Version May 2024
Note: Chromium-containing products have been discontinued in the United States for >1 year.
Parenteral nutrition, maintenance requirement: Note: Dosing recommendations are for the product Tralement; use in patients who require supplementation with all 4 of the individual trace elements (zinc, copper, manganese, and selenium); product does not contain chromium. Products that contain chromium are available in Canada; refer to manufacturer's labeling for product-specific dosing information.
IV: 1 mL per day added to parenteral nutrition (1 mL provides the following: zinc 3 mg, copper 0.3 mg, manganese 55 mcg, selenium 60 mcg).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Trace metals: Pediatric drug information")
Parenteral nutrition additive, maintenance requirement:
Note: Does not contain chromium. Use in patients who require supplementation with all 4 of the individual trace elements (zinc, copper, manganese, and selenium). Use of multi-trace element products make it difficult to meet ASPEN's trace element dose recommendation; additional daily supplementation of zinc, copper, and/or selenium may be needed; see individual monographs.
Infants and Children weighing 3 to <10 kg: Multrys: IV: 1 mL/day added to parenteral nutrition; each 1 mL dose provides zinc 1,000 mcg, copper 60 mcg, manganese 3 mcg, and selenium 6 mcg per mL.
Children and Adolescents weighing ≥10 kg:
Tralement (zinc 3,000 mcg, copper 300 mcg, manganese 55 mcg, and selenium 60 mcg per mL): IV: Add to parenteral nutrition daily.
|
Body Weight |
Volume of Tralement |
Amount of Trace Element Provided by the Corresponding Tralement Volume | |||
|---|---|---|---|---|---|
|
Zinc |
Copper |
Manganese |
Selenium | ||
|
10 to <20 kg |
0.2 mL |
600 mcg |
60 mcg |
11 mcg |
12 mcg |
|
20 to <30 kg |
0.4 mL |
1,200 mcg |
120 mcg |
22 mcg |
24 mcg |
|
30 to <40 kg |
0.6 mL |
1,800 mcg |
180 mcg |
33 mcg |
36 mcg |
|
40 to <50 kg |
0.8 mL |
2,400 mcg |
240 mcg |
44 mcg |
48 mcg |
|
≥50 kg |
1 mL |
3,000 mcg |
300 mcg |
55 mcg |
60 mcg |
There are no dosage adjustments provided in the manufacturer's labeling; some components may require dosing adjustment; see individual agents.
There are no dosage adjustments provided in the manufacturer's labeling; some components may require dosing adjustment; see individual agents. Consider using individual trace element products in patients with hepatic and/or biliary dysfunction.
There are no adverse reactions listed in the manufacturer's labeling.
Hypersensitivity to zinc, copper, or any component of the formulation; administration of undiluted solutions by direct injection into a peripheral vein.
Concerns related to adverse effects:
• Hypersensitivity reactions: Hypersensitivity reactions (eg, angioedema, dyspnea, pruritus, rash, urticaria) have been reported in patients exposed to copper or zinc containing products (eg, zinc-containing insulin or copper-containing intrauterine devices). Discontinue treatment and institute appropriate treatment if hypersensitivity occurs.
Disease-related concerns:
• Hepatic impairment: Copper and manganese may accumulate in severe hepatic impairment and/or biliary obstruction; consider reduction in dosage or deletion of copper and manganese in patients with severe hepatic impairment or biliary obstruction.
• Renal impairment: Use with caution in patients with renal impairment; metals may accumulate in renal failure.
Other warnings/precautions:
• Aluminum toxicity: Contains aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or in patients with renal impairment. 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.
• Manganese toxicity: Basal ganglia accumulation (detected on MRI) and clinical symptoms (eg, neuropsychiatric, seizures, parkinsonian-like tremor, dysarthria, mask-face, halting gate, dystonic movements) of manganese toxicity have been reported in adult and pediatric patients, including patients receiving manganese at or below recommended doses and with normal blood manganese levels. Risk may be increased in patients receiving higher than recommended doses and with cholestatic liver disease. Symptoms and MRI findings generally improve over weeks to months following discontinuation of manganese but may not completely resolve. Monitor manganese blood levels and for neurologic toxicity in patients receiving manganese long-term as a component of parenteral nutrition therapy. If manganese toxicity is suspected, temporarily discontinue and further evaluate.
• Overdose potential: Multiple trace metal solutions present a risk of overdosage when the need for one trace element is appreciably higher than for others in the formulation; utilization of individual trace metal solutions may be needed (especially chromium if using a product that does not contain chromium).
Chromium-containing products have been discontinued in the United States for >1 year.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous:
Multitrace-4: chromium 4 mcg, copper 400 mcg, manganese 100 mcg, and zinc 1,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]
Multitrace-5: chromium 4 mcg, copper 400 mcg, manganese 100 mcg, selenium 20 mcg, and zinc 1,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]
Multitrace-4 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, and zinc 5,000 mcg per 1 mL (1 mL [DSC])
Multitrace-4 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, and zinc 5,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]
Multitrace-4 Neonatal: chromium 0.85 mcg, copper 100 mcg, manganese 25 mcg, and zinc 1,500 mcg per 1 mL (2 mL [DSC])
Multitrace-5 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, selenium 60 mcg, and zinc 5,000 mcg per 1 mL (1 mL [DSC])
Multitrace-5 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, selenium 60 mcg, and zinc 5,000 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]
Trace Elements 4/Pediatric: chromium 1 mcg, copper 100 mcg, manganese 30 mcg, and zinc 500 mcg per 1 mL (10 mL [DSC]) [contains benzyl alcohol]
Solution, Intravenous [preservative free]:
Multitrace-4 Pediatric: chromium 1 mcg, copper 100 mcg, manganese 25 mcg, and zinc 1,000 mcg per 1 mL (3 mL)
Multrys: copper 60 mcg, manganese 3 mcg, selenium 6 mcg, and zinc 1,000 mcg per 1 mL (1 mL)
Tralement: copper 300 mcg, manganese 55 mcg, selenium 60 mcg, and zinc 3,000 mcg per 1 mL (1 mL)
Yes
Solution (Multitrace-4 Pediatric Intravenous)
1-100-25-1000 mcg/mL (per mL): $4.86
Solution (Multrys Intravenous)
60-3-6-1000 mcg/mL (per mL): $26.21
Solution (Tralement Intravenous)
300-55-60-3000 mcg/mL (per mL): $28.18
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. [DSC] = Discontinued product
Solution, Intravenous:
Micro +5 Concentrate: chromium 10 mcg, copper 1,000 mcg, manganese 500 mcg, selenium 60 mcg, and zinc 5,000 mcg per 1 mL ([DSC])
Micro+4 Regular: chromium 4 mcg, copper 400 mcg, manganese 100 mcg, and zinc 1,000 mcg per 1 mL (5 mL)
For IV use only. Must be diluted prior to use and infused as component of parenteral nutrition or parenteral solutions. Do not administer undiluted solutions by direct injection into a peripheral vein.
Parenteral: IV infusion: Must be diluted prior to use; not for direct IV infusion. Administer as a component of parenteral nutrition. May be infused via peripheral or central catheter as determined by osmolarity of the final parenteral nutrition solution; solutions with osmolarity ≥900 mOsm/L must be infused via central venous catheter. Refer to institutional policies and procedures for osmolarity requirements for peripheral and central administration.
Trace element supplement for parenteral nutrition: Prevent and correct trace element deficiencies as a supplement to parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated.
Refer to individual elements for requirements in pregnancy.
Refer to individual elements for requirements while breast-feeding.
Recommended daily dose for parenteral nutrition (ASPEN 2020): Note: These requirements are a general range and may differ than what is provided from the multi-trace element products or for patients with liver and/or kidney impairment.
Zinc:
Preterm neonates: 400 mcg/kg/day.
Term neonates and infants weighing 3 to <10 kg: 250 mcg/kg/day.
Children weighing 10 to 40 kg: 50 mcg/kg/day; maximum dose: 5 mg/day.
Children and Adolescents weighing >40 kg: 2 to 5 mg/day.
Adult: 3 to 5 mg/day.
Copper:
Neonates (preterm and term), Infants, and Children ≤40 kg: 20 mcg/kg/day; maximum dose: 500 mcg/day.
Children and Adolescents weighing >40 kg: 200 to 500 mcg/day.
Adult: 0.3 to 0.5 mg/day.
Manganese:
Neonates (preterm and term), Infants, and Children ≤40 kg: 1 mcg/kg/day; maximum dose: 55 mcg/day.
Children and Adolescents weighing >40 kg: 40 to 100 mcg/day.
Adult: 55 mcg/day.
Selenium:
Neonates (preterm and term), Infants, and Children ≤40 kg: 2 mcg/kg/day; maximum dose: 100 mcg/day.
Children and Adolescents weighing >40 kg: 40 to 60 mcg/day.
Adult: 60 to 100 mcg/day.
Periodically monitor plasma zinc, copper, manganese, and selenium.
Copper: Cofactor for serum ceruloplasmin, an oxidase necessary for proper formation of the iron carrier protein, transferrin; also helps maintain normal rates of red and white blood cell formation and prevents development of leukopenia, neutropenia, anemia, depressed ceruloplasmin levels, impaired transferrin formation and secondary iron deficiency.
Manganese: Activator for enzymes such as polysaccharide polymerase, liver arginase, cholinesterase and pyruvate carboxylase and prevents development of nausea and vomiting, weight loss, dermatitis, and changes in growth and hair color.
Selenium: Protects cell components from oxidative damage due to peroxides produced in cellular metabolism and prevents development of muscle pain and tenderness.
Zinc: Facilitates wound healing, helps maintain normal growth rates, normal skin hydration and senses of taste and smell and prevents development of parakeratosis, hypogeusia, anorexia, dysosmia, geophagia, hypogonadism, growth retardation and hepatosplenomegaly.
Distribution:
Manganese: Widely distributed into tissues including liver and specific brain regions (ie, basal ganglia).
Zinc: 85% found in skeletal muscle and bone.
Protein binding:
Copper: 7% bound to albumin and amino acids.
Manganese: Albumin and beta1-globulin.
Selenium: 95% bound by 24 hours.
Zinc: 80% bound to albumin; remainder bound to alpha-2 macroglobulin and amino acids.
Excretion:
Copper: Bile (primary route), urine, feces.
Manganese: Bile.
Selenium: Urine, feces.
Zinc: Urine, feces.
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
