GLYCINE 1.5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for GLYCINE 1.5% IN PLASTIC CONTAINER (GLYCINE 1.5% IN PLASTIC CONTAINER).
Glycine is an amino acid that acts as an inhibitory neurotransmitter in the central nervous system by binding to glycine receptors, causing hyperpolarization of neurons. In irrigation solutions, it provides an iso-osmotic medium for urologic procedures to minimize hemolysis and tissue irritation.
| Metabolism | Glycine is metabolized through the glycine cleavage system and via conversion to serine by serine hydroxymethyltransferase. |
| Excretion | Glycine is eliminated primarily by renal excretion of unchanged glycine and its metabolites (e.g., serine). Approximately 90-95% of absorbed glycine is excreted renally, with less than 5% eliminated via biliary/fecal routes. |
| Half-life | The terminal elimination half-life is approximately 0.5-2 hours. In patients with renal impairment, half-life may be prolonged, requiring dose adjustment. |
| Protein binding | Glycine is minimally protein-bound (<5%, primarily to albumin). |
| Volume of Distribution | The volume of distribution is approximately 0.4-0.6 L/kg, indicating distribution into total body water. |
| Bioavailability | Glycine is not intended for systemic absorption via irrigation; however, if absorbed transmucosally, systemic bioavailability is variable. Intravenous administration yields 100% bioavailability, but irrigation solution is not for IV use. |
| Onset of Action | When administered as 1.5% irrigation solution during endoscopic surgery, the onset of distension and irrigation effect is immediate upon infusion. |
| Duration of Action | The duration of action (irrigation and distension) lasts as long as the solution is infused. After discontinuation, systemic effects (if absorbed) persist for 1-2 hours, correlating with the elimination half-life. |
Intravenous irrigation during transurethral resection of the prostate (TURP) or other endoscopic surgery; typical volume 1-3 L as needed, rate adjusted to maintain clear surgical field. Maximum total dose should not exceed 30 g (2000 mL of 1.5% solution).
| Dosage form | SOLUTION |
| Renal impairment | No specific dose adjustment for GFR; however, in severe renal impairment (CrCl <30 mL/min), avoid use due to risk of glycine accumulation and potential toxicity (e.g., hyperammonemia, encephalopathy). |
| Liver impairment | No specific dose adjustment for Child-Pugh class; but use with caution in severe hepatic impairment due to impaired glycine metabolism and increased risk of ammonia toxicity. |
| Pediatric use | Not indicated for pediatric use; safety and efficacy not established. |
| Geriatric use | No specific dose adjustment but monitor for fluid overload and electrolyte disturbances, especially in patients with cardiovascular or renal compromise. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for GLYCINE 1.5% IN PLASTIC CONTAINER (GLYCINE 1.5% IN PLASTIC CONTAINER).
| Breastfeeding | It is not known whether glycine is excreted in human milk. Due to the lack of data, caution should be exercised when administered to nursing women. The M/P ratio is not available. |
| Teratogenic Risk | Glycine 1.5% is an amino acid solution used as an irrigation fluid. There are no adequate studies in pregnant women. Animal reproduction studies are not available. The risk to the fetus is unknown; therefore, use during pregnancy only if clearly needed. No specific teratogenic effects have been reported; however, systemic absorption may occur, and fetal effects cannot be ruled out. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to glycine","Severe hepatic impairment","Severe renal impairment"]
| Precautions | ["Risk of glycine toxicity (hyperammonemia, encephalopathy) with prolonged or extensive absorption","Monitor serum electrolytes and ammonia levels in patients with hepatic or renal impairment","Not for intravenous administration"] |
| Food/Dietary | No specific food interactions. However, if hyponatremia occurs, sodium-rich foods or fluids may be recommended under medical advice. |
| Clinical Pearls |
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| Fetal Monitoring | Monitor serum electrolytes, renal function, and signs of fluid overload or hyponatremia in the mother. Fetal monitoring should include heart rate and uterine activity if used during labor. Assess for maternal metabolic disturbances such as hyperglycinemia or hyperammonemia. |
| Fertility Effects | No studies on fertility have been conducted with glycine irrigation. No effects on fertility are expected based on the drug's mechanism and limited systemic absorption. |
| Monitor for hyponatremia and cerebral edema during irrigation use, especially in prolonged endoscopic procedures. Avoid use in patients with known glycine hypersensitivity. Ensure sterile technique; discard unused portion. |
| Patient Advice | This solution is used for irrigation during surgical procedures, not for injection. · Report any signs of confusion, headache, nausea, or weakness to your healthcare provider. · You may experience temporary swelling or fluid retention. |