OLIMEL N9E Emulsion for Infusion

BAXTER HEALTHCARE (ASIA) PTE LTD

BAXTER HEALTHCARE (ASIA) PTE LTD

Therapeutic

Prescription Only

EMULSION

**4.2 Posology and method of administration** **Posology** OLIMEL N9E is not recommended for use in children less than 2 years of age due to inadequate composition and volume (see sections 4.4; 5.1 and 5.2 – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_). The maximum daily dose mentioned below should not be exceeded. Due to the static composition of the multi-chamber bag, the ability to simultaneously meet all nutrient needs of the patient may not be possible. Clinical situations may exist where patients require amounts of nutrients varying from the composition of the static bag. In this situation any volume (dose) adjustments must take into consideration the resultant effect this will have on the dosing of all other nutrient components of OLIMEL N9E. **_In adults_** The dosage depends on the patient’s energy expenditure, clinical status, body weight, and the ability to metabolise the constituents of OLIMEL N9E, as well as additional energy or proteins provided orally/enterally; therefore, the bag size should be chosen accordingly. The average daily requirements are: - 0.16 to 0.35 g nitrogen/ kg body weight (1 to 2 g of amino acids/kg), depending on the patient’s nutritional status and degree of catabolic stress, - 20 to 40 kcal/kg, - 20 to 40 ml fluid /kg, or 1 to 1.5 ml per expended kcal. For OLIMEL N9E, the maximal daily dose is defined by amino acid intake, 35 ml/kg corresponding to 2.0 g/kg amino acids, 3.9 g/kg glucose, 1.4 g/kg lipids, 1.2 mmol/kg sodium and 1.1 mmol/kg potassium. For a 70 kg patient, this would be equivalent to 2450 ml OLIMEL N9E per day, resulting in an intake of 140 g amino acids, 270 g glucose and 98 g lipids (i.e. 2058 non-protein kcal and 2622 total kcal). Normally, the flow rate must be increased gradually during the first hour and then be adjusted to take into account the dose being administered, the daily volume intake and the duration of the infusion. For OLIMEL N9E, the maximal infusion rate is 1.8 ml/kg/hour, corresponding to 0.10 g/kg/hour amino acids, 0.19 g/kg/hour glucose and 0.07 g/kg/hour lipids. _**In children greater than two years of age and adolescents**_ There have been no studies performed in the paediatric population. The dosage depends on the patient’s energy expenditure, clinical status, body weight, and the ability to metabolise constituents of OLIMEL N9E, as well as additional energy or proteins given orally/enterally; therefore, the bag size should be chosen accordingly. In addition, daily fluid, nitrogen and energy requirements continuously decrease with age. Two groups, ages 2 to 11 years and 12 to 18 years, are considered. For OLIMEL N9E in the 2 to 11 year age group, the magnesium concentration is the limiting factor for daily dose. In this age group, the glucose concentration is the limiting factor for hourly rate. In the 12 to 18 year age group, amino acid and magnesium concentrations are the limiting factors for daily dose. In this age group, the amino acid concentration is the limiting factor for hourly rate. The resulting intakes are displayed below:  Normally, the flow rate must be increased gradually during the first hour and then be adjusted to take into account the dose being administered, the daily volume intake, and the duration of the infusion. In general, it is recommended to start the infusion for small children with low daily dose and gradually increase it up to the maximal dosage (see above). **Method and duration of administration** For single use only. It is recommended that, after opening the bag, the contents are used immediately and not stored for subsequent infusion. After reconstitution, the mixture is homogenous with a milky appearance. For instructions for preparation and handling of the emulsion for infusion see section 6.6 – _please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information_. Due to its high osmolarity, OLIMEL N9E can only be administered through a central vein. The recommended duration of infusion for a parenteral nutrition bag is between 12 and 24 hours. Treatment with parenteral nutrition may be continued for as long as required by the patient’s clinical conditions.