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Chromium
Overview
What is Chromium?
Chromium 4 mcg/mL (Chromic Chloride Injection, USP) is a sterile, nonpyrogenic solution intended for use as an additive to intravenous solutions for total parenteral nutrition (TPN). Each mL of solution contains 20.5 mcg chromic chloride, hexahydrate and 9 mg sodium chloride. The solution contains no bacteriostat, antimicrobial agent, or added buffer. The pH is 2.0 (1.5 to 2.5); product may contain hydrochloric acid and/or sodium hydroxide for pH adjustment. The osmolarity is 0.308 mOsm/mL (calc.).
Chromic Chloride, USP is chemically designated chromic chloride, hexahydrate CrCl • 6HO, a crystalline compound soluble in water.
Sodium Chloride, USP is chemically designated NaCl, a white, crystalline compound freely soluble in water.
The semi-rigid vial is fabricated from a specially formulated polyolefin. It is a copolymer of ethylene and propylene. The safety of the plastic has been confirmed by tests in animals according to USP biological standards for plastic containers. The small amount of water vapor that can pass through the plastic container wall will not significantly alter the drug concentration.
What does Chromium look like?
What are the available doses of Chromium?
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What should I talk to my health care provider before I take Chromium?
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How should I use Chromium?
Chromium 4 mcg/mL (Chromic Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for TPN. Administration helps to maintain chromium serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms.
Chromium 4 mcg/mL (Chromic Chloride Injection, USP) contains 4 mcg chromium/mL and is administered intravenously only after dilution. The additive should be administered in a volume of fluid not less than 100 mL. For the adult receiving TPN, the suggested additive dosage is 10 to 15 mcg chromium/day (2.5 to 3.75 mL/day). The metabolically stable adult with intestinal fluid loss may require 20 mcg chromium/day (5 mL/day), with frequent monitoring of blood levels as a guideline for subsequent administration. For pediatric patients, the suggested additive dosage is 0.14 to 0.20 mcg/kg/day (0.035 to 0.05 mL/kg/day).
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See .
What interacts with Chromium?
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What are the warnings of Chromium?
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What are the precautions of Chromium?
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What are the side effects of Chromium?
Sorry No records found
What should I look out for while using Chromium?
None known.
Direct intramuscular or intravenous injection of Chromium 4 mcg/mL (Chromic Chloride Injection, USP) is contraindicated, as the acidic pH of the solution may cause considerable tissue irritation.
Severe kidney disease may make it necessary to reduce or omit chromium and zinc doses because these elements are primarily eliminated in the urine.
WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.
What might happen if I take too much Chromium?
Trivalent chromium administered intravenously to TPN patients has been shown to be nontoxic when given at dosage levels of up to 250 mcg/day for two consecutive weeks.
Reported toxic reactions to chromium include nausea, vomiting, ulcers of the gastrointestinal tract, renal and hepatic damage, convulsions and coma. The acute LD for intravenous trivalent chromium in rats was reported as 10 to 18 mg/kg.
How should I store and handle Chromium?
Voriconazole tablets should be stored at 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature].Voriconazole powder for Oral Suspension should be stored at 2° – 8°C (36°– 46° F) (in a refrigerator) before reconstitution. The shelf-life of the powder for oral suspension is 24 months.The reconstituted suspension should be stored at 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature]. Do not refrigerate or freeze. Keep the container tightly closed. The shelf-life of the reconstituted suspension is 14 days. Any remaining suspension should be discarded 14 days after reconstitution.Voriconazole tablets should be stored at 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature].Voriconazole powder for Oral Suspension should be stored at 2° – 8°C (36°– 46° F) (in a refrigerator) before reconstitution. The shelf-life of the powder for oral suspension is 24 months.The reconstituted suspension should be stored at 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature]. Do not refrigerate or freeze. Keep the container tightly closed. The shelf-life of the reconstituted suspension is 14 days. Any remaining suspension should be discarded 14 days after reconstitution.Voriconazole tablets should be stored at 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature].Voriconazole powder for Oral Suspension should be stored at 2° – 8°C (36°– 46° F) (in a refrigerator) before reconstitution. The shelf-life of the powder for oral suspension is 24 months.The reconstituted suspension should be stored at 15° – 30°C (59° – 86°F) [see USP Controlled Room Temperature]. Do not refrigerate or freeze. Keep the container tightly closed. The shelf-life of the reconstituted suspension is 14 days. Any remaining suspension should be discarded 14 days after reconstitution.Chromium (Chromic Chloride Injection, USP) is supplied as follows:Store at 20 to 25ºC (68 to 77ºF). [See USP Controlled Room Temperature.]Manufactured by Hospira, Inc., Lake Forest, IL 60045 USAN+ and NOVAPLUS are registered trademarks of Vizient, Inc.LAB-1066-1.0Revised: 9/2017Chromium (Chromic Chloride Injection, USP) is supplied as follows:Store at 20 to 25ºC (68 to 77ºF). [See USP Controlled Room Temperature.]Manufactured by Hospira, Inc., Lake Forest, IL 60045 USAN+ and NOVAPLUS are registered trademarks of Vizient, Inc.LAB-1066-1.0Revised: 9/2017Chromium (Chromic Chloride Injection, USP) is supplied as follows:Store at 20 to 25ºC (68 to 77ºF). [See USP Controlled Room Temperature.]Manufactured by Hospira, Inc., Lake Forest, IL 60045 USAN+ and NOVAPLUS are registered trademarks of Vizient, Inc.LAB-1066-1.0Revised: 9/2017Chromium (Chromic Chloride Injection, USP) is supplied as follows:Store at 20 to 25ºC (68 to 77ºF). [See USP Controlled Room Temperature.]Manufactured by Hospira, Inc., Lake Forest, IL 60045 USAN+ and NOVAPLUS are registered trademarks of Vizient, Inc.LAB-1066-1.0Revised: 9/2017Chromium (Chromic Chloride Injection, USP) is supplied as follows:Store at 20 to 25ºC (68 to 77ºF). [See USP Controlled Room Temperature.]Manufactured by Hospira, Inc., Lake Forest, IL 60045 USAN+ and NOVAPLUS are registered trademarks of Vizient, Inc.LAB-1066-1.0Revised: 9/2017Chromium (Chromic Chloride Injection, USP) is supplied as follows:Store at 20 to 25ºC (68 to 77ºF). [See USP Controlled Room Temperature.]Manufactured by Hospira, Inc., Lake Forest, IL 60045 USAN+ and NOVAPLUS are registered trademarks of Vizient, Inc.LAB-1066-1.0Revised: 9/2017
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
Trivalent chromium is part of glucose tolerance factor, an essential activator of insulin-mediated reactions. Chromium helps to maintain normal glucose metabolism and peripheral nerve function.
Providing chromium during TPN helps prevent deficiency symptoms including impaired glucose tolerance, ataxia, peripheral neuropathy and a confusional state similar to mild/moderate hepatic encephalopathy.
Serum chromium is bound to transferrin (siderophilin) in the beta globulin fraction. Typical blood levels for chromium range from 1 to 5 mcg/liter, but blood levels are not considered a meaningful index of tissue stores. Administration of chromium supplements to chromium-deficient patients can result in normalization of the glucose tolerance curve from the diabetic-like curve typical of chromium deficiency. This response is viewed as a more meaningful indicator of chromium nutriture than serum chromium levels.
Excretion of chromium is via the kidneys, ranging from 3 to 50 mcg/day. Biliary excretion via the small intestine may be an ancillary route, but only small amounts of chromium are believed to be excreted in this manner.
Non-Clinical Toxicology
None known.Direct intramuscular or intravenous injection of Chromium 4 mcg/mL (Chromic Chloride Injection, USP) is contraindicated, as the acidic pH of the solution may cause considerable tissue irritation.
Severe kidney disease may make it necessary to reduce or omit chromium and zinc doses because these elements are primarily eliminated in the urine.
WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.
Thiazides may add to or potentiate the action of other antihypertensive drugs. See for concomitant use with other antihypertensive drugs.
The effect of oral anticoagulants may be decreased when used concurrently with hydrochlorothiazide; dosage adjustments may be necessary.
Triamterene and hydrochlorothiazide capsules, USP may raise the level of blood uric acid; dosage adjustments of antigout medication may be necessary to control hyperuricemia and gout.
The following agents given together with triamterene may promote serum potassium accumulation and possibly result in hyperkalemia because of the potassium-sparing nature of triamterene, especially in patients with renal insufficiency: blood from blood bank (may contain up to 30 mEq of potassium per liter of plasma or up to 65 mEq per liter of whole blood when stored for more than 10 days); low-salt milk (may contain up to 60 mEq of potassium per liter); potassium-containing medications (such as parenteral penicillin G potassium); salt substitutes (most contain substantial amounts of potassium).
Exchange resins, such as sodium polystyrene sulfonate, whether administered orally or rectally, reduce serum potassium levels by sodium replacement of the potassium; fluid retention may occur in some patients because of the increased sodium intake.
Chronic or overuse of laxatives may reduce serum potassium levels by promoting excessive potassium loss from the intestinal tract; laxatives may interfere with the potassium-retaining effects of triamterene.
The effectiveness of methenamine may be decreased when used concurrently with hydrochlorothiazide because of alkalinization of the urine.
Do not use unless solution is clear and seal is intact. Chromium 4 mcg/mL (Chromic Chloride Injection, USP) should only be used in conjunction with a pharmacy directed admixture program using aseptic technique in a laminar flow environment; it should be used promptly and in a single operation without any repeated penetrations. Solution contains no preservatives; discard unused portion immediately after admixture procedure is completed.
In assessing the contribution of chromium supplements to maintenance of glucose homeostasis, consideration should be given to the possibility that the patient may be diabetic.
None known.
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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