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vitamin a palmitate injection, solution
AQUASOL A® Parenteral
water-miscible vitamin A Palmitate
50,000 USP Units
(15 mg retinol/mL)
with 0.5% chlorobutanol as preservative; 12% polysorbate 80, 0.1% citric acid, and sodium hydroxide to adjust pH.
THIS IS A STERILE PRODUCT FOR INTRAMUSCULAR INJECTION
AQUASOL A® Parenteral (water-miscible vitamin A Palmitate) provides 50,000 USP Units of vitamin A per mL as retinol (C20H30O) in the form of vitamin A palmitate, a light yellow to amber oil. The structural formula of retinol is:
Ordinarily oil-soluble, the vitamin A in this product has been water solubilized by special processing1 and is available in a water solution for intramuscular injection.
One USP Unit is equivalent to one international unit (IU) and to 0.3 mcg of retinol or 0.6 mcg of beta-carotene.
Beta-carotene, retinol, and retinal have effective and reliable vitamin A activity. Retinal and retinol are in chemical equilibrium in the body and have equivalent antixerophthalmic activity. Retinal combines with the rod pigment, opsin, in the retina to form rhodopsin, necessary for visual dark adaptation. Vitamin A prevents retardation of growth and preserves the epithelial cells’ integrity. Normal adult liver storage is sufficient to satisfy two years’ requirements of vitamin A.
Vitamin A is readily absorbed from the gastrointestinal tract, where the biosynthesis of vitamin A from beta-carotene takes place. Vitamin A absorption requires bile salts, pancreatic lipase, and dietary fat. It is transported in the blood to the liver by the chylomicron fraction of the lymph. Vitamin A is stored in Kupffer cells of the liver mainly as the palmitate. Normal serum vitamin A is 80–300 Units per 100 mL (plasma range is 30–70 mcg per dl) and for carotenoids 270–753 Units per 100 mL.The normal adult liver contains approximately 100 to 300 micrograms per gram, mostly as retinol palmitate.
Vitamin A injection is effective for the treatment of vitamin A deficiency.
The parenteral administration is indicated when the oral administration is not feasible as in anorexia, nausea, vomiting, pre- and postoperative conditions, or it is not available as in the “Malabsorption Syndrome” with accompanying steatorrhea.
Vitamin A treatment for deficiency states has been recognized as an especially effective and important therapy in the pediatric population.
Vitamin A supplementation for deficiency states in this population has been addressed by the Committee on Clinical Practice Issues of the American Society for Clinical Nutrition, by the American Society for Parenteral and Enteral Nutrition, and by the World Health Organization.
The intravenous administration. Hypervitaminosis A. Sensitivity to any of the ingredients in this preparation.
Use in Pregnancy
Safety of amounts exceeding 6,000 Units of vitamin A daily during pregnancy has not been established at this time. The use of vitamin A in excess of the recommended dietary allowance may cause fetal harm when administered to a pregnant woman. Animal reproduction studies have shown fetal abnormalities associated with overdosage in several species. Malformations of the central nervous system, the eye, the palate, and the urogenital tract are recorded. Vitamin A in excess of the recommended dietary allowance is contraindicatedin women who are or may become pregnant. If vitamin A is used during pregnancy, or if the patient becomes pregnant while taking vitamin A, the patient should be apprised of the potential hazard to the fetus.
Avoid overdosage. Keep out of the reach of children.
Protect from light. Prolonged daily dose administration over 25,000 Units vitamin A should be under close supervision. Blood level assays are not a direct measure of liver storage. Liver storage should be adequate before discontinuing therapy. Single vitamin A deficiency is rare. Multiple vitamin deficiency is expected in any dietary deficiency.
Women on oral contraceptives have shown a significant increase in plasma vitamin A levels.
There are no studies that show that administration of vitamin A will cause or prevent cancer.
See OVERDOSAGE section. Anaphylactic shock and death have been reported using the intravenous route. Allergic reactions have been reported rarely with administration of AQUASOL A® Parenteral including one case of an anaphylactoid type reaction.
The following amounts have been found to be toxic orally. Toxicity manifestations depend on the age, dosage, size, and duration of administration.
Acute toxicity — single dose (25,000 Units/kg body weight)
Chronic toxicity (4,000 Units/kg body weight for 6 to 15 months)
Hypervitaminosis A Syndrome:
The treatment of hypervitaminosis A consists of immediate withdrawal of the vitamin along with symptomatic and supportive treatment.
DOSAGE AND ADMINISTRATION
For intramuscular use.
Follow-up therapy with an oral therapeutic multivitamin preparation, containing 10,000 to 20,000 Units vitamin A for adults and for pediatric patients over 8 years old, and 5,000 to 10,000 Units for infants and other pediatric patients under 8 years old, is recommended daily for two months. Low birth-weight infants may require additional vitamin A though the exact dosing in these pediatric patients has not been established. In malabsorption, the parenteral route must be used for an equivalent preparation. Poor dietary habits should be corrected and an abundant and well-balanced dietary intake should be prescribed.
AQUASOL A® Parenteral (water-miscible vitamin A Palmitate) is available as:
NDC 61703-418-07; 50,000 USP Units (15 mg retinol/mL); 2 mL single-dose vial, box of 10.
Store at 2–8°C (36–46°F). Do not freeze.
Revised: 11/2007 Mayne Pharma ( USA) Inc.
Reproduced with permission of U.S. National Library of Medicine
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