KABIVEN Rx

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KABIVEN

Parenteral nutrition
Only 4 drugs may be compared at once

Generic Name and Formulations:

Lipid 20% (Intralipid 20%) emulsion (soybean oil 3.9g), dextrose anhydrous 9.8g, amino acids 3.31g, total nitrogen 526mg, electrolytes (sodium acetate 239mg, potassium chloride 174mg, sodium glycerophosphate 147mg, magnesium sulfate 96mg, calcium chloride 29mg); per 100mL; for IV infusion after mixed; contains aluminum.

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Indications for KABIVEN:

To provide a source of calories, protein, electrolytes, and essential fatty acids in adults requiring parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated. May be used to prevent essential fatty acid deficiency or treat negative nitrogen balance.

Adult:

Individualize. Dose based on patient’s clinical condition, body wt, nutritional/fluid requirements, and additional energy given orally/enterally. Administer by IV infusion via a central vein only. Usual dose: 19–38mL/kg/day; max: 40mL/kg/day. Max infusion rate: 2.6mL/kg/hr. Usual infusion duration: 12–24 hours; may continue treatment based on patient’s clinical condition. If serum triglycerides (>400mg/dL): interrupt infusion and monitor serum triglycerides; restart at a lower rate once triglycerides are <400mg/dL; increase in smaller increments and check levels before each adjustment. Renal impairment: may adjust dose based on protein requirements; see full labeling.

Children:

<2yrs: not recommended.

Contraindications:

Egg, soybean, peanut, corn or corn product allergy. Severe hyperlipidemia or severe disorders of lipid metabolism characterized by hypertriglyceridemia (serum triglyceride >1000mg/dL). Inborn error of amino acid metabolism. Cardiopulmonary instability (including pulmonary edema, cardiac insufficiency, MI, acidosis, hemodynamic instability requiring significant vasopressor support). Hemophagocytic syndrome.

Warnings/Precautions:

Risk of deaths in preterm and low birth weight infants: see full labeling. Correct severe fluid, electrolyte and acid-base disorders prior to initiating. Measure serum triglycerides at baseline, with each dose increase, and regularly during therapy. Discontinue and treat if hypersensitivity reactions occur. Monitor for signs/symptoms of infection and essential fatty acid deficiency (EFAD). Severely undernourished: avoid overfeeding. Diabetes or hyperglycemia. Heart failure or pulmonary edema; monitor fluid status closely. Risk of Parenteral Nutrition Associated Liver Disease (PNALD); consider discontinuation or dose reduction if abnormal LFTs occur. Monitor fluids, electrolytes, serum osmolarity, blood glucose, liver and kidney function, ammonia levels, CBCs, platelets, coagulation parameters, and overall energy intake throughout treatment. Renal or hepatic impairment. Elderly. Pregnancy. Nursing mothers.

Interactions:

Vitamin K content may antagonize anticoagulants (eg, coumarin, warfarin); monitor. Avoid simultaneous co-administration with ceftriaxone; precipitation can occur. High lipid levels in plasma may interfere with blood tests (eg, hemoglobin, triglycerides, bilirubin, LDH, oxygen saturation).

Pharmacological Class:

Macronutrients + electrolytes.

Adverse Reactions:

Nausea, pyrexia, hypertension, vomiting, decreased hemoglobin and total protein, hypokalemia, increased gamma glutamyltransferase; hyperglycemia, hyperosmolar syndrome, refeeding syndrome, hepatobiliary disorders, hyperammonemia, PNALD, hypertriglyceridemia, aluminum toxicity (esp. preterm infants, renal impairment); rare: fat overload syndrome.

Generic Availability:

NO

How Supplied:

Emulsion (2566mL, 2053mL, 1540mL, 1026mL)—1