TRAVAMULSION 20%

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRAVAMULSION 20% (TRAVAMULSION 20%).

How it works

Travamulsion 20% is a lipid emulsion providing essential fatty acids and calories for parenteral nutrition. It serves as a source of calories and essential fatty acids, preventing and treating essential fatty acid deficiency. The lipids are metabolized similarly to endogenous lipoproteins, providing energy and structural components for cell membranes.

What the body does with it

Metabolism	Lipid emulsions are cleared from the bloodstream by the reticuloendothelial system and metabolized in the liver via lipoprotein lipase and hepatic lipase, following the same pathways as endogenous chylomicrons.
Excretion	Travamulsion 20% (intravenous lipid emulsion) is primarily eliminated via metabolism in the reticuloendothelial system (liver, spleen, bone marrow) and peripheral tissues (e.g., muscle, adipose) by lipoprotein lipase. Excretion: <5% renal (as free fatty acids or glycerol), biliary/fecal negligible.
Half-life	Terminal elimination half-life of the lipid particles is approximately 30-60 minutes for the triglyceride component, but the clinical half-life (clearance of fat emulsion) is dose-dependent; at typical infusion rates, clearance is 0.1-0.3 g/kg/h.
Protein binding	Not applicable; the lipid emulsion particles do not bind to plasma proteins. Free fatty acids released after metabolism are highly protein-bound (>99% to albumin).
Volume of Distribution	Volume of distribution of the intact emulsion is approximately 0.1-0.3 L/kg (confined to plasma compartment initially); free fatty acids have a larger Vd (0.1-0.5 L/kg) due to tissue distribution.
Bioavailability	Intravenous: 100% (complete bioavailability). Not administered via other routes.
Onset of Action	Intravenous: immediate onset for energy provision (minutes); for reversal of local anesthetic toxicity (e.g., lipid rescue), clinical effect seen within minutes of bolus administration.
Duration of Action	Duration of caloric effect: continuous during infusion; metabolic effects persist for hours after cessation (as triglycerides are cleared). For lipid rescue, effect lasts until drug redistribution (typically 30-60 minutes).

Classification & Brands

Dosing & administration

Intravenous infusion; 1-2 g/kg/day for parenteral nutrition, typically 20-40 mL/kg/day of 20% emulsion. Maximum infusion rate: 0.11 g/kg/hour (0.5 mL/kg/hour).

Dosage form	INJECTABLE
Renal impairment	In severe renal impairment (eGFR <30 mL/min/1.73 m²), reduce dose to 0.5-1 g/kg/day and monitor triglycerides. No adjustment for mild-moderate impairment.
Liver impairment	Child-Pugh Class A: no adjustment; Class B: reduce dose by 50% with monitoring; Class C: contraindicated due to risk of fat overload syndrome.
Pediatric use	Preterm infants: start 0.5-1 g/kg/day, increase by 0.5-1 g/kg/day to max 3 g/kg/day. Full-term infants/children: 1-2 g/kg/day up to 3 g/kg/day. Infusion rate ≤0.17 g/kg/hour.
Geriatric use	Initiate at lower end of adult dose (0.5-1 g/kg/day) and titrate based on metabolic tolerance and renal function.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRAVAMULSION 20% (TRAVAMULSION 20%).

Breastfeeding	Excretion in human milk unknown; M/P ratio not established. Caution advised due to potential for essential fatty acid imbalance in infant. Use only if benefit outweighs risk.
Teratogenic Risk	TRAVAMULSION 20% is a fat emulsion for parenteral nutrition. No teratogenic effects reported in animal studies. First trimester: No known risk; second/third trimester: Use only if clearly needed; peripartum: Monitor maternal lipid metabolism.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Death in preterm infants has been reported with intravenous lipid emulsions. Preterm infants have poor clearance of intravenous lipid emulsion and may develop fat overload syndrome. Use only if clearly needed and monitor serum triglycerides.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to eggs, soybeans, or peanuts","Severe hyperlipidemia","Bone marrow biopsy with lipid deposits (fat overload syndrome)","Severe hepatic failure"]

Clinical Precautions

Precautions

["Monitor serum triglycerides; discontinue if hypertriglyceridemia occurs","Risk of fat overload syndrome with rapid infusion or impaired clearance","Use with caution in patients with severe hepatic impairment, coagulopathies, or pancreatitis","Hypersensitivity reactions including anaphylaxis possible","Risk of infection from catheter-related sepsis with long-term use"]

Clinical Tips & Counseling

Drug interactions

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TRAVAMULSION 20%

Clinical safety rating: caution

Comprehensive clinical and safety monograph for TRAVAMULSION 20% (TRAVAMULSION 20%).

How it works

What the body does with it

Metabolism	Lipid emulsions are cleared from the bloodstream by the reticuloendothelial system and metabolized in the liver via lipoprotein lipase and hepatic lipase, following the same pathways as endogenous chylomicrons.
Excretion	Travamulsion 20% (intravenous lipid emulsion) is primarily eliminated via metabolism in the reticuloendothelial system (liver, spleen, bone marrow) and peripheral tissues (e.g., muscle, adipose) by lipoprotein lipase. Excretion: <5% renal (as free fatty acids or glycerol), biliary/fecal negligible.
Half-life	Terminal elimination half-life of the lipid particles is approximately 30-60 minutes for the triglyceride component, but the clinical half-life (clearance of fat emulsion) is dose-dependent; at typical infusion rates, clearance is 0.1-0.3 g/kg/h.
Protein binding	Not applicable; the lipid emulsion particles do not bind to plasma proteins. Free fatty acids released after metabolism are highly protein-bound (>99% to albumin).
Volume of Distribution	Volume of distribution of the intact emulsion is approximately 0.1-0.3 L/kg (confined to plasma compartment initially); free fatty acids have a larger Vd (0.1-0.5 L/kg) due to tissue distribution.
Bioavailability	Intravenous: 100% (complete bioavailability). Not administered via other routes.
Onset of Action	Intravenous: immediate onset for energy provision (minutes); for reversal of local anesthetic toxicity (e.g., lipid rescue), clinical effect seen within minutes of bolus administration.
Duration of Action	Duration of caloric effect: continuous during infusion; metabolic effects persist for hours after cessation (as triglycerides are cleared). For lipid rescue, effect lasts until drug redistribution (typically 30-60 minutes).

Classification & Brands

Dosing & administration

Intravenous infusion; 1-2 g/kg/day for parenteral nutrition, typically 20-40 mL/kg/day of 20% emulsion. Maximum infusion rate: 0.11 g/kg/hour (0.5 mL/kg/hour).

Dosage form	INJECTABLE
Renal impairment	In severe renal impairment (eGFR <30 mL/min/1.73 m²), reduce dose to 0.5-1 g/kg/day and monitor triglycerides. No adjustment for mild-moderate impairment.
Liver impairment	Child-Pugh Class A: no adjustment; Class B: reduce dose by 50% with monitoring; Class C: contraindicated due to risk of fat overload syndrome.
Pediatric use	Preterm infants: start 0.5-1 g/kg/day, increase by 0.5-1 g/kg/day to max 3 g/kg/day. Full-term infants/children: 1-2 g/kg/day up to 3 g/kg/day. Infusion rate ≤0.17 g/kg/hour.
Geriatric use	Initiate at lower end of adult dose (0.5-1 g/kg/day) and titrate based on metabolic tolerance and renal function.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for TRAVAMULSION 20% (TRAVAMULSION 20%).

Breastfeeding	Excretion in human milk unknown; M/P ratio not established. Caution advised due to potential for essential fatty acid imbalance in infant. Use only if benefit outweighs risk.
Teratogenic Risk	TRAVAMULSION 20% is a fat emulsion for parenteral nutrition. No teratogenic effects reported in animal studies. First trimester: No known risk; second/third trimester: Use only if clearly needed; peripartum: Monitor maternal lipid metabolism.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to eggs, soybeans, or peanuts","Severe hyperlipidemia","Bone marrow biopsy with lipid deposits (fat overload syndrome)","Severe hepatic failure"]