INTRALIPID 10%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for INTRALIPID 10% (INTRALIPID 10%).
Intralipid 10% is a fat emulsion that provides essential fatty acids (linoleic and linolenic acids) and a source of energy. It acts as a carrier for fat-soluble vitamins and prevents essential fatty acid deficiency. The mechanism involves direct utilization of triglycerides for energy after hydrolysis by lipoprotein lipase.
| Metabolism | The lipids in Intralipid are hydrolyzed by lipoprotein lipase in the vascular endothelium into free fatty acids and glycerol. Free fatty acids are taken up by tissues for oxidation or re-esterification. Excretion is minimal; metabolism primarily occurs via beta-oxidation. |
| Excretion | Intralipid 10% (IV fat emulsion) is metabolized like endogenous chylomicrons; elimination is not via renal or biliary routes. Triglycerides are hydrolyzed by lipoprotein lipase, and the resulting free fatty acids are taken up by tissues. Less than 0.5% is excreted unchanged in urine. Biliary excretion of metabolites is negligible. |
| Half-life | The terminal elimination half-life of Intralipid triglycerides is approximately 30-60 minutes in adults with normal lipid metabolism. In neonates and patients with impaired clearance, half-life may be prolonged to 2-4 hours. Clinical context: half-life increases with infusion rate; at steady state, clearance is rapid due to extrahepatic lipolysis. |
| Protein binding | Triglycerides in Intralipid are not protein-bound; they circulate as part of the lipid emulsion. However, free fatty acids released after hydrolysis are highly bound to albumin (approximately 99%). |
| Volume of Distribution | Intralipid 10% distributes primarily into the plasma volume initially (Vd ~0.05 L/kg). Over time, it enters the interstitial space and tissues, giving an apparent Vd of 0.1-0.2 L/kg. Clinical meaning: Low Vd indicates limited extravascular distribution; rapid clearance from plasma. |
| Bioavailability | Intravenous: 100% bioavailable. No other routes are clinically relevant; oral or intramuscular administration is not used. |
| Onset of Action | IV infusion: Caloric effect and fatty acid delivery begin immediately upon infusion, but clinically meaningful elevation of plasma triglycerides is detectable within 15-30 minutes. Reduction of toxicity (e.g., in local anesthetic systemic toxicity) occurs within minutes of bolus administration. |
| Duration of Action | IV infusion: Duration of effect on plasma triglyceride levels is 4-6 hours after a single dose, but can persist longer with high doses or impaired clearance. Clinical note: Continuous infusion is required to maintain caloric support; for reversal of local anesthetic toxicity, effect lasts 30-60 minutes typically necessitating repeat bolus or infusion. |
Intravenous infusion. Adult: 500 mL of 10% emulsion (50 g fat) over 4-6 hours, up to 2.5 g fat/kg/day. Maximum infusion rate: 0.1 g fat/kg/hour.
| Dosage form | INJECTABLE |
| Renal impairment | No dosage adjustment required for renal impairment. Use with caution in severe renal failure. |
| Liver impairment | Contraindicated in severe hepatic insufficiency (Child-Pugh class C). In mild to moderate impairment (Child-Pugh A or B), use with caution; dose reduction may be necessary based on clinical response and triglyceride levels. |
| Pediatric use | Premature infants: 0.5 g fat/kg/day as continuous IV infusion, increase by 0.5 g/kg/day to maximum 1 g/kg/day. Term infants/children: 1-2 g fat/kg/day as continuous IV infusion; maximum 3 g/kg/day. Monitor serum triglycerides. |
| Geriatric use | No specific dose adjustments required. Use with caution due to potential comorbidities; start at lower end of dosing range and monitor lipid clearance. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for INTRALIPID 10% (INTRALIPID 10%).
| Breastfeeding | Intralipid is a component of human milk; exogenous administration increases milk triglyceride content minimally. M/P ratio unknown. Considered compatible with breastfeeding; monitor infant for gastrointestinal intolerance. |
| Teratogenic Risk | No evidence of teratogenic risk in animal studies; human data limited. Intravenous fat emulsion is essential for maternal nutrition; used as a component of total parenteral nutrition. No specific fetal malformations reported. Use only if clearly needed. |
■ FDA Black Box Warning
Death in premature infants: Intravenous fat emulsion administration has been associated with death in premature infants. Use of Intralipid in this population should be limited to situations where alternative nutritional therapies are not available, and the decision to use should be based on careful risk-benefit assessment. Strict aseptic technique and monitoring for signs of fat overload syndrome are required.
| Serious Effects |
["Absolute: Known hypersensitivity to egg, soybean, peanut, or any component of the formulation.","Relative: Severe hyperlipidemia, severe hepatic insufficiency, acute pancreatitis with hypertriglyceridemia, and conditions with disturbed fat metabolism (e.g., pathological hyperlipidemia, lipoid nephrosis)."]
| Precautions | ["Fluid overload: Use with caution in patients with pulmonary edema, cardiac or renal insufficiency, or severe hepatic impairment.","Fat overload syndrome: Monitor for hepatomegaly, splenomegaly, jaundice, hyperlipidemia, coagulopathy, and neurological symptoms.","Allergic reactions: Including anaphylaxis, particularly in patients with egg, soy, or peanut allergies (Intralipid contains egg phospholipids and soybean oil).","Premature infants: Increased risk of complications; monitor closely for hypertriglyceridemia and respiratory distress."] |
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| Fetal Monitoring |
| Monitor maternal serum triglycerides, electrolytes, liver function, and signs of fat overload syndrome. Fetal monitoring: ultrasound for growth if long-term use. Check for metabolic acidosis, hypertriglyceridemia. |
| Fertility Effects | No known direct effect on fertility. Correction of maternal malnutrition may improve fertility outcomes. |