Dosage guidance:
Safety: Use the 25% concentration with extreme caution in neonates, due to risk of intraventricular hemorrhage (from rapid expansion of the intravascular volume); infuse slowly.
Clinical considerations: Albumin 5% should be used in hypovolemic or intravascularly depleted patients; albumin 25% should be used in patients with fluid or sodium restrictions (eg, patients with hypoproteinemia and generalized edema, or nephrotic syndrome). Dose depends on condition of patient.
Ascites with hypoalbuminemia: Limited data available: 25% albumin: IV: 0.5 to 1 g/kg/dose over 2 to 3 hours; may repeat up to 3 times per day until albumin is >2.5 g/dL (Ref).
Hemolytic disease of the newborn: 25% albumin: IV: 1 g/kg/dose, administer prior to or during plasma exchange.
Hyperbilirubinemia: 25% albumin: IV: 1 g/kg/dose, administer prior to or during plasma exchange.
Hypotension: Limited data available: 5% albumin: IV: 0.5 g/kg/dose (10 mL/kg/dose) over 15 to 20 minutes; may repeat once if necessary. Dosing from 2 studies comparing albumin to NS for hypotension in newborns (<24 hours old). In one study, neonates in the albumin treatment group (n=49, GA: 30.8 ± 4.4 weeks) had a greater improvement in blood pressure and were less likely to require subsequent vasopressors compared to the NS treatment arm (n=52, GA: 30.1 ± 4.1 weeks) (Ref). Another study used the same dose but found no statistically significant difference between neonates receiving albumin (n=21, GA: 25 to 40 weeks) compared to NS (n=20, GA: 25 to 40 weeks) (Ref).
Hypovolemia, plasma volume expansion: Limited data available: 5% albumin: IV: 0.5 to 1 g/kg/dose (10 to 20 mL/kg/dose) over ≥60 minutes (may be administered more rapidly over at least 10 to 20 minutes for use in hypovolemic shock), may repeat if response is not adequate (Ref). Note: NS (or blood) are preferred for volume expansion in the delivery room (Ref).
Dosage guidance:
Clinical considerations: Albumin 5% should be used in hypovolemic or intravascularly depleted patients; albumin 25% should be used in patients with fluid or sodium restrictions (eg, patients with hypoproteinemia and generalized edema, or nephrotic syndrome). Dose depends on condition of patient.
Ascites with hypoalbuminemia: Limited data available: Infants, Children, and Adolescents: 25% albumin: IV: 0.5 to 1 g/kg/dose over 2 to 3 hours; may repeat up to 3 times per day until albumin is >2.5 g/dL; maximum dose: 25 g/dose (Ref).
Hypovolemia, plasma volume expansion, including hypovolemic shock: Infants, Children, and Adolescents: 5% albumin: IV: 0.5 to 1 g/kg/dose (10 to 20 mL/kg/dose) over 5 to 10 minutes (Ref). Note: Usual adult dose: 12.5 to 25 g/dose (250 to 500 mL/dose). May repeat after 15 to 30 minutes if response is not adequate.
Large volume paracentesis: Limited data available: Infants, Children, and Adolescents: 5% or 25% albumin: IV: 0.5 to 1 g/kg over 1 to 2 hours after paracentesis (Ref).
Nephrotic syndrome edema, refractory: Infants, Children, and Adolescents: 25% albumin: IV: 0.5 to 1 g/kg/dose over 30 to 60 minutes followed by diuretic therapy (Ref).
There are no dosing adjustments provided in the manufacturer's labeling; use with caution.
There are no dosing adjustments provided in the manufacturer's labeling.
(For additional information see "Albumin solution: Drug information")
Dosage guidance:
Clinical considerations: Use 5% solution in hypovolemic patients or intravascularly depleted patients. Use 25% solution in patients in whom fluid and sodium intake is restricted or to mobilize fluids.
Usual dose: IV: 25 g; initial dose may be repeated in 15 to 30 minutes if response is inadequate.
Adult respiratory distress syndrome:
Note: Although listed in manufacturer's labeling, impact on major clinical outcome data (eg, mortality) is limited and the potential benefit remains to be seen (Ref).
25% albumin: IV: 25 g over 30 minutes (in combination with furosemide); may repeat at 8 hours (if necessary) for 3 days; titrate to fluid loss and normalization of serum total protein. Patients enrolled into the clinical trial had hypoproteinemia (total protein <6 g/dL) (Ref).
Cirrhotic ascites, therapeutic large volume paracentesis (adjunctive agent):
25% albumin: IV: 6 to 8 g for every liter removed (Ref) or 50 g total for paracentesis >5 L (Ref). Note: Administer at the time of or soon after the procedure to avoid postparacentesis complications (eg, hypovolemia, hyponatremia, kidney impairment) (Ref).
Hepatorenal syndrome type 1 or acute kidney injury in cirrhosis, treatment (adjunctive agent) (off-label use):
Note: Used before or in combination with norepinephrine, terlipressin, or midodrine plus octreotide (Ref).
25% albumin: IV: Initial: 1 g/kg daily for 2 days (maximum: 100 g/day), followed by 20 to 50 g daily until clinical outcome is achieved (Ref).
Hypovolemia: Note: For replacement of volume deficit, 5% albumin is generally preferred.
IV: Initial: 12.5 to 25 g (250 to 500 mL); repeat after 15 to 30 minutes as needed (if hemodynamic stability is not achieved). Note: In patients with sepsis or septic shock, may consider after inadequate response to large volumes of crystalloid therapy. The volume administered and the rate of infusion should be adapted to individual response (Ref).
Ovarian hyperstimulation syndrome (treatment): 25% albumin: IV: 50 to 100 g over 4 hours; repeat at 4 to 12 hours intervals as needed.
Plasma exchange, therapeutic: 5% albumin: IV: Titrate dose to plasma volume removed during procedure.
Spontaneous bacterial peritonitis, treatment (off-label use):
Note: Some experts reserve for patients with existing kidney or severe hepatic impairment (eg, creatinine >1 mg/dL, BUN >30 mg/dL, or bilirubin >4 mg/dL) (Ref).
25% albumin: IV: Initial: 1.5 g/kg within 6 hours of diagnosis in combination with appropriate antimicrobial therapy, followed by 1 g/kg on day 3 (Ref); a possible alternative dose is 1 g/kg once daily for 2 days but it is not well studied (Ref). While the maximum albumin dose varies in clinical practice, some suggest not exceeding 100 g per dose (Ref).
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney impairment (Ref).
Hemodialysis, intermittent (thrice weekly): Unlikely to be dialyzed (large molecular weight of 66 kDa): No supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Unlikely to be dialyzed (large molecular weight): No dosage adjustment necessary (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Frequency not defined:
Cardiovascular: Flushing, heart failure, hypotension, tachycardia
Dermatologic: Pruritus, skin rash, urticaria
Gastrointestinal: Nausea, vomiting
Nervous system: Chills, rigors
Respiratory: Bronchospasm, dyspnea, pulmonary edema
Miscellaneous: Fever
Postmarketing:
Cardiovascular: Acute myocardial infarction, atrial fibrillation
Endocrine & metabolic: Hyperchloremic metabolic acidosis (Ritzenthaler 2016)
Gastrointestinal: Dysgeusia, sialorrhea
Hypersensitivity: Anaphylactic shock, anaphylaxis (Lozano 2019), hypersensitivity reaction (including severe hypersensitivity reaction), nonimmune anaphylaxis (Fujita 2007), type 1 hypersensitivity reaction (Wang 2019)
Nervous system: Headache
Miscellaneous: Febrile reaction
Hypersensitivity to albumin or any component of the formulation; severe anemia, heart failure; patients at risk of volume overload (eg, patients with kidney insufficiency, severe anemia, stabilized chronic anemia, or heart failure); dilution with sterile water for injection (may cause hemolysis or acute kidney failure).
Concerns related to adverse effects:
• Hypersensitivity: Severe allergic or anaphylactic reaction may occur. Discontinue immediately and manage appropriately if allergic or anaphylactic reactions are suspected.
• Coagulation abnormality: Large replacement volumes may result in coagulation abnormality. Monitor and replete with blood constituents if indicated.
• Electrolyte imbalance: Large replacement volumes may result in electrolyte imbalance. Monitor electrolytes and replace or maintain as indicated.
• Hemodynamic effects: Cardiac or respiratory failure, kidney failure, or increasing intracranial pressure can occur; closely monitor hemodynamic parameters in all patients.
• Hypervolemia/hemodilution: Use with caution in conditions where hypervolemia and its consequences or hemodilution may increase the risk of adverse effects (eg, heart failure, pulmonary edema, hypertension, hemorrhagic diathesis, cirrhosis, esophageal varices). Adjust rate of administration per hemodynamic status and solution concentration; monitor closely with rapid infusions. Avoid rapid infusions in patients with a history of cardiovascular disease (may cause volume overload and pulmonary edema). Discontinue at the first signs of cardiovascular overload (eg, headache, dyspnea, jugular venous distention, rales, abnormal elevations in systemic or central venous BP). All patients should be observed for signs of hypervolemia, such as pulmonary edema. Monitor BP.
Disease-related concerns:
• Critical illness: Avoid use for resuscitation in patients with traumatic brain injury due to increased mortality when used in this population (Myburgh 2007).
• Hepatic impairment: Use with caution in patients with hepatic impairment; protein load may exacerbate or precipitate encephalopathy.
• Kidney impairment: Use with caution in patients with kidney impairment; protein load may precipitate azotemia. Patients with chronic kidney insufficiency receiving albumin solution may be at risk for accumulation of aluminum and potential toxicities (eg, hypercalcemia, vitamin D refractory osteodystrophy, anemia, severe progressive encephalopathy).
Special populations:
• Sodium restricted patients: Use with caution in those patients for whom sodium restriction is necessary. Albumin 5% and 25% solutions contain 130 to 160 mEq/L sodium and are considered isotonic with plasma.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum (Kelly, 1989); toxic aluminum concentrations may be seen with high doses, prolonged use, or kidney dysfunction. Premature neonates are at higher risk due to immature kidney 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). See manufacturer's labeling.
• Dilution: Do not dilute 5% albumin with sterile water for injection (may result in hemolysis and/or kidney failure).
• Human plasma: Product of human plasma; may potentially contain infectious agents which could transmit disease. Screening of donors, as well as testing and/or inactivation or removal of certain viruses, reduces the risk. Infections thought to be transmitted by this product should be reported to the manufacturer.
• Latex: Packaging may contain natural latex rubber.
In neonates, use the 25% concentration with extreme caution due to risk of intraventricular hemorrhage (from rapid expansion of the intravascular volume); infuse slowly.
Due to the occasional shortage of 5% human albumin, 5% solutions may at times be prepared by diluting 25% human albumin with NS or with D5W (if sodium load is a concern); however, do not use sterile water to dilute albumin solutions, as this may result in hypotonic-associated hemolysis which can be fatal.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous:
Albumin-ZLB: 5% (250 mL, 500 mL); 25% (50 mL, 100 mL)
Generic: 25% (50 mL, 100 mL)
Solution, Intravenous [preservative free]:
Albuked 5: 5% (250 mL)
Albuked 25: 25% (50 mL, 100 mL)
Albuminex: 5% (250 mL, 500 mL); 25% (50 mL, 100 mL)
AlbuRx: 5% (250 mL, 500 mL)
Albutein: 5% (50 mL, 250 mL, 500 mL); 25% (20 mL, 50 mL, 100 mL)
Flexbumin: 5% (250 mL); 25% (50 mL, 100 mL)
Human Albumin Grifols: 25% (50 mL [DSC], 100 mL [DSC])
Kedbumin: 25% (50 mL, 100 mL)
Plasbumin-5: 5% (50 mL, 250 mL)
Plasbumin-25: 25% (20 mL, 50 mL, 100 mL)
Generic: 5% (100 mL, 250 mL, 500 mL); 25% (50 mL, 100 mL)
Yes
Solution (Albuked 25 Intravenous)
25% (per mL): $1.15
Solution (Albuked 5 Intravenous)
5% (per mL): $0.23
Solution (Albumin Human Intravenous)
5% (per mL): $0.33
25% (per mL): $1.38 - $2.16
Solution (Albuminex Intravenous)
5% (per mL): $0.35
25% (per mL): $1.68
Solution (Albutein Intravenous)
5% (per mL): $0.22
25% (per mL): $1.12
Solution (Flexbumin Intravenous)
5% (per mL): $1.39
25% (per mL): $1.39
Solution (Human Albumin Grifols Intravenous)
25% (per mL): $2.16
Solution (Plasbumin-25 Intravenous)
25% (per mL): $1.18
Solution (Plasbumin-5 Intravenous)
5% (per mL): $0.78
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Alburex-5: 5% (100 mL, 250 mL, 500 mL)
Alburex-25: 25% (50 mL, 100 mL)
Plasbumin-5: 5% (50 mL, 250 mL, 500 mL)
Generic: 5% (50 mL, 100 mL, 250 mL, 500 mL); 25% (50 mL, 100 ea, 100 mL)
In certain conditions (eg, hypoproteinemia with generalized edema, nephrotic syndrome), doses of albumin may be followed with IV furosemide: 0.5 to 1 mg/kg/dose.
Both albumin 5% and 25% contain 130 to 160 mEq/L of sodium; albumin 5% is osmotically equivalent to an equal volume of plasma; albumin 25% is osmotically equivalent to 5 times its volume of plasma.
Parenteral: IV: Note: Some products may require a filter; refer to product labeling. Rate of infusion is dependent upon use and clinical condition. See indication-specific rates in dosing or refer to institutional protocol. Too rapid infusion may result in vascular overload. In emergencies, may administer as rapidly as necessary to improve clinical condition.
Manufacturer recommended maximum administration rates:
5%: Do not exceed 1 mL/minute in patients with normal plasma volume (Ref).
25%: Do not exceed 1 to 2 mL/minute in patients without shock (Ref).
IV: For IV administration only. Note: Some products may require a filter; refer to product labeling. Rate of infusion is dependent upon use and clinical condition. See indication for specific rates in dosing or refer to institutional protocol. Too rapid infusion may result in volume overload. In emergencies, may administer as rapidly as necessary to improve clinical condition.
Manufacturer's recommended maximum administration rates:
5%, 25%: Typically, not recommended to exceed 1 to 2 mL/minute in patients without shock.
Albumin 25% may be given undiluted or diluted in normal saline. May give in combination or through the same administration set as saline or carbohydrates. Warm to room temperature before use if large volumes are administered. Use within 4 hours after entering package; discard unused portion. Do not use with ethanol or protein hydrolysates (precipitation may form).
Store at ≤25°C (≤77°F); do not freeze. Do not use solution if it is turbid or contains a deposit; use within 4 hours after opening vial; discard unused portion.
Note: Safety and efficacy in pediatric patients based on previously demonstrated clinical experience with albumin; product specific data may not be available. Approved ages and uses for products may vary; consult labeling for specific information.
5% formulations: Treatment of hypovolemic shock (Albuked, Albuminex, AlbuRx, Flexbumin, Plasbumin: FDA approved in pediatric patients [age not specified] and adults; Albutein: FDA approved in adults); treatment of hypoalbuminemia secondary to inadequate production, excessive catabolism, loss from the body, or redistribution within the body (Albuminex, Flexbumin: FDA approved in pediatric patients [age not specified] and adults; Albutein: FDA approved in adults); adjunctive treatment in burn patients (Albuked, Albuminex, AlbuRx, Flexbumin, Plasbumin: FDA approved in pediatric patients [age not specified] and adults; Albutein: FDA approved in adults); priming of pump for cardiopulmonary bypass (Albuked, Albuminex, Flexbumin, Plasbumin: FDA approved in pediatric patients [age not specified] and adults; Albutein: FDA approved in adults); adjunctive treatment in liver failure patients (Albuked, Albuminex, Plasbumin: FDA approved in pediatric patients [age not specified] and adults; Albutein: FDA approved in adults); treatment of sequestration of protein-rich fluids in conditions such as acute peritonitis, pancreatitis, mediastinitis, and extensive cellulitis (Albuked, AlbuRx, Plasbumin: FDA approved in pediatric patients [age not specified] and adults); treatment of postoperative albumin loss (AlbuRx: FDA approved in pediatric patients [age not specified] and adults; Albutein: FDA approved in adults); treatment of hypoproteinemia with an oncotic deficit (AlbuRx: FDA approved in pediatric patients [age not specified] and adults); replacement fluid during plasma exchange procedures (Albutein: FDA approved in adults); adjunctive treatment in patients with acute nephrosis in combination with loop diuretics (Albuminex: FDA approved in pediatric patients [age not specified] and adults); adjunctive treatment of fluid overload in patients with acute respiratory distress syndrome in combination with diuretics (Albuminex: FDA approved in pediatric patients [age not specified] and adults).
25% formulations: Treatment of neonatal hyperbilirubinemia (Albutein: FDA approved in neonates); treatment of neonatal hemolytic disease (Albuked, Flexbumin, Plasbumin: FDA approved in neonates); treatment of hypovolemia (Albuminex; Albutein, Flexbumin, Kedbumin: FDA approved in pediatric patients [age not specified] and adults); treatment of hypovolemic shock (Albuked, Albuminex, Flexbumin, Plasbumin: FDA approved in pediatric patients [age not specified] and adults); treatment of hypoalbuminemia (Albuked, Albuminex, Albutein, Flexbumin; Plasbumin: FDA approved in pediatric patients [age not specified] and adults; Kedbumin: FDA approved in adults); adjunctive treatment in cardiopulmonary bypass procedures including dilution of blood and pump prime (Albuked, Albuminex, Albutein, Flexbumin, Kedbumin; Plasbumin: FDA approved in pediatric patients [age not specified] and adults); adjunctive treatment in burn patients (Albuked, Albuminex, Flexbumin; Kedbumin; Plasbumin: FDA approved in pediatric patients [age not specified] and adults); adjunctive treatment of peripheral edema in patients with acute nephrosis refractory to cyclophosphamide, corticosteroids, or diuretics (Albutein, Flexbumin, Plasbumin: FDA approved in pediatric patients [age not specified] and adults; Albuked: FDA approved in adults); adjunctive treatment in patients with acute nephrosis in combination with loop diuretics (Albuminex: FDA approved in pediatric patients [age not specified] and adults); adjunctive treatment in ovarian hyperstimulation syndrome (Albutein: FDA approved in adults); adjunctive treatment of fluid overload in patients with adult respiratory distress syndrome in combination with diuretics (Albuminex, Albuked, Albutein, Flexbumin; Kedbumin, Plasbumin: FDA approved adults); adjunctive treatment in patients with cirrhotic ascites following paracentesis (Albuminex, Albutein; Kedbumin: FDA approved in adults); adjunct treatment in patients with acute liver failure (Albuked, Plasbumin: FDA approved in adults); treatment of sequestration of protein-rich fluids in conditions such as acute peritonitis, pancreatitis, mediastinitis, and extensive cellulitis (Albuked, Plasbumin: FDA approved in pediatric patients [age not specified] and adults); adjunctive treatment for erythrocyte resuspension (Albuked, Plasbumin: FDA approved in pediatric patients [age not specified] and adults).
Albutein may be confused with albuterol.
None known.
There are no known significant interactions.
Some products may contain potassium and/or sodium.
Albumin may be used for the treatment of severe ovarian hyperstimulation syndrome (OHSS) when hydration with NS is insufficient to achieve or maintain hemodynamic stability and urine output. Available data are insufficient to recommend use of albumin to reduce the risk OHSS in patients undergoing controlled ovarian stimulation (ASRM 2016; SOGC [Shmorgun 2017]).
Albumin is an endogenous substance; products are prepared from pooled human plasma. Use in pregnant patients may be considered when contraindications to nonprotein colloids exist (Liumbruno 2009).
Observe for signs of hypervolemia, pulmonary edema, cardiac failure, vital signs, fluid status, hemoglobin, hematocrit, urine specific gravity.
Provides increase in intravascular oncotic pressure and causes mobilization of fluids from interstitial into intravascular space
Half-life: 15 to 20 days
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