Curosurf Dosage

2.1 Important Administration Instructions

For intratracheal administration only.

CUROSURF should be administered by, or under the supervision of clinicians experienced in intubation, ventilator management, and general care of premature infants. Before administering CUROSURF, assure proper placement and patency of the endotracheal tube. At the discretion of the clinician, the endotracheal tube may be suctioned before administering CUROSURF. Allow the infant to stabilize before proceeding with dosing.

Administer CUROSURF either:

• Intratracheally by instillation in two divided aliquots through a 5 French end-hole catheter or
• Intratracheally in a single bolus through the secondary lumen of a dual lumen endotracheal tube without interrupting mechanical ventilation.

2.2 Recommended Dosage

The initial recommended dose is 2.5 mL/kg birth weight, administered as one or two aliquots depending upon the instillation procedure [see Dosage and Administration (2.4)].

Up to two repeat doses of 1.25 mL/kg birth weight each may be administered at approximately 12-hour intervals in infants in whom RDS is considered responsible for their persisting or deteriorating respiratory status. The maximum recommended total dosage (sum of the initial and up to two repeat doses) is 5 mL/kg.

2.3 Preparation of the CUROSURF Suspension

1. Remove the vial of CUROSURF suspension from a refrigerator at +2°C to +8°C (36°F to 46°F) and slowly warm the vial to room temperature before use.
2. Visually inspect the CUROSURF suspension for discoloration prior to administration. The color of the CUROSURF suspension should be white to creamy white. Discard the CUROSURF vial if the suspension is discolored.
3. Gently turn the vial upside-down, in order to obtain a uniform suspension. DO NOT SHAKE.
4. Locate the notch (FLIP UP) on the colored plastic cap and lift the notch and pull upwards.
5. Pull the plastic cap with the aluminum portion downwards.
6. Remove the whole ring by pulling off the aluminum wrapper.
7. Remove the rubber cap to extract content.
8. Unopened, unused vials of CUROSURF suspension that have warmed to room temperature can be returned to refrigerated storage within 24 hours for future use. Do not warm to room temperature and return to refrigerated storage more than once. Protect from light.

2.4 Administration

For endotracheal tube instillation using a 5 French end-hole catheter

1. Slowly withdraw the entire contents of the vial of CUROSURF suspension into a 3 or 5 mL plastic syringe through a large-gauge needle (e.g., at least 20 gauge). Enter each single-use vial only once.
2. Attach the 5 French end-hole catheter of appropriate length to position the catheter tip proximal to the distal portion of the endotracheal tube, to the syringe. Fill the catheter with CUROSURF suspension. Discard excess CUROSURF through the catheter so that only the dose to be given remains in the syringe.
   • For the first dose: 1.25 mL/kg (birth weight) per aliquot
   • For each repeated dose: 0.625 mL/kg (birth weight) per aliquot
3. First aliquot of CUROSURF suspension:
   1. Position the infant in a neutral position (head and body in alignment without inclination), with either the right or left side dependent.
   2. Immediately before CUROSURF administration, ventilate the infant with supplemental oxygen sufficient to maintain SaO2 > 92%.
   3. Insert the catheter into the endotracheal tube and instill the first aliquot of CUROSURF suspension.
   4. After the first aliquot is instilled, remove the catheter from the endotracheal tube and manually ventilate with supplemental oxygen until clinically stable.
4. Second aliquot of CUROSURF suspension:
   1. When the infant is stable, reposition the infant such that the other side is dependent.
   2. Administer the remaining aliquot using the same procedures as the first aliquot.
5. After completion of the dosing procedure, do not suction airways for 1 hour after surfactant instillation unless signs of significant airway obstruction occur [see Clinical Studies (14.1)].

For endotracheal tube instillation using the secondary lumen of a dual lumen endotracheal tube

1. Slowly withdraw the entire contents of the vial of CUROSURF suspension into a 3 or 5 mL plastic syringe through a large-gauge needle (e.g., at least 20 gauge). Do not attach 5 French end-hole catheter. Remove the needle and discard excess CUROSURF so that only the dose to be given remains in the syringe.
2. Keep the infant in a neutral position (head and body in alignment without inclination).
3. Administer CUROSURF suspension through the proximal end of the secondary lumen of the endotracheal tube as a single dose, given over 1 minute, and without interrupting mechanical ventilation.
4. After completion of this dosing procedure, ventilator management may require transient increases in FiO2 , ventilator rate, or PIP. Do not suction airways for 1 hour after surfactant instillation unless signs of significant airway obstruction occur.