lipid emulsion, injectable

REMS

To provide a source of calories and essential fatty acids when oral/enteral nutrition is not possible.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Known hypersensitivity to egg or soybean proteins, lipid emulsion or other contents of product;
Severe hyperlipidemia or dyslipidemia.

Use Cautiously in:

Hepatic impairment;
Severe fluid/electrolyteolic/metab disorders (correct prior to use);
↑triglyceride levels (initiate at lower dose, advance in small increments);
Geri: Elderly patients may be sensitive to effects;
OB: Use during pregnancy only if clearly needed;
Lactation: Use cautiously if breastfeeding;
Pedi: Pre-term/low birth weight infants have poor lipid clearance (deaths have occurred); does not contain sufficient amounts of essential fatty acids for routine use in children.

Adv. Reactions/Side Effects ⬆ ⬇

Endo: hyperglycemia

GI: ↑liver enzymes, PARENTERAL NUTRITION-ASSOCIATED LIVER DISEASE, nausea, vomiting

Metab: ↑triglycerides, fat overload syndrome, hypoproteinemia, refeeding syndrome

Misc: ANAPHYLAXISHYPERSENSITIVITY REACTIONS INCLUDING

Interactions ⬆ ⬇

Drug-drug:

May ↓ anticoagulant effect of warfarin (due to soybean oil Vitmain K₁ content).

Availability ⬆ ⬇

Emulsion for intravenous infusion: 20% lipid emulsion (contains 0.2 g lipids/mL)

Route/Dosage ⬆ ⬇

IV (Adults ): Usual dose: 1–1.5 g/kg/day (not to exceed 2.5 g/kg/day); dose depends on multiple considerations including energy expenditure, clinical status, body weight, tolerance, metabolic status and other energy sources.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Provision of calories and fatty acids which act as substrates for energy production (beta oxidation of fatty acids), also provide membrane structure/function, provide precursor for bioactive molecules and gene expression.

Therapeutic effects:

Maintenance of lipid homeostasis during parenteral nutrition.

Classifications ⬆ ⬇

Therapeutic Classification: parenteral nutrition

Pharmacologic Classification: lipid calorie sources

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability; fatty acids are converted to other fatty acids by the liver.

Distribution: Unknown.

Metabolism/Excretion: Metabolized by cell to CO₂ and water, which are converted to energy in the form to adenosine triphosphate (ATP). Storage forms allow continual turnover. Excess CO₂ is expired via lungs and water is eliminated in urine, skin and other tissue surfaces. Additional lipids may undergo biliary excretion.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IV	unknown	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose of lipid infusion to patient.
If patient is trained to self-administer lipid infusion at home instruct patient to inspect bag for particulate matter and evenly distributed liquid, ensure in-line filter is used, and emphasize need for periodic lab tests. Advise patient to notify health care professional immediately if signs and symptoms of infection or allergic reaction occur.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇