Gastrointestinal: Nausea (≤10%), vomiting (≤10%) The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.Įndocrine and metabolic: Hyperlipidemia (≤10%), hyperglycemia (2% to 10%) Consult drug interactions database for more information. Suggested maximum dose: 10 to 12.5 mL/kg ( Ref).ĭosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. If instability re-emerges, the infusion rate may be increased to 0.25 mL/kg/minute or the 1.5 mL/kg bolus may be repeated ( Ref). If the patient demonstrates a significant response, the infusion rate may be reduced to 0.025 mL/kg/minute (ie, one-tenth the initial rate). Infants, Children, and Adolescents: Very limited data available, optimal dose not defined: 20% lipid emulsion: IV: 1.5 mL/kg bolus over 2 to 3 minutes followed immediately by a continuous IV infusion at 0.25 mL/kg/minute assess response after 3 minutes of infusion. Serious hemodynamic or other instability secondary to highly lipid soluble substances (including, but not limited to, local anesthetics, calcium channel blockers, tricyclic antidepressants, bupropion, lamotrigine, and quetiapine): Note: Use is reserved for patients not responsive to standard resuscitation measures. Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consider rebolus or increase the infusion rate to 0.5 mL/kg/minute if hemodynamic instability persists or recurs ( Ref).ĭosage adjustment for increased serum triglycerides: Stop infusion and monitor if triglycerides >400 mg/dL restart at a lower dose/infusion rate and advance in smaller increments once triglycerides are 1,000 mg/dL ( Ref).ĭosage adjustment for concomitant therapy: For patients receiving other lipid emulsion-based medications (eg, propofol, clevidipine), reduce dosage to avoid fat overload syndrome ( Ref). If instability re-emerges, the infusion rate may be increased back to 0.25 mL/kg/minute or the bolus may be repeated ( Ref).Īmerican Heart Association recommendations: Continue infusion for 30 to 60 minutes ( Ref).Īmerican Society of Regional Anesthesia and Pain Medicine: Continue infusion for at least 10 minutes after hemodynamic stability has been restored. Maximum suggested dose: 10 to 12 mL/kg over the first 30 to 60 minutes ( Ref).Īfter administration of the initial bolus and continuous infusion, recommendations regarding the continuous infusion vary significantly:Īmerican College of Medical Toxicology: If after the bolus and continuing the infusion for 3 minutes the patient demonstrates a significant response, the infusion rate may be reduced to 0.025 mL/kg/minute (ie, one-tenth the initial rate). Some suggest dosing based on lean body weight ( Ref). Intralipid 20%: IV: 1.5 mL/kg (maximum: 100 mL ( Ref)) administered over 1 to 3 minutes, followed immediately by an infusion of 0.25 mL/kg/minute (maximum: 200 to 250 mL ( Ref))(recommended infusion durations vary see below) may repeat the bolus as necessary for persistent cardiovascular collapse or if instability re-emerges ( Ref). Consultation with a clinical toxicologist or poison control center is recommended. Continue chest compressions during administration if patient is in cardiac arrest to circulate the lipid emulsion. Serious hemodynamic or other instability secondary to highly lipid soluble substances (off-label use): Note: May be considered when the patient does not respond to standard resuscitation measures (eg, fluids, vasopressors, inotropes) ( Ref) may also consider early use of lipid emulsion ( Ref).
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