Version July 2025
Acquired fibrinogen deficiency; treatment of acute bleeding: Note: Dosing must be individualized for each patient based on the extent of bleeding, laboratory values, clinical condition of the patient, fibrinogen concentration, or viscoelastic properties of fibrin-based clot.
Children <12 years: Fibryga: IV: 70 mg/kg; may repeat dose as needed in bleeding patients when plasma fibrinogen ≤200 mg/dL or thromboelastometry FIBTEM A10 ≤10 mm (or equivalent values measured by other viscoelastic testing methodology).
Children ≥12 years and Adolescents: Fibryga: IV: 50 mg/kg; may repeat dose as needed in bleeding patients when plasma fibrinogen ≤200 mg/dL or thromboelastometry FIBTEM A10 ≤10 mm (or equivalent values measured by other viscoelastic testing methodology).
Congenital fibrinogen deficiency; treatment of acute bleeding: Note: Dosing must be individualized for each patient based on the extent of bleeding, laboratory values, clinical condition of the patient, and target fibrinogen concentration. The recommended target fibrinogen concentration is 100 mg/dL for minor bleeding and 150 mg/dL for major bleeding.
Initial dose:
When baseline fibrinogen concentration is known:
RiaSTAP: Infants, Children, and Adolescents (Ref): IV:
Dose (mg/kg) = [Target fibrinogen concentration (mg/dL) – measured fibrinogen concentration (mg/dL)] divided by 1.7 (mg/dL per mg/kg body weight)
Fibryga:
Children <12 years: IV:
Dose (mg/kg) = [Target fibrinogen concentration (mg/dL) – measured fibrinogen concentration (mg/dL)] divided by 1.4 (mg/dL per mg/kg body weight)
Children ≥12 years and Adolescents: IV:
Dose (mg/kg) = [Target fibrinogen concentration (mg/dL) – measured fibrinogen concentration (mg/dL)] divided by 1.8 (mg/dL per mg/kg body weight)
When baseline fibrinogen level is not known: Fibryga, RiaSTAP: Infants, Children, and Adolescents: IV: 70 mg/kg.
Repeat doses: Adjust dose based on laboratory values and condition of patient. Administer additional doses if the fibrinogen concentration falls below 80 mg/dL for minor bleeding and below 130 mg/dL for major bleeding until hemostasis is achieved.
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
(For additional information see "Fibrinogen, concentrate from human plasma: Drug information")
Acquired fibrinogen deficiency (Fibryga): IV: 4 g as a single dose; administer additional doses of 4 g as needed when plasma fibrinogen level is ≤200 mg/dL or thromboelastometry FIBTEM A10 is ≤10 mm (or equivalent values generated by other viscoelastic testing methods). May adjust dose based on plasma fibrinogen levels or viscoelastic testing, severity of bleeding, body weight, or patient's clinical condition.
Congenital fibrinogen deficiency: IV: Note: Maintain a target fibrinogen level of 100 mg/dL for minor bleeding and 150 mg/dL for major bleeding.
When baseline fibrinogen level is known:
Fibryga: Dose (mg/kg) = [Target level (mg/dL) - measured level (mg/dL)] divided by 1.8 (mg/dL per mg/kg body weight)
RiaSTAP: Dose (mg/kg) = [Target level (mg/dL) - measured level (mg/dL)] divided by 1.7 (mg/dL per mg/kg body weight)
When baseline fibrinogen level is not known: 70 mg/kg
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Atrial fibrillation (29%)
Hematologic & oncologic: Anemia (16%)
Nervous system: Delirium (15%)
1% to 10%:
Cardiovascular: Thromboembolic complications (9%; including acute myocardial infarction, arterial thrombosis, cerebrovascular accident, deep vein thrombosis, disseminated intravascular coagulation, ischemic hepatitis, mesenteric ischemia, peripheral ischemia, pulmonary embolism, thrombophlebitis, transient ischemic attacks)
Gastrointestinal: Nausea (>5%), vomiting (>5%)
Hematologic: Thrombocytopenia (4%), thrombocytosis (>5%)
Hepatic: Abnormal liver function (7%)
Nervous system: Headache (>1%)
Renal: Acute kidney injury (8%), kidney failure (5%)
Respiratory: Pneumonia (5%)
Miscellaneous: Fever (>1%)
Frequency not defined:
Cardiovascular: Ischemia (digital foot), peripheral thrombophlebitis (upper limbs), portal vein thrombosis (following splenectomy)
Dermatologic: Erythema of skin, pruritus
Postmarketing:
Hypersensitivity: Hypersensitivity reaction (including anaphylaxis)
Nervous system: Chills
Severe, immediate hypersensitivity reactions, including anaphylaxis to fibrinogen, human plasma-derived products, or any component of the formulation.
Concerns related to adverse effects:
• Hypersensitivity: Hypersensitivity reactions (eg, hives, generalized urticaria, chest tightness, wheezing, hypotension, anaphylaxis) may occur. In the event of hypersensitivity reactions, treatment should be discontinued immediately.
• Thrombotic events: Thrombosis may occur spontaneously in patients with acquired or congenital fibrinogen deficiency with or without fibrinogen replacement therapy. Thromboembolic events have been reported in patients receiving fibrinogen concentrate. Consider potential risk of thrombosis with use.
Dosage form specific issues:
• Human plasma: Product of human plasma; may potentially contain infectious agents which could transmit disease (eg, viruses and theoretically the Creutzfeldt-Jakob disease [CJD]). Screening of donors, as well as testing and/or inactivation or removal of certain viruses, reduces the risk. Infections thought to be transmitted by this product should be reported to the manufacturer.
Other warnings/precautions:
• Appropriate use: Not indicated for the treatment of dysfibrinogenemia.
Strengths expressed with approximate values. Consult individual vial labels for exact potency within each vial.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution:
Fibryga: ~1 g [exact potency labeled on vial]
RiaSTAP: 900-1300 mg [contains albumin (human); exact potency labeled on vial]
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution:
Fibryga: ~1 g [exact potency labeled on vial]
RiaSTAP: 900-1300 mg [contains albumin (human); exact potency labeled on vial]
IV: For IV administration only; rate dependent upon indication. Solution should be infused at room temperature. Do not administer with other products or IV solutions.
Acquired fibrinogen deficiency: Fibryga: Infuse at a rate ≤20 mL/minute.
Congenital fibrinogen deficiency: Fibryga, RiaSTAP: Infuse at a rate ≤5 mL/minute.
IV: For IV administration only; infuse at a rate not exceeding 5 mL/minute (congenital fibrinogen deficiency) or 20 mL/minute (acquired fibrinogen deficiency). Solution should be infused at room temperature. Do not administer with other products or IV solutions. Administration should be completed within 8 hours (RiaSTAP) or 4 hours (Fibryga) after reconstitution. For RiaSTAP, filter reconstituted solution with a 17-micron filter (not supplied) into an appropriate syringe before administration. For Fibryga, filter reconstituted solution with the supplied 17-micron particle filter into an appropriate syringe before administration.
Fibryga: Store intact vials at 2°C to 25°C (36°F to 77°F) in original carton; do not freeze. Protect from light. Discard partially used vials. Reconstituted solution should be used within 4 hours; do not refrigerate or freeze.
RiaSTAP: Store intact vials at 2°C to 8°C (36°F to 46°F) in original carton; do not freeze. Protect from light. Discard partially used vials. Reconstituted solution is stable for 8 hours when stored at 20°C to 25°C (68°F to 77°F).
Treatment of acute bleeding episodes in patients with congenital fibrinogen deficiency including afibrinogenemia and hypofibrinogenemia (Fibryga: FDA approved in children, adolescents, and adults; RiaSTAP: FDA approved in pediatric patients [age not specified] and adults); supplementation in patients bleeding with acquired fibrinogen deficiency (Fibryga: FDA approved in children, adolescents, and adults).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
There are no known significant interactions.
Patients with congenital fibrinogen deficiency may have an increased risk of bleeding, thrombosis, and pregnancy loss; replacement therapy may be initiated prior to conception (RCOG [Pavord 2017]).
Pregnant patients with congenital fibrinogen deficiency may have an increased risk of bleeding, thrombosis, and pregnancy loss; therefore, close surveillance is recommended. Maternal fibrinogen concentrations increase during pregnancy but do not protect against potential complications. Prophylaxis throughout pregnancy may be needed and higher doses may be required as pregnancy progresses. Plasma derived fibrinogen concentrate may be used for treatment or prevention of bleeding in patients with severe deficiency (RCOG [Pavord 2017]).
Fibrinogen level; viscoelastic properties of the fibrin-based clot (if treating acquired fibrinogen deficiency); signs/symptoms of hypersensitivity and thrombosis.
Normal fibrinogen concentrations: 200 to 450 mg/dL (SI: 5.9 to 13.2 micromoles/L).
Congenital fibrinogen deficiency: Target fibrinogen concentrations for acute bleeding:
Minor bleeding: 100 mg/dL (SI: 2.9 micromoles/L).
Major bleeding: 150 mg/dL (SI: 4.4 micromoles/L).
Fibrinogen (coagulation factor I), a protein found in normal plasma, is required to clot blood. It leads to the formation of fibrin monomers that undergo polymerization and are stabilized by activated factor XIII. Factor XIIIa forms cross links between fibrin polymers which support the platelet plug and achieve hemostasis. Fibrinogen concentrate made from pooled human plasma replaces this protein which is missing or reduced in patients with a congenital or acquired fibrinogen deficiency.
Note: In pediatric patients (12 to 17 years of age) receiving Fibryga, pharmacokinetic values were reported to be similar to adult data. In children 1 to <12 years of age, lower in vivo recovery, faster clearance, and shorter half-life were observed.
Distribution: Vd:
Fibryga:
Patients <6 years of age: 68.6 ± 4.4 mL/kg (range: 63.9 to 72.7 mL/kg).
Patients 6 to <12 years of age: 67.2 ± 8.2 mL/kg (range: 52.8 to 76.8 mL/kg).
Patients ≥12 years of age (including adults): 70.2 ± 29.9 mL/kg (range: 36.9 to 149.1 mL/kg).
RiaSTAP: Patients 8 to 61 years of age: 52.7 ± 7.48 mL/kg (range: 36.22 to 67.67 mL/kg).
Half-life elimination: Similar to biological fibrinogen.
Biological fibrinogen: 100 hours (Kamath 2003).
Fibryga:
Patients <6 years of age: 56.9 ± 10.8 hours (range: 45.6 to 67 hours).
Patients 6 to <12 years of age: 66.1 ± 12.1 hours (range: 57.7 to 91.6 hours).
Patients ≥12 years of age (including adults): 75.9 ± 23.8 hours (range: 40 to 157 hours).
RiaSTAP:
Patients <16 years of age: 69.9 ± 8.54 hours.
Patients ≥16 years of age: 82.3 ± 20.04 hours.
Excretion:
Clearance:
Fibryga:
Patients <6 years of age: 0.9 ± 0.1 mL/hour/kg (range: 0.8 to 1 mL/hour/kg).
Patients 6 to <12 years of age: 0.7 ± 0.1 mL/hour/kg (range: 0.5 to 0.9 mL/hour/kg).
Patients ≥12 years of age (including adults): 0.7 ± 0.2 mL/hour/kg (range: 0.4 to 1.2 mL/hour/kg).
RiaSTAP: Patients 8 to 61 years of age: 0.59 ± 0.13 mL/hour/kg (range: 0.45 to 0.86 mL/hour/kg); subgroup analysis showed faster clearance in subjects <16 years of age.
