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LIPOFLEX PLUS EMULSION FOR INFUSION

Active substance(s): ALANINE / ARGININE / ASPARTIC ACID / CALCIUM CHLORIDE DIHYDRATE / GLUCOSE MONOHYDRATE / GLUTAMIC ACID / GLYCINE / HISTIDINE HYDROCHLORIDE MONOHYDRATE / ISOLEUCINE / LEUCINE / LYSINE HYDROCHLORIDE / MAGNESIUM ACETATE TETRAHYDRATE / MEDIUM CHAIN TRIGLYCERIDES / METHIONI

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PACKAGE LEAFLET

Package leaflet: Information for the user
Lipoflex plus emulsion for infusion
Read all of this leaflet carefully before you start using this medicine because it contains important
information for you.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor, pharmacist or nurse.

This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if
their signs of illness are the same as yours.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side
effects not listed in this leaflet. See section 4.
What is in this leaflet
1.
What Lipoflex plus is and what it is used for
2.
What you need to know before you use Lipoflex plus
3.
How to use Lipoflex plus
4.
Possible side effects
5.
How to store Lipoflex plus
6.
Contents of the pack and other information

1.

What Lipoflex plus is and what it is used for

Lipoflex plus contains fluids and substances called amino acids, electrolytes and fatty acids that are essential
for the body to grow or to recover. It also contains calories in the form of carbohydrates and fats.
You are given Lipoflex plus when you are unable to eat food normally. There are many situations when this
might be the case, for example when you are recovering from surgery, injuries or burns, or when you are unable
to absorb food from your stomach and gut.

2.

What you need to know before you use Lipoflex plus

Do not use Lipoflex plus

if you are allergic to any of the active substances, to egg, peanut or soybean or to any of the other
ingredients of this medicine (listed in section 6).

This medicine must not be given to newborn infants, infants and toddlers under two years old.
Also, do not use Lipoflex plus if you suffer from any of the following:

life-threatening blood circulation problems such as those that can occur if you are in a state of collapse or
shock

heart attack or stroke

severely impaired blood clotting function, bleeding risk (severe coagulopathy, aggravating haemorrhagic
diatheses)

blocking of blood vessels by blood clots or fat (embolism)

severe liver failure

impaired bile flow (intrahepatic cholestasis)

severe kidney failure in the absence of kidney replacement therapy

disturbances of your body salt composition

fluid deficit or excess water in your body





water on your lungs (pulmonary oedema)
severe heart failure
certain metabolic disorders such as
– too much lipid (fat) in the blood
– inborn errors of amino acid metabolism
– abnormally high blood sugar level that needs more than 6 units of insulin per hour to be controlled
– abnormalities of metabolism that may occur after operations or injuries
– coma of unknown origin
– insufficient supply of oxygen to tissues
– abnormally high acid level in the blood.

Warnings and precautions
Talk to your doctor before using Lipoflex plus.
Please inform your doctor if:

you have heart, liver or kidney problems

you suffer from certain types of metabolic disorders such as diabetes, abnormal blood fat values and
disorders of your body fluid and salt composition or your acid-base balance.
You will be monitored closely to detect early signs of an allergic reaction (such as fever, shivering, rash, or
shortness of breath) when you receive this medicine.
Further monitoring and tests such as various examinations of blood samples will be applied to make sure that
your body handles the administered foodstuffs properly.
The nursing staff may also take measures to ensure that your body’s fluid and electrolyte requirements are met.
In addition to Lipoflex plus you may receive further nutrients (foodstuffs) in order to fully cover your
requirements.
Children
This medicine must not be given to newborn infants, infants and toddlers under two years old.
Other medicines and Lipoflex plus
Tell your doctor if you are taking, have recently taken or might take any other medicines.
Lipoflex plus can interact with some other medicines. Please tell your doctor if you are taking or receiving any
of the following:

insulin

heparin

medicines that prevent undesirable blood clotting such as warfarin or other coumarin derivatives

medicines to promote urine flow (diuretics)

medicines to treat high blood pressure (ACE inhibitors)

medicines to treat high blood pressure or heart problems (angiotensin-II-receptor antagonists)

medicines used in organ transplants such as ciclosporin and tacrolimus

medicines to treat inflammation (corticosteroids)

hormone preparations that affect your fluid balance (adrenocorticotropic hormone or ACTH)

Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your
doctor for advice before taking this medicine. If you are pregnant, you will receive this medicine only if the
doctor considers it absolutely necessary for your recovery. There is no data available about the use of Lipoflex
plus in pregnant women.
Breast-feeding is not recommended for mothers on parenteral nutrition.
Driving and using machines
This medicine is normally given to immobile patients, e.g. in a hospital or clinic which would exclude driving
or using machines. However, the medicine itself has no effect on the ability to drive or use machines. If you
have any further questions on the use of this medicine, ask your doctor or pharmacist.

3.

How to use Lipoflex plus

This medicine is administered by intravenous infusion (drip), that is, through a small tube directly into a vein.
This medicine will be administered through one of your large (central) veins only.
Your doctor will decide how much of this medicine you need and for how long you will require treatment with
this medicine.
Use in children
This medicine must not be given to newborn infants, infants and toddlers under two years old.
If you use more Lipoflex plus than you should
If you have received too much of this medicine you may suffer from a so-called ‘overload syndrome’ and the
following symptoms:

fluid excess and electrolyte disorders

water on your lungs (pulmonary oedema)

loss of amino acids through the urine and disturbed amino acid balance

vomiting, feeling sick

shivering

high blood sugar level

glucose in the urine

fluid deficit

blood much more concentrated than normal (hyperosmolality)

impairment or loss of consciousness due to extremely high blood sugar

enlargement of the liver (hepatomegaly) with and without jaundice (icterus)

enlargement of the spleen (splenomegaly)

fat deposition in the inner organs

abnormal values of liver function tests

reduction of red blood cell count (anaemia)

reduction of white blood cell count (leucopenia)

reduction of blood platelet count (thrombocytopenia)

increase of immature red blood cells (reticulocytosis)

rupture of blood cells (haemolysis)







bleeding or a tendency to bleeding
impairment of blood coagulation (as can be seen by changes of bleeding time, coagulation time,
prothrombin time etc.)
fever
high blood fat levels
loss of consciousness

If any of these symptoms occur, the infusion must be stopped immediately.

4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
The following side effects may be serious. If any of the following side effects occur, tell your doctor
immediately, he will stop giving you this medicine:
Rare (may affect up to 1 in 1,000 people):

allergic reactions, for example skin reactions, shortness of breath, swelling of the lips, mouth, and throat,
difficulty breathing
Other side effects include:
Uncommon (may affect up to 1 in 100 people):

feeling sick, vomiting, loss of appetite
Rare (may affect up to 1 in 1,000 people):

increased tendency for your blood to clot

bluish discolouration of the skin

shortness of breath

headache

flushing

reddening of skin (erythema)

sweating

chills

feeling cold

high body temperature

drowsiness

pain in the chest, back, bones or lumbar region

decrease or increase in blood pressure
Very rare (may affect up to 1 in 10,000 people):

abnormally high blood fat or blood sugar values

high levels of acidic substances in your blood

Too much lipid can lead to fat overload syndrome, for more information on this please see under the
heading ‘If you use more Lipoflex 38/120 plus than you should’ in section 3. Symptoms normally
disappear when the infusion is stopped.
Not known (frequency cannot be estimated from the available data):

reduction of white blood cell count (leucopenia)

reduction of blood platelet count (thrombocytopenia)



impaired bile flow (cholestasis)

Reporting of side effects
If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this
leaflet.
You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By
reporting side effects you can help provide more information on the safety of this medicine.

5.

How to store Lipoflex plus

Keep this medicine out of the sight and reach of children.
Do not store above 25 °C.
Do not freeze. If accidentally frozen, discard the bag.
Keep the bag in the protective overwrap in order to protect from light.
Do not use this medicine after the expiry date which is stated on the label. The expiry date refers to the last day
of that month.
6.

Contents of the pack and other information

What Lipoflex plus contains
The active substances in the ready-for-use mixture are:
from the top chamber
(glucose solution)
Glucose monohydrate
equivalent to anhydrous glucose
Sodium dihydrogen phosphate
dihydrate
Zinc acetate dihydrate

in 1000 ml

in 1250 ml

in 1875 ml

in 2500 ml

132.0 g
120.0 g
1.872 g

165.0 g
150.0 g
2.340 g

247.5 g
225.0 g
3.510 g

330.0 g
300.0 g
4.680 g

5.264 mg

6.580 mg

9.870 mg

13.16 mg

from the middle chamber
(fat emulsion)
Soya-bean oil, refined
Triglycerides, medium chain

in 1000 ml

in 1250 ml

in 1875 ml

in 2500 ml

20.00 g
20.00 g

25.00 g
25.00 g

37.50 g
37.50 g

50.00 g
50.00 g

from the bottom chamber
(amino acid solution)
Isoleucine
Leucine
Lysine hydrochloride
equivalent to lysine
Methionine
Phenylalanine
Threonine
Tryptophan
Valine
Arginine
Histidine hydrochloride monohydrate
equivalent to histidine
Alanine
Aspartic acid
Glutamic acid
Glycine
Proline
Serine
Sodium hydroxide
Sodium chloride
Sodium acetate trihydrate
Potassium acetate
Magnesium acetate tetrahydrate
Calcium chloride dihydrate

Electrolytes
Sodium
Potassium
Magnesium
Calcium
Zinc
Chloride
Acetate
Phosphate
Amino acid content
Nitrogen content
Carbohydrate content
Lipid content

in 1000 ml

in 1250 ml

in 1875 ml

in 2500 ml

2.256 g
3.008 g
2.728 g
2.184 g
1.880 g
3.368 g
1.744 g
0.544 g
2.496 g
2.592 g
1.624 g
1.202 g
4.656 g
1.440 g
3.368 g
1.584 g
3.264 g
2.880 g
0.781 g
0.402 g
0.222 g
2.747 g
0.686 g
0.470 g

2.820 g
3.760 g
3.410 g
2.729 g
2.350 g
4.210 g
2.180 g
0.680 g
3.120 g
3.240 g
2.030 g
1.503 g
5.820 g
1.800 g
4.210 g
1.980 g
4.080 g
3.600 g
0.976 g
0.503 g
0.277 g
3.434 g
0.858 g
0.588 g

4.230 g
5.640 g
5.115 g
4.094 g
3.525 g
6.315 g
3.270 g
1.020 g
4.680 g
4.860 g
3.045 g
2.255 g
8.730 g
2.700 g
6.315 g
2.970 g
6.120 g
5.400 g
1.464 g
0.755 g
0.416 g
5.151 g
1.287 g
0.882 g

5.640 g
7.520 g
6.820 g
5.459 g
4.700 g
8.420 g
4.360 g
1.360 g
6.240 g
6.480 g
4.060 g
3.005 g
11.64 g
3.600 g
8.420 g
3.960 g
8.160 g
7.200 g
1.952 g
1.006 g
0.554 g
6.868 g
1.716 g
1.176 g

in 1000 ml
40 mmol
28 mmol
3.2 mmol
3.2 mmol
0.024 mmol
36 mmol
36 mmol
12 mmol

in 1250 ml
50 mmol
35 mmol
4.0 mmol
4.0 mmol
0.03 mmol
45 mmol
45 mmol
15 mmol

in 1875 ml
75 mmol
52.5 mmol
6.0 mmol
6.0 mmol
0.045 mmol
67.5 mmol
67.5 mmol
22.5 mmol

in 2500 ml
100 mmol
70 mmol
8.0 mmol
8.0 mmol
0.06 mmol
90 mmol
90 mmol
30 mmol

38 g
5.4 g
120 g
40 g

48 g
6.8 g
150 g
50 g

72 g
10.2 g
225 g
75 g

96 g
13.7 g
300 g
100 g

Energy in the form of lipids
Energy in the form of carbohydrates
Energy in the form of amino acids
Non-protein energy
Total energy

Osmolality
Theoretical osmolarity
pH

1590 kJ
(380 kcal)
2010 kJ
(480 kcal)
635 kJ
(150 kcal)
3600 kJ
(860 kcal)
4235 kJ
(1010 kcal)

1990 kJ 2985 kJ (715
(475 kcal)
kcal)
2510 kJ 3765 kJ (900
(600 kcal)
kcal)
800 kJ 1200 kJ (285
(190 kcal)
kcal)
4500 kJ 6750 kJ (1615
(1075 kcal)
kcal)
5300 kJ 7950 kJ (1900
(1265 kcal)
kcal)

3980 kJ
(950 kcal)
5020 kJ
(1200 kcal)
1600 kJ
(380 kcal)
9000 kJ
(2150 kcal)
10600 kJ
(2530 kcal)

1540 mOsm 1540 mOsm 1540 mOsm/ 1540 mOsm
/kg
/kg
kg
/kg
1215 mOsm 1215 mOsm 1215 mOsm/l 1215 mOsm
/l
/l
/l
5.0 - 6.0
5.0 - 6.0
5.0 - 6.0
5.0 - 6.0

The other ingredients are citric acid monohydrate (for pH adjustment), egg lecithin, glycerol, sodium oleate,
all-rac-alpha-tocopherol and water for injections.
What Lipoflex plus looks like and contents of the pack
The ready-to-use product is an emulsion for infusion, i.e. it is administered through a small tube into a vein.
Lipoflex plus is supplied in flexible multichamber bags containing:

1250 ml (500 ml of amino acids solution + 250 ml of fat emulsion + 500 ml of glucose solution)

1875 ml (750 ml of amino acids solution + 375 ml of fat emulsion + 750 ml of glucose solution)

2500 ml (1000 ml of amino acids solution + 500 ml of fat emulsion + 1000 ml of glucose solution)

Figure A

Figure B

Figure A: The multichamber bag is packed in a protective overwrap. An oxygen absorber and an oxygen
indicator are placed between the bag and the overwrap; the oxygen absorber sachet is made of inert material
and contains iron hydroxide.
Figure B: The top chamber contains a glucose solution, the middle chamber contains a fat emulsion, and the
bottom chamber contains an amino acid solution.

The glucose and the amino acid solutions are clear and colourless or straw-coloured. The fat emulsion is milkywhite.
The top chamber and the middle chamber can be connected with the bottom chamber by opening the
intermediate seams.
The different container sizes are presented in cartons containing five bags.
Pack sizes: 5 x 1250 ml, 5 x 1875 ml and 5 x 2500 ml
Not all pack sizes may be marketed.
Marketing Authorisation Holder and Manufacturer
B. Braun Melsungen AG
Carl-Braun-Str. 1
34212 Melsungen, Germany

Postal address:
34209 Melsungen, Germany

Tel.: +49-(0)-5661-71-0
Fax: +49-(0)-5661-71-4567
This medicinal product is authorised in the Member States of the EEA under the following names:
Austria
Nutriflex Lipid 38/120 plus
Nutriflex Lipid plus, 38 g/l aminozuren en 120 g/l glucose, emulsie voor infusie
Belgium
Nutriflex Lipid plus 38/120
Czech Republic
Denmark
Lipoflex Plus
Nutriflex Lipid 38/120/40
Finland
Lipoflex Lipide G120/N4,6/E, émulsion pour perfusion
France
Nutriflex Lipid 38/120 plus
Germany
Nutriflex Lipid 38/120 plus
Greece
Nutriflex Lipid 38/120 plus
Iceland
Lipoflex, AA38/G120
Italy
Nutriflex Lipid 38/120 plus
Luxembourg
Nutriflex Lipid 38/120
Netherlands
Lipoflex plus
Norway
Lipoflex plus
Poland
Lipoflex 38/120
Portugal
Lipoflex plus emulsie perfuzabila
Romania
Slovakia
Nutriflex Lipid plus 38/120
Nutriflex Lipid 38/120 plus Emulsión para perfusión
Spain
Nutriflex Lipid 38/120/40
Sweden
United Kingdom
Lipoflex plus emulsion for infusion
This leaflet was last revised in 05.2016
______________________________________________________________________________
The following information is intended for healthcare professionals only:
No special requirements for disposal.
Parenteral nutrition products should be visually inspected for damage, discolouration and emulsion instability
before use.

Do not use bags which are damaged; neither overwrap nor the primary bag should be damaged. Use only if the
peel seams between the chambers are intact, if amino acid and glucose solutions are clear and colourless up to
straw coloured and the emulsion is a homogenous liquid with milky white appearance. Do not use if the
solutions are discoloured or contain particulate matter. Do not use if the emulsion shows signs of phase
separation (oil drops, oil layer).
Before opening the overwrap, check the colour of the oxygen indicator (see Figure A). Do not use if the oxygen
indicator is pink. Use only if the oxygen indicator is yellow.
Preparation of the mixed emulsion
To open: Tear overwrap starting from the tear notches (Fig. 1). Remove the bag from its protective overwrap.
Discard overwrap, oxygen indicator, and oxygen absorber.
Visually inspect the primary bag for leaks. Leaky bags must be discarded, since the sterility cannot be
guaranteed.

To open and mix the chambers sequentially, roll the bag with both hands, starting first by opening the peel
seam that separates the top chamber (glucose) and the bottom chamber (amino acids) (Fig. 2a). Then continue
applying pressure so that the peel seam separating the middle chamber (lipids) and the bottom chamber opens
(Fig. 2b).
After removing the aluminium seal (Fig. 3) one can add compatible additives via the medication port (Fig. 4).

Mix the contents of the bag thoroughly (Fig. 5) and visually inspect the mixture (Fig. 6). There should be no
signs of emulsion phase separation.
The mixture is a milky white homogenous oil-in-water emulsion.

Preparation for infusion
The emulsion should always be brought to room temperature prior to infusion.
Remove the aluminium foil (Fig. 7) from the infusion port and attach the infusion set (Fig. 8). Use a non-vented
infusion set or close the air vent when using a vented set. Hang the bag on an infusion stand (Fig. 9) and carry
out infusion using the standard technique.

For single use only. Container and unused residues must be discarded after use.
Do not reconnect partially used containers.
If filters are used they must be lipid-permeable (pore size ≥ 1.2 µm).
Shelf life after removing the protective overwrap and after mixing of the contents of the bag
After mixing the contents of the chambers the final emulsion is to be used immediately.
Shelf life after admixture of compatible additives
From a microbiological point of view, the product should be used immediately after admixture of additives. If
not used immediately after admixture of additives, in-use storage times and conditions prior to use are the
responsibility of the user.
The emulsion is to be used immediately after opening of the container.
Lipoflex plus must not be mixed with other medicinal products for which compatibility has not been
documented. Compatibility data for different additives (e.g. electrolytes, trace elements, vitamins) and the
corresponding shelf life of such admixtures can be provided on demand by the manufacturer.
Lipoflex plus should not be given simultaneously with blood in the same infusion set due to the risk of
pseudoagglutination.
Duration of infusion of one single bag
The recommended duration of infusion for a parenteral nutrition bag is maximum 24 h.

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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