Heme replacement
Haem arginate
Brand names: Normosang
Adult dose
Dose: 3 mg/kg/day IV for 4 days (max 250mg/day)
Route: IV
Frequency: OD x 4 days
Clinical pearls
- Acute hepatic porphyria attacks
- Infuse via central or large peripheral vein; flush after
Contraindications
- Hypersensitivity
- Severe hepatic impairment
Side effects
- Phlebitis
- Iron overload with repeated courses
- Anaphylaxis
- Coagulopathy
- Pyrexia
Interactions
- Drugs metabolised by CYP enzymes (transient inhibition)
Monitoring
- LFTs
- Ferritin (long-term)
- ALA/PBG
Reference: BNF; British and Irish Porphyria Network; https://bnf.nice.org.uk/drugs/haem-arginate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Weight-Based Levothyroxine Dose Calculator · Thyroid
- Cryoprecipitate Dose Calculator for Fibrinogen Replacement · Transfusion Medicine
- Free Water Deficit in Hypernatraemia · Fluid / Electrolytes
- Potassium Deficit Calculator · Electrolytes
- Indications for Renal Replacement Therapy (RRT) in AKI · Treatment Decision
Pathways
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO