alanine + arginine + aspartic acid + 15 other active ingredients: clinical use

Prescribing considerations

• Assess amino-acid and fluid requirements against nutritional status, nitrogen catabolism and organ function.
• Correct fluid and electrolyte disturbances before starting parenteral nutrition.
• Use cautiously with cardiac impairment, increased serum osmolarity or non-congenital disorders of amino-acid metabolism.
• Account for amino-acid losses during renal replacement therapy.
• Provide appropriate non-protein energy, essential fats, electrolytes, vitamins, fluids and trace elements when complete parenteral nutrition is required.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient
• Inborn errors of amino-acid metabolism
• Life-threatening circulatory disturbance, hypoxia or metabolic acidosis
• Severe hepatic impairment or decompensated cirrhosis with advanced hepatic encephalopathy
• Severe renal impairment without renal replacement therapy
• Decompensated heart failure, acute pulmonary oedema or disturbed fluid and electrolyte balance
• Age under 2 years

Monitoring

• Serum electrolytes and blood glucose
• Fluid and acid-base balance
• Renal and liver function
• Serum proteins
• Clinical evidence of intolerance, fluid overload or allergic reaction

Clinical pharmacology

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

Formulation and product differences

• The selected formulation is a clear amino-acid solution intended only for central venous infusion.
• It contains acetate and citrate, with acetylcysteine, citric acid monohydrate and water for injections as excipients.
• It is supplied in single-use glass bottles and is not a complete parenteral-nutrition formulation by itself.
• Only documented compatible additions should be made under strict aseptic conditions.