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NUTRIFLEX LIPID PERI 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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176/12262528/0814

Package leaflet: Information for the user
B. Braun Melsungen AG · 34209 Melsungen, Germany

NuTRIflex® Lipid peri
Emulsion for Infusion

Read all of this leaflet carefully 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 NuTRIflex® Lipid peri is and what it is used for
2. What you need to know before you use NuTRIflex® Lipid peri
3. How to use NuTRIflex® Lipid peri
4. Possible side effects
5. How to store NuTRIflex® Lipid peri
6. Contents of the pack and other information

1. What NuTRIflex® Lipid peri is and what it is used for
NuTRIflex® Lipid peri contains 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 NuTRIflex® Lipid peri 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 NuTRIflex®
Lipid peri
Do not use NuTRIflex® Lipid peri
• if you are allergic 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 NuTRIflex® Lipid peri 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)
• blocking of blood vessels by blood clots or fat (embolism)
• severe liver failure
• impaired bile flow (intrahepatic cholestasis)
• severe kidney failure where no dialysis facilities are available
• 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 NuTRIflex® Lipid peri.
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.
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 NuTRIflex® Lipid
peri 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 medicinesand NuTRIflex® Lipid peri
Tell your doctor if you are taking, have recently taken or might take any
other medicines.
NuTRIflex® Lipid peri 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 (angiotensinII-receptor antagonists)
• medicines used in organ transplants such as cyclosporine 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 NuTRIflex® Lipid peri in pregnant women.
Breast-feeding is not recommended for mothers on parenteral nutrition.

Driving and using machines
NuTRIflex® Lipid peri is normally given to immobile patients in a hospital
or clinic. This will exclude driving and using machines.
If you have any further questions on the use of this product, ask your
doctor or pharmacist.

3. How to use NuTRIflex® Lipid peri
This medicine is administered by intravenous infusion (drip), that
is, through a small tube directly into a vein. This medicine can be
administered through one of your smaller (peripheral) or larger (central)
veins.
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 NuTRIflex® Lipid peri 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 (leukopenia)
• 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 (affects 1 to 10 users in 10,000):
• allergic reactions, for example skin reactions, shortness of breath,
swelling of the lips, mouth, and throat, difficulty breathing

Other side effects include:
Common (affects 1 to 10 users in 100):
• irritation or inflammation of veins (phlebitis, thrombophlebitis)
Uncommon (affects 1 to 10 users in 1,000):
• feeling sick, vomiting, loss of appetite
Rare (affects 1 to 10 users in 10,000):
• 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 (affects less than 1 user in 10,000):
• 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 Nutriflex Lipid
peri than you should” in section 3. Symptoms normally disappear when
the infusion is stopped.

Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist 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 NuTRIflex® Lipid peri
Keep this medicine out of the sight and reach of children.
Do not store above 25 °C. Keep the bags in the outer carton in order to
protect from light.
Do not freeze.
Do not use this medicine after the expiry date which is stated on the
label.

6. Contents of the pack and other information
What NuTRIflex® Lipid peri contains
the large upper,
left chamber (500,
750 and 1000 mL)

in 1250 ml in 1875 ml in 2500 ml
Size 1
Size 2
Size 3

Glucose monohydrate
equivalent to
anhydrous glucose

Quantity
per
1000 ml

88.0 g
80.0 g

132.0 g
120.0 g

176.0 g
160.0 g

70.4 g
64.0 g

1.170 g

1.755 g

2.340 g

0.936 g

9.938 mg 13.250 mg

5.30 mg

the small upper,
in 1250 ml in 1875 ml in 2500 ml
right chamber (250,
Size 1
Size 2
Size 3
375 and 500 ml)

Quantity
per
1000 ml

Sodium dihydrogen
phosphate dihydrate
Zinc acetate dihydrate

6.625 mg

Soya bean oil, refined

25.0 g

37.5 g

50.0 g

20.0 g

Medium chain
triglycerides

25.0 g

37.5 g

50.0 g

20.0 g

in 1250 ml in 1875 ml in 2500 ml
Size 1
Size 2
Size 3

Quantity
per
1000 ml

the lower chamber
(500, 750 and
1000 mL)
Isoleucine

2.34 g

3.51 g

4.68 g

1.87 g

Leucine

3.13 g

4.70 g

6.26 g

2.50 g

Lysine hydrochloride
equivalent to Lysine

2.84 g
2.26 g

4.26 g
3.39 g

5.68 g
4.52 g

2.27 g
1.81 g

Methionine

1.96 g

2.94 g

3.92 g

1.57 g

Phenylalanine

3.51 g

5.27 g

7.02 g

2.81 g

Threonine

1.82 g

2.73 g

3.64 g

1.46 g

Tryptophan

0.57 g

0.86 g

1.14 g

0.46 g

Valine

2.60 g

3.90 g

5.20 g

2.08 g

Arginine

2.70 g

4.05 g

5.40 g

2.16 g

Histidine
hydrochloride
monohydrate
equivalent to
Histidine

1.69 g

2.54 g

3.38 g

1.35 g

1.25 g

1.88 g

2.50 g

1.00 g

Alanine

4.85 g

7.28 g

9.70 g

3.88 g

Aspartic acid

1.50 g

2.25 g

3.00 g

1.20 g

Glutamic acid

3.50 g

5.25 g

7.00 g

2.80 g

Glycine

1.65 g

2.48 g

3.30 g

1.32 g

Proline

3.40 g

5.10 g

6.80 g

2.72 g

Serine

3.00 g

4.50 g

6.00 g

2.40 g

Sodium hydroxide

0.800 g

1.200 g

1.600 g

0.640 g

Sodium chloride

1.081 g

1.622 g

2.162 g

0.865 g

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size: 9 pt.

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Sodium acetate
trihydrate

0.544 g

0.816 g

1.088 g

0.435 g

Potassium acetate

2.943 g

4.415 g

5.886 g

2.354 g

Magnesium acetate
tetrahydrate

0.644 g

0.966 g

1.288 g

0.515 g

Calcium chloride
dihydrate

0.441 g

0.662 g

0.882 g

0.353 g

Electrolyte contents for Nutriflex Lipid peri after mixing the chamber bags:
Electrolytes [mmol] in 1250 ml in 1875 ml in 2500 ml
Size 1
Size 2
Size3

Quantity
per
1000 ml

Sodium

50

75

100

40

Potassium

30

45

60

24

Magnesium

3.0

4.5

6.0

2.4

Calcium

3.0

4.5

6.0

2.4

0.03

0.045

0.06

0.024

Chloride

Zinc

48

72

96

38.4

Acetate

40

60

80

32

Phosphate

7.5

11.25

15

6

in 1250 ml in 1875 ml in 2500 ml
Size 1
Size 2
Size 3

Quantity
per
1000 ml

40

60

80

32

Nitrogen content [g]

5.7

8.6

11.4

4.6

Carbohydrate
content

[g]

80

120

160

64

Lipid content

[g]

50

75

100

40

Amino acid
content

[g]

The other ingredients are citric acid monohydrate, egg lecithin, glycerol,
sodium oleate and water for injections.

The following information is intended for healthcare professionals only:
NuTRIflex® Lipid peri is supplied in containers for single use. Discard
container and any unused content after use.
Do not re-connect partially used containers.
Only use bags that are undamaged and in which the amino acid and
glucose solutions are clear, colourless up to faintly straw-coloured
solutions. Do not use bags where there is a discolouration or discernible
phase separation (oil drops) in the chamber containing the lipid emulsion.
If filters are used they must be lipid-permeable.
Preparation of the mixed emulsion:
Remove the bag from its protective overwrap and proceed as follows:
• put the bag on a solid, flat surface
• mix glucose with amino acids by pressing the upper left chamber
against the peel seam, then add the fat emulsion by pressing the upper
right chamber against the peel seam
• mix the contents of the bag thoroughly.
Preparation for infusion:
• fold the bag and hang it on the infusion stand by the centre hanging
loop
• remove the protective cap from the infusion port and carry out infusion
using the standard technique.
The mixture is a milky white homogenous oil in water emulsion.
If accidentally frozen, discard the bag.
The emulsion should always be brought to room temperature prior to
infusion.
Shelf life after removing the protective overwrap and after mixing
of the contents of the bag:
Chemical and physical in-use stability after mixing the contents has
been demonstrated for 7 days at 2‑8 °C plus 48 hours at 25 °C.
The emulsion is to be used immediately after opening the container
(spiking the infusion port)..

What NuTRIflex® Lipid peri 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.
NuTRIflex® Lipid peri 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)
The glucose and the amino acid solutions are clear and colourless or
faintly straw-coloured. The fat emulsion is milky white.
The multichamber bag is packed in a protective overwrap. An oxygen
absorber is placed between the bag and the overwrap.
The two upper chambers can be connected with the lower chamber by
opening the intermediate seam.
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
Tel.: +49-(0)-5661-71-0
Fax: +49-(0)-5661-71-4567

Postal address:
34209 Melsungen, Germany

This leaflet was last revised in 07/2014

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B. Braun Melsungen AG
34209 Melsungen, Germany

01.08.14 14:01

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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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