From: Richard Cramer
To: Pharmacists
Cc: Keith Moss
Sent: Thursday, June 7, 2018 10:12:05 AM
Subject: Alphanate formulary use

Folks, there are 2 similar products (Alphanate and Humate-P) on the market that contain both factor 8 and von Willebrand factor and are used for control and prevention of bleeding in patients with hemophilia and von Willebrand disease (VWD).  The efficacy and safety info with the 2 products is similar.  Humate P has an FDA indication for bleeding from trauma in VWD patients while Alphanate does not.  The 2 products differ some in the ratio of VWF-Ristocetin Cofactor to Factor 8 ratio (Alphanate is 1.3:1 and Humate P is 2.4:1), but they are essentially used for the same indications.  Historically we have stocked and used Humate-P, but Alphanate is now significantly lower cost for us.  Other advantages of using Alphanate are ease of reconstitution and administration, and available in more strengths so easier to get dose without wastage. These are agents where each lot may be a little different in amount of drug supplied.  At the April P and T meeting it was approved to make Alphanate our workhorse agent instead of Humate P;  using Alphanate was also approved by the Hematology/Oncology Subcommittee. All the hematologists that this was discussed with agreed to use Alphanate.

Humate P will be available if the MD uses a no substitution order, if for some reason they particularly want Humate P in a specific patient.  If Humate P is ordered, the pharmacist should contact the prescriber to determine if the physician could use Alphanate for that patient, and discuss what dose the MD wants to use (dose info is in PI).  If the physician prefers Humate P for that particular case, then as a no sub we should supply the Humate P.    Let me know if you have any questions. 

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Richard Cramer, Pharm. D., FASHP, BCGP
Drug Information Coordinator