INPERSOL-LC/LM W/ DEXTROSE 1.5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for INPERSOL-LC/LM W/ DEXTROSE 1.5% IN PLASTIC CONTAINER (INPERSOL-LC/LM W/ DEXTROSE 1.5% IN PLASTIC CONTAINER).
Inpersol-LC/LM with dextrose 1.5% is a peritoneal dialysis solution. The mechanism involves instillation into the peritoneal cavity, where dextrose creates an osmotic gradient that drives ultrafiltration of fluid and removal of uremic toxins (e.g., urea, creatinine) across the peritoneal membrane. The low calcium (LC) and low magnesium (LM) formulation helps prevent hypercalcemia and hypermagnesemia.
| Metabolism | Dextrose is absorbed systemically and metabolized via cellular glycolysis and subsequent glucose oxidation. No hepatic or renal metabolism required for the dialysate components. |
| Excretion | Renal: negligible; primarily eliminated via peritoneal dialysis (dialysate outflow). Biliary/fecal: <1%. |
| Half-life | Not applicable via systemic absorption; glucose absorbed from dialysate exhibits a terminal half-life of 1.5–2 hours in plasma, reflecting rapid cellular uptake and metabolism. |
| Protein binding | Glucose: negligible; components (electrolytes, lactate) are not significantly protein-bound. |
| Volume of Distribution | Glucose: 0.2–0.3 L/kg, corresponding to extracellular fluid. Electrolytes distribute according to body water compartments. |
| Bioavailability | Intraperitoneal: glucose absorption ~60–80% over a 4-hour dwell; lactate ~100% absorbed; electrolytes fully bioavailable into systemic circulation. |
| Onset of Action | Intraperitoneal: ultrafiltration begins within minutes; peak glucose absorption occurs at 1–2 hours. |
| Duration of Action | Intraperitoneal: dwell time 4–6 hours for typical exchanges; longer dwells (8–12 hours) used in automated peritoneal dialysis. |
Intraperitoneal administration: For continuous ambulatory peritoneal dialysis (CAPD), instill 2 liters of 1.5% dextrose solution into the peritoneal cavity via a permanent indwelling catheter. Exchange 4 times per day (every 6 hours) with a dwell time of 4-6 hours. For automated peritoneal dialysis (APD), typical regimen includes 2 liters per cycle with 4-5 cycles overnight and a daytime dwell.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for renal impairment as the drug is administered intraperitoneally and is used specifically for renal replacement therapy. However, GFR-based adjustments are not applicable since the drug is not systemically absorbed; treatment is indicated for end-stage renal disease (ESRD) with GFR < 15 mL/min. |
| Liver impairment | No specific dose adjustment recommended for hepatic impairment. However, monitor for signs of hepatic encephalopathy as dextrose absorption may increase ammonia production in decompensated cirrhosis (Child-Pugh class C). Consider reducing dextrose concentration if hyperglycemia or fluid overload occurs. |
| Pediatric use | For neonates and infants: 10-15 mL/kg per exchange, 4-5 exchanges per day. For children: 30-40 mL/kg per exchange, 4 exchanges per day. Adjust dwell time to 30-60 minutes for neonates, 1-2 hours for infants, and 4-6 hours for older children. Dextrose 1.5% solution is used for standard hydration; higher concentrations (2.5% or 4.25%) may be used for ultrafiltration. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for INPERSOL-LC/LM W/ DEXTROSE 1.5% IN PLASTIC CONTAINER (INPERSOL-LC/LM W/ DEXTROSE 1.5% IN PLASTIC CONTAINER).
| Breastfeeding | Not absorbed systemically in significant amounts. Excretion into breast milk is negligible. M/P ratio not available; considered compatible with breastfeeding due to lack of systemic absorption. |
| Teratogenic Risk | Inpersol-LC/LM with Dextrose 1.5% is a peritoneal dialysis solution. No teratogenic effects have been reported; however, data are limited. Glucose exposure may affect fetal growth in conditions like maternal diabetes, but risk is theoretical. First trimester: No known structural anomalies. Second trimester: Monitor for fetal growth restriction. Third trimester: Risk of neonatal hypoglycemia if maternal hyperglycemia occurs. |
■ FDA Black Box Warning
None
| Serious Effects |
["Pre-existing severe hyperglycemia or uncontrolled diabetes mellitus","Hypercalcemia or hypermagnesemia (given low calcium/magnesium formulation)","Hypokalemia uncorrected prior to dialysis","Severe hyperosmolality","Known hypersensitivity to any component","Active peritonitis or abdominal infection","Recent abdominal surgery or extensive abdominal adhesions limiting peritoneal space","Severe pulmonary disease with risk of respiratory compromise from diaphragmatic elevation","Documented loss of peritoneal function or membrane failure"]
| Precautions | ["Peritonitis risk from contamination during catheter access","Fluid and electrolyte disturbances: hyperglycemia, hypernatremia, hypokalemia, hyperosmolality","Abdominal complications: hernia, leakage, abdominal pain, catheter malfunction","Infections: exit-site and tunnel infections","Metabolic acidosis or alkalosis (depending on buffer)","Peritoneal membrane failure with long-term use"] |
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| Geriatric use | No specific dose adjustments are required. However, elderly patients may have reduced peritoneal membrane function, requiring closer monitoring of ultrafiltration and solute clearance. Lower initial fill volumes (1.5-2 liters) and gradual titration are recommended to minimize discomfort and risk of hernia. Monitor blood glucose levels frequently as dextrose absorption can cause hyperglycemia, especially in diabetic patients. |
| Fetal Monitoring | Monitor maternal glucose levels, electrolyte balance (including potassium, calcium, magnesium), and acid-base status. Fetal surveillance: fetal growth ultrasound each trimester, amniotic fluid index, and non-stress test in third trimester if maternal complications arise. |
| Fertility Effects | No known adverse effects on fertility. Peritoneal dialysis may improve metabolic milieu in end-stage renal disease, potentially improving fertility, but data are limited. |