INTRALIPID 30%
Clinical safety rating: caution
Comprehensive clinical and safety monograph for INTRALIPID 30% (INTRALIPID 30%).
Intralipid is a source of calories and essential fatty acids. It provides a mixture of triglycerides, primarily long-chain fatty acids, which are metabolized to generate energy and serve as substrates for lipid membrane synthesis. It also prevents essential fatty acid deficiency.
| Metabolism | Metabolized by lipoprotein lipase (LPL) in peripheral tissues, releasing free fatty acids that are taken up by cells. The emulsion is cleared from the bloodstream via the reticuloendothelial system and metabolized via beta-oxidation in mitochondria. |
| Excretion | Intralipid 30% is a fat emulsion containing soybean oil, egg lecithin, and glycerin, providing essential fatty acids and triglycerides. The lipid particles are metabolized similarly to endogenous chylomicrons, primarily cleared from the bloodstream by lipoprotein lipase in peripheral tissues, releasing free fatty acids which are then utilized or stored. Less than 10% of the administered dose is excreted unchanged in urine; the majority of the lipid components are oxidized to CO2 and water or incorporated into body stores. Biliary/fecal excretion is negligible for the intact emulsion but metabolites may be excreted in bile or feces in small amounts. |
| Half-life | The elimination half-life of Intralipid 30% triglycerides is approximately 30-45 minutes under steady-state conditions in patients with normal lipid metabolism, though this may extend to several hours in critically ill patients or those with impaired clearance. Clinically, the half-life is dose- and infusion-rate-dependent; for continuous infusion, clearance rates are typically 0.1-0.3 g/kg/h, with complete clearance of infused lipids within 4-6 hours after cessation of infusion in healthy adults. |
| Protein binding | Lipid particles in Intralipid 30% are not bound to plasma proteins; they circulate as chylomicron-like particles. Free fatty acids released after lipolysis are highly bound to albumin (>99%), with a binding capacity of approximately 20-30 g/L. |
| Volume of Distribution | The apparent volume of distribution (Vd) for Intralipid 30% is approximately 0.1-0.2 L/kg, reflecting primary distribution within the plasma compartment and rapid uptake by the reticuloendothelial system and peripheral tissues. The small Vd indicates limited extravascular distribution until lipolysis occurs. |
| Bioavailability | Intravenous administration yields 100% bioavailability. Oral administration is not applicable due to formulation; the product is for IV use only. |
| Onset of Action | Intravenous administration provides immediate systemic availability of triglycerides and essential fatty acids, with detectable increases in serum triglyceride levels within minutes. Clinical effects such as correction of essential fatty acid deficiency and caloric provision are dependent on cumulative dose; significant metabolic effects occur after several hours to days of continuous infusion. |
| Duration of Action | The caloric and fatty acid effects persist as long as the infusion continues; after discontinuation, serum triglyceride levels typically return to baseline within 4-6 hours in patients with normal clearance. However, incorporation into cellular membranes and storage in adipose tissue extends the nutritional benefit for days to weeks. |
Intralipid 30% is administered intravenously as a component of parenteral nutrition. The typical adult dose is 1-2 g/kg/day of fat, not to exceed 60% of total calories. The infusion rate should not exceed 0.11 g/kg/hour (equivalent to 0.37 mL/kg/hour of 30% emulsion).
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment is required for renal impairment. However, use with caution in patients with severe renal dysfunction (eGFR <30 mL/min/1.73 m²) due to potential for fluid and electrolyte disturbances and monitor triglycerides closely. |
| Liver impairment | In patients with hepatic impairment, use with caution. For Child-Pugh class B or C, reduce dose by 50% and monitor serum triglycerides; avoid use in severe hepatic insufficiency due to impaired fat clearance. |
| Pediatric use | Neonates and children: Initial dose 0.5-1 g/kg/day of fat, increasing by 0.5-1 g/kg/day to a maximum of 3 g/kg/day (preterm infants) or 4 g/kg/day (term infants and children). Infusion rate not to exceed 0.17 g/kg/hour. Adjust based on serum triglyceride levels. |
| Geriatric use | No specific dose adjustment is required for elderly patients. However, caution is advised due to potential comorbidities; monitor triglycerides and fluid status closely. Use the lower end of the standard dosing range (1 g/kg/day) and adjust based on tolerance. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for INTRALIPID 30% (INTRALIPID 30%).
| Breastfeeding | Intralipid 30% is considered compatible with breastfeeding. The components (soybean oil, egg phospholipids, glycerin) are normal dietary constituents. No data on M/P ratio; however, lipid emulsions are rapidly metabolized and do not accumulate in milk in significant amounts. Use caution in mothers with hyperlipidemia. |
| Teratogenic Risk | No evidence of teratogenicity in animal studies. Intralipid 30% is a fat emulsion providing essential fatty acids and calories. In pregnancy, it is used as a component of parenteral nutrition when oral/enteral intake is inadequate. Limited human data; no increased risk of major birth defects reported. However, maternal metabolic derangements during pregnancy (e.g., hypertriglyceridemia, pancreatitis) associated with lipid emulsions may pose fetal risks including preterm birth and growth restriction. Administer only if clearly needed. |
■ FDA Black Box Warning
Death in preterm infants: When given to preterm infants, Intralipid has been associated with increased risk of death, pulmonary hemorrhage, and other complications. Use only when clearly indicated and with extreme caution.
| Serious Effects |
Absolute: Known hypersensitivity to egg, soybean, or peanut proteins; severe hypertriglyceridemia (e.g., >1000 mg/dL); severe hepatic impairment; acute pancreatitis with hypertriglyceridemia; hemodynamic instability (e.g., shock); uncontrolled sepsis. Relative: Renal impairment, diabetes mellitus, pulmonary disease, coagulopathy.
| Precautions | Risk of fat overload syndrome (hypertriglyceridemia, hepatomegaly, coagulopathy, splenomegaly, respiratory distress); monitor serum triglycerides; risk of infections from line contamination; pulmonary complications (especially in preterm infants); risk of hypertriglyceridemia; monitor liver function tests and platelet counts. |
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| Fetal Monitoring | Monitor maternal serum triglycerides, liver function tests, and pancreatic enzymes (amylase, lipase) due to risk of hypertriglyceridemia and pancreatitis. In long-term use, monitor for essential fatty acid deficiency. Fetal monitoring includes growth ultrasound and assessment for preterm labor signs. Monitor for signs of infection at infusion site. |
| Fertility Effects | No known adverse effects on fertility. Inadequate nutrition may impair fertility; Intralipid as part of parenteral nutrition could restore nutritional status and improve fertility. |