chromic chloride + cupric chloride + ferrous chloride + 6 other active ingredients: clinical use

Prescribing considerations

• Assess individual requirements in hepatic or renal impairment, hypercatabolic states, abnormal gastrointestinal losses and prolonged parenteral nutrition.
• Treat confirmed deficiency of an individual element with specific supplementation rather than assuming the fixed combination is sufficient.
• Consider total exposure from parenteral nutrition, transfusions and other trace-element or iodine sources.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient.
• Pronounced cholestasis.
• Wilson's disease.
• Disturbed iron storage, including haemochromatosis or haemosiderosis.
• Use in neonates, infants or children.

Monitoring

• Monitor manganese during prolonged artificial nutrition and reduce or stop exposure if accumulation occurs.
• Monitor ferritin when iron overload is a concern, particularly with hepatic impairment or transfusions.
• Monitor glucose closely in insulin-treated diabetes.
• Consider zinc and selenium status during medium- or long-term parenteral nutrition; diarrhoea may increase zinc losses.
• Interpret biochemical results alongside clinical context because inflammation and organ dysfunction can complicate assessment.

Clinical pharmacology

The elements have catalytic, structural and regulatory roles. Copper and manganese depend mainly on biliary clearance; chromium, molybdenum, fluoride and iodine rely substantially on renal clearance, creating accumulation risks in organ dysfunction.

Formulation and product differences

• Clear, colourless acidic aqueous concentrate for infusion solution.
• Contains nine trace-element salts and is essentially sodium-free.
• Must be diluted before intravenous administration; it is not an oral supplement or complete parenteral-nutrition formulation.
• Supplied in glass ampoules, with hydrochloric acid for pH adjustment and water for injections as the listed excipients.