INTRALIPID 20%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for INTRALIPID 20% (INTRALIPID 20%).
Intralipid 20% is a fat emulsion providing essential fatty acids and triglycerides. It serves as a source of calories and essential fatty acids. In parenteral nutrition, it prevents and treats essential fatty acid deficiency. In lipid rescue therapy for local anesthetic toxicity, it acts as a 'lipid sink' to sequester lipophilic drugs, and may also enhance mitochondrial fatty acid oxidation and improve cardiac contractility.
| Metabolism | Intralipid is metabolized via lipoprotein lipase in peripheral tissues, releasing free fatty acids which are then oxidized or stored. Exogenous and endogenous lipoproteins are cleared via the reticuloendothelial system. |
| Excretion | Renal: negligible. Biliary/fecal: >90% as component of lipid metabolism, excretion via bile and fecal elimination of lipid particles. |
| Half-life | Terminal elimination half-life of lipid particles: approximately 30 minutes for chylomicron-like particles; triglycerides half-life ~15-30 minutes. Clinical context: rapid clearance by lipoprotein lipase. |
| Protein binding | Phospholipids and triglycerides are bound to lipoproteins; unbound fraction <1%. Binding proteins: apolipoproteins (apoE, apoB, apoC). |
| Volume of Distribution | Vd: 0.1-0.2 L/kg (for lipid particles), primarily confined to plasma volume. Clinical meaning: low Vd indicates limited extravascular distribution. |
| Bioavailability | Intravenous: 100% (complete bioavailability). Not administered via other routes. |
| Onset of Action | Intravenous: immediate increase in plasma triglyceride level; clinical effect on energy supply within minutes. |
| Duration of Action | Duration: ~12-24 hours for triglyceride elevation; clinical caloric support persists as long as infusion continues. Notes: continuous infusion recommended for stable metabolic support. |
Intravenous infusion at a rate of 0.1 g fat/kg/hour, increasing to 0.5 g fat/kg/hour if tolerated. Maximum daily dose: 2.5 g fat/kg (50 mL/kg/day of 20% emulsion).
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment required for renal impairment; monitor serum triglycerides and electrolytes. |
| Liver impairment | Contraindicated in severe hepatic insufficiency (Child-Pugh class C). In Child-Pugh class A or B, use with caution; reduce dose by 50% and monitor liver function tests and triglycerides. |
| Pediatric use | Premature infants: 0.5-1 g fat/kg/day (2.5-5 mL/kg/day), increasing by 0.5 g fat/kg/day to a maximum of 3 g fat/kg/day. Term infants and children: 1-2 g fat/kg/day (5-10 mL/kg/day) initially, up to 3 g fat/kg/day. Administer as continuous intravenous infusion over 20-24 hours. |
| Geriatric use | No specific dose adjustment required; consider age-related decreases in lipid clearance. Start at lower end of dosing range (0.1 g fat/kg/hour) and monitor triglycerides. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for INTRALIPID 20% (INTRALIPID 20%).
| Breastfeeding | Intralipid 20% is not expected to pass into breast milk in significant amounts as it is metabolized and cleared rapidly. No data on M/P ratio. Likely compatible with breastfeeding. Use caution due to lack of data. |
| Teratogenic Risk | Intralipid 20% is a fat emulsion used as a source of calories and essential fatty acids. No teratogenic effects have been reported in animal studies. Due to its composition (soybean oil, egg phospholipids, glycerol), it is not anticipated to be teratogenic in humans. However, data in pregnant women are limited. Use only if clearly needed, especially during the first trimester. |
■ FDA Black Box Warning
Deaths in preterm infants have been reported with use of Intralipid. Autopsy findings included intravascular fat accumulation in the lungs. Premature and low birth weight infants have poor clearance of intravenous lipids, and increased free fatty acid levels may compete with bilirubin for albumin binding sites, increasing the risk of kernicterus.
| Serious Effects |
["Hypersensitivity to egg, soybean, or peanut protein","Severe hyperlipidemia","Severe hepatic insufficiency","Severe coagulation disorders"]
| Precautions | ["Monitor for signs of fat overload syndrome (hyperlipidemia, hepatomegaly, splenomegaly, thrombocytopenia, coagulopathy)","Use with caution in patients with severe hepatic damage, pulmonary disease, anemia, or coagulation disorders","Risk of hypertriglyceridemia; monitor serum triglycerides","Risk of infection from catheter-related sepsis; use aseptic technique","In preterm infants, monitor for risk of kernicterus"] |
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| Fetal Monitoring | Monitor maternal serum triglycerides, liver function tests, and coagulation parameters during prolonged or high-dose therapy. Observe fetus for potential risk of hypertriglyceridemia if maternal levels are elevated. No specific fetal monitoring required. |
| Fertility Effects | No known adverse effects on fertility. Use in parenteral nutrition does not impair reproductive function. |