Cabivenes peripheral

The drug Kabiven peripheral contains solutions of amino acids and glucose, as well as a fat emulsion. This drug is designed to save the lives of patients who, due to circumstances, are unable to receive enteral nutrition. Thus, the complex of vital drugs "three in one" performs the most important functions: it replenishes the deficiency of carbohydrates, fats and proteins in the body.

Indications Cabivenes peripheral

Indications for use Kabiven peripheral - ensuring high-quality parenteral nutrition of patients with various pathologies. The effective action of this drug is due to the pharmacological activity of its components. Thus, Vamin 18 Novum replenishes the protein deficiency in the body when enteral nutrition of the patient is impossible. Intralipid acts as a supplier of essential fatty acids. Glucose ensures normal metabolism of amino acids. Infusion of glucose solution together with lipid emulsion helps reduce the risk of thrombophlebitis, which often occurs with intravenous administration of various hypertonic solutions.

[ 1 ]

Release form

Kabiven peripheral is presented in the form of an emulsion and is intended for infusions in cases of mild to moderate protein-energy malnutrition.

The drug is available in a three-chamber bag (plastic container) containing amino acid and glucose solutions, as well as a fat emulsion, and in three volume options: 2400 ml, 1920 ml and 1440 ml. The container volume determines the amount of solutions. The three main components of Kabiven peripheral are presented in a balanced ratio.

As a result of mixing the components of the 3 chambers, a homogeneous emulsion, colored white, is formed.

• Vamine (amino acids + electrolytes) is a solution of amino acids with maximum biological value.
• Intralipid is the so-called “gold standard” of fat emulsion widely used in the USA and Europe.
• Glucose has many advantages, among which it is necessary to highlight the optimally balanced composition, simplicity and ease of use, the ability to reduce the risk of developing infectious complications. In addition, through a special port, it is possible to introduce glucose into the central and peripheral veins along with vitamins and various microelements.

It should be noted that for the best technology and design, the medicinal product Kabiven peripheral was awarded the Medical Design Excellence Awards in 2001 (New York).

Pharmacodynamics

Kabiven peripheral is effective due to its special composition, which determines the pharmacological properties of this drug.

The pharmacodynamics of Kabiven peripheral is due to the action of its active components – a solution of amino acids and glucose, as well as intralipid (fat emulsion).

Vamin 18 N (amino acid solution) is optimal for patients who need to compensate for protein deficiency as a result of surgical interventions, burns and various injuries; it is widely used in ENT practice and surgery (including maxillofacial surgery), in cases where enteral nutrition of the patient is impossible or does not produce the desired effect.

Intralipid fat emulsion is an effective energy source, which is indicated for patients with a pronounced deficiency of essential fatty acids. It is necessary for patients who have an acute need to normalize the balance of essential fatty acids.

Glucose is an essential source of so-called “rapidly released” energy and plays a major role in amino acid metabolism.

Together, these three main components of Kabiven Peripheral provide a positive result in therapy and help quickly replenish the deficiency of fats, proteins and carbohydrates in the patient’s body.

[ 2 ], [ 3 ]

Pharmacokinetics

Kabiven peripheral is a medicinal product in the form of a three-component mixture, which is used in medical practice to maintain optimal protein-energy metabolism. The recommended duration of infusion of Kabiven peripheral is usually from 12 to 24 hours.

The pharmacokinetics of Kabiven peripheral is determined by the elimination of its three components from the body. Thus, the elimination of Intralipid from the bloodstream occurs in a similar way to chylomicrons (neutral fat particles). In general, hydrolysis of exogenous fat particles occurs in the blood. As for the rate of elimination, it depends directly on the infusion rate, the composition of the fat particles, and the general condition of the patient.

The intravenously administered solution of amino acids and electrolytes (Vamin 18 N) has practically the same pharmacokinetic characteristics as when amino acids enter the body with food. The only difference is that amino acids of food proteins enter the bloodstream through the hepatic portal vein, and those administered intravenously enter the systemic bloodstream immediately. As for the pharmacokinetic characteristics of glucose administered by infusion, they are no different from those observed when it enters the body with food.

[ 4 ], [ 5 ]

Dosing and administration

Kabiven peripheral is administered intravenously. Infusions can be performed into the patient's central or peripheral veins. The selection of the dosage of the drug and the rate of its intravenous administration depend on the individual ability of the human body to remove lipids and metabolize glucose.

The method of administration and dosage of this drug are selected individually, depending on the clinical picture of the disease. The choice of the container volume with the active substances of Kabiven peripheral depends on the general condition of the patient, his weight, and the level of the body's need for nutrients. Implementation of parenteral nutrition in full may require additional addition of individual vitamins, electrolytes and microelements.

The maximum daily dose is usually 40 ml/kg/day, which is equivalent to one three-chamber bag of Kabiven peripheral, which has the largest size - a volume of 2400 ml. This dosage is optimal for adults with an average body weight of 64 kg. It should be noted that the choice of the maximum daily dose may vary, since this indicator completely depends on the clinical picture of the disease and the patient's well-being. For obese people, the dosage of the drug is determined taking into account the ideal body weight.

Kabiven peripheral can be prescribed to children from two years of age. In this case, its administration is carried out starting with the lowest dosages (from 14 to 28 ml/kg/day), after which the dose is gradually increased to the maximum indicator - 40 ml/kg/day. For children over 10 years of age, the dosage of Kabiven peripheral is set in the same quantities as for adults.

[ 13 ], [ 14 ], [ 15 ], [ 16 ]

Use Cabivenes peripheral during pregnancy

Kabiven peripheral belongs to a group of combined drugs used in modern medicine for parenteral nutrition of patients in cases where oral or enteral nutrition is contraindicated, is carried out in insufficient quantities or is practically impossible.

The instructions for the drug say that it can be used by both adults and children over 2 years of age. The use of Kabiven peripheral during pregnancy remains questionable, since the annotation to the drug states that to date no special studies have been conducted on the safety of Kabiven peripheral during pregnancy and lactation. The instructions also emphasize that, in principle, the prescription of this drug to pregnant women and nursing mothers is possible, but only in cases where the expected therapeutic effect exceeds the possible risks to the fetus.

Thus, the decision to prescribe Kabiven peripheral as a therapeutic agent during pregnancy should be made exclusively by a doctor, who will weigh all the pros and cons and only use this drug for treatment in case of extreme necessity. In this case, it is necessary to take into account the condition of the pregnant woman, the results of her examination and medical tests.

Contraindications

Kabiven peripheral is prescribed to patients with caution due to a number of contraindications that can cause complications during therapeutic treatment.

Contraindications to the use of Kabiven peripheral concern the following pathological conditions:

• hypersensitivity to one of the auxiliary components of the drug, in particular, soy and egg proteins;
• hyperglycemia;
• hyperlipidemia;
• liver/renal failure (acute form of the disease);
• severe blood clotting disorders;
• contraindications to infusions (hyperhydration (excessive accumulation of fluid in the body), dehydration (significant loss of water), heart failure or acute pulmonary edema, etc.);
• inborn error of amino acid metabolism;
• pathological increase in the concentration in the blood plasma of any of the peripheral electrolytes included in Kabiven;
• acute phase of shock;
• various unstable conditions (severe sepsis, diabetes mellitus in the patient, all kinds of post-traumatic conditions, heart attack, etc.).

Kabiven peripheral is prescribed with great caution when a patient has lipid metabolism disorders following the development of diabetes mellitus, as well as renal failure or liver dysfunction, pancreatitis, metabolic acidosis (change in acid state), sepsis, a tendency to electrolyte retention, a pronounced need for plasma-substituting therapy, increased blood osmolarity, etc.

[ 6 ], [ 7 ], [ 8 ]

Side effects Cabivenes peripheral

Kabiven peripheral may have side effects only in the rarest cases. If the infusion is carried out correctly, side effects from taking this drug, as a rule, do not occur.

Side effects of Kabiven peripheral include the following symptoms:

• allergic reactions (skin rash, tremors, fever, hives, chills, anaphylactic reaction);
• arterial hypo- or hypertension;
• tachypnea (breathing disorder);
• abdominal pain (neurotic abdominal pain);
• headache;
• reticulocytosis (increased number of reticulocytes in the peripheral blood);
• increased activity of liver enzymes;
• hemolysis (the process of destruction of red blood cells);
• priapism (pathologically occurring (painful) erection of the penis).

Possible local reactions include the occurrence of thrombophlebitis when the drug is administered into the patient's peripheral veins.

If any adverse reactions occur as a result of taking Kabiven Peripheral, the dosage of the drug is changed or alternative therapy is selected. Everything depends on the specific situation and the correct administration of the drug. In any case, infusions of Kabiven Peripheral are carried out in a medical institution under the strict supervision of medical personnel.

[ 9 ], [ 10 ], [ 11 ], [ 12 ]

Overdose

Kabiven peripheral must be administered to the patient taking into account the overall picture of the disease and the patient's condition, since various complications are possible due to an overdose.

Overdose may cause the so-called "fat overload syndrome", which is a disorder of the body's ability to eliminate fats. This syndrome may result from either an overdose of the drug or from a violation of the infusion rate in cases where the patient's clinical condition changes abruptly, leading to acute liver or kidney failure. Treatment of such conditions involves stopping the administration of lipids.

The main signs of fat overload syndrome:

• fever;
• coagulopathy (blood clotting disorder);
• anemia (decreased hemoglobin);
• hyperlipidemia (lipid metabolism disorder);
• hepatosplenomegaly (simultaneous enlargement of the liver and spleen);
• leukopenia (decrease in the number of leukocytes in the blood);
• thrombocytopenia (low platelet count in the blood);
• coma (deep loss of consciousness as a result of the development of a critical state of orgasm due to pathology).

To avoid drug overdose, it is important to administer Kabiven peripheral infusions strictly in a hospital setting, under the supervision of medical personnel and in accordance with the doctor’s instructions.

Interactions with other drugs

Kabiven peripheral may interact with other drugs, adversely affecting certain processes in the body. This should be taken into account when combining this drug.

The interactions of Kabiven peripheral with other drugs have their own characteristics. In particular, the drug can be combined only with those drugs and nutrient solutions that are compatible with it at the chemical level, i.e. will not cause any negative consequences and complications. Such drugs include: Vitalipid N (for adults and children), Dipeptiven, Addamel N, Soluvit N. Mixing of solutions must be done exclusively under aseptic conditions.

Heparin in clinically used doses causes a transient release of lipoprotein lipase into the bloodstream, which may initially lead to increased lipolysis in the blood plasma and then to a transient decrease in triglyceride clearance.

Insulin may also affect lipase activity, but there is no evidence that this factor has an adverse effect on the therapeutic value of the drug.

Vitamin K1, contained in soybean oil, is an antagonist of coumarin derivatives, so it is recommended to carefully monitor blood clotting in patients receiving these drugs.

Kabiven peripheral can only be mixed with those medications for which compatibility with it has been confirmed, for example: adult and Vitalipid N for children;

[ 17 ], [ 18 ], [ 19 ]

Storage conditions

At a temperature not exceeding 25 °C. Do not freeze. Keep out of reach of children.

After opening the fixators, the chemical and physical stability of the mixed contents of the 3 chambers is maintained for 24 hours at a temperature of 25 °C. To ensure microbiological safety, the mixture should be used immediately after the addition of additives. If the mixture is not used immediately, then, provided that aseptic conditions are observed when adding additives, the emulsion mixture can be stored for up to 6 days at a temperature of 2–8 °C, after which it must be used within 24 hours.

Shelf life

The shelf life of the drug in the outer bag is 2 years.

[ 20 ]