ALBUMIN INJECTION 20% GCC

Indications

• Hypoalbuminemia
• Volume resuscitation in shock
• Liver cirrhosis
• Nephrotic syndrome
• Burns
• Postoperative fluid management

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations based on clinical condition and patient response.

Adults: Refer to the appropriate guidelines for specific dosing recommendations based on clinical condition and patient response.

Mechanism of action

Albumin acts by maintaining oncotic pressure in the vascular system, thus preventing fluid from leaking into tissues and promoting the return of interstitial fluid to the bloodstream. This action helps restore blood volume and improve circulation in patients with conditions that lead to hypovolemia or edema. Additionally, albumin can bind and transport various endogenous and exogenous substances, influencing their distribution and elimination.

Pharmacodynamics

The primary pharmacodynamic effect of albumin is the increase in plasma oncotic pressure, which helps to retain fluid within the vascular space. This effect is critical in managing conditions associated with fluid imbalance. Albumin also has antioxidant properties and may play a role in modulating inflammatory responses, although these effects are secondary to its role in volume expansion.

Pharmacokinetics

Albumin is administered intravenously, where it is distributed rapidly throughout the vascular compartment. The half-life of albumin in circulation is typically around 15 to 20 days, depending on physiological conditions. It is metabolized primarily in the liver, with a small percentage undergoing renal clearance. The distribution volume is influenced by factors such as hydration status and the presence of diseases affecting protein levels.

Contra-indications

• Severe anemia
• Congestive heart failure
• Pulmonary edema
• Severe dehydration
• Allergy to albumin or any component of the formulation

Adverse effects

• Allergic reactions including anaphylaxis
• Headache
• Nausea
• Vomiting
• Fever
• Hypotension
• Fluid overload

Interactions

• Caution should be exercised when administering with other fluids or medications that may affect fluid balance
• May alter the pharmacokinetics of certain drugs due to changes in plasma volume

Precautions

• Monitor for signs of fluid overload, especially in patients with heart or kidney disease
• Use cautiously in patients with a history of allergic reactions
• Ensure proper storage and handling to avoid contamination

Pregnancy

Albumin is generally considered safe during pregnancy when administered for appropriate indications, but its use should be assessed on a case-by-case basis.

Breast-feeding

Albumin can be used during breastfeeding, as it is a naturally occurring protein in human milk.

Storage

Store at 2 to 8 degrees Celsius. Do not freeze. Protect from light and use within the expiry date.

Formulations

• Human albumin solution (various concentrations)
• Albumin (500 mL bags, 20% and 5% solutions)

Indications

• Primary immunodeficiency syndromes
• Secondary immunodeficiency
• Immunomodulation in certain autoimmune disorders
• Prevention of infections in patients undergoing immunosuppressive therapy

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations in pediatric patients, as it varies based on age, weight, and clinical condition.

Adults: Refer to the BNF for specific dosing recommendations for adults, as it varies based on clinical indications and patient circumstances.

Mechanism of action

Normal immunoglobulin works by providing a broad spectrum of antibodies that neutralize pathogens and enhance the immune response. These antibodies bind to pathogens, facilitating their removal by immune cells and providing immediate passive immunity against infections.

Pharmacodynamics

The pharmacodynamic effects of normal immunoglobulin include the neutralization of toxins and pathogens, opsonization, and enhancement of phagocytosis. It modulates immune responses and provides immediate humoral immunity, particularly in individuals with inadequate antibody production.

Pharmacokinetics

Normal immunoglobulin is administered intravenously or subcutaneously. After administration, it is distributed throughout the body, with a half-life of approximately 21 to 30 days. It is metabolized by the reticuloendothelial system, and the rate of clearance can vary based on individual patient factors and the presence of underlying conditions.

Interactions

• normal immunoglobulin + monoclonal antibodies: Severe (affects effects)
• normal immunoglobulin + dinutuximab: Severe (affects effects)
• normal immunoglobulin + live vaccines, measles, mumps and rubella vaccine, live, rotavirus vaccine, typhoid vaccine, oral, varicella-zoster vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + bacillus Calmette-Guérin vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + herpes-zoster vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + live: Unknown (decreases efficacy)
• normal immunoglobulin + influenza vaccine, live: Unknown (decreases efficacy)

Pregnancy

Consult relevant guidelines for use in pregnancy.

Breast-feeding

Consult relevant guidelines for use during breastfeeding.

Storage

Store at 2-8°C. Do not freeze.

Indications

• Diagnostic blood tests
• Assessment of organ function
• Evaluation of electrolyte balance
• Monitoring of therapeutic drug levels
• Detection of antibodies or infectious agents

Dosage

Children: Dosage is not applicable as serum is a biological fluid used for diagnostic purposes and not an administered drug.

Adults: Dosage is not applicable as serum is a biological fluid used for diagnostic purposes and not an administered drug.

Mechanism of action

Serum itself does not have a specific mechanism of action as it is a biological fluid. However, its components, particularly proteins such as albumin and immunoglobulins, contribute to homeostasis, transport, and immune response. Albumin helps in maintaining oncotic pressure and transporting various substances, while immunoglobulins play a vital role in the immune response.

Pharmacodynamics

The pharmacodynamics of serum are closely related to its composition. The proteins in serum, including enzymes, hormones, and antibodies, exert various physiological effects. For example, serum albumin helps maintain blood volume and pressure, while globulins are involved in immune function. Changes in serum composition can affect the pharmacodynamics of drugs, influencing their distribution, metabolism, and elimination.

Pharmacokinetics

Serum does not follow a traditional pharmacokinetic profile, as it is a complex mixture rather than a single drug. However, the elimination and distribution of substances within the serum can be influenced by factors such as protein binding, blood flow, and the physiological state of the individual. The half-life of any drugs or substances present in serum will depend on their specific characteristics and interactions with serum components.

Adverse effects

• Allergic reactions
• Infection at the injection site
• Fever
• Rash
• Joint pain

Precautions

• Use with caution in individuals with a history of allergic reactions
• Monitor for signs of infection
• Assess for any history of autoimmune conditions

Pregnancy

Consult healthcare provider. Safety in pregnancy is not well established.

Breast-feeding

Consult healthcare provider. Limited information is available regarding excretion in breast milk.

Storage

Store at 2 to 8 degrees Celsius. Do not freeze. Protect from light.

Formulations

• Intravenous solution
• Subcutaneous injection