NIRMIN 5-S
Descripton
Nirmin is a clear,colorless injection containing well-balanced mixture of pure crystalline essential and non essential amino acids,which is optimum concentration for protein synthesis. The infusion is available in two formulations: Nirmin 5S- Amino acid 5% w/v + 5% w/v sorbitol
Dosage Strength & Form
50mg/ml (5%w/v) Amino Acidsin 5% w/v Sorbitol Soln. for Intravenous infusion
Pharmacodynamic
The amino acids contained in Nirmin are all naturally occurring physiological compounds .As with the amino acids derived from the ingestion and assimilation of food proteins parenterally administered amino acids enter the body pool of free amino acids and all subsequent metabolic pathways
Pharmacokinetic
The amino acids in Nirmin enter the plasma pool of corresponding free amino, acids. From the intravascular space, amino acids distribute to the interstitial fluid and, are individually regulated for each single amino acid, into the intracellular space of different tissues as required. Plasma and intracellular free amino acid conc. are endogenously regulated w/ narrow ranges,depending on the age,nutritional status and pathological condition of the patient.Balanced amino acid solutions such as Nirmin do not significantly alter the physiological amino acid pool when infused at a constant and slow infusion rate.Characteristic changes in the physiological amino acid pool of the plasma are only foreseeable when the regulate function of essential organs like liver and kidneys are seriously impaired. In such cases special formulated amino acid solutions may be recommended for restorin homeostasis.Only a small proportion of the infused amino acids are eliminated by the kidneys. For the majority of amino acids plasma half-lives between 10 and 30 mins. have been reported.
Indications
Nirmin is highly appreciated as a parenteral nutrition supplement in the following conditions: prophylaxis and therapy for protein deficiency, pre & post -operative conditions,inadequate or impossible oral feeding,stenosis in the gastrointestinal tract,inflammatory bowel disease and short gut syndrome, chronic diarrhea and vomiting, malabsorption syndrome, sepsis, diffuse peritonitis, fistulas, chylous ascites, malnutrition and clinical outcomes, persistent pyrexial state, nephrosis, amyloidosis, immuno compromised patients, HIV infections, transplantations, cancer and related cachexia, burns, pregnancy, head injuries, prolonged coma
Dosage and Administration
Dosage depends on the severity of the catabolic state and on the amino acid requirement
Recommended Dosage
Daily Dose: 0.8 to 1.0 g amino acids/kg BW Maximum Infusion rate:2.0ml/kg BW hr equivalent to 0.1 g Amino acid/kg BW/hr .Maximum daily dose;1.0g amino acidskg BW for the administration via a peripheral or central vein as a continuous infusion. The soln is administered as long as a parenteral nutrition is required. Nirmin is contraindicated in children
Contraindications
Disturbances of amino acid metabolism ,metabolic acidosis,renal insufficiency w/o haemodialysis or haemofiltration treatment,advanced liver insufficiency, fluid overload, shock, hypoxia, decompensated heart failure. The administration of Nirmin is contra-indicated in neonates For parenteral nutrition of infants and small children paediatric amino acid preparations should. be used ,which are formulated to meet the different metabolic needs of children.
Warning and Precautions
Serum electrolytes,fluid balance and renal function should.be monitored .In cases of hypokalemia and / or hyponatremia adequate amounts of potassium and/or sodium should be supplied simultaneously. Amino acid solutions may precipitate acute folate deficiency,folic acid should therefore be given daily. Care should. be exercised in the administration of large volume infusion fluids to patients w/ cardiac insufficiency. The choice of a peripheral or central vein depends on the final osmolarity of the mixture .The general accepted limit for peripheral infusion is about 800 mosm/l,but it varies considerably with the age and the general condition of the patient and the characteristics of the peripheral veins. Strict asepsis should. be maintained,particularly when inserting a central vein catheter. Nirmin is applicable as part of a total parenteral nutrition regimen in combination with adequate amounts of energy supplements.(Carbohydrate solutions. fat emulsions),electrolytes,vitamins and trace elements
Drug Interactions
Due to the increased risk of microbiological contamination and incompatibilities,amino acids solutions should not be mixed with other medicinal products
Overdose
As with other amino acids solutions shivering, vomiting, nausea, and increased renal amino acid losses can occur when Nirmin is given in overdose or the infusion rate is exceeded infusion should. Be stopped immediately in this case. It may be possible to continue w/a reduced dosage. A too rapid infusion can cause fluid overload .Emergency procedures should. be general supportive measures, with particular attention to respiratory and cardiovascular systems.
Storage
Store below 25C .Do not Freeze. Protect from Light
Presentation
100ml, 200ml, 500ml and 1000ml Glass Bottle
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