Lipid emulsion

- Lipid emulsion 20%, 100ml vials* and 500ml bags* (IV)

  *Intralipid® and Smoflipid® formulations

Executive Summary

(March 29, 2023)

Intravenous lipid emulsion (IVLE) is a nutritional supplement approved by the US-FDA for parenteral nutrition (22, 23), that have promising results for the treatment of lipophilic agents toxicity, mostly for local anesthetic systemic toxicity (LAST): 


Adult dose for Local Anesthetic Systemic Toxicity (LAST)(9, 11, 17, 18, 19)

Intralipid® 20%, 1,5 ml/kg IV bolus over 1 minute (approximately 100ml in adults), followed by an infusion of 0.25ml/kg/min IV over the next 30-60 minutes. 

Adult dose

Adult dose for Local Anesthetic Systemic Toxicity (LAST)(9, 11, 17, 18, 19)


Adult dose for non-local anesthetics acute toxicity 

Usage of IVLE for other lipophilic agents overdose such as calcium channel blockers, tricyclic antidepressants, beta-adrenergic antagonists, etc, has not been yet validated as a  standard treatment measure. 

Indications

US FDA-Labeled (22, 23)

Off-label (6, 10, 12, 19)

About LAST

Local Anesthetics Systemic Toxicity (LAST)

Guidelines on lipid emulsion for LAST

A precise dosing regimen is not yet well established (5, 6, 13, 17, 18, 19).

Mechanism of action for acute toxicity

The mechanisms of action of IVLE in toxicology are not well understood. There are three proposed mechanisms (19):

Brands

Cautions

In depth safety*concerns about Intralipid® and Smoflipid® are discussed in labeling information (22, 23). 

*Known safety data have been studied in IVLE as a nutritional supplement, not for acute toxicity management (6, 8). 


Black Box Warning** (22):


**Black box warning is not included in Smoflipid labeling (23).


Contraindications (22, 23)


Comments

Pharmacology

Pregnancy and Lactation

Pregnancy risk classification


Comments

References

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