Get your patient on Clinisol - Lysine, Leucine, Phenylalanine, Valine, Histidine, Isoleucine, Methionine, Threonine, Tryptophan, Alanine, Arginine, Glycine, Proline, Glutamic Acid, Serine, Aspartic Acid, Tyrosine injection, Solution (Lysine, Leucine, Phenylalanine, Valine, Histidine, Isoleucine, Methionine, Threonine, Tryptophan, Alanine, Arginine, Glycine, Proline, Glutamic Acid, Serine, Aspartic Acid, Tyrosine)
Clinisol - Lysine, Leucine, Phenylalanine, Valine, Histidine, Isoleucine, Methionine, Threonine, Tryptophan, Alanine, Arginine, Glycine, Proline, Glutamic Acid, Serine, Aspartic Acid, Tyrosine injection, Solution prescribing information
INDICATIONS AND USAGE
15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package is indicated as an adjunct in the offsetting of nitrogen loss or in the treatment of negative nitrogen balance in patients where: (1) the alimentary tract cannot or should not be used, (2) gastrointestinal absorption of protein is impaired, or (3) metabolic requirements for protein are substantially increased, as with extensive burns.
DOSAGE AND ADMINISTRATION
Doses which achieve nitrogen equilibrium or positive balance are the most desirable. The dosage on the first day should be approximately half the anticipated optimal dosage and should be increased gradually to minimize glycosuria; similarly, withdrawal should be accomplished gradually to avoid rebound hypoglycemia.
Fat emulsion coadministration should be considered when prolonged (more than 5 days) parenteral nutrition is required in order to prevent essential fatty acid deficiency (EFAD).
Pediatric Use:
Use of 15% CLINISOL - sulfite-free (Amino Acid) Injection in pediatric patients is governed by the same considerations that affect the use of any amino acid solution in pediatrics. The amount administered is dosed on the basis of grams of amino acids/kg of body weight/day. Two to three g/kg of body weight for infants with adequate calories are generally sufficient to satisfy protein needs and promote positive nitrogen balance. Solutions administered by peripheral vein should not exceed twice normal serum osmolarity (718 mOsmol/L).
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
A slight yellow color does not alter the quality and efficacy of this product.
Additives may be incompatible. Complete information is not available. Those additives known to be incompatible should not be used. Consult with pharmacist, if available. When compounding admixtures, use aseptic technique. Mix thoroughly. Do not store any unused portion of 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package.
Central Vein Infusion
In unstressed adult patients with no unusual nitrogen losses, a minimum dosage of 0.1 gram nitrogen (4.2 mL of 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package) plus 4.4 grams (15 calories) of dextrose/fat emulsion per kilogram of body weight per day is required to achieve nitrogen balance and weight stability. For patients stressed by surgery, trauma or sepsis, and those with unusual nitrogen losses, the dosage required for maintenance may be as high as 0.3 to 0.4 grams of nitrogen (13 to 17 mL 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package) per kilogram of body weight per day, with proportionate increases in non-protein calories. Periodic assessment of nitrogen balance of the individual patient is the best indicator of proper dosage. Use of an infusion pump is advisable to maintain a steady infusion rate during central venous infusion.
Peripheral Infusion
In patients for whom central vein catheterization is not advisable, admixtures with 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package can be administered by peripheral vein. Dilution of 250 mL 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package in 750 mL of 10% dextrose will reduce the osmolarity to a level (718 mOsmol/L) which is more favorable to the maintenance of the integrity of the walls of the veins. If infused simultaneously, fat emulsion will provide a dilution effect upon the osmolarity, as well. In pediatric patients, the final solution should not exceed twice normal serum osmolarity (718 mOsmol/L).
CONTRAINDICATIONS
Hypersensitivity to one or more amino acids
Severe liver disease or hepatic coma
Anuria
Metabolic disorders involving impaired nitrogen utilization
ADVERSE REACTIONS
Local reactions consisting of a warm sensation, erythema, phlebitis and thrombosis at the infusion site have occurred with peripheral intravenous infusion of amino acids. In such cases the infusion site should be changed promptly to another vein. Generalized flushing, fever and nausea also have been reported during peripheral infusions of amino acid solutions.
The following metabolic complications have been reported with administration of TPN: metabolic acidosis and alkalosis, hypophosphatemia, hypocalcemia, osteoporosis, glycosuria, hyperglycemia, hyperosmolar nonketotic states and dehydration, rebound hypoglycemia, osmotic diuresis and dehydration, elevated liver enzymes, hypo- and hypervitaminosis, electrolyte imbalances, hyperammonemia, coma and death.
Sepsis has been reported following intravenous therapy, especially when using central venous catheters for prolonged periods.
Complications known to occur from the placement of central venous catheters are pneumothorax, hemothorax, hydrothorax, artery puncture and transection injury to the brachial plexus, malposition of the catheter, formation of arteriovenous fistula, phlebitis, thrombosis and air and catheter emboli.
DESCRIPTION
15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package is a sterile, clear, nonpyrogenic, hypertonic solution of essential and nonessential amino acids. A Pharmacy Bulk Package is a container of a sterile preparation for parenteral use that contains many single doses. The contents are intended for use in a pharmacy admixture program and are restricted to the preparation of admixtures for intravenous infusion.
The VIAFLEX plastic container is fabricated from a specially formulated polyvinyl chloride (PL 146 Plastic). Exposure to temperatures above 25ºC/77ºF during transport and storage will lead to minor losses in moisture content. Higher temperatures lead to greater losses. It is unlikely that these minor losses will lead to clinically significant changes within the expiration period. The amount of water that can permeate from inside the container into the overwrap is insufficient to affect the solution significantly. Solutions in contact with the plastic container can leach out certain of its chemical components in very small amounts within the expiration period, e.g., di-2-ethylhexyl phthalate (DEHP), up to 5 parts per million; however, the safety of the plastic has been confirmed in tests in animals according to USP biological test for plastic containers as well as by tissue culture toxicity studies.
Each 100 mL of 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package contains:
Amino Acids Total Nitrogen pH | 15.0 g 2.37 g 6.0 (5.0 to 7.0) |
(pH adjusted with glacial acetic acid) | |
Essential Amino Acids Lysine - (from Lysine Acetate) C 6 H 14 N 2 O 2 Leucine - C 6 H 13 NO 2 Phenylalanine – C 9 H 11 NO 2 Valine - C 5 H 11 NO 2 Histidine - C 6 H 9 N 3 O 2 Isoleucine - C 6 H 13 NO 2 Methionine - C 5 H 11 NO 2 S Threonine - C 4 H 9 NO 3 Tryptophan - C 11 H 12 N 2 O 2 Nonessential Amino Acids Alanine - C 3 H 7 NO 2 Arginine - C 6 H 14 N 4 O 2 Glycine - C 2 H 5 NO 2 Proline - C 5 H 9 NO 2 Glutamic Acid - C 5 H 9 NO 4 Serine – C 3 H 7 NO 3 Aspartic Acid – C 4 H 7 NO 4 Tyrosine – C 9 H 11 NO 3 Anion profiles per liter• Acetate from Lysine Acetate and glacial acetic acic •Balanced by ions from amino acids Osmolarity (Calc.) | 1.18 g 1.04 g 1.04 g 960 mg 894 mg 749 mg 749 mg 749 mg 250 mg 2.17 g 1.47 g 1.04 g 894 mg 749 mg 592 mg 434 mg 39 mg 127 mEq 1357 mOsmol/L |
CLINICAL PHARMACOLOGY
15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package administered parenterally will provide biologically utilizable source material for protein synthesis when used with concentrated calorie sources, electrolytes, vitamins and minerals.
Central Infusion
15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package is intended for use in a pharmacy admixture program and as such is restricted to the preparation of admixtures for intravenous use. 15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package given by central venous infusion in combination with energy sources, vitamins, trace elements and electrolytes, will meet the requirements for weight maintenance or weight gain. The energy component may be derived solely from dextrose or may be provided by a combination of dextrose and intravenous fat emulsion.
Peripheral Infusion
15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package, when diluted to an appropriate osmolarity level (718 mOsmol/L) can also be administered by a peripheral vein when use of a central venous catheter is contraindicated.
HOW SUPPLIED
15% CLINISOL - sulfite-free (Amino Acid) Injection Pharmacy Bulk Package is available in VIAFLEX plastic containers as follows.
2B6187 | 500 mL | NDC 0338-0502-03 |
2B6189 | 2000 mL | NDC 0338-0502-06 |
Exposure of pharmaceutical products to heat should be minimized. Avoid excessive heat. Protect from freezing. It is recommended the product be stored at room temperature (25ºC/77ºF).
