albumin IV (Albuminar, Alba, Albuked, Albutein, Buminate, Flexbumin, Kedbumin, Plasbumin)
Classes: Volume Expanders
Dosing and uses of Albuminar, Alba (albumin IV)
Adult dosage forms and strengths
injectable solution
- 50mg/mL (5%)
- 250mg/mL (25%)
Usual Dosing Guidelines
Initial: 25 g (5% or 25% solution) IV infusion; may repeat q15-30min if response inadequate
Not to exceed 250 g/48 hr
See Administration section for infusion rate
Choice of 5% vs 25% depends on whether patient requires primarily volume (5%) or primarily protein/oncotic pressure (25%)
25% Solution
Acute nephrosis
Acute liver failure
ARDs
Burns
Cardiopulmonary bypass
Hypoproteinemia
Renal dialysis
Hypovolemic shock
Hemolytic disease of newborn
Hepatic surgery/transplantation
5% Solution
Hypovolemic shock
Burns
Hypoproteinemia
Cardiopulmonary bypass
Acute liver disease
Pediatric dosage forms and strengths
injectable solution
- 50mg/mL (5%)
- 250mg/mL (25%)
Usual Dosing Guidelines
Neonates (<28 days old)/infants: 10-20 mL/kg IV of 5% solution
500-1000 mg/kg IV infusion
Not to exceed 250 g/48 hr or 6 g/kg/day
See Administration section for infusion rate
Choice of 5% vs 25% depends on whether patient requires primarily volume (5%) or primarily protein/oncotic pressure (25%)
Albuminar, Alba (albumin IV) adverse (side) effects
Frequency not defined
Anaphylaxis
CHF precipitation
Edema
Hypertension/hypotension
Hypervolemia
Tachycardia
Decr myocardial contractility
Bronchospasm
Pulmonary edema
Salt and water retention
Chills
Fever
Headache
Nausea/vomiting
Pruritus
Rash
Urticaria
Warnings
Contraindications
Hypersensitivity to commercially available albumin products; suspected hypersensitivity to perflutren, blood, blood products or albumin
Severe anemia, cardiac failure
25% solution in preemies (risk of IVH)
Cautions
Serious cardiopulmonary reactions, including fatalities; always have resuscitation equipment and trained personnel readily available
Chronic renal insufficiency, chronic anemia, low cardiac reserve, normal plasma albumin
Ineffective in chronic nephrosis or hypoproteinemia due to chronic cirrhosis, malabsorption, enteropathies, pancreatic insufficiency or undernutrition
Do NOT use sterile water as diluent
Avoid using 25% concentration in preterm infants due to high risk of intraventricular hemorrhage
Use caution in patients on sodium restriction
All commercial formulations contain 130-160 mEq/L of sodium
Monitor patients for signs of hypervolemia, such as, pulmonary edema
Pregnancy and lactation
Pregnancy category: C
Lactation: Endogenous albumin found in breast milk; compatible
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Albuminar, Alba (albumin IV)
Mechanism of action
Replacement of plasma protein; increases intravascular oncotic pressure, mobilizes fluids from interstitial into intravascular space
Distribution
Plasma compartment: 30-40%
Extravascular compartments: 67%
Half-life, distribution: 16 hr; inversely proportional to plasma albumin concentrations
Metabolism
Minimally in the liver; main site is unknown
Elimination
Elimination half-life: 15-20 days
Excretion: Intestinal mucosa, not via kidney
Administration
IV Incompatibilities
Additive: VerapamiL
Y-site: Fat emulsions, midazolam, vancomycin, verapamiL
IV Compatibilities
Solution: Dextrose solutions, saline solutions, dextrose-saline, Ringer LR, Na-lactate 1/6m
Y-site: Diltiazem, lorazepam
IV Preparation
Reconstitution: If 5% human albumin is unavailable, dilute 25% human albumin with NS or D5W
Do NOT use sterile water as diluent - risk of potentially fatal hemolysis & ARF
IV Administration
For IV administration only
Use within 4 hr after opening vial; discard unused portion
Do not dilute 5% solution
Albumin 25% may be given undiluted or diluted in Ns
May give in combination or through same administration set as saline or carbohydrates
Do not use with ethanol or protein hydrolysates; precipitation may form
Hypoproteinemia: Infuse over 30-120 min; not to exceed 5-10 mL/min for 5% solution, 2 mL/min for 20% solution, and 2-3 mL/min for 25% solution
Hypovolemic shock
- Initial bolus infusion as rapidly as desired
- As plasma volume approaches normal, infuse 5% solution up to 2-4 mL/min and 25% solution up to 1 mL/min to avoid circulatory overload
Storage
Store at <30°C (86°F); do not freeze
Do not use solution if turbid or contains a deposit; use within 4 hr of opening vial; discard unused portion
