alanine + arginine + aspartic acid + 22 other active ingredients: clinical use

Prescribing considerations

• Use only through a central vein because of the formulation's high osmolarity.
• Assess and correct severe fluid, electrolyte and metabolic disturbances before initiation.
• Account for nutrients and electrolytes supplied by other oral, enteral and intravenous sources.
• The fixed composition may not meet every patient's individual nutrient requirements.
• Provide appropriate vitamins and trace elements; naturally present amounts are insufficient.
• Assess refeeding risk in severely malnourished patients and monitor closely.
• Confirm compatibility before adding supplements or sharing administration equipment.

Contraindications and cautions

• Premature neonates, infants and children younger than 2 years
• Hypersensitivity to egg, soya-bean, peanut or corn products, active substances or excipients
• Congenital abnormalities of amino-acid metabolism
• Severe hyperlipidaemia or severe lipid-metabolism disorders with hypertriglyceridaemia
• Severe hyperglycaemia
• Pathologically raised sodium, potassium, magnesium, calcium or phosphorus concentrations

Monitoring

• Clinical condition, fluid balance and weight
• Central-line site, catheter function and signs of infection or extravasation
• Blood glucose and urine glucose or ketones where relevant
• Sodium, potassium, magnesium, calcium and phosphate
• Renal function and acid-base status
• Liver function, bilirubin and signs of hepatobiliary disease
• Serum triglycerides and lipid clearance
• Full blood count and coagulation parameters where indicated
• Infusion equipment and emulsion for separation or precipitates

Clinical pharmacology

The formulation provides L-amino acids for protein synthesis and nitrogen balance, glucose as carbohydrate energy, and olive/soya-derived triglycerides for energy and essential fatty acids. Its constituents are distributed, metabolised and eliminated as they would be when administered separately.

Formulation and product differences

• The selected product is a three-compartment emulsion containing electrolytes.
• The lipid component uses predominantly refined olive oil with refined soya-bean oil and purified egg phospholipids.
• The glucose is derived from corn.
• The product becomes a homogeneous milky emulsion after all compartments are mixed.
• Its high osmolarity makes it unsuitable for peripheral-vein administration.