arginine (Rx)

Brand and Other Names:L-arginine, RGene-10
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intravenous solution

  • 30g/300mL

Pituitary Stimulation

Used as a diagnostic pituitary stimulant to measure human growth hormone (hGH) reserve for conditions such as panhypopituitarism, pituitary dwarfism, chromophobe adenoma, postsurgical craniopharyngioma, hypophysectomy, pituitary trauma, acromegaly, gigantism, and problems of growth and stature

300 mL (30 g) IV infused over 30 minutes

Test procedure

  • Schedule AM
  • Fast overnight and continue through test period
  • Place patient on bed rest for at least 30 minutes before infusion begins
  • Take sample draws at -30, 0, 30, 60, 90, 120 and 150 minutes
  • To confirm negative response to insulin hypoglycemia test allow 1 day waiting period after insulin test patients may not respond during first test, second test may be performed after 1 day waiting period

Hemoglobinopathies & Thalassemia (Orphan)

Indicated for treatment of beta-hemoglobinopathies and beta-thalassemia

Orphan indication sponsor

  • Perrine, Susan P, MD; Boston University, Cancer Research Center; Boston, MA 02118

Dosage Forms & Strengths

intranvenous solution

  • 30g/300mL

Pituitary Stimulation

Used as a diagnostic pituitary stimulant to measure human growth hormone (hGH) reserve for conditions such as panhypopituitarism, pituitary dwarfism, chromophobe adenoma, postsurgical craniopharyngioma, hypophysectomy, pituitary trauma, acromegaly, gigantism, and problems of growth and stature

0.5 g/kg IV infused over 30 minutes; not to exceed 30 g/dose

Test procedure

  • Schedule AM
  • Fast overnight and continue through test period
  • Place patient on bed rest for at least 30 minutes before infusion begins
  • Take sample draws at -30, 0, 30, 60, 90, 120 and 150 minutes
  • To confirm negative response to insulin hypoglycemia test allow 1 day waiting period after insulin test patients may not respond during first test, second test may be performed after 1 day waiting period
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Interactions

Interaction Checker

and arginine

No Results

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (12)

                • amyl nitrite

                  amyl nitrite, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • dichlorphenamide

                  dichlorphenamide, arginine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

                • glyceryl trinitrate pr

                  glyceryl trinitrate pr, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • isosorbide dinitrate

                  isosorbide dinitrate, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • isosorbide mononitrate

                  isosorbide mononitrate, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nicorandil

                  nicorandil, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nitroglycerin IV

                  nitroglycerin IV, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nitroglycerin PO

                  nitroglycerin PO, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nitroglycerin sublingual

                  nitroglycerin sublingual, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nitroglycerin topical

                  nitroglycerin topical, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nitroglycerin transdermal

                  nitroglycerin transdermal, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                • nitroglycerin translingual

                  nitroglycerin translingual, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

                Minor (0)

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                  Adverse Effects

                  1-10%

                  Headache (3%)

                  Flushing (3%)

                  Nausea (3%)

                  Vomiting (3%)

                  Numbness (3%)

                  Local venous irritation (3%)

                  <1%

                  Macular rash

                  Swelling of hands and feet

                  Hematuria

                  Hyperkalemia

                  Skin burn/necrosis

                  Loss of consciousness

                  Perioral tingling

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                  Warnings

                  Contraindications

                  Hypersensitivity to product or components

                  Cautions

                  Hypersensitivity reactions, including anaphylaxis reported

                  Confirm with 2nd test if diagnosis results show hGH deficiency; allow 1 day waiting period between tests

                  Avoid overdosage in pediatric patients (risk of causing metabolic acidosis, cerebral edema, or death)

                  Administer IV route only

                  Electorlyte imbalances including hypophosphatemia, hyponatremia (following overdose) and acidosis, and hyperkalemia reported with arginine infusions; risk may increase in renal impairment, diabetes mellitus, and hepatic impairment

                  Not intended for therapeutic use

                  Use caution in patients with electrolyte imbalance

                  Use caution in diabetes mellitus (may lead to life-threatening hyperkalemia)

                  Tissue damage may occur with extravasation

                  Avoid use in myocardial infarction

                  Use caution in impaired renal function or electrolyte imbalance

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                  Pregnancy & Lactation

                  Pregnancy Category: B

                  Lactation: Enters breast milk, use caution

                  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

                  Induces rise of human growth hormone (HGH); patients with impaired pituitary function have lower or no increase in plasma concentration of growth hormone following arginine administration; used as test for pituitary function

                  Pharmacokinetics

                  Peak serum time: ~20-30 min (IV)

                  Half-life: 0.7-1.3 hr

                  Vd: ~33 L/kg following 30 g IV dose

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                  Administration

                  IV Preparation

                  A special air-inletting, air-filtering set w/ bacterial air filter is required

                  No airway needle is needed

                  Remove metal seal and metal disc from bottle to expose rugger stopper

                  Do not contaminate target site of stopper

                  With shut-off clamp closed, remove sterility protector from spike of administration set and immediately insert set with quick trust into center of stopper with bottle upright on table (ie, push straight in, DO NOT twist)

                  Invert bottle to establish fluid level in drip chamber and to check for vacuum by observing rising air bubbles

                  Discard bottle if no vacuum or solution not clear

                  Clear tubing of air and proceed with infusion

                  Patients ≤59 kg: Withdraw weight based dose from a sealed bottle and place in a separate container for IV infusion to avoid inadvertent administration of the total volume from the commercially available container

                  IV Administration

                  Infuse through indwelling needle or soft catheter; take blood samples from contralateral arm

                  Infuse over 30 min

                  Storage

                  Avoid excessive heat, store at 25 C

                  Do not use solution previously frozen

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                  Images

                  No images available for this drug.
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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.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
                  Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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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.