Intralipid 20%

/ Cure Medical & Technical Supply

1g triglycerides corresponds to 5 ml INTRALIPID 20%.
Adults: The recommended maximum dosage is 3 g triglycerides/ kg body weight/day. Within this upper limit, INTRALIPID can be given to contribute up to 70% of the energy requirements, also in patients with highly increased energy requirements. The infusion rate should not exceed 500 ml in 5 hours.
Neonates and infants: The recommended dosage range in neonates and infants is 0.5-4 g triglycerides/ kg bw/day. The rate of infusion should not exceed 0.17 g triglycerides/kg bw/hour (4 g in 24 hours). In prematures and low birthweight neonates, this product should preferably be infused continuously over 24 hours. The initial dosage should be 0.5-1 g/kg bw/day followed by a successive increase by 0.5-1 g/kg bw/day up to 2g/kg bw/day. Only with close monitoring of serum triglyceride concentration, liver tests and oxygen saturation may the dosage be increased to 4 g/kg bw/day. The rates given are maximum rates and no attempt should be made to exceed these in order to compensate for missed doses.
Essential fatty acid deficiency (EFAD): To prevent or correct essential fatty acid deficiency, 4 to 8% of the nonprotein energy should be supplied as INTRALIPID to provide sufficient amounts of linoleic and linolenic acid. When EFAD is associated with stress, the amount needed to correct the deficiency may be substantially increased.
Fat Elimination:
Adults: The ability to eliminate fat should be closely monitored in patients with conditions mentioned in Special precautions, and in patients given Intralipid for more than one week. This is done by collecting a blood sample after a fat- free clearance period of 5-6 hours. Blood cells are then separated from plasma by centrifugation. If the plasma is opalescent, the infusion should be postponed. The sensitivity of this method is such that hypertriglyceridaemia can pass undetected. Therefore, it is recommended that serum triglyceride concentrations should be measured in patients who are likely to have impaired fat tolerance.
Neonates and infants: The ability to eliminate fat should be tested regularly in neonates and infants. Measuring serum triglyceride levels is the only reliable method.
For full details see prescribing information.

INTRALIPID is indicated in patients needing intravenous nutrition to supply energy and essential fatty acids. It  is also indicated in patients with essential fatty acid deficiency (EFAD) who cannot maintain or restore a normal essential fatty acid pattern by oral intake.

This product  is contraindicated in patients with acute shock and in patients with severe hyperlipemia. Severe liver insufficiency. Hemophagocytotic syndrome. Hypersensitivity to egg-, soya- or peanut protein or to any of the active substances or excipients.

This product should be given with caution in conditions of impaired lipid metabolism as in renal insufficiency, uncompensated diabetes mellitus, pancreatitis, impaired liver function, hypothyroidism (if hypertri-glyceridemic) and sepsis. If given to patients with these conditions, close monitoring of the serum triglyceride concentration is obligatory.
This medicinal product contains soya-bean oil and egg phospholipids, which may rarely cause allergic reactions. Cross allergic reactions have been observed between soybean and peanut.
This product should be given with caution to neonates and prematures with hyperbilirubinemia and cases with suspected pulmonary hypertension. In neonates, particularly prematures on long term parenteral nutrition, platelet count, liver test and serum triglyceride concentration should be monitored.
It may interfere with certain laboratory measurements (bilirubin, lactate dehydrogenase, oxygen saturation, Hb etc) if blood is sampled before fat has been adequately cleared from the blood stream. Fat is cleared after a fat free interval of 5-6 hours in most patients.

INTRALIPID infusion may cause a rise in body temperature and, less frequently, shivering, chills and nausea/vomiting (incidence<1%).
Reports of other adverse events in conjunction with this infusion are extremely rare, less than one adverse event per one million infusions.

Some drugs, like insulin, may interfere with the body’s lipase system. This kind of interaction seems, however, to be of only limited clinical importance. Heparin in clinical doses causes a transient increase in lipolysis in plasma, resulting in a transient decrease in triglyceride clearance due to depletion of lipoprotein lipase.
Soybean oil has a natural content of vitamin K1. This is considered important only for patients treated with coumarin derivatives, which interfere with vitamin K1.
For full details see prescribing information.

No adverse events during pregnancy and lactation has been reported.

“Fat overload syndrome”. Severe overdose of fat emulsions containing triglycerides can, especially if carbohydrates are not administered simultaneously, lead to acidosis.
For full details see prescribing information.