selenious acid (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

solution for injection

  • 600mcg/10mL (60mcg/mL of selenium)
  • For admixing only; not for direct IV infusion

Parenteral Nutrition

Indicated as a source of selenium for parenteral nutrition (PN) when oral or enteral nutrition is not possible, insufficient, or contraindicated

Individualize dose based on patient’s clinical condition, nutritional requirements, and the contribution of oral or enteral selenium intake

General recommendation: 60 mcg/day added to PN; however, based on clinical requirements, some patients may require a higher dosage

Dosing Considerations

Dosage of the final PN solution containing selenious acid must be based on concentrations of all components in the solution and the recommended daily nutritional requirements

Consult prescribing information of all added components to determine recommended nutritional requirements for dextrose, amino acids, and lipid emulsion, as applicable

Before administering PN solution containing selenious acid, correct severe fluid, electrolyte, and acid-base disorders

Monitoring

  • Monitor selenium concentrations during treatment
  • Concentrations may vary depending on the assay used and the laboratory reference range
  • Lower end of range reported in healthy adults: 7-10 mcg/dL

Dosage Forms & Strengths

solution for injection

  • 600mcg/10mL (60mcg/mL of selenium)
  • For admixing only; not for direct IV infusion

Parenteral Nutrition

Indicated as a source of selenium for parenteral nutrition (PN) when oral or enteral nutrition is not possible, insufficient, or contraindicated

Individualize dose based on patient’s clinical condition, nutritional requirements, and the contribution of oral or enteral selenium intake

General dose recommendations

  • <7 kg: 2-4 mcg/kg/day added to PN
  • >7 kg: 2 mcg/kg/day added to PN; not to exceed 60 mcg/day
  • Based on clinical requirements, some patients may require a higher dosage

Dosing Considerations

Dosage of the final PN solution containing selenious acid must be based on concentrations of all components in the solution and the recommended daily nutritional requirements

Consult prescribing information of all added components to determine recommended nutritional requirements for dextrose, amino acids, and lipid emulsion, as applicable

Before administering PN solution containing selenious acid, correct severe fluid, electrolyte, and acid-base disorders

Monitoring

  • Monitor selenium concentrations during treatment
  • Concentrations may vary depending on the assay used and the laboratory reference range
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Interactions

Interaction Checker

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            Adverse Effects

            Frequency Not Defined

            Pulmonary embolism due to pulmonary vascular precipitates

            Vein damage and thrombosis

            Aluminum toxicity

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            Warnings

            Contraindications

            None

            Cautions

            Pulmonary vascular precipitates causing pulmonary vascular emboli and pulmonary distress reported in patients receiving PN; in some fatal cases, pulmonary emboli occurred as a result of calcium phosphate precipitates; if signs of pulmonary distress occur, stop infusion and initiate medical evaluation

            Monitor selenium concentrations, fluid and electrolyte status, serum osmolarity, blood glucose, liver and kidney function, blood cell count, and coagulation parameters during treatment

            Vein damage and thrombosis

            • Selenious acid has a low pH and must be prepared and used as an admixture in PN solutions; it is not for direct IV infusion
            • Additionally, consider final PN solution osmolarity to determine peripheral versus central administration
            • Solution with osmolarity of >900 mOsm/L must be infused through a central catheter
            • Infusion of hypertonic nutrient injections into a peripheral vein may result in vein irritation, vein damage, and/or thrombosis

            Aluminum toxicity

            • Selenious acid injection contains aluminum that may be toxic
            • Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired
            • Preterm infants are particularly at risk for aluminum toxicity because of immature kidneys, and they require large amounts of calcium and phosphate solutions, which also contain aluminum
            • Patients with impaired kidney function, including preterm neonates, who receive >4-5 mcg/kg/day of parenteral aluminum can accumulate aluminum to levels associated with central nervous system and bone toxicity
            • Tissue loading may occur at even lower rates of administration
            • Exposure to aluminum from selenious acid <0.6 mcg/kg/day
            • Determine total daily exposure to aluminum from entire admixture contents; daily aluminum should not exceed 5 mcg/kg/day

            Drug interaction overview

            • Selenium is a polyvalent cation that may interfere with absorption of certain drugs (eg, baloxavir marboxil, bictegravir, bisphosphonates, eltrombopag, penicillamine)
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            Pregnancy & Lactation

            Pregnancy

            Administration of the recommended dose in PN is not expected to cause major birth defects, miscarriage, or adverse maternal or fetal outcomes

            Animal reproduction studies have not been conducted

            Clinical considerations

            • Deficiency of trace elements, including selenium, is associated with adverse pregnancy and fetal outcomes
            • Pregnant women have an increased metabolic demand for trace elements, including selenium
            • PN with selenium should be considered if a pregnant woman’s nutritional requirements cannot be fulfilled by oral or enteral intake

            Lactation

            Selenium is present in human milk; administration of the approved recommended dose is not expected to cause harm to a breastfed infant

            There is no information on the effects of selenious acid on milk production

            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

            Selenious acid is converted in vivo to hydrogen selenide via glutathione-involved electron reductions

            Hydrogen selenide acts as a selenium pool to form selenoproteins, which include, but are not limited to, glutathione peroxidase, iodothyronine deiodinase, peroxidase, and thioredoxins

            Distribution

            Protein bound: 85% (within 4-6 hr); 95% (within 24 hr)

            Metabolism

            Converted in vivo to hydrogen selenide via glutathione-involved electron reductions

            Elimination

            Excretion: Primarily eliminated in urine

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            Administration

            IV Preparation

            Prepare per current standard of practice as an admixture for PN solutions

            IV Administration

            Not for direct IV infusion; must be prepared and used as an admixture in PN solutions

            PN solutions with osmolarity ≥900 mOsm/L must be infused through a central venous catheter

            Inspect final PN solution to ensure that precipitates have not formed during mixing or addition of additives

            Discard if any precipitates are observed

            Storage

            Unopened vials: Store at 20-25ºC (68-77ºF)

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            Formulary

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            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.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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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.