Indications for SMOFLIPID:
To provide a source of calories and essential fatty acids in adults requiring parenteral nutrition when oral or enteral nutrition is not possible, insufficient, or contraindicated.
Individualize. Dose based on patient’s energy requirements, age, clinical status, body wt, tolerance, ability to eliminate and metabolize lipids, and additional energy given orally/enterally. Administer by IV infusion via a peripheral or central vein. Usual dose: 1–2g/kg/day; max 2.5g/kg/day. Initiate rate at 0.5mL/min for the first 15–30mins; increase gradually to required rate after 30mins; max 0.5mL/kg/hr. Max daily dose: 60% of total energy requirements. Usual infusion duration: 12–24 hours based on patient’s clinical status. If serum triglycerides (>400mg/dL): initiate at a lower dose and increase in smaller increments; check levels before each adjustment.
Fish, egg, soybean, or peanut allergy. Severe hyperlipidemia or severe disorders of lipid metabolism characterized by hypertriglyceridemia (serum triglyceride >1000mg/dL).
Death in preterm infants.
Risk of deaths in preterm and low birth weight infants: see full labeling. Correct severe fluid and electrolyte disorders prior to initiating. Measure serum triglycerides at baseline, with each dose increase, and regularly during therapy. Discontinue and treat if hypersensitivity reactions occur. Monitor for signs/symptoms of infection and essential fatty acid deficiency (EFAD). Severely undernourished: avoid overfeeding. Risk of parenteral nutrition-associated liver disease (PNALD); consider discontinuation or dose reduction if abnormal LFTs occur. Monitor fluids, electrolytes, blood glucose, liver and kidney function, CBCs, platelets, coagulation parameters throughout treatment. Hepatic impairment. Pregnancy. Nursing mothers.
Vitamin K content may antagonize anticoagulants (eg, coumarin, warfarin); monitor. High lipid levels in plasma may interfere with blood tests (eg, hemoglobin, triglycerides, bilirubin, LDH, oxygen saturation).
Nausea, vomiting, hyperglycemia, flatulence, pyrexia, abdominal pain, hypertriglyceridemia, hypertension, sepsis, dyspepsia, UTI, anemia, device-related infections; refeeding syndrome, PNALD, aluminum toxicity (esp. preterm infants, renal impairment); rare: fat overload syndrome.
Generic Drug Availability:
Emulsion (100mL, 250mL)—10; (500mL)—12