FREAMINE HBC 6.9%

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FREAMINE HBC 6.9% (FREAMINE HBC 6.9%).

How it works

FREAMINE HBC 6.9% is a branched-chain amino acid (BCAA) solution that provides essential and non-essential amino acids. It promotes protein synthesis and serves as a substrate for gluconeogenesis. BCAAs may compete with tryptophan and aromatic amino acids for entry into the brain, potentially reducing hepatic encephalopathy.

What the body does with it

Metabolism	Primarily metabolized in the liver via transamination and oxidation of branched-chain amino acids. Branched-chain amino acids are also metabolized in muscle tissue.
Excretion	Amino acids are primarily eliminated via metabolism; <2% excreted unchanged in urine. Excess nitrogen is converted to urea and excreted renally as urea. Biliary/fecal elimination is negligible.
Half-life	Not applicable as a mixture; individual amino acids have half-lives ranging from minutes to hours. For clinical purposes, infusion rate and metabolic clearance are monitored rather than half-life.
Protein binding	Variable, generally low (<20%) for most amino acids; albumin and globulins bind some branched-chain amino acids (e.g., leucine, isoleucine, valine).
Volume of Distribution	Approximately 0.15–0.25 L/kg, reflecting distribution primarily in extracellular fluid and lean tissue.
Bioavailability	Intravenous: 100%.
Onset of Action	Intravenous: Immediate upon infusion; plasma amino acid levels rise within minutes.
Duration of Action	Duration of effect is continuous during infusion; after cessation, plasma levels decline rapidly over 1–2 hours due to metabolism and redistribution.

Classification & Brands

Dosing & administration

Intravenous infusion, 1.0 to 2.0 g amino acids/kg/day (14.5 to 29.0 mL/kg/day of FREAMINE HBC 6.9%). Typically 0.5-1.0 L per day in adults, titrated to metabolic needs.

Dosage form	INJECTABLE
Renal impairment	Contraindicated in severe renal impairment (GFR < 25 mL/min) unless dialysis is used. In moderate impairment (GFR 25-50 mL/min), reduce dose by 50% and monitor BUN, creatinine, electrolytes.
Liver impairment	Contraindicated in Child-Pugh class C. In Child-Pugh class A or B, use with caution; reduce dose by 50% and monitor ammonia levels frequently.
Pediatric use	Neonates and infants: 2.0-3.0 g/kg/day (29-43.5 mL/kg/day). Older children: 1.5-2.5 g/kg/day (21.7-36.2 mL/kg/day). Administer as continuous intravenous infusion with appropriate electrolytes and energy sources.
Geriatric use	Start at low end of adult dosing (1.0 g/kg/day). Monitor renal function and fluid balance closely due to decreased renal reserve and higher risk of fluid overload. Adjust dose based on creatinine clearance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for FREAMINE HBC 6.9% (FREAMINE HBC 6.9%).

Breastfeeding	It is not known whether amino acids administered intravenously are excreted in human milk. Many drugs are excreted, so caution is advised. M/P ratio is unknown.
Teratogenic Risk	FREAMINE HBC 6.9% is an amino acid injection used in parenteral nutrition. No adequate and well-controlled studies in pregnant women. Animal reproduction studies have not been conducted. Therefore, potential fetal risk cannot be ruled out, especially in first trimester. Use only if clearly needed.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component of the formulation","Inborn errors of amino acid metabolism (e.g., maple syrup urine disease)","Severe hyponatremia or hypervolemia"]

Clinical Precautions

Precautions

["Monitor serum electrolytes, fluid status, and liver function tests regularly.","Use with caution in patients with severe renal impairment or hyperammonemia.","May cause metabolic acidosis or hyperglycemia."]

Clinical Tips & Counseling

Drug interactions

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FREAMINE HBC 6.9%

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FREAMINE HBC 6.9% (FREAMINE HBC 6.9%).

How it works

What the body does with it

Metabolism	Primarily metabolized in the liver via transamination and oxidation of branched-chain amino acids. Branched-chain amino acids are also metabolized in muscle tissue.
Excretion	Amino acids are primarily eliminated via metabolism; <2% excreted unchanged in urine. Excess nitrogen is converted to urea and excreted renally as urea. Biliary/fecal elimination is negligible.
Half-life	Not applicable as a mixture; individual amino acids have half-lives ranging from minutes to hours. For clinical purposes, infusion rate and metabolic clearance are monitored rather than half-life.
Protein binding	Variable, generally low (<20%) for most amino acids; albumin and globulins bind some branched-chain amino acids (e.g., leucine, isoleucine, valine).
Volume of Distribution	Approximately 0.15–0.25 L/kg, reflecting distribution primarily in extracellular fluid and lean tissue.
Bioavailability	Intravenous: 100%.
Onset of Action	Intravenous: Immediate upon infusion; plasma amino acid levels rise within minutes.
Duration of Action	Duration of effect is continuous during infusion; after cessation, plasma levels decline rapidly over 1–2 hours due to metabolism and redistribution.

Classification & Brands

Dosing & administration

Intravenous infusion, 1.0 to 2.0 g amino acids/kg/day (14.5 to 29.0 mL/kg/day of FREAMINE HBC 6.9%). Typically 0.5-1.0 L per day in adults, titrated to metabolic needs.

Dosage form	INJECTABLE
Renal impairment	Contraindicated in severe renal impairment (GFR < 25 mL/min) unless dialysis is used. In moderate impairment (GFR 25-50 mL/min), reduce dose by 50% and monitor BUN, creatinine, electrolytes.
Liver impairment	Contraindicated in Child-Pugh class C. In Child-Pugh class A or B, use with caution; reduce dose by 50% and monitor ammonia levels frequently.
Pediatric use	Neonates and infants: 2.0-3.0 g/kg/day (29-43.5 mL/kg/day). Older children: 1.5-2.5 g/kg/day (21.7-36.2 mL/kg/day). Administer as continuous intravenous infusion with appropriate electrolytes and energy sources.
Geriatric use	Start at low end of adult dosing (1.0 g/kg/day). Monitor renal function and fluid balance closely due to decreased renal reserve and higher risk of fluid overload. Adjust dose based on creatinine clearance.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for FREAMINE HBC 6.9% (FREAMINE HBC 6.9%).

Breastfeeding	It is not known whether amino acids administered intravenously are excreted in human milk. Many drugs are excreted, so caution is advised. M/P ratio is unknown.
Teratogenic Risk	FREAMINE HBC 6.9% is an amino acid injection used in parenteral nutrition. No adequate and well-controlled studies in pregnant women. Animal reproduction studies have not been conducted. Therefore, potential fetal risk cannot be ruled out, especially in first trimester. Use only if clearly needed.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component of the formulation","Inborn errors of amino acid metabolism (e.g., maple syrup urine disease)","Severe hyponatremia or hypervolemia"]