Recombinate: Uses, Dosing, Side Effects, Storage, and Administration

Recombinate is an FDA-approved intravenous (IV) factor VIII replacement therapy used to control bleeding episodes in people with hemophilia A. It is also used to manage bleeding before, during, and after surgery in people with hemophilia A. 

Recombinate Introduction and Uses

Recombinate is a brand-name prescription product. The active ingredient is a lab-made form of factor VIII, also known as antihemophilic factor, a natural clotting protein found in blood. Recombinate does not contain any human blood products. 

Recombinate belongs to the drug class called coagulation factors or hemostatics. 

A healthcare provider may prescribe Recombinate for people with hemophilia A to control bleeding episodes or manage bleeding around surgery. 

Recombinate is not indicated for the treatment of von Willebrand disease (VWD).  

Availability note: Takeda has announced the global discontinuation of Recombinate and previously stated that it intended to continue supplying the medication to existing patients until inventory was depleted or expired in mid-2026. Patients currently using Recombinate should speak with their healthcare provider about product availability and whether a transition to another factor VIII therapy is needed. 

Recombinate Mechanism of Action

People with hemophilia A have deficient or dysfunctional clotting factor VIII. Factor VIII is necessary for the blood-clotting process, and a deficiency can cause prolonged or spontaneous bleeding into the joints, muscles, or internal organs.

Recombinate works by temporarily replacing the missing clotting factor VIII in the blood, helping the blood form clots and control bleeding.

Recombinate Dosing

Your healthcare provider will calculate your dose based on your body weight, desired increase in factor VIII activity, clinical response, and treatment needs. Always use the dose prescribed specifically for you.

Recombinate comes as an off-white to faint yellow powder in single-dose vials. It is available in nominal dosage strengths of approximately 250, 500, 1,000, 1,500, and 2,000 International Units (IU) per vial. The powder must be mixed with an appropriate volume of Sterile Water for Injection before intravenous (IV) infusion. Your provider will use a vial size that is appropriate for your calculated dose.

Dosing for Treatment of Bleeding Episodes 

Mild bleeding: The dose is individualized to achieve a post-infusion factor VIII activity level of approximately 20% to 40% of normal. It is administered every 12 to 24 hours for 1 to 3 days until healing is achieved or the bleeding is adequately resolved. 

Moderate bleeding: The dose is individualized to achieve a post-infusion factor VIII activity level of approximately 30% to 60% of normal. Treatment may be repeated every 12 to 24 hours for 3 days or more until pain or disability is resolved. 

Life-threatening bleeding: The dose is individualized to achieve a post-infusion factor VIII activity level of approximately 60% to 100% of normal. Treatment may be repeated every 8 to 24 hours until the threat no longer exists. 

Dosing for Surgery

Minor surgery: The dose is individualized to achieve a post-infusion factor VIII activity level of approximately 60% to 80% of normal. According to the prescribing information, a single infusion plus oral antifibrinolytic therapy within 1 hour is sufficient in approximately 70% of cases. 

Major surgery: The dose is individualized to achieve a factor VIII activity level of 80% to 100% of normal (pre- and post-operative). Treatment may be repeated every 8 to 24 hours. 

Recombinate Side Effects

Common Side Effects

In clinical studies, the most commonly reported side effects included:

• Chills
• Flushing
• Rash
• Nosebleeds

Other side effects reported during clinical trials included nausea, fatigue, fever, dizziness, itching, pain in an extremity, and low blood pressure.

Serious risks include severe allergic reactions and the development of factor VIII inhibitors. Contact your healthcare provider right away if bleeding does not stop after using Recombinate, as this may be a sign that the medication is not working as expected. Seek immediate medical care if you develop symptoms of a severe allergic reaction. 

Recombinate Important Information and Warnings

Never attempt to inject this medication on your own unless you know how to safely administer it. Carefully follow your healthcare provider’s instructions about the dose and schedule for administering Recombinate. 

Severe Allergic Reactions

Recombinate may cause serious allergic reactions, including anaphylaxis. Anaphylaxis is a potentially life-threatening allergic reaction that can cause difficulty breathing, swelling, chest tightness, wheezing, or low blood pressure.

Stop using Recombinate and seek immediate medical care if you develop symptoms of a severe allergic reaction, such as:

• Rash and itching
• Hoarseness
• Breathing difficulty
• Trouble swallowing
• Swelling of your hands, face, or mouth
• Chest tightness
• Low blood pressure

Inhibitor (Antibody) Production

In some cases, your body can develop proteins called inhibitors (antibodies) against factor VIII, which can prevent Recombinate from working well to treat or prevent bleeding. Inhibitor development is an important concern, particularly in previously untreated patients. 

Your healthcare provider will likely order tests to measure factor VIII inhibitors in your blood if:

• Factor VIII level doesn’t increase as expected after starting treatment
• Bleeding doesn’t stop with an appropriate dose

Before Taking Recombinate

Before using Recombinate, tell your healthcare provider if you:

• Are allergic to Recombinate, any of its ingredients, or mouse, hamster, or bovine proteins
• Have or have previously developed factor VIII inhibitors
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed 

Don’t use Recombinate if you have a known hypersensitivity to Recombinate, any of its ingredients, or mouse, hamster, or bovine proteins. 

Proper Use

Use this or any medication exactly as directed. You may receive your first dose in a hospital, clinic, or treatment center. If home treatment is appropriate, your healthcare provider will teach you how to prepare and administer the medication safely.

• Read and follow the Instructions for Use included with the product
• Wash your hands and work on a clean surface
• Allow the kit to reach room temperature
• Administer Recombinate at room temperature and follow your healthcare provider’s instructions for the infusion rate. Do not infuse faster than instructed. 
• Use only the supplies provided or specifically recommended by your healthcare provider
• You may need blood tests after receiving Recombinate to help determine if the blood level of factor VIII is enough for clot formation. 
• Check the reconstituted solution before infusion. It should be colorless to faint yellow and substantially free of visible particles.
• Do not use the solution if it is discolored or contains visible particles.
• If you miss a scheduled dose, contact your healthcare provider for instructions. Do not change your dose or treatment schedule unless instructed to do so. 

Contact your healthcare provider immediately if:

• Bleeding is not controlled after treatment
• You administer more than your prescribed dose
• You have difficulty preparing or infusing the medication

Recombinate Storage and Handling

• Store unopened Recombinate in a refrigerator at 2°C to 8°C (36°F to 46°F) or at room temperature up to 30°C (86°F). Keep the vials in their original box and protect them from extreme exposure to light. 
• Don’t freeze. 
• If you choose to store this medication at room temperature, keep it at room temperature until infusion and never put it back in the refrigerator. 
• Use the reconstituted solution within 3 hours. Don’t store or refrigerate the reconstituted solution. 
• Safely throw away any drug left in the vial at the end of the infusion. 

Recombinate Cost and Financial Assistance

Cost can vary depending on your insurance plan, location, and pharmacy. Contact your insurance provider to find out if your plan covers this medication or if you need prior authorization. If cost is a concern, contact us to explore financial assistance and copay assistance for Recombinate.