alanine + arginine + glycine + histidine + isoleucine + leucine + lysine + methionine + phenylalanine + proline + serine + threonine + tryptophan + tyrosine + valine: clinical use

Prescribing considerations

• Assess nutritional requirements, metabolic capacity, fluid status and the need for non-protein energy, electrolytes, vitamins, trace elements and essential fatty acids.
• Correct severe fluid, electrolyte or metabolic disturbances before starting.
• Recognise and manage refeeding risk in severely undernourished patients.
• Use aseptic catheter care and formula preparation to reduce bloodstream-infection risk.
• Stop administration and reassess if hypersensitivity, pulmonary distress or clinically significant hyperammonaemia occurs.

Contraindications and cautions

• Hypersensitivity to an active substance, excipient or container component.
• Congenital abnormality of amino-acid metabolism.
• Use cautiously in hepatic or renal impairment, heart failure, pulmonary oedema and fluid-overload states.

Monitoring

• Water and electrolyte balance, fluid status and body weight.
• Serum osmolarity and acid–base balance.
• Blood and urine glucose.
• Kidney and liver function.
• Signs of catheter infection, thrombosis, infusion reaction or precipitate formation.
• Blood ammonia, particularly in newborns, infants and patients with liver dysfunction.
• Clinical and biochemical features of refeeding syndrome.

Clinical pharmacology

A balanced L-amino-acid solution providing a directly bioavailable nitrogen source for endogenous amino-acid and protein synthesis.

Formulation and product differences

• The selected formulation contains amino acids without electrolytes.
• It is a clear or slightly coloured sterile solution intended for central intravenous infusion.
• Glacial acetic acid is used for pH adjustment, with water for injections as the vehicle.
• Larger bulk-source containers are for pharmacy use and not direct infusion.
• Neonatal and young-child admixtures and administration sets require protection from ambient light.