BYFAVO Powder for solution for injection Ref.[10184] Active ingredients: Remimazolam

2.1 Important Dosage and Administration Instructions

BYFAVO can depress respiration. Continuously monitor patients for early signs of hypoventilation, airway obstruction, and apnea using capnography, pulse oximetry, and clinical assessment.

Only personnel trained in the administration of procedural sedation, and not involved in the conduct of the diagnostic or therapeutic procedure, should administer BYFAVO.

Administering personnel must be trained in the detection and management of airway obstruction, hypoventilation, and apnea, including the maintenance of a patent airway, supportive ventilation, and cardiovascular resuscitation.

Supplemental oxygen, resuscitative drugs, and age- and size-appropriate equipment for bag/valve/mask assisted ventilation must be immediately available during administration of BYFAVO. A benzodiazepine reversal agent should be immediately available.

Continuously monitor vital signs during sedation and through the recovery period [see Warnings and Precautions (5.1)].

Peak sedation occurs approximately 3 to 3.5 minutes after an initial 5 mg intravenous injection of BYFAVO given over a 1-minute period [see Clinical Pharmacology (12.2)].

Titrate subsequent doses of BYFAVO on the basis of clinical judgment and assessment of the depth of sedation. If maintenance of procedural sedation is inadequate, consider alternative medications [see Clinical Studies (14)].

2.2 Basic Dosing Information

• Individualize BYFAVO dosing and titrate to desired clinical response.
• In clinical studies, fentanyl 25 to 75 mcg was administered for analgesia prior to the first dose of BYFAVO. Supplemental doses of fentanyl were administered as needed for analgesia [see Clinical Studies (14)].
• Recommended dosing guidelines:

2.3 Preparation

Reconstitution of BYFAVO (remimazolam) for injection:

• Strict aseptic technique must be maintained during handling of BYFAVO.
• This product does not contain preservative.
• Once removed from packaging, protect vials from light.
• Each single-patient-use vial contains 20 mg BYFAVO lyophilized powder for reconstitution. The product must be prepared immediately before use.
• To reconstitute, add 8.2 mL sterile 0.9% Sodium Chloride Injection, USP, to the vial, directing the stream of solution toward the wall of the vial. Gently swirl the vial (do not shake) until the contents are fully dissolved. The reconstituted product will deliver a final concentration of 2.5 mg/mL solution of BYFAVO.
• Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Upon reconstitution, the solution should be a clear, colorless to pale yellow solution. Discard if particulate matter or discoloration is observed.
• If not used immediately, reconstituted BYFAVO may be stored in the vial for up to 8 hours under controlled room temperature at 20°C to 25°C (68°F to 77°F). After 8 hours, any unused portion must be discarded.

2.4 Administration with Other Fluids

• BYFAVO has been shown to be compatible with the following fluids: 0.9% Sodium Chloride Injection, USP, 5% Dextrose Injection, USP, 20% Dextrose Injection, USP, 5% Dextrose and 0.45% Sodium Chloride Injection, USP, and Ringer’s Solution. Do not mix BYFAVO with other drugs or fluids prior to administration.
• BYFAVO compatibility with other agents has not been adequately evaluated.

Clinical Presentation

Overdose may lead to CNS depression, associated with drowsiness, confusion, and lethargy, with possible progression to ataxia, respiratory depression, and hypotension.

Management of Overdosage

Flumazenil, a specific benzodiazepine-receptor antagonist, is indicated for the reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with BYFAVO is known or suspected. Prior to the administration of flumazenil, institute necessary measures to secure the airway, and ensure adequate ventilation and oxygenation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Flumazenil will only reverse benzodiazepine-induced effects and will not reverse the effects of other medications, such as opioid analgesics. Consult the complete flumazenil package insert, including CONTRAINDICATIONS, WARNINGS, and PRECAUTIONS, prior to use.

Monitor patients treated with flumazenil for re-sedation, respiratory depression, and other residual benzodiazepine effects. Re-sedation by BYFAVO has not been observed after administration of flumazenil in clinical trials.

Store at controlled room temperature 20°C to 25°C (68°F to 77°F) excursions between 15° and 30°C (59° and 86°F) are allowed.

Reconstituted BYFAVO can be stored in the vial for up to 8 hours under controlled room temperature at 20°C to 25°C (68°F to 77°F).

Protect vials from light once they are removed from packaging.

Discard unused portion.