calcium chloride dihydrate + histidine + histidine hydrochloride monohydrate + 6 other active ingredients: clinical use

Prescribing considerations

• Restrict to intraoperative cardioplegia, organ protection or transplant-organ preservation; not for systemic volume, electrolyte or amino-acid replacement.
• Ensure adequate ventricular drainage because the inactivated myocardium is susceptible to distension.
• Paediatric evidence is limited; particular caution is required in infants and children.
• Consider sodium and potassium content in people requiring restriction or with impaired kidney function.
• Use only intact containers containing clear, colourless to pale-yellow solution.

Contraindications and cautions

• Hypersensitivity to any active substance or excipient.

Monitoring

• Monitor haemodynamics during and after perfusion.
• Monitor serum sodium and calcium when clinically significant systemic entry is possible.
• After substantial systemic uptake, monitor calcium, sodium, magnesium and potassium and assess for volume overload.
• Avoid inappropriate systemic administration and excessive myocardial distension.

Clinical pharmacology

This intracellular-type electrolyte solution reduces sodium- and calcium-driven cellular activation, lowering metabolic demand during ischaemia. Histidine supports buffering; ketoglutarate enters intermediary metabolism, while mannitol is eliminated unchanged by the kidneys.

Formulation and product differences

• Clear, colourless to pale-yellow aqueous solution supplied in glass bottles or plastic bags.
• Contains water for injections and potassium hydroxide for pH adjustment.
• Single-use presentation requiring immediate use after opening; refrigerated storage and protection from light are required.
• Not intended for use with a continuous perfusion machine.