ammonium chloride (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 5 mEq/mL

Hypochloremic States & Metabolic Alkalosis

mEq of chloride ion (as ammonium chloride-NH4Cl) = [0.2 L/kg X BW (kg)] X [103 - observed serum chloride]; administer 50% of dose over 12 hr and reevaluate

103 is the average normal serum chloride concentration (mEq/L) and 0.2 L/kg is the estimated chloride volume of distribution

Dosage Forms & Strengths

injectable solution

  • 5 mEq/mL

Hypochloremic States & Metabolic Alkalosis

mEq of chloride ion (as ammonium chloride-NH4Cl) = [0.2 L/kg X BW (kg)] X [103 - observed serum chloride]; administer 50% of dose over 12 hr and reevaluate

103 is the average normal serum chloride concentration (mEq/L) and 0.2 L/kg is the estimated chloride volume of distribution

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Interactions

Interaction Checker

and ammonium chloride

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (6)

                • dextroamphetamine

                  ammonium chloride decreases levels of dextroamphetamine by increasing renal clearance. Use Caution/Monitor.

                • dichlorphenamide

                  dichlorphenamide and ammonium chloride both decrease serum potassium. Use Caution/Monitor.

                  dichlorphenamide, ammonium chloride. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

                • lisdexamfetamine

                  ammonium chloride decreases levels of lisdexamfetamine by increasing renal clearance. Use Caution/Monitor.

                • methamphetamine

                  ammonium chloride decreases levels of methamphetamine by increasing renal clearance. Use Caution/Monitor.

                • methylenedioxymethamphetamine

                  ammonium chloride decreases levels of methylenedioxymethamphetamine by increasing renal clearance. Use Caution/Monitor.

                • pseudoephedrine

                  ammonium chloride decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

                Minor (1)

                • spironolactone

                  spironolactone, ammonium chloride. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of systemic acidosis.

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                Adverse Effects

                Frequency Not Defined

                Metabolic acidosis

                Rash

                EEG abnormalities

                Seizure

                Mental confusion

                Drowsiness

                Injection site reactions

                Ammonia toxicity symptoms

                Calcium-deficient tetany

                Hypokalemia

                Hyperchloremia

                Abdominal pain

                Nausea/vomiting

                Hyperventilation

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                Warnings

                Contraindications

                Severe hepatic or renal impairment

                Cautions

                Pulmonary insufficiency, cardiac edema, severe renal impairment (do not give NH4Cl alone if concomitant Na loss)

                Risk of ammonia toxicity (monitor)

                Monitor patients CO2 combining power prior to IV administration to avoid serious acidosis

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                Pregnancy & Lactation

                Pregnancy Category: C

                Lactation: N/A

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Increases acidity by increasing the amount of hydrogen ion concentrations

                Pharmacokinetics

                Metabolism: Ammonium ion is converted to urea in the liver; chloride ion replaces bicarbonate

                Excretion: Urine

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                Administration

                IV Incompatibilities

                Additive: dimenhydrinate(?), levorphanol

                Y-site: warfarin(?)

                IV Preparation

                Must dilute the 26.75% (5 mEq/mL) concentrate by adding 100 or 200 mEq (20 or 40 mL) of NH4Cl to 500 or 1000 mL of NS

                IV Administration

                Not to exceed infusion rate of 5 mL/min in adults

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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.