Aminofuschin

Description
Parenteral nutrient solution with an amino acid (AA) pattern adjusted to the altered AA metabolism
of patients with hepatic insufficiency. The high content of branched-chain amino acids (isoleucine,
leucine, valine) and the low content of methionine, phenylalanine and tryptophan take the altered
influences on CNS function into account. This in particular counteracts the risk of neurological
deterioration which was previously present in patients with serious liver disease receiving parenteral
nutrition in the form of standard amino acid solutions. Use of this preparation may bring about
increased mental alertness in cases where sensory disorders due to hepatic insufficiency are
present.

Other factors contributing to this objective are the use of reliable substances which back up the
detoxication functions of the diseased liver e.g. ornithine aspartate, arginine, malate (malic acid) and
adjustments of the electrolyte pattern to the specific requirements of. patients with liver disease, for
example, reduced Na+, average K+ and increased Mg++ content.

The solution contains 50 g AA, 7.59 g nitrogen and 1750 kJ (approx. 400 kcal) per litre. Osmolarity of
approx. 800 mOsm/l allows the solution to be applied via peripheral venous network.

Indications
Essential parenteral nutrition in patients with severe chronic hepatic insufficiency, e.g.
decompensated liver cirrhosis, shunt patients with liver cirrhosis, hepatic insuffiency resulting from
other causes (e.g. metastatic liver); possibly also in cases of chronic hepatitis.

Dosage Instructions
For intravenous infusion.
Dosage unless otherwise prescribed, 0.7-1 g AA/kg BW/day. In special cases a reduced dosage
(approx. 0.5 g AA/kg BW/day) or with considerably increased requirements, up to 1.4 g AA/kg
BW/day. This yields 14-20 ml (10-28 ml)/kg BW/day or approx. 1000-1500 ml (700-2000 ml)/day for
patient weighing 70 kg.
The infusion rate under normal circumstances is 0.10 g AA/kg BW/h equivalent to 2 ml/kg BW/h or
2.3 ml/min (45 drops/min. or 500 ml in approx. 3 h) in 70 kg patient. A rate of 0.15 g AA/kg BW/h
(approx. 3.5 ml or 70 drops/min. in a 70 kg patient) should not be exceeded.

Adverse Reactions and Side Effects

There are no known adverse reactions or side effects. Reactions which may occur because of the
solution or the technique of administration include fibrile response, infection at the site of injection,
venous thrombosis or phlebitis extending from the site of injection, extra vasation and hyper
volemia. If an adverse reaction occurs, discontinue infusion. Initiate appropriate treatment and
retain the remainder of the fluid for examination if deemed necessary.

Contraindications
This preparation is contraindicated in patients with coma due to liver atrophy (so-called endogenous
hepatic coma, acute liver atrophy) occuring as a result of hepatitis or severe poisoning, for example:
chronic renal disease with serious restriction of renal performance, hyperkalaemia, shock
decompensated, cardiac insufficiency, fructose or sorbitol intolerance,
fructose-l-6-diphosphatase deficiency, methanol poisoning, metabolic anomalies in connection with
the amino acids contained in this preparation.

Presentation and Pack Sizes

Infusion solution in bottles containing 500 ml.
Clinic pack available with 10 bottles.

Notes
Energy in the form of non-protein nutrients should be given separately at a rate approx. 100-150 kJ
(approx. 25-35 kcal)/kg BW/day, or in spesial cases where required 170 kJ (40kcal)/kg BW/day,
preferably via either the parenteral or the enteral (with feeding tube if necessary) route, or a
combination of the two methods. Vitamin supply must also be ensured. If ascites develops increased
diuretic therapy should be considered. Parenteral nutrition should not be
applied for periods of more than two to three weeks without control of protein synthesis (i.e.
assessment of plasma proteins, coagulation factors etc.) Little practical experience has so far been
gained in cases of acute poisoning where comatose states are imminent. No definite guidelines can
be given regarding the use of this product in children as their requirements vary during the growth
phase.
Ensure adequate renal function.
Use only clear solutions in condition of intact containers.
Protect from light. Store below 25C.