albumin IV (Albuminar, Alba, Albuked, Albutein, Buminate, Flexbumin, Kedbumin, Plasbumin)

Dosing and uses of Albuminar, Alba (albumin IV)

• Adult
• Pediatric

 

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