acetylcysteine + alanine + arginine + 15 other active ingredients: clinical use

Prescribing considerations

• Assess nutritional, amino-acid and fluid requirements individually.
• Correct fluid and electrolyte disturbances before starting parenteral nutrition.
• Account for renal or hepatic impairment and amino-acid losses during renal replacement therapy.
• Provide non-protein energy and other components required for complete parenteral nutrition.
• Consider the sodium contribution when sodium restriction is required.

Contraindications and cautions

• Hypersensitivity to an ingredient.
• Inborn errors of amino-acid metabolism.
• Severe circulatory compromise, hypoxia or metabolic acidosis.
• Severe hepatic insufficiency or decompensated cirrhosis with advanced hepatic encephalopathy.
• Severe renal insufficiency without renal replacement therapy.
• Decompensated cardiac failure, acute pulmonary oedema, or uncorrected fluid and electrolyte disturbance.
• Children younger than 2 years.

Monitoring

• Serum electrolytes and glucose.
• Fluid and acid-base balance.
• Renal and liver function.
• Serum proteins and clinical nutritional response.
• Infusion-line condition and signs of infection or fluid overload.

Clinical pharmacology

Intravenous administration gives complete systemic availability. Amino acids enter physiological pools for protein synthesis; surplus amino nitrogen is principally converted to urea, while carbon skeletons may be oxidised or used in gluconeogenesis.

Formulation and product differences

• This concentrated amino-acid solution is intended only for central venous infusion.
• It does not provide complete parenteral nutrition on its own.
• The clear, colourless to faintly straw-coloured solution is supplied in single-use glass bottles.
• It contains no carbohydrate or lipid energy source and has a small sodium contribution.