FREAMINE III 3% W/ ELECTROLYTES

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FREAMINE III 3% W/ ELECTROLYTES (FREAMINE III 3% W/ ELECTROLYTES).

How it works

Provides essential and non-essential amino acids for protein synthesis, maintaining nitrogen balance, and supporting metabolic functions. Electrolytes help maintain acid-base balance and osmotic pressure.

What the body does with it

Metabolism	Amino acids are metabolized via deamination, transamination, and incorporation into proteins. Electrolytes are excreted or reabsorbed by renal and gastrointestinal pathways.
Excretion	Renal excretion of amino acid nitrogen as urea (85-90%) and other nitrogenous wastes; minimal biliary/fecal (<5%)
Half-life	Variable; based on individual amino acid components (alanine ~2.3h, glycine ~1.5h, etc.); clinical context: continuous infusion achieves steady state within 8-12h
Protein binding	Minimal protein binding (<5%) for most amino acids; not bound to carrier proteins
Volume of Distribution	Vd ~0.5-1.0 L/kg, reflecting distribution into total body water and lean body mass
Bioavailability	100% intravenous; not applicable via oral route due to first-pass metabolism
Onset of Action	Intravenous: immediate (within minutes) as plasma amino acid levels rise
Duration of Action	Duration depends on infusion rate; metabolic utilization continues for hours post-infusion; clinical note: transient elevation of amino acids persists for 4-6h after infusion stops

Classification & Brands

Dosing & administration

Administered intravenously. Typical adult dose: 500-1000 mL/day (15-30 g amino acids) infused at a rate not exceeding 0.1 g/kg/hour. Frequency: continuous or intermittent infusion as part of parenteral nutrition.

Dosage form	INJECTABLE
Renal impairment	GFR 30-60 mL/min: Reduce dose by 25-50%. GFR 15-29 mL/min: Reduce dose by 50-75%. GFR <15 mL/min: Avoid use or use with extreme caution, monitor electrolytes. Hemodialysis: May require dose adjustment based on amino acid losses.
Liver impairment	Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% and monitor ammonia. Child-Pugh C: Avoid use due to risk of hepatic encephalopathy.
Pediatric use	Weight-based dosing: Initial dose 1-2 g amino acids/kg/day (10-20 mL/kg/day of Freamine III 3%), increase gradually up to 3 g/kg/day. Infusion rate: 0.1-0.15 g/kg/hour. Monitor electrolytes and nitrogen balance.
Geriatric use	Elderly patients may require reduced dose due to decreased renal function. Start at lower end of adult dose (e.g., 0.8 g/kg/day amino acids) and adjust based on renal function and nutritional status. Monitor electrolytes and fluid balance closely.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for FREAMINE III 3% W/ ELECTROLYTES (FREAMINE III 3% W/ ELECTROLYTES).

Breastfeeding	Excretion into breast milk is negligible due to high molecular weight and endogenous nature; M/P ratio not determined. Considered compatible with breastfeeding.
Teratogenic Risk	No evidence of teratogenic risk from intravenous amino acid solutions; fetal risks are indirect secondary to maternal metabolic disturbances if improperly dosed (e.g., electrolyte imbalances, hyperammonemia).
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Not for administration to patients with hepatic coma or metabolic disorders involving impaired nitrogen utilization. Solutions containing amino acids should be used with caution in patients with renal insufficiency or hepatic failure. Risk of hyperammonemia, particularly in pediatric patients.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to any component","Inborn errors of amino acid metabolism","Hepatic coma or severe hepatic insufficiency","Severe renal failure without dialysis","Hyperammonemia","Metabolic alkalosis"]

Clinical Precautions

Precautions

["Monitor serum electrolytes, renal and hepatic function, blood glucose, and acid-base balance","Risk of hyperammonemia, especially in neonates","Use with caution in patients with cardiac, renal, or hepatic disease","Do not administer simultaneously with blood products through same tubing"]

Clinical Tips & Counseling

Drug interactions

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FREAMINE III 3% W/ ELECTROLYTES

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FREAMINE III 3% W/ ELECTROLYTES (FREAMINE III 3% W/ ELECTROLYTES).

How it works

What the body does with it

Metabolism	Amino acids are metabolized via deamination, transamination, and incorporation into proteins. Electrolytes are excreted or reabsorbed by renal and gastrointestinal pathways.
Excretion	Renal excretion of amino acid nitrogen as urea (85-90%) and other nitrogenous wastes; minimal biliary/fecal (<5%)
Half-life	Variable; based on individual amino acid components (alanine ~2.3h, glycine ~1.5h, etc.); clinical context: continuous infusion achieves steady state within 8-12h
Protein binding	Minimal protein binding (<5%) for most amino acids; not bound to carrier proteins
Volume of Distribution	Vd ~0.5-1.0 L/kg, reflecting distribution into total body water and lean body mass
Bioavailability	100% intravenous; not applicable via oral route due to first-pass metabolism
Onset of Action	Intravenous: immediate (within minutes) as plasma amino acid levels rise
Duration of Action	Duration depends on infusion rate; metabolic utilization continues for hours post-infusion; clinical note: transient elevation of amino acids persists for 4-6h after infusion stops

Classification & Brands

Dosing & administration

Dosage form	INJECTABLE
Renal impairment	GFR 30-60 mL/min: Reduce dose by 25-50%. GFR 15-29 mL/min: Reduce dose by 50-75%. GFR <15 mL/min: Avoid use or use with extreme caution, monitor electrolytes. Hemodialysis: May require dose adjustment based on amino acid losses.
Liver impairment	Child-Pugh A: No adjustment. Child-Pugh B: Reduce dose by 50% and monitor ammonia. Child-Pugh C: Avoid use due to risk of hepatic encephalopathy.
Pediatric use	Weight-based dosing: Initial dose 1-2 g amino acids/kg/day (10-20 mL/kg/day of Freamine III 3%), increase gradually up to 3 g/kg/day. Infusion rate: 0.1-0.15 g/kg/hour. Monitor electrolytes and nitrogen balance.
Geriatric use	Elderly patients may require reduced dose due to decreased renal function. Start at lower end of adult dose (e.g., 0.8 g/kg/day amino acids) and adjust based on renal function and nutritional status. Monitor electrolytes and fluid balance closely.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for FREAMINE III 3% W/ ELECTROLYTES (FREAMINE III 3% W/ ELECTROLYTES).

Breastfeeding	Excretion into breast milk is negligible due to high molecular weight and endogenous nature; M/P ratio not determined. Considered compatible with breastfeeding.
Teratogenic Risk	No evidence of teratogenic risk from intravenous amino acid solutions; fetal risks are indirect secondary to maternal metabolic disturbances if improperly dosed (e.g., electrolyte imbalances, hyperammonemia).
Fetal Monitoring