CHROMIC CHLORIDE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CHROMIC CHLORIDE (CHROMIC CHLORIDE).
Chromic chloride dissociates to provide trivalent chromium (Cr3+), a component of glucose tolerance factor (GTF) that potentiates insulin action by increasing insulin receptor binding, insulin receptor number, and insulin internalization. It also activates insulin receptor tyrosine kinase activity and enhances downstream signaling pathways (e.g., PI3K/Akt), thereby improving glucose uptake and metabolism.
| Metabolism | Chromic chloride is not metabolized; it is excreted primarily unchanged in urine, with trace amounts via bile and feces. Trivalent chromium may be reduced to divalent chromium in the gastrointestinal tract, but this is negligible with intravenous administration. |
| Excretion | Renal: ~60% (20-60% as unchanged chromium); Biliary/fecal: ~40% (unabsorbed fraction and small amount in bile); total body elimination is slow due to tissue binding. |
| Half-life | Terminal half-life: approximately 18-24 hours for systemic clearance, but tissue retention half-life may be prolonged (weeks) due to intracellular binding. |
| Protein binding | Approximately 90% bound to transferrin and other plasma proteins; also binds to albumin and beta-globulins. |
| Volume of Distribution | Vd: 0.6-1.2 L/kg (total body water and beyond, indicating extensive tissue distribution). |
| Bioavailability | Oral bioavailability: 0.5-2% (chromic chloride). |
| Onset of Action | Not applicable for replacing deficiency; therapeutic effect (normalization of chromium-dependent glucose metabolism) occurs over days to weeks of supplementation. |
| Duration of Action | Clinical effect persists as long as supplementation continues; after cessation, effects subside over weeks as body stores are depleted. |
10-15 mcg/kg intravenously over 8-24 hours as part of total parenteral nutrition (TPN). Typical adult dose: 10-15 mcg daily.
| Dosage form | INJECTABLE |
| Renal impairment | Not required; chromium is primarily excreted renally but supplementation is at physiological levels; no dose adjustment needed for mild to moderate renal impairment. For severe renal impairment (eGFR <30 mL/min), consider monitoring or reducing dose by 50%. |
| Liver impairment | No adjustment recommended; chromium excretion is not significantly affected by hepatic dysfunction. Use standard dosing regardless of Child-Pugh class. |
| Pediatric use | Neonates and infants: 0.14-0.2 mcg/kg/day intravenously in TPN. Children: 0.14-0.2 mcg/kg/day (max 5 mcg/day) intravenously. |
| Geriatric use | No specific dose adjustment for elderly; use standard adult dose based on nutritional requirements and renal function. Monitor renal function due to age-related decline. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CHROMIC CHLORIDE (CHROMIC CHLORIDE).
| Breastfeeding | Chromic chloride is present in breast milk as chromium is a normal constituent. No adverse effects reported at recommended intakes. M/P ratio not well-defined; typical dietary intake is considered safe. Excessive supplementation should be avoided. |
| Teratogenic Risk | Chromic chloride (CrCl3) is an essential trace element. At physiological doses, no teratogenic effects are known. At high doses, animal studies suggest potential fetotoxicity but not teratogenicity. Trimester-specific data are lacking; however, as a required nutrient, deficiency may pose greater risk than excess. |
■ FDA Black Box Warning
None
| Serious Effects |
["Known hypersensitivity to chromium or any component of the formulation","Severe renal impairment (or use only with extreme caution and dose adjustment)"]
| Precautions | ["Risk of toxicity in renal impairment (decreased excretion may lead to accumulation and potential chromium toxicity)","Allergic reactions (urticaria, anaphylaxis) have been reported with intravenous administration","May cause irritation at injection site; extravasation can lead to tissue necrosis","Use with caution in patients with hepatic impairment (lack of data)","Monitor for signs of chromium toxicity: nausea, vomiting, diarrhea, gastrointestinal bleeding, renal failure, hepatic necrosis, and hemolysis"] |
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| Fetal Monitoring | No specific monitoring required for therapeutic use. In cases of parenteral nutrition, monitor serum chromium levels to avoid toxicity; pregnancy may alter requirements. Assess for signs of deficiency or excess (e.g., glucose intolerance, renal dysfunction). |
| Fertility Effects | Chromium picolinate has been studied for polycystic ovary syndrome (PCOS) with mixed results on ovulation. At physiological doses, no adverse fertility effects; deficiency may impair reproduction. High-dose animal studies show reduced fertility; human relevance uncertain. |