Version May 2024
Continuous renal replacement circuit: Pre- or post-hemofilter or hemodiafilter: Volume of solution administered depends upon the patient's clinical condition and fluid, electrolyte, acid-base, and glucose balance.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Continuous renal replacement circuit: Infants, Children, and Adolescents: Refer to adult dosing.
No dosage adjustment necessary.
There are no dosage adjustments in manufacturer’s labeling. In patients with hepatic impairment, the ability to convert lactate salts to bicarbonate may be impaired; use caution and monitor closely.
The following adverse drug reactions are derived from product labeling unless otherwise specified. Reactions listed are based on reports for other agents in this same pharmacologic class (renal replacement therapy solutions).
Postmarketing:
Cardiovascular: Hypotension
Endocrine & metabolic: Acid-base imbalance, electrolyte disorder (including hyperphosphatemia, hypophosphatemia, and increased ionized serum calcium), fluid volume disorder, metabolic acidosis
Hypersensitivity to any component of the formulation.
Concerns related to adverse effects:
• Fluid and electrolyte imbalances: Multiple electrolyte and volume abnormalities may occur (Fall 2010). Monitor hemodynamic status, fluid input/output, potassium, phosphorous, other electrolytes, and acid-base balance throughout the procedure. Abnormalities may be corrected by changing the formulation of replacement solution and/or dialysate, supplementation, or adjusting flow rates appropriately.
• Glucose abnormalities: Solutions may increase the risk for hyperglycemia or hypoglycemia depending on the dextrose content of the replacement solution; abnormalities may require initiation of or modification of antidiabetic therapy during treatment. Adjusting solutions or rates of administration may cause changes in dextrose delivery. Monitor blood glucose regularly.
Concurrent drug therapy issues:
• Anticoagulants: Citrate, when used as an anticoagulant, can contribute to the base load and cause hypocalcemia.
Dosage form specific issues:
• Hydrogen phosphate: Phoxillum replacement solutions contain hydrogen phosphate (a weak acid) and may increase the risk of metabolic acidosis.
Other warnings/precautions:
• Appropriate use: Administer only under the direction of a health care provider competent in intensive care treatment, including CRRT. Use only with extracorporeal dialysis equipment appropriate for CRRT.
Strength presented in the Dosage Forms field represents the final solution after mixing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Phoxillum B22K4/0: Bicarbonate 22 mEq/L, chloride 122 mEq/L, magnesium 1.5 mEq/L, phosphate 1 mmol/L, potassium 4 mEq/L, sodium 140 mEq/L (5000 mL)
Phoxillum BK4/2.5: Bicarbonate 32 mEq/L, calcium 2.5 mEq/L, chloride 114.5 mEq/L, magnesium 1.5 mEq/L, phosphate 1 mmol/L, potassium 4 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol B22GK 4/0: Bicarbonate 22 mEq/L, chloride 120.5 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1.5 mEq/L, potassium 4 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol BGK 2/0: Bicarbonate 32 mEq/L, chloride 108 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1 mEq/L, potassium 2 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol BGK 4/0/1.2: Bicarbonate 32 mEq/L, chloride 110.2 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1.2 mEq/L, potassium 4 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol BGK 0/2.5: Bicarbonate 32 mEq/L, calcium 2.5 mEq/L, chloride 109 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1.5 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol BGK 2/3.5: Bicarbonate 32 mEq/L, calcium 3.5 mEq/L, chloride 111.5 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1 mEq/L, potassium 2 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol BGK 4/2.5: Bicarbonate 32 mEq/L, calcium 2.5 mEq/L, chloride 113 mEq/L, dextrose 100 mg/dL, lactate 3 mEq/L, magnesium 1.5 mEq/L, potassium 4 mEq/L, sodium 140 mEq/L (5000 mL)
PrismaSol BK 0/0/1.2: Bicarbonate 32 mEq/L, chloride 106.2 mEq/L, lactate 3 mEq/L, magnesium 1.2 mEq/L, sodium 140 mEq/L (5000 mL)
Yes
Solution (PrismaSol B22GK 4/0 Extracorporeal)
22-4 mEq/L (per mL): $0.02
Solution (PrismaSol BGK 0/2.5 Extracorporeal)
32-2.5 mEq/L (per mL): $0.02
Solution (PrismaSol BGK 2/0 Extracorporeal)
32-2 mEq/L (per mL): $0.02
Solution (PrismaSol BGK 2/3.5 Extracorporeal)
32-2-3.5 mEq/L (per mL): $0.02
Solution (PrismaSol BGK 4/0/1.2 Extracorporeal)
32-4-1.2 mEq/L (per mL): $0.02
Solution (PrismaSol BGK 4/2.5 Extracorporeal)
32-4-2.5 mEq/L (per mL): $0.02
Solution (PrismaSol BK 0/0/1.2 Extracorporeal)
32-1.2 mEq/L (per mL): $0.02
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.
Ensure separate compartments are mixed completely prior to use. Administer into the extracorporeal circuit before (pre-dilution) the hemofilter or hemodiafilter; after (post-dilution) the hemofilter or hemodiafilter; or before and after the hemofilter or hemodiafilter.
Continuous renal replacement circuit: Ensure separate compartments are mixed completely prior to use. Administer into the extracorporeal circuit before (predilution) the hemofilter or hemodiafilter; after (post-dilution) the hemofilter or hemodiafilter; or before and after the hemofilter or hemodiafilter.
Continuous renal replacement circuit: Used as a replacement solution in continuous renal replacement therapy (CRRT) to replace water and to correct electrolyte and acid-base imbalances; in drug poisoning when CRRT is used to remove dialyzable substances (Phoxillum and PrismaSol only)
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
Animal reproduction studies have not been conducted. Administration to pregnant women with appropriate monitoring would not be expected to cause harm to the fetus.
These products are excreted in breast milk. Administration to a lactating woman with appropriate monitoring would not be expected to cause harm to the nursing infant.
Hemodynamic status; fluid, electrolyte and acid-base balance; serum glucose. Concentrations of certain dialyzable drugs may need to be monitored and appropriate therapy implemented to correct for removal during CRRT.
Replacement fluids achieve fluid and electrolyte balance by substituting for the ultrafiltrate removed during some forms of CRRT. Replacement solutions may vary in composition and may include a buffer and electrolytes to manage acid-base disorders and electrolyte imbalances.
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