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

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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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                    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.
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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.