Version May 2024
Note: Dosing units: All dosages are expressed as elemental zinc unless stated otherwise.
Parenteral nutrition additive, maintenance requirement: Note: Individualize dose based on the patient's clinical condition, nutritional requirements, and the contribution of oral or enteral zinc intake.
Acute metabolic states: IV: Optimal dose not determined; monitor and replace as clinically indicated. Expert consensus recommendations suggest: 2.5 to 6.5 mg/day (Blaauw 2019).
Metabolically stable: IV: 3 to 5 mg/day (ASPEN 2020).
Replacement for small bowel fluid loss (metabolically stable): IV: Additional zinc replacement may be required due to excessive zinc loss in patients with high-output intestinal fistula, ostomy effluent, or severe diarrhea. Estimated loss ranges from up to an additional 12 mg of zinc per L for small bowel fluid loss or an additional ~17 mg of zinc per kg of stool or ileostomy output (Blaauw 2019; Jeejeebhoy 2009; Vanek 2012; manufacturer's labeling).
There are no dosage adjustments provided in the manufacturer's labeling. However, dosage adjustment may be necessary in severe impairment since zinc is primarily renally excreted. Additionally, aluminum accumulation may occur in the setting of renal impairment.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Zinc chloride: Pediatric drug information")
Note: Dosages may be presented in units of mcg or mg, use caution to ensure correct units. Clinical response may not occur for up to 6 to 8 weeks:
Parenteral nutrition, maintenance zinc requirement: Note: Higher doses may be needed if impaired intestinal absorption or an excessive loss of zinc (eg, excessive, prolonged diarrhea, high-output intestinal fistula, burns).
Age-directed dosing (ASPEN [Vanek 2012]):
Infants <3 months: IV: 250 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution.
Infants ≥3 months: IV: 50 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution.
Children: 50 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution; maximum daily dose: 5,000 mcg/day.
Weight-directed dosing (ASPEN [Mirtallo 2004]):
Infants <10 kg: 50 to 250 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution.
Children 10 to 40 kg: 50 to 125 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution; maximum daily dose: 5,000 mcg/day.
Children and Adolescents >40 kg: 2,000 to 5,000 mcg/day elemental zinc as an additive to parenteral nutrition solution.
There are no dosage adjustments provided in the manufacturer's labeling; however, dosage adjustments may be necessary in severe impairment. In addition, aluminum accumulation may occur in the setting of renal impairment.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
<1%, postmarketing, and/or case reports: Dyspepsia, hypotension, jaundice, leukopenia, nausea, neutropenia, pulmonary edema, vomiting
Direct IM or IV injection.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment.
Concurrent drug therapy issues:
• Copper: Chronic administration of high-dose zinc may cause a decrease in enteral copper absorption and subsequent decreased copper deficiency (Kumar 2022; Marumo 2021; manufacturer's labeling).
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002).
Strength of zinc chloride injection is expressed as elemental zinc
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous [preservative free]:
Generic: 1 mg/mL (10 mL)
Yes
Solution (Zinc Chloride Intravenous)
1 mg/mL (per mL): $2.84
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
IV: Do not administer IM or by direct IV infusion; acidic pH of the solution may cause tissue irritation. Must be prepared and used as an admixture in parenteral nutrition solutions only. Administer after dilution in volume of fluid ≥100 mL.
IV: Dilute as component of daily parenteral nutrition or maintenance fluids; do not give undiluted by direct injection into a peripheral vein due to potential for phlebitis and tissue irritation and potential to increase renal losses of minerals from a bolus injection
Parenteral nutrition additive, maintenance requirement: Trace element added to parenteral nutrition to prevent deficiency.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Dolutegravir: Zinc Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral zinc salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral zinc salts. Risk D: Consider therapy modification
Levonadifloxacin: Zinc Salts may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination
Zinc crosses the placenta and can be measured in the cord blood and placenta. Fetal concentrations are regulated by the placenta (de Moraes 2011).
Zinc is found in breast milk; concentrations decrease over the first 6 months of lactation. Concentrations are generally not affected by dietary supplementation (IOM 2001)
Periodic serum copper and serum zinc levels (patients on parenteral nutrition or chronic therapy); alkaline phosphatase, taste acuity, mental depression.
Zinc, serum: 75 to 140 mcg/dL (11.5 to 21.4 mmol/L) (ABIM 2023). Note: Serum zinc concentrations are dependent on age and sex, and may fluctuate depending on time of blood draw, infection, hormone changes, and muscle catabolism; correlation with clinical signs and/or symptoms of zinc deficiency is recommended (NIH 2022).
Distribution: Stored primarily in skeletal muscle and bone (>85%) (IOM 2001).
Protein binding: Albumin and alpha 1-macroglobulin (Foote 1984).
Excretion: Feces and urine (IOM 2001).
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