medium-chain triglycerides + soya bean oil, refined: clinical use

Prescribing considerations

• Correct fluid, electrolyte and acid–base disturbances before starting.
• Use cautiously where lipid metabolism may be impaired, including diabetes, pancreatitis, sepsis, hypothyroidism with hypertriglyceridaemia, or renal or hepatic impairment.
• Ensure complete parenteral nutrition contains the required carbohydrate, amino acids, electrolytes, vitamins, trace elements and fluid.
• Consider that circulating lipids can interfere with some laboratory assays if samples are taken before lipid clearance.
• Protect neonatal and infant preparations and administration sets from light.

Contraindications and cautions

• Hypersensitivity to egg or soya-bean protein, soya-bean or peanut products, or another component
• Severe hyperlipidaemia, coagulopathy or hepatic insufficiency; intrahepatic cholestasis
• Severe renal insufficiency without renal replacement therapy
• Acute thromboembolism, fat embolism, aggravating haemorrhagic diathesis or metabolic acidosis
• General contraindications to parenteral nutrition, including life-threatening circulatory instability, unstable metabolism, acute myocardial infarction or stroke, uncorrected fluid or electrolyte disorders, decompensated cardiac failure or acute pulmonary oedema

Monitoring

• Serum triglycerides and clinical tolerance during infusion
• Fluid balance, electrolytes and acid–base status
• Blood glucose and cardiovascular function
• Blood count, coagulation and hepatic function during extended treatment
• Triglycerides and bilirubin in infants at risk of hyperbilirubinaemia
• Signs of hypersensitivity, emulsion intolerance or fat-overload syndrome

Clinical pharmacology

Intravenous administration provides complete bioavailability. Medium-chain triglycerides are cleared and oxidised faster than long-chain triglycerides; the long-chain fraction supplies essential polyunsaturated fatty acids. Clearance varies with metabolic state and concurrent illness.

Formulation and product differences

• The selected product is a sterile, milky-white oil-in-water emulsion containing equal amounts of medium-chain triglycerides and refined soya-bean oil.
• It contains egg phospholipids, glycerol, alpha-tocopherol and sodium oleate as formulation ingredients.
• It is suitable for peripheral intravenous administration but must not be used as a carrier for medicines or mixed without confirmed compatibility.
• It is supplied for single use; separated, discoloured, frozen or damaged products must be discarded.