acetylcysteine + alanine + arginine + 16 other active ingredients: clinical use

Prescribing considerations

• Use only as part of a complete, individually planned parenteral-nutrition regimen.
• Correct fluid and electrolyte disturbances before administration.
• Use a central venous route and protect the complete administration system from light in patients younger than 2 years.
• Adjust carefully in renal or hepatic impairment and consider fluid volume in cardiac insufficiency.
• Confirm compatibility before adding carbohydrates, lipids, vitamins, trace elements, electrolytes or medicines.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient
• Inborn errors of amino-acid metabolism
• Shock or another severe circulation disorder with vital risk
• Hypoxia or metabolic acidosis
• Severe hepatic insufficiency
• Severe renal insufficiency without renal replacement therapy
• Decompensated cardiac insufficiency or acute pulmonary oedema
• Uncorrected fluid or electrolyte imbalance

Monitoring

• Serum electrolytes and blood glucose
• Fluid balance and acid–base status
• Renal and liver function
• Serum proteins
• For prolonged use, blood count and coagulation factors

Clinical pharmacology

Intravenous administration provides complete systemic availability. Amino acids enter circulating and intracellular pools for protein synthesis; unused amino groups are principally converted to urea, while carbon skeletons may be oxidised or used in gluconeogenesis.

Formulation and product differences

• Paediatric amino-acid profile containing taurine, acetylcysteine as a cysteine source and N-acetyltyrosine as a tyrosine source.
• Clear, colourless to light-yellow solution intended for central venous infusion.
• Contains citric acid monohydrate for pH adjustment and water for injections; no electrolytes are listed as ingredients.
• Single-use, PVC-free, DEHP-free and latex-free container system.