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Albumin solution: Drug information

Copyright 1978-2021 Lexicomp, Inc. All rights reserved.

(For additional information see "Albumin solution: Patient drug information" and see "Albumin solution:
Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp ( show table)

Brand Names: US
Albuked 25; Albuked 5; Albumin-ZLB; Albuminar-25 [DSC]; Albuminar-5 [DSC]; Albuminex;
AlbuRx; Albutein; Buminate [DSC]; Flexbumin; Human Albumin Grifols; Kedbumin;
Plasbumin-25; Plasbumin-5

Brand Names: Canada

Alburex-25; Alburex-5; Albutein; Octalbin; Plasbumin-25; Plasbumin-5

Pharmacologic Category
Blood Product Derivative; Plasma Volume Expander, Colloid

Dosing: Adult
Note: Use 5% solution in hypovolemic patients or intravascularly depleted patients. Use 25%
solution in patients in whom fluid and sodium intake is restricted or to mobilize fluids.

Usual dose: IV: 25 g; initial dose may be repeated in 15 to 30 minutes if response is

inadequate.

Adult respiratory distress syndrome: IV: 25 g over 30 minutes (in combination with
furosemide); may repeat at 8 hours (if necessary) for 3 days; titrate to fluid loss and
normalization of serum total protein. Patients enrolled into the clinical trial had
hypoproteinemia (total protein <6 g/dL) (Martin 2005).

Hypovolemia: 5% albumin: IV: Initial: 12.5 to 25 g (250 to 500 mL); repeat after 15 to 30
minutes as needed (if hemodynamic stability is not achieved). Note: May be considered
after inadequate response to crystalloid therapy and when nonprotein colloids are
contraindicated. The volume administered and the rate of infusion should be adapted to
individual response.
 Large-volume paracentesis: IV:

25% albumin: 5 to 10 g for every liter removed (usual dose cited: 8 g for every liter
removed) (Bernardi 2012; Moore 2003; AASLD [Runyon 2012]) or 50 g total for
paracentesis >5 L (ATS 2004). Note: Administer soon after the procedure to avoid
postprocedural complications (eg, hypovolemia, hyponatremia, renal impairment)
(Moore, 2003).

Manufacturer's labeling: Dosing in the prescribing information may not reflect

current clinical practice. 25% albumin: 8 g for every liter removed.

Ovarian hyperstimulation syndrome (treatment): 25% albumin: IV: 50 to 100 g over 4

hours; repeat at 4 to 12 hours intervals as needed.

Plasma exchange: 5% albumin: IV: Titrate dose to plasma volume removed during
procedure.

Spontaneous bacterial peritonitis (treatment) (off-label use): 25% albumin: IV: Initial:
1.5 g/kg within 6 hours of diagnosis (in conjunction with appropriate antimicrobial
therapy), followed by 1 g/kg on day 3 (Abd 2012; AASLD [Runyon 2012]; Sort 1999). Note:
Clinical trials used albumin 20%; the difference in concentration compared with 25%
albumin is deemed to be clinically inconsequential.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Pediatric

(For additional information see "Albumin solution: Pediatric drug information")

Note: Albumin 5% should be used in hypovolemic or intravascularly depleted patients;
albumin 25% should be used in patients with fluid or sodium restrictions (eg, patients with
hypoproteinemia and generalized edema, or nephrotic syndrome). Dose depends on
condition of patient:

Ascites with hypoalbuminemia: Limited data available: Infants, Children, and

Adolescents: 25% albumin: IV: 0.5 to 1 g/kg/dose over 2 to 3 hours; may repeat up to 3
times per day until albumin is >2.5 g/dL; maximum dose: 25 g/dose (Giefer 2011; Lane
2015; Sabri 2003).

Hypovolemia, plasma volume expansion, including hypovolemic shock: Infants,

Children, and Adolescents: 5% albumin: IV: 0.5 to 1 g/kg/dose (10 to 20 mL/kg/dose) over
 5 to 10 minutes (SCCM [Dellinger 2013]; manufacturer's labeling). Note: Usual adult
dose: 12.5 to 25 g/dose (250 to 500 mL/dose). May repeat after 15 to 30 minutes if
response is not adequate.

Large volume paracentesis: Limited data available: Infants, Children, and Adolescents:
5% or 25% albumin: IV: 0.5 to 1 g/kg over 1 to 2 hours after paracentesis (Giefer 2011;
Kramer 2001).

Nephrotic syndrome edema, refractory: Infants, Children, and Adolescents: 25%

albumin: IV: 0.5 to 1 g/kg/dose over 30 to 60 minutes followed by diuretic therapy
(Kliegman 2020; Robinson 2003).

Dosing: Renal Impairment: Pediatric

There are no dosing adjustments provided in the manufacturer's labeling; use with caution.

Dosing: Hepatic Impairment: Pediatric

There are no dosing adjustments provided in the manufacturer's labeling.

Dosing: Geriatric
Refer to adult dosing.

Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult
specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Albumin-ZLB: 5% (250 mL, 500 mL); 25% (50 mL, 100 mL)

Albuminar-5: 5% (250 mL [DSC], 500 mL [DSC])

Albuminar-25: 25% (50 mL [DSC], 100 mL [DSC])

Albutein: 25% (50 mL, 100 mL)

Buminate: 5% (250 mL [DSC], 500 mL [DSC]); 25% (20 mL [DSC])

Plasbumin-5: 5% (50 mL [DSC], 250 mL [DSC])

Plasbumin-25: 25% (20 mL [DSC], 50 mL [DSC], 100 mL [DSC])

Generic: 25% (50 mL, 100 mL)

Solution, Intravenous [preservative free]:

Albuked 5: 5% (250 mL)

 Albuked 25: 25% (50 mL, 100 mL)

Albuminex: 5% (250 mL, 500 mL); 25% (50 mL, 100 mL)

AlbuRx: 5% (250 mL, 500 mL)

Albutein: 5% (50 mL, 250 mL, 500 mL); 25% (20 mL, 50 mL, 100 mL)

Flexbumin: 5% (250 mL); 25% (50 mL, 100 mL)

Human Albumin Grifols: 25% (50 mL, 100 mL)

Kedbumin: 25% (50 mL, 100 mL)

Plasbumin-5: 5% (50 mL, 250 mL)

Plasbumin-25: 25% (20 mL, 50 mL, 100 mL)

Generic: 5% (100 mL, 250 mL, 500 mL); 25% (50 mL, 100 mL)

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.

Solution, Intravenous:

Alburex-5: 5% (100 mL, 250 mL, 500 mL)

Alburex-25: 25% (50 mL, 100 mL)

Albutein: 5% (250 mL); 25% (100 mL)

Plasbumin-5: 5% (50 mL, 250 mL, 500 mL)

Plasbumin-25: 25% (50 mL, 100 mL)

Generic: 5% (50 mL, 100 mL, 250 mL, 500 mL); 25% (50 mL, 100 ea, 100 mL)

Administration: Adult

For IV administration only. Infusion rate depends on indication and clinical situation. In
emergencies, may administer as rapidly as necessary to improve clinical condition. After
initial volume replacement:

5%: Do not exceed 2 to 4 mL/minute in patients with normal plasma volume; 5 to 10

mL/minute in patients with hypoproteinemia
 25%: Do not exceed 1 mL/minute in patients with normal plasma volume; 2 to 3
mL/minute in patients with hypoproteinemia

Rapid infusion may cause vascular overload. Albumin 25% may be given undiluted or
diluted in normal saline. May give in combination or through the same administration
set as saline or carbohydrates. Warm to room temperature before use if large volumes
are administered. Use within 4 hours after entering package; discard unused portion.
Some products may require a filter; refer to product labeling. Do not use with ethanol or
protein hydrolysates (precipitation may form).

Administration: Pediatric

Parenteral: IV: Too rapid infusion may result in vascular overload. Rate of infusion
dependent upon use and clinical condition. In emergencies, may administer as rapidly as
necessary to improve clinical condition. Some products may require a filter; refer to
product labeling and institutional protocol. After initial volume replacement:

5%: Do not exceed 2 to 4 mL/minute in patients with normal plasma volume; 5 to 10

mL/minute in patients with hypoproteinemia.

25%: Do not exceed 1 mL/minute in patients with normal plasma volume; 2 to 3

mL/minute in patients with hypoproteinemia.

Use: Labeled Indications

Acute respiratory distress syndrome (25% solution only): To correct interstitial

pulmonary edema and hypoproteinemia associated with acute respiratory distress
syndrome in conjunction with diuretics.

Cirrhotic ascites, adjunct treatment: To maintain intravascular volume following

removal of large-volume paracentesis in cirrhotic patients.

Erythrocyte resuspension: To avoid excessive hypoproteinemia, during certain types of

exchange transfusion, or with the use of very large volumes or previously frozen or
washed red cells.

Hypovolemia: Plasma volume expansion and maintenance of intravascular volume in

the emergency treatment of hypovolemia (with or without shock).

Neonatal hemolytic disease: Binds and detoxifies unconjugated bilirubin in severe

hemolytic disease of the newborn during exchange transfusion.

Nephrosis (acute), adjunct: Treatment of edema in patients with acute nephrosis in

combination with diuretics.
 Ovarian hyperstimulation syndrome, treatment (25% solution only): As a plasma
volume expander in fluid management for the treatment of severe ovarian
hyperstimulation syndrome.

Use: Off-Label: Adult

Cirrhosis (in combination with diuretics to facilitate diuresis); Spontaneous bacterial

peritonitis (treatment); Volume expansion in dehydrated, mildly hypotensive patients with
cirrhosis

Medication Safety Issues

Sound-alike/look-alike issues:

Albuminar-25 (albumin) may be confused with Privigen (immune globulin) due to

similar packaging

Albutein may be confused with albuterol

Buminate may be confused with bumetanide

Adverse Reactions
The following adverse drug reactions and incidences are derived from product labeling
unless otherwise specified. Frequency not defined.

Cardiovascular: Cardiac failure (precipitation), edema, hypertension, hypotension,

tachycardia

Central nervous system: Chills, headache

Dermatologic: Pruritus, skin rash, urticaria

Endocrine & metabolic: Hypervolemia

Gastrointestinal: Nausea, vomiting

Hypersensitivity: Anaphylaxis

Respiratory: Bronchospasm, pulmonary edema

Miscellaneous: Fever

Contraindications
Hypersensitivity to albumin or any component of the formulation; severe anemia, heart
failure; patients at risk of volume overload (eg, patients with renal insufficiency, severe
anemia, stabilized chronic anemia, or heart failure); dilution with sterile water for injection
(may cause hemolysis or acute renal failure)
Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity: Severe allergic or anaphylactic reaction may occur. Discontinue

immediately and manage appropriately if allergic or anaphylactic reactions are
suspected.

• Coagulation abnormality: Large replacement volumes may result in coagulation

abnormality. Monitor and replete with blood constituents if indicated.

• Electrolyte imbalance: Large replacement volumes may result in electrolyte

imbalance. Monitor electrolytes and replace or maintain as indicated.

• Hemodynamic effects: Cardiac or respiratory failure, renal failure, or increasing

intracranial pressure can occur; closely monitor hemodynamic parameters in all
patients.

• Hypervolemia/hemodilution: Use with caution in conditions where hypervolemia

and its consequences or hemodilution may increase the risk of adverse effects (eg,
heart failure, pulmonary edema, hypertension, hemorrhagic diathesis, esophageal
varices). Adjust rate of administration per hemodynamic status and solution
concentration; monitor closely with rapid infusions. Avoid rapid infusions in patients
with a history of cardiovascular disease (may cause circulatory overload and
pulmonary edema). Discontinue at the first signs of cardiovascular overload (eg,
headache, dyspnea, jugular venous distention, rales, abnormal elevations in
systemic or central venous blood pressure). All patients should be observed for signs
of hypervolemia, such as pulmonary edema. Monitor blood pressure.

Disease-related concerns:

• Critical illness: In patients with increased microvascular permeability (eg, sepsis,

trauma, burn), the translocation of fluid from the interstitial compartment to the
intravascular compartment may decrease due to increased albumin in the interstitial
space. Furthermore, in extreme microvascular permeability states, administration of
albumin (or other colloids) may increase the net flux of fluid into the interstitial
space reducing intravascular volume and precipitating edematous states (eg,
pulmonary edema) (Roberts, 1998).

• Hepatic impairment: Use with caution in patients with hepatic impairment; protein
load may exacerbate or precipitate encephalopathy.

• Renal impairment: Use with caution in patients with renal impairment; protein load
may precipitate azotemia. Patients with chronic renal insufficiency receiving albumin
 solution may be at risk for accumulation of aluminum and potential toxicities (eg,
hypercalcemia, vitamin D refractory osteodystrophy, anemia, severe progressive
encephalopathy).

Special populations:

• Sodium restricted patients: Use with caution in those patients for whom sodium
restriction is necessary. Albumin 5% and 25% solutions contain 130 to 160 mEq/L
sodium and are considered isotonic with plasma.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum (Kelly, 1989); toxic
aluminum concentrations may be seen with high doses, prolonged use, or renal
dysfunction. Premature neonates are at higher risk due to immature renal function
and aluminum intake from other parenteral sources. Parenteral aluminum exposure
of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may
occur at lower doses (Federal Register 2002). See manufacturer's labeling.

• Dilution: Do not dilute 5% albumin with sterile water for injection (may result in
hemolysis and/or renal failure).

• Human plasma: Product of human plasma; may potentially contain infectious

agents which could transmit disease. Screening of donors, as well as testing and/or
inactivation or removal of certain viruses, reduces the risk. Infections thought to be
transmitted by this product should be reported to the manufacturer.

• Latex: Packaging may contain natural latex rubber.

Warnings: Additional Pediatric Considerations

In neonates, use the 25% concentration with extreme caution due to risk of intraventricular
hemorrhage (from rapid expansion of the intravascular volume); infuse slowly.

Due to the occasional shortage of 5% human albumin, 5% solutions may at times be

prepared by diluting 25% human albumin with NS or with D5W (if sodium load is a concern);
however, do not use sterile water to dilute albumin solutions, as this may result in hypotonic-
associated hemolysis which can be fatal.

Metabolism/Transport Effects
None known.

Drug Interactions
(For additional information: Launch drug interactions program)
There are no known significant interactions.

Pregnancy Considerations
Albumin is an endogenous substance; products are prepared from pooled human plasma.
Available data are insufficient to recommend use of albumin to reduce the risk of ovarian
hyperstimulation syndrome (Practice Committee 2016). Use for other indications may be
considered in pregnant women when contraindications to nonprotein colloids exist
(Liumbruno 2009).

Breast-Feeding Considerations

Endogenous albumin is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should

consider the risk of infant exposure, the benefits of breastfeeding to the infant, and
benefits of treatment to the mother.

Dietary Considerations
Some products may contain potassium and/or sodium.

Monitoring Parameters
Monitor electrolytes, hemoglobin/hematocrit, and urine output regularly; monitor
hemodynamic parameters, blood pressure, heart rate, central venous pressure, pulmonary
artery occlusion pressure.

Mechanism of Action
Provides increase in intravascular oncotic pressure and causes mobilization of fluids from
interstitial into intravascular space

Pharmacodynamics and Pharmacokinetics

Half-life: 15 to 20 days

Pricing: US

Solution (Albuked 25 Intravenous)

25% (per mL): $1.15

Solution (Albuked 5 Intravenous)

5% (per mL): $0.23

Solution (Albumin Human Intravenous)

5% (per mL): $0.33

 25% (per mL): $1.38 - $2.16

Solution (Albuminex Intravenous)

5% (per mL): $0.34

25% (per mL): $1.68

Solution (Albutein Intravenous)

5% (per mL): $0.22

25% (per mL): $1.10

Solution (Flexbumin Intravenous)

5% (per mL): $0.28

25% (per mL): $1.39

Solution (Human Albumin Grifols Intravenous)

25% (per mL): $2.16

Solution (Plasbumin-25 Intravenous)

25% (per mL): $1.18

Solution (Plasbumin-5 Intravenous)

5% (per mL): $0.78

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided
as reference price only. A range is provided when more than one manufacturer's AWP price is
available and uses the low and high price reported by the manufacturers to determine the
range. The pricing data should be used for benchmarking purposes only, and as such should
not be used alone to set or adjudicate any prices for reimbursement or purchasing functions
or considered to be an exact price for a single product and/or manufacturer. Medi-Span
expressly disclaims all warranties of any kind or nature, whether express or implied, and
assumes no liability with respect to accuracy of price or price range data published in its
solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or
consequential damages arising from use of price or price range data. Pricing data is updated
monthly.

Brand Names: International

Acebumin (PE); Alba (IN); Albapure (ID, TW); Albiomin (TH); Albotein (IT); Albuman (IS, MT);
Albumar (MX); Albumax (PH); Albumer (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU,
MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW); Albumex (AU, NZ); Albumex 20 (HK);
Albumin 5% (CH); Albumin 5% Human (DE); Albumin Human Salzarm 25% (DE); Albumina
Humana (BR, CU); Albuminar (BR, ID, PH, VN); Albuminar 25 (TH); Albuminativ (AT, SE);
Albuminative (QA, SA); Albumine-LFB (HK); Albunate (MX); Albunorm (BG, HR, HU, IE, LU, LV,
MY, NL, NO, PH, RO, SI, UA); Alburel (PH, ZW); Alburex (CO, CY); Alburx (CN, VN); Albusol (ZA);
Albutein (AE, BH, EG, HR, LB, LK, PH, SA, VN); Albutein 25% (BR, CN, HK); Biseko (PL);
Buminate (SA); Buminate 25% (HK, PH); Cealb (AE); Flexbumin (CZ, IE, LV, SK, VN); Human
Albumin 25% (DE); Human Albumin 5% (DE); Kedrialb (PH); Octalbin (CR, DK, DO, ES, FI, GT,
HN, ID, MX, NZ, PA, SV); Plasbumin (AE, ID, KW, LB, SG); Seralbumin (PY); SRK (CH); Uman
Albumin (IL); Vialebex (FR); Vialebex -Wilson (HK); Volumin (IN); Zenalb (GR, IL, MT, SG, TH,
VN); Zenalb 20 (CO)

For country abbreviations used in Lexicomp ( show table)

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