Ammonul Disease Interactions

Sodium chloride can induce sodium and water retention and result in hypernatremia, hypokalemia, edema and aggravation of congestive heart failure. Therapy with sodium- containing agents should be administered with extreme caution, if at all, in patients with congestive heart failure, severe renal insufficiency, and in clinical states where there is edema with sodium retention. Clinical monitoring of acid/base balance and electrolytes prior to, during, a following completion of therapy with sodium- containing agents is recommended.

The combination product of sodium phenylacetate and sodium benzoate injection 10%/10% contains 30.5 mg of sodium per mL of undiluted product. Sodium phenylacetate and sodium benzoate injection should be used with great care, if at all, in patients with congestive heart failure or severe renal insufficiency, and in clinical states in which there is sodium retention with edema. It is recommended to discontinue administration of sodium phenylacetate and sodium benzoate injection, 10%/10%, evaluate the patient, and institute appropriate therapeutic countermeasures as appropriate.

Potassium levels should be carefully monitored as the excretion of the non-reabsorbable anions, phenylacetylglutamine and hippurate can enhance urine potassium loss. Care should be taken when using products containing sodium phenylacetate and sodium benzoate in patients with low blood potassium levels.

The administration of intravenous phenylacetate may cause neurotoxicity. It is recommended to exercise care when using products containing sodium phenylacetate and sodium benzoate in cancer patients or in patients with neurotoxic disorders.

Phenylacetate conjugates with glutamine in the liver and kidneys to form phenylacetylglutamine, via acetylation. Phenylacetylglutamine is excreted by the kidneys via glomerular filtration and tubular secretion. Similarly, preceded by acylation, benzoate conjugates with glycine to form hippuric acid, which is rapidly excreted by the kidneys by glomerular filtration and tubular secretion. It is recommended to use caution and close monitoring when using products containing sodium phenylacetate and sodium benzoate in patients with impaired renal function and in patients with hepatic insufficiency.

Sodium benzoate is structurally similar to salicylates and mild respiratory alkalosis may occur. Therapy with sodium benzoate should be administered cautiously in patients with or predisposed to respiratory acidosis.

Sodium benzoate is structurally similar to salicylates and exacerbation of peptic ulcers may occur. Therapy with sodium benzoate should be administered cautiously in patients with or predisposed to peptic ulcer disease.