.5 million. Last year, the parent company sought coverage from its insurers for lawsuits related to Scientific Protein Laboratories’ involvement in the tainted heparin scandal.

While Baxter International is at the center of the tainted heparin controversy, the Charter Oak Fire Insurance Co. and Travelers Property Casualty Co. of America argue that in its application for coverage, Scientific Protein Laboratories’ parent company American Capital claimed it had no subsidiaries and never mentioned Scientific Protein Laboratories or its China-based heparin venture, according to the report. In its lawsuit filed last week, the insurance companies claim that “American Capital provided false answers to Charter Oak and Travelers regarding the non-existence of subsidiaries.”

The lawsuit also claims that American Capital and Scientific Protein Laboratories entered into an agreement with Baxter International that included making payments to Baxter and giving “rights to insurance proceeds and benefits,” according to the report.

SOURCE: Heparin Recall › Heparin producer’s insurers file lawsuit

Dr. Torti joined the FDA in May, just as the tainted heparin scandal was still brewing at the agency. Dr. Von Eschenbach recruited Dr. Torti to “help bolster the agency’s scientific infrastructure,” according to the news story.

Last year more than 80 Americans died and hundreds more became ill after they received injections of the blood thinner heparin. An investigation revealed that batches of heparin manufactured in China had been contaminated. The FDA later admitted it was not sufficiently staffed to inspect all foreign food and drug manufacturing plants.

Dr. Torti bypassed Dr. Janet Woodcock for the interim FDA commissioner post. Dr. Woodcock was the FDA’s deputy commissioner for scientific and medical programs, chief medical officer, and acting director of its Center for Drug Evaluation and Research. She had been favorite choice for the post by pharmaceutical manufacturers. Congressional critics claimed she was too closely tied to pharmaceutical groups and cited serious drug safety issues under her watch, including the tainted heparin scandal.

SOURCE: Heparin Recall › Torti named interim commissioner of FDA

Calling the findings a sign of “dangerous lack of accountability,” Rep. Bob Filner said he would investigate the matter that put the safety of VA patients risk. “VA continues to discover problems and attempts to fix them quietly and internally, and then downplays them as inconsequential and nonthreatening,” Rep. Filner told AP. “No one expects new software to operate perfectly, but confidence must be inherent in any electronic medical records system.”

When the VA moved from a paper system for medical records to an electronic one, the process was designed to reduce human error. However, between August 2008 and December 2008, there were reports of patients receiving incorrect doses of medications, including cases where heparin was given to patients for up to 11 hours longer than necessary. Other errors included medications and vital signs showing up on the wrong patient’s medical charts. Health experts say that errors like these prove that more careful monitor needs to be done to prevent future errors.

“VA bureaucrats consistently refuse to provide necessary information regarding the serious problems that affect veterans and this pattern of secrecy is disconcerting and does enormous harm,” Filner told AP. “Oversight of this incident will continue.”

SOURCE: Heparin Recall › Lawmaker opens investigation into ’software glitches’ at VA

The study also reported, “the use of heparin manufactured by Baxter Healthcare was the factor most strongly associated with reactions (present in 100 percent of case facilities vs. 4.3 percent of control facilities).” Those facilities included 21 dialysis facilities that reported reactions and 23 facilities that had no reported reactions. Adverse reactions reported included hypotension, nausea and shortness of breath. Most symptoms presented within 30 minutes of administering the drug.

All of the facilities that reported adverse reactions had vials of heparin manufactured by Baxter Healthcare that were contaminated with OSCS, according to the report. Researchers found that of the 130 reactions for which information on the heparin was available, more than 98 percent occurred in a facility that had OSCS-laced heparin on premises. Of the 54 reactions for which the lot number was known, the report shows that 96.3 percent occurred after the patients received the OSCS-tainted heparin.

According to the report, “Heparin contaminated with OSCS was epidemiologically linked to adverse reactions in this nationwide outbreak. The reported clinical features of many of the cases further support the conclusion that contamination of heparin with OSCS was the cause of the outbreak.”

SOURCE: Heparin Recall › CDC study provides details on OSCS-laced heparin

The program is designed to assist the FDA in its efforts to “prevent the importation of drugs that do not comply with applicable FDA requirements by allowing the agency to focus its resources on foreign-produced drugs that fall outside the program and may not be compliant,” according to the FDA press release.

“This initiative creates incentives for drug makers to develop and maintain secure supply chains,” said Deborah Autor, Director of the Office of Compliance in FDA’s Center for Drug Evaluation and Research, in the press release. “This is one of several agency initiatives to enhance drug product safety.”

The pilot program compliments the agency’s recent placement of offices in foreign countries to oversee quality control standards of foods and drugs imported into the U.S. The efforts likely stem from scrutiny the agency received last year after batches of heparin produced in China were found to have been contaminated. The tainted heparin killed more than 80 people and sickened hundreds more before an investigation revealed that the heparin was most likely contaminated during manufacturing at Baxter International’s China plant. The finding led to an FDA recall of specific lots of heparin.

In the months following the heparin scandal, the FDA has come under fire from lawmakers and advocacy groups for not adequately inspecting foreign food and drug manufacturing plants, and for mishandling the contaminated heparin investigation.

SOURCE: Heparin Recall › FDA launches pilot project to oversee foreign drug products

Moving from a paper system to an electronic medical records system was designed to reduce human error; however, health care experts say the errors prove that the VA’s system still needs to be carefully monitored. There have been no reports of harm caused by the errors, but the situation remains under review.

The errors involved medical data such as lab results, medications and vital signs that would show up under the wrong patient’s name. Doctor’s orders also were not clearly displayed, often resulting in unnecessary administering of intravenous drugs such as heparin.

VA released a statement saying that nine patients at the VA hospitals in Milwaukee, Durham, N.C., and Marion, Ind., were given incorrect doses, six of which involved heparin that was given for up to 11 hours longer than necessary, according to the Associated Press report. Other cases included infusions of sodium chloride or dextrose mixtures that were given up to 15 hours longer than prescribed.

Veterans with questions or concerns can request a copy of their medical records at www.myhealth.va.gov.

SOURCE: Heparin Recall › AP: ’software glitches’ led to prolonged infusions of heparin

Allie recently posted a video on YouTube in light of the heparin scandal, asking “Is my insulin tainted?” Last year, more than 80 Americans died and hundreds more were sickened after receiving doses of the blood thinner heparin. An investigation found that batches of heparin manufactured at Baxter International’s China facility had been contaminated. That led to a recall, and further questions about the quality of the foods and drugs imported into the United States from foreign countries, especially China.

Demanding answers, Allie made phone calls to insulin companies and 24 hours later, reported on her results. Her first call was to Sanofi Aventis, a pharmaceutical company based in Bridgewater, NJ. Sanofi Aventis manufactures medications such as Allegra, Ambien, and Ketek as well as diabetes medications such as insulin glargine injection Lantus and insulin gluisine injection Apidra. Allie reports that she was able to speak with a customer service representative with Sanofi Aventis who informed her that the raw materials are manufactured in Germany and are “completely FDA approved and do not come from China.”

Allie compared her attempts to reach Eli Lilly and Company’s customer service as being in the “twilight zone.” Her repeated calls “during normal business hours” were either cut off or unanswered. Lilly is the 10th largest pharmaceutical company in the world and offers a variety of products. It’s diabetes products include Byetta, Gluagon and Humulin.

Allie then called Novo Nordisk, a manufacturer and marketer of pharmaceutical products and services headquartered in Denmark. Novo Nordisk offers a line of diabetes products such as insulin pens, needles and hypokits. She was told that its diabetes products are bottled in North Carolina.  Its FlexPen is manufactured in Denmark. Customer Service assured her they follow FDA guidelines and run batch tests to ensure safety.

SOURCE: Heparin Recall › Diabetic questions safety of insulin in light of heparin scandal

Researchers at Beaumont Hospital in Royal Oak, Michigan, have developed a treatment protocol to quickly and effectively diagnose brain bleeds in patients who are on blood thinners and bump their heads. The study treated 105 patients under the new protocol. As a result, diagnosis of brain bleeds occurred in half the time and treatments were started faster. Under this new system, death rate also was reduced from 40 percent to 11 percent.

The protocol includes rapid initial evaluation by a doctor or nurse, a CT scan performed on a priority basis, a blood transfusion and administration of vitamin K to help the blood clot, according to the report.

“These seem like relatively simple steps, but when combined they become a powerful force that helps save lives,” Emax Health quoted Greg Howells, M.D., director of Trauma Surgery. When the head bumps occur, many people can appear fine even if the injury is causing the brain to bleed. Previous studies have shown that people on blood thinners are four times more likely to die from a blow to the head than those not on blood thinners.

As a result of the study, more than 40 other hospitals across the country have asked about Beaumont’s treatment protocol for people on blood thinners who bump their heads.

SOURCE: Heparin Recall › Head injury protocol reduces death rate for patients on blood thinners

Blood thinners are routinely given to patients before certain types of surgery and treatments such as kidney dialysis to prevent blood clots from forming. Clots that do not naturally dissolve can travel through the blood stream and end up in the brain, causing a stroke, or in the lungs, causing a pulmonary embolism. Blood clots, also known as thrombosis, is a serious problem affecting nearly a million Americans each year and killing nearly 300,000 annually.

Two more common types of blood thinners are heparin and warfarin. Heparin is administered intravenously, requiring medical supervision, whereas warfarin is given orally. Both drugs have been used medically for decades. Both have side effects that doctors and patients find bothersome, including easy bruising, excessive bleeding, lower back pain, weakness or light-headedness, and flu-like symptoms. Thus physicians are eager to find safer alternatives.

Furthermore, heparin has been in the spotlight continuously over the past several months for confusing labeling that has resulted from overdoses that have sickened and killed patients, as well as batches of contaminated heparin that made its way into hospitals, causing more illnesses and deaths in patients who received the bad lots.

SOURCE: Heparin Recall › Drug makers rush to produce new blood thinners

First, researchers noted that the evaluations were short term and that many of the studies were supported by the generic drug companies, who have a vested interest in the positive outcome of the results.

Furthermore, the story points out that generics are more likely to be made in factories in other countries where labor and overhead are far less expensive, such as India and China. In fact, China is producing more and more generic drugs and, according to the story, is expected to offer even lower prices in the future.

This should raise concerns with the general public, given the tainted heparin scandal earlier this year that killed more than 80 Americans and sickened hundreds more. That tainted heparin was traced to manufacturing plants in China and resulted in a major recall of the blood thinner.

The FDA is hoping to give more guidance on U.S. quality control standards on imported food and drugs by opening offices and placing regulators in foreign countries. The first office opened in Beijing last month. However, congressional investigators say that inspecting the more than 3,000 drug plants in other countries could take more than a decade.

SOURCE: Heparin Recall › Generics may be bio-equivalent of brands, but are they as safe?

“Previously it was nearly impossible to change the nature of the heparin generated by the enzyme,” said Jian Liu, Ph.D., associate professor at the UNC Eshelman School of Pharmacy medicinal chemistry and natural products division. “The degree of difficulty was 10-plus. Now it’s more like a two or three, which opens the door to the possibility of improving on the natural product.”

The method involves modifying the enzyme heparan sulfate 2-O-sulfotransferase, which produces heparin in the human body in addition to other heparin-like molecules. By modifying 2-O-sulfotransferase, researchers will be able to create customized forms of synthetic heparin with different properties, according to the report.

Heparin is typically administered to most patients during surgery and before some treatments such as kidney dialysis to prevent blood clots from forming. Heparin is produced naturally by most animals, including humans, but most heparin available today is derived from pig intestines. China has become a popular location for manufacturing heparin because it has a much larger pig population.

However, heparin manufactured in China raised concerns earlier this year after batches from Baxter International’s China plant were found to have been contaminated. The investigation into heparin resulted after more than 80 Americans died and hundreds more were sickened after receiving doses of the tainted heparin. As a result, researchers have been working to find safer alternatives to heparin, including developing synthetic versions.

“The pig stuff has served us well for 50 years and is very inexpensive, but if we cannot control the supply chain, we cannot ensure the safety of the drug,” Liu said. “I am working for the day when synthetic heparin can be brewed in large laboratories at a low cost.”

Liu and her colleagues also are looking into customizing heparin for other uses, such as a treatment for small-cell lung cancer.

Liu’s research recently was published online in the journal Proceedings of the National Academy of Sciences.

SOURCE: Heparin Recall › Scientists on road to modifying, customizing human heparin

During dialysis, patients are hooked up to a machine that draws out the blood through tubing. Since blood tends to clot when it moves through the tubing, patients routinely are given the blood thinner heparin to prevent clotting.

One week before Christmas, after two months of regular dialysis, Bonnie fell ill with diarrhea, vomiting and soon, severe pain in her chest and abdomen. She was rushed to intensive care and within days was unconscious and on a breathing tube. The doctors said there was no more she could do. Leroy’s wife was suddenly and unexpectedly dead.

As Leroy tried to cope with the loss of his longtime wife, their son Randy suddenly became sick with the same symptoms. He was born with the same genetic kidney disease as his mother, and was receiving regular dialysis treatments. His wife, a dialysis nurse, tried desperately to revive him but it was no use. Randy died just three weeks after his mother.

Both Bonnie and Randy were victims of tainted heparin, batches of the drug manufactured in China and later found to have been contaminated with over-sulfated chondroitin sulfate (OSCS). The Hubleys were just two of more than 80 deaths caused by the contaminated heparin. Several hundreds more were sickened by the drug before the FDA recalled batches made in the Baxter International Chinese plant. To date, the FDA has recalled 13 different contaminated medical products containing heparin from various companies.

Last week had U.S. Marshals raided Celsus Laboratories Inc., and found 11 lots of the tainted blood thinner that had not been removed. The recalls and FDA crackdowns come too late for the Hubley family and for the hundreds of families affected by the contaminated heparin. We need to be assured that the contaminated heparin is removed for good so that no more lives are in jeopardy.

SOURCE: Heparin Recall › Time shares story of family affected by heparin contamination

“It’s really horrible for two reasons: one, that a company that knows that their product is not a good product that should be distributed and they’ve been told so,” said Dr. Lynne Wagoner, a Christ Hospital Heart Specialist, who was quoted in the story by WTOL-TV in Toledo, Ohio.

Earlier this month, U.S. Marshals seized a total of 11 lots of the blood thinner at Celsus Laboratories Inc. Heparin was recalled earlier this year after an FDA investigation found that batches of the blood thinner were contaminated with over-sulfated chondroitin sulfate (OACA) at a manufacturing plant in China. The investigation was launched after more than 80 Americans died and hundreds more fell ill after receiving the medication.

The FDA said Celsus Laboratories did not sufficiently carry out the recall process by notifying customers of the contaminant in the heparin it provided. The company distributes both heparin lithium and heparin sodium USP, both of which fell under the recall. As a result, the FDA issued an advisory to manufacturers who may have purchased heparin from Celsus Laboratories to contact the company to make certain they are not using a product from the contaminated batch.

The FDA has recalled 13 different contaminated medical products containing heparin from various companies.

SOURCE: Heparin Recall › Doctors outraged by heparin seizure

Heparin is a blood thinner that is routinely used before certain types of surgery or other procedures to prevent clotting. It also is widely used for patients with chronic thrombotic conditions. Heparin is administered intravenously, which requires constant monitoring of doses and in-patient hospital stays. An oral alternative could reduce the need for expensive hospital stays.

About 2 million Americans each year suffer from thrombotic conditions and another 200,000 die each year from stroke, myocardial infarctions or pulmonary emboli as a result of thrombosis, according to the report.

The heparin will use glycosaminoglycan (GAG) technology to develop the oral alternative.

“The introduction of an oral heparin into clinical medicine would be a significant development and would have commercial, therapeutic and economic potential. We are pleased that Glycotek will take on this important challenge while at HCAR,” said Laura Butcher, Executive Director of HCAR, in the Business Wire report.

Glycotek will pursue both business and research and development activities at HCAR. Building upon its activities already in practice at its New York location. HCAR provides state-of-the-art facilities and high-value business and research resources.

SOURCE: Heparin Recall › Glycotek developing oral alternative to heparin

The method uses a machine that removes blood from a patient through an IV, separates it into red blood cells and plasma, and returns the red blood cells back into the patient’s arm. The plasma is then infused with the blood thinner heparin, which binds to the low-density lipoprotein (LDL), or “bad” cholesterol, and separates from the plasma. The LDL is then filtered out and the remaining plasma is put back into the patient’s vein. The process filters about half of the body’s total supply of blood, removing more than half of the LDL cholesterol. The process can be repeated every two weeks as LDL builds back up.

High cholesterol, especially high LDL levels, can clog arteries to the heart and brain, which can cause heart attacks and strokes.

Innovative uses for heparin present the need for more safeguards to protect recipients of pharmaceutical medications. Batches of heparin made by Baxter International were recalled earlier this year after numerous patients died or became ill after receiving injections of heparin. The drug was later found to have been contaminated at Baxter’s Chinese manufacturing plant.

The LDL-removing treatment, which has been available in the United States for about 10 years, is generally available only to individuals with LDL levels that stay above 300 even after drug therapy, diet and exercise. However, because of its high expense and low number of eligible patients, few machines are readily available.

SOURCE: Heparin Recall › Heparin used in innovative cholesterol-separating method

The report revealed that inspecting the more than 3,000 overseas drug plants would take the FDA more than 13 years to complete The agency fired back, saying “The conclusion that FDA should endeavor to conduct foreign inspections based on the same criteria as domestic inspections is…problematic because of the differences in regulatory methodology and resources,” according to the Associated Press.

The need for careful inspections of foreign drug manufacturing plants has come to the forefront since the tainted heparin scare earlier this year that killed more than 80 people and sickened hundreds more. Those batches of heparin were found to have been contaminated in Baxter International’s Chinese manufacturing plant.

Now the Natural News is reporting that the FDA is refusing to release information on which Chinese companies supplied the tainted heparin. According to Natural News, the FDA claims that a confidentially agreements with producers of heparin are preventing the government agency from revealing which Chinese companies supplied heparin ingredients to the United States. It also claims that because of the Memorandum of Agreement that regulates relationships between the FDA and China, the FDA does not have the legal authority to prevent Chinese-manufactured medicines from being imported into the U.S. The FDA says it relies on companies to voluntarily rest their own heparin ingredients, a process that obviously failed last year when contaminated heparin entered the United States.

Meanwhile, Chinese health officials say that it has not been proven that the heparin was contaminated in Chinese plants, and that contamination could just have easily happened in Baxter’s New Jersey plant.

SOURCE: Heparin Recall › FDA will not name Chinese plants that supplied tainted heparin

The U.S. Food and Drug Administration (FDA) recently announced that it will place more than 60 food and drug regulators worldwide over the next year to inspect foreign drug manufacturing plants.

However, congressional investigators say inspecting the more than 3,000 drug plants in other countries could take as long as 13 years, according to the Associated Press. In comparison, U.S. pharmaceutical factories are inspected by the federal government every 2.7 years on average.

Of the 3,249 foreign facilities for which the FDA has set enforcement priorities, the government agency has only been able to inspect an average of 247 per year, compared to 50 percent of the 3,000 U.S. facilities, according to the Government Accountability Office (GAO).

Inspections of most domestic plants involve ongoing surveillance of facilities’ manufacturing practices. By contrast, foreign facilities are inspected before they are allowed to ship drugs to the U.S. When problems are found at a foreign plant, steps are taken to fix them. However, follow up inspections on those measures by the FDA can take up to five years, the report said.

The GAO report stated significant growth in the foreign drug manufacturing market has presented the FDA with “significant challenges” in ensuring the safety of imported drugs, and urged more surveillance of all foreign drug facilities.

SOURCE: Heparin Recall › FDA inspections of foreign drug facilities could take years

The blood thinner heparin made news recently when the FDA recalled batches of heparin after more than 80 people died and several others became ill after receiving heparin. It was later determined that heparin made by Baxter International was contaminated in the company’s Chinese manufacturing facility.

While heparin is considered an effective treatment for preventing blood clots and is widely used, it must be injected, which makes long-term therapy difficult. The new drugs would be taken by mouth, which would make dosing easier and eliminate the need for laboratory monitoring.

Heparins garner about $700 million in annual sales, with Sanofi-Aventis’ Lovenox making up nearly two-thirds of the world’s share of the drug. Pfizer’s Fragmin and GlaxoSmithKline’s Fraxiparine account for 6.3 and 5.9 of sales, respectively. Vitamin K Antagonists are responsible for more than $6 billion in sales worldwide, with Bristol-Myers Squibb’s Coumadin, Barr’s Warfarin and Eisai’s Warfarin owning slightly more than half the market’s share.

Three of the five companies are in the late phases of clinical testing, two of which already have been approved in Canada and are awaiting approval in the United States. Two other companies’ drugs have been approved for short-term use in Europe.

SOURCE: Heparin Recall › Pharmaceutical companies developing drugs to fight blood clots

FDA approval isn’t a guarantee of safety. For example, last spring, FDA-approved batches of heparin were recalled after they were found to have been contaminated. The tainted drug killed more than 80 people and sickened hundreds more before the FDA recalled the medication.

At issue in the new Supreme Court term is the “final rule” established on June 30, 2006, by the FDA. That rule protects drug companies whose drugs have harmed others from lawsuits by individuals who have been harmed. This extends to companies that deliberately withheld information that would have proven their drug to be harmful.

According to the Natural News story, the FDA runs without oversight and has declared that it gets the final word on a drug’s safety regardless of its harmful effects. Therefore, both the FDA and the pharmaceutical companies it represents are protected from suits under this arbitrary rule.

The Supreme Court currently is considering a lawsuit against drug-maker Wyeth and its drug Phenergan after a woman who received an injection of the nausea drug led to a gangrene infection that resulted in the amputation of her arm. Wyeth is accused of inadequately warning about the risks involved with this type of injection.

SOURCE: Heparin Recall › High court rule may affect right to sue drug makers

Italian researches carefully selected 700 of the “lowest risk” patients to participate in the trial. This included patients with single blockages of a heart artery, currently taking two clot-preventing medications such as aspirin and thienopyridine, and with no immediate danger of heart attack.

The study found that the incidence of heart damage and bleeding events were lower in the patients who participated in the study, and there was a lower risk of death, heart attack or blood vessel problems.

According to the American Heart Association, the artery-opening procedure, formerly called percutaneous coronary interventions, is a procedure used to treat patients with diseased arteries of the heart. For example, chest pain caused by a build-up of fats, cholesterol and other substances from the blood that can reduce blood flow to a near trickle or heart attack caused by a large blood clot that completely blocks the artery.

The Italian study cautioned that using no heparin is a bold step and one that should be taken only after serious consideration and evaluation of the patient’s health.

While more work is needed to confirm the results, some researches applaud efforts to move medical innovations like this forward. This is especially welcome news considering the recent contaminated heparin scare that killed more than 80 Americans and sickened hundreds more.

SOURCE: Heparin Recall › Artery procedures successfully performed without heparin

Alchemia’s CEO, Dr Peter Smith said “The impending commercialization of generic fondaparinux and anticipated revenues in calendar year 2009 will form a strong financial base for Alchemia. This will enable the company to advance its drug targeting and drug discovery technologies to further build a sustainable pipeline of opportunities for future commercialization.”

The company’s report states: “Given the complexity of the synthesis, Alchemia continues to believe that its generic fondaparinux will be the only generic brought to market, restricting competition to two drugs, Alchemia’s fondaparinux and GSK’s Arixtra. Typically, a first generic will take 40-50 percent of the prescription share, and with Alchemia’s fondaparinux expected to be the sole generic, a modest level of price discounting is anticipated.”

Arixtra is the only heparin drug not derived from biological sources as it is a synthetic molecule. Thus, it was not among the recent heparin recall.

Alchemia contends that there are no significant technical hurdles remaining and that generic fondaparinux approval and launch is expected in the first half of 2009, depending on review time at the FDA.

SOURCE: Heparin Recall › Synthetic heparin expected to launch early 2009

Lovenox, the company’s number one selling medicine, was first recalled last June after some batches of its pre-filled injectible solution were found to be contaminated with trace amounts of oversulphated chondroitin sulphate, according to Reuters.

Oversulphated chondroitin sulphate is the same contaminate found last March by the Food and Drug Administration (FDA) in batches of heparin that killed more than 80 Americans and sickened hundreds more. Those batches were traced back to Baxter International’s Chinese plant.

The level of contaminant found in Lovenox was much lower than what was found in the heparin manufactured by Baxter International, according to Forbes.

So, what exactly is oversulphated chondroitin sulphate?

According to a March 20, 2008, New York Times report, chondroitin sulphate is an inexpensive and readily available dietary supplement made from animal cartilage. In its natural state chondroitin sulphate does not have anticlotting properties, however when it is altered to what is called oversulphated chondroitin sulphate, it mimics heparin.

According to the FDA, oversulphated chondroitin sulphate is not an approved drug in the U.S., nor should it be found in heparin, as it likely caused the allergic reactions that have killed and sickened so many individuals worldwide.

SOURCE: Heparin Recall › French Lovenox brand heparin recall

According to information on its web site, Fresenius, based in Hamburg, Germany, is the world’s largest integrated provider of products and services for individuals undergoing dialysis because of chronic kidney failure. It estimates more than 1.6 million people are affected by kidney failure worldwide.

The AP says the purchase of APP Pharmaceuticals will help Fresenius lower its expenses. Heparin is used by patients on kidney dialysis.

U.S. regulators approved the purchase, which is expected to close by mid-September, according to the AP report. As a result of the sale, APP Pharmaceutical shares rose 13 cents to $23.80, the AP reports.

SOURCE: Heparin Recall › Fresenius buys heparin maker APP

According to a report in the Pharmaceutical Business Review, APP currently manufactures nine products at its Puerto Rico facility, including doxycycline, azithromycin and diphenhydramine. The report says the company plans to manufacture more than 19 million units in Puerto Rico during 2008 and to eventually transfer more than 25 additional product codes to the facility.

The recall of contaminated heparin manufactured in China has affected the availability of the product, which is a blood thinner used in surgical procedures.

Baxter International, Inc., recalled all remaining lots and doses of its sodium injection multi-dose, single-dose vials and HEP-LOCK heparin flush products, both preserved and preservative-free, in February, and suspended production of the products. Prior to the recall, Baxter manufactured about half the multidose vials used each month by health care providers.

APP expects the transfer of its additional product codes to the Puerto Rico facility will translate to approximately 50 million units annually. APP currently has manufacturing facilities in Illinois and New York.

Pharmaceutical Business Review quotes Tom Silberg, CEO of APP Pharmaceuticals, as saying, “Bringing this third manufacturing site on-line is an important part of our commitment to ensuring that an uninterrupted and safe supply of heparin of the highest quality is available for US patients.”

Founded in 1996, APP Pharmaceuticals is a leading manufacturer of multi-source and branded injectable pharmaceutical products for acute medical care both in patient and ambulatory settings.

SOURCE: Heparin Recall › APP ok to make heparin in Puerto Rico

The new expanded recall includes all remaining lots and doses of Baxter’s heparin sodium injection multi-dose, single-dose vials and HEP-LOCK heparin flush products, both preserved and preservative-free. The recall will not include Baxter’s heparin pre-mix IV solutions in bags.

Although there was a danger of contamination that could result in adverse patient reaction, the U.S. Food & Drug Administration did not require Baxter to do a full recall of the product in January because pulling all of the product could create a shortage for operating rooms, dialysis centers and other critical areas that use the product, which is a blood thinner.

According to a Baxter news release, in January the FDA determined the risk of patients not receiving any heparin blood thinners when it was critically needed was greater than that of patients receiving contaminated product. Baxter is one of the leading suppliers of heparin products, manufacturing about one half of the multidose vials used each month by health care providers.

The FDA now feels there is enough heparin available from other sources to allow Baxter to pull its remaining, possibly contaminated, product.

Customers are advised to immediately discontinue use of recalled product, and to contact Baxter for return and replacement.

Despite FDA assurances that there is enough heparin product in the market to treat critical patient needs, by March health care providers were being more careful with prescribing their existing supplies as a result of the more limited supply.

SOURCE: Heparin Recall › Baxter expands heparin recall

The U.S. Food and Drug Administration announced today that Baxter Healthcare Corporation has temporarily stopped manufacturing multiple-dose vials of the injectable blood-thinning drug heparin due to reports of serious allergic reactions and hypotension (low blood pressure) in patients who receive high “bolus” doses of the drug.

Serious reactions to the drug have included difficulty breathing, nausea, vomiting, excessive sweating, and rapidly falling blood pressure that can lead to life-threatening shock. Four people have died after receiving heparin, although the relationship to the drug is unclear.

Heparin sodium is derived from pig intestines and has been marketed in the United States since the 1930s. Millions of patients benefit from the intravenous administration of this drug every year to avoid potentially life-threatening blood clots in the veins, arteries, and lungs.

“FDA concurs with Baxter’s decision to halt manufacture of heparin sodium in multiple-dose vials,” said Janet Woodcock, M.D., FDA’s deputy commissioner for scientific and medical programs, chief medical officer, and acting director of its Center for Drug Evaluation and Research. “FDA is vigorously investigating to determine the root cause of these serious reactions associated with the use of heparin made by Baxter. In the meantime, patients and health care professionals who cannot obtain alternative sources of heparin should use caution in administering any Baxter multiple-dose vials that remain.”

Heparin is commonly used before certain types of surgery, including coronary artery bypass graft surgery, and in kidney patients before they undergo dialysis. In some situations, heparin treatment is initiated using a high bolus dose given directly into the bloodstream (intravenously) over a short period of time, usually less than one hour. The reported adverse events occurred in patients who were given heparin in this form of administration. There are many other uses of heparin involving lower doses or administration over a longer period of time; adverse events have not been seen with those uses.

About 350 adverse events associated with the Baxter product have been reported since the end of last year compared to less than 100 reports in 2007. Most of the events have taken place at hemodialysis centers, almost exclusively involving patients receiving a bolus dose – which is a high dose administered over a short time. While most of the reports involve multiple-dose vials, several cases include patients who received a bolus dose after their health care professional combined heparin from single-dose vials.

The Missouri Department of Health and Senior Services first notified the Centers for Disease Control and Prevention (CDC) in January of several severe allergic-type reactions to heparin that occurred at a single pediatric hospital beginning in November. The CDC in turn alerted FDA and Baxter, prompting the company’s voluntary recall of nine lots of heparin on Jan. 17.

Since then, FDA has learned of adverse events that extend beyond the recalled lots and involve patients receiving heparin for other purposes besides hemodialysis. Recent cases have included patients undergoing cardiac surgery and a specialized blood cell treatment known as photopheresis.

Over one million multiple-dose vials of heparin are sold per month in the United States; half of the vials are manufactured by Baxter of Deerfield, Ill. FDA is currently investigating whether similar events have been seen with other heparin manufacturers.

Physicians, dialysis center staff and health care providers are advised to use an alternate source of heparin or another blood-thinning drug when possible. When only Baxter product is available:

• Administer the heparin as an infusion (not a bolus) whenever possible.
• Use the lowest dose necessary at the slowest infusion rate acceptable to obtain the desired clinical effect.
• Closely monitor the patient for adverse events, particularly hypotension and signs and symptoms of hypersensitivity and ensure that resuscitation equipment is available.
• Consider pretreatment with corticosteroids (cortisone type medicines) or antihistamines (drugs that relieve the symptoms of allergic reactions) although it is not known if such pretreatment is effective.

Any allergic-type reaction to heparin infusion should be reported to FDA’s MedWatch Program by phone at 800-FDA-1088, by fax at 800-FDA-0178, by mail at MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, M.D. 20852-9787, or on the MedWatch Web site at www.fda.gov/medwatch.

SOURCE: http://www.fda.gov/bbs/topics/NEWS/2008/NEW01797.html

SOURCE: Heparin Recall › Heparin Linked to Severe Allergic Reactions