A Comparison of brand-name and generic versions of the anticoagulant, nafamostat mesilate, for hemodialysis

Hirashima, Chika; Izumi, Masayuki; Misumi, Fumiko; Kawagoe, Eiko; Suemitsu, Koutaro; Nariyama, Shinichi; Fukumoto, Hiromi; Kiyobayashi, Yuri; Nakanishi, Takeshi

doi:10.4009/jsdt.39.105

Cited by 2 publications

(2 citation statements)

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“…8). Although Arishima et al reported on precipitate formation in the circuit of blood flow, 9) Hirashima et al detected precipitates in the infusion tube. In hemodialysis, 10) the infusion rate of NFM (2-5 mL/h) is much slower than blood flow (6 L/h).…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] In contrast to such a variety of uses, the formation of a precipitate during the infusion of NFM into blood, especially during hemodialysis could lead to the interruption of hemodialysis. 9,10) The pharmaceutical formulation of NFM is a lyophilized powder with some added excipients (e.g., mannitol or pH controller). It is generally administered in a 5% glucose solution and not physiological saline, since mesilate of NFM can be exchanged by some anionic salts such as chloride, resulting in the formation of insoluble salts.…”

Section: Introductionmentioning

confidence: 99%

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Possible Role of Electrolytes on the Formation of Precipitates during the Infusion of Nafamostat Mesilate in Hemodialysis

Yamasaki

Nishi

Tsukigawa

et al. 2021

Biological & Pharmaceutical Bulletin

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Nafamostat mesilate (NFM) is used as an anticoagulant during hemodialysis in patients who have had complications due to hemorrhages. The formation of precipitates, which could lead to the interruption of hemodialysis has been reported when NFM is infused into blood during hemodialysis. We report herein on an examination of possible factors that could cause this. The effects of electrolytes such as phosphates, citrates or succinates on the formation of precipitates were examined by mixing NFM with aqueous solutions or plasma that contained these electrolytes. The formation of precipitates was observed in all electrolyte solutions when higher concentrations of NFM were mixed at around physiological pH. In the case of plasma, precipitates were observed when solutions containing higher concentrations of NFM were mixed with plasma that contained phosphate and citrate. In addition, the formation of precipitates under dynamic conditions where NFM was infused into flowing electrolyte solutions was also evaluated. The data suggested that such precipitates might be formed and disrupt the blood flow and/or an NFM infusion when NFM is infused into blood flowing in the hemodialysis circuit. The findings presented herein suggest the serum levels of anionic electrolytes (e.g., phosphate), the type of excipients present in pharmaceutical products (e.g., succinic acid or citric acid), the concentration of NFM used for the infusion or the rates of NFM infusion and blood flow are all factors that could affect precipitate formation during NFM infusions for hemodialysis.

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Section: Discussionmentioning

confidence: 99%