Cysteine Hydrochloride
Pronunciation: SIS-te-een HYE-droe-KLOR-ide
Class: Amino acid
Trade Names
Cysteine Hydrochloride
- Injection, solution, concentrate 50 mg/mL
L-Cysteine Hydrochloride
- Injection, solution, concentrate 50 mg/mL
Pharmacology
Essential amino acid in infants.
Indications and Usage
As an additive to crystalline amino acid solution to meet the IV amino acid nutritional requirements of infants receiving TPN.
Contraindications
Hepatic coma; metabolic disorders involving impaired nitrogen utilization.
Dosage and Administration
AdultsNot intended for use in adults.
InfantsIV 500 mg (10 mL) of cysteine injection combined with 12.5 g of crystalline amino acid injection (eg, 250 mL of 5% injection). The admixture is then diluted with 250 mL of dextrose 50% or such lesser volume as indicated.
General Advice
- Do not give undiluted. Add to crystalline amino acid injection.
- Use within 1 h of mixing. Otherwise, refrigerate immediately and use within 24 h.
- Add to TPN solution.
- Use of large peripheral veins, in-line filters, and slowing the rate of infusion may reduce the incidence of local venous irritation.
Storage/Stability
Store between 59° and 86°F.
Drug Interactions
TetracyclineTetracycline may reduce the nitrogen-sparing effects of infused amino acids.
Adverse Reactions
GI
Nausea.
Local
Erythema, phlebitis, thrombosis at the infusion site, warm sensation.
Miscellaneous
Fever, generalized flushing.
Precautions
MonitorMonitor glucose, urea nitrogen, serum electrolytes, ammonia, cholesterol, acid-base balance, serum proteins, kidney and liver function tests, osmolarity, and hemogram. WBC and blood cultures are to be determined if indicated. Urinary osmolarity and glucose should be determined frequently. Carefully monitor nitrogen intake in patients with impaired renal function. |
Pregnancy
Not indicated for use in pregnant women.
Lactation
Not indicated for use in breast-feeding women.
Children
The effect of infusion of amino acids, without dextrose, upon carbohydrate metabolism of children is not known at this time.
Renal Function
May increase BUN. Discontinue if BUN levels exceed normal postprandial limits and continue to rise. A modest rise in BUN normally occurs as a result of increased protein intake.
Hepatic Function
May increase BUN, and cause serum amino acid imbalances, metabolic alkalosis, prerenal azotemia, hyperammonemia, stupor, and coma.
Special Risk Patients
Use with caution in patients with a history of renal disease, pulmonary disease, or with cardiac insufficiency to avoid excessive fluid accumulation. Use sodium-containing solutions with caution, if at all, in patients with CHF or severe renal insufficiency, and in clinical states in which there exists edema with sodium retention. Use potassium-containing solutions with caution, if at all, in patients with hyperkalemia or severe renal failure, and in clinical states in which potassium retention is present. Use acetate-containing solutions with caution in patients with metabolic or respiratory alkalosis and in those conditions in which there is an increased level or an impaired utilization of this ion (eg, severe hepatic insufficiency).
DiabetesUse caution when administering hypertonic glucose to provide calories in diabetic or prediabetic patients.
Aluminum toxicity
Parenteral products may contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk.
Exogenous calories
Provide exogenous calories concurrently with amino acids in patients receiving long-term total nutrition or if the patient has inadequate fat stores.
Hyperammonemia
May result in mental retardation in infants. Monitor blood ammonia levels frequently.
Patient Information
- Advise patient that medication will be prepared and administered by a health care provider in a hospital setting.
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