alanine + arginine + aspartic acid + 21 other active ingredients: clinical use

Prescribing considerations

• Individualise to clinical condition and amino-acid, glucose, energy, electrolyte and fluid requirements.
• Correct fluid, electrolyte and acid-base disturbances before starting.
• Assess refeeding risk and correct pre-existing thiamine deficiency before administration.
• Ensure lipids, essential fatty acids, vitamins and trace elements are provided where required.
• Use strict aseptic technique and confirm compatibility before additions or co-administration.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient.
• Inborn errors of amino-acid metabolism.
• Insulin-resistant hyperglycaemia as defined in the product information.
• Acidosis, severe hepatic insufficiency or severe renal insufficiency without renal replacement therapy.
• Intracranial or intraspinal haemorrhage.
• Children below 2 years.
• Life-threatening circulatory instability, acute myocardial infarction, stroke or unstable metabolic states.

Monitoring

• Blood glucose, including after interruption in people at risk of hypoglycaemia.
• Serum electrolytes, fluid balance, serum osmolarity and acid-base status.
• Renal and hepatic function.
• Infusion site for phlebitis or thrombophlebitis.
• Blood-cell count, coagulation and longer-term metabolic complications where relevant.

Clinical pharmacology

Intravenous administration makes amino acids, glucose and electrolytes immediately available. Amino acids support protein synthesis and nitrogen-dependent pathways; glucose is metabolised for energy and cellular substrates; electrolytes support metabolic and physiological functions.

Formulation and product differences

• Two-chamber bag separating amino-acid/electrolyte and glucose/electrolyte solutions until activation.
• Contains no lipid emulsion, essential fatty acids, vitamins or trace elements.
• May be administered through an appropriate peripheral or central vein.
• Only clear solution from an undamaged container should be used; discard any remainder after infusion.