Tromethamine (tromethamine)
Agents to treat Metabolic Acidosis Intravenous Intravenous Solution
Last reviewed · Source: First Databank (FDB) drug data
Overview
Generic name: tromethamine
Drug class: Agents to treat Metabolic Acidosis
Therapeutic class: Electrolyte Balance-Nutritional Products
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Tromethamine
Indications
The following indications are listed for Tromethamine:
- Metabolic Acidosis
Dosing
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Drug interactions
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Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Urinary Alkalinizers/Methenamine
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Urinary alkalinizers may elevate urinary ph preventing the conversion of methenamine to formaldehyde and mandelic acid.(1)
CLINICAL EFFECTS: Concurrent administration may result in alkalinization of the urine causing methenamine to be less effective.(1)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: The Australian and UK manufacturers of methenamine state that concurrent use with agents that make urine alkaline or urine alkalinizing agents should be avoided.(2,3) Patients receiving concurrent therapy should be monitored for urinary ph and any worsening symptoms of their infection, including dysuria, flank pain, or fever.(1)
DISCUSSION: Administration of urinary alkalinizers may result in alkalinization of the urine resulting in therapeutic failure of methenamine. Formaldehyde is released by acid hydrolysis from methenamine resulting in bactericidal concentrations at urinary ph 5.0 to 5.5. Above urinary ph 6.0 there is insufficient quantities of formaldehyde and methenamine released to achieve a therapeutic response.(1) An in vitro study showed that methenamine efficacy is achieved when the urine pH is less than 5.7 to 5.85.(4)
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Urinary Alkalinizers/Dextroamphetamine Transdermal
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Urinary alkalinizers decrease the renal elimination of dextroamphetamine.(1)
CLINICAL EFFECTS: Concurrent use of dextroamphetamine and urinary alkalinizers may result in increased dextroamphetamine levels and side effects.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Coadministration of dextroamphetamine with urinary alkalinizing agents should be avoided.(1)
DISCUSSION: Concurrent use of alkalinizing agents with dextroamphetamine decreases the renal elimination of dextroamphetamine. Co-administration of these should be avoided because of the potential of increased actions of dextroamphetamine.(1)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Urinary Alkalinizers/Memantine; Amantadine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Memantine and amantadine elimination is impaired by urinary alkalinization.(1,2)
CLINICAL EFFECTS: Potentiation of memantine or amantadine effects may be observed.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Monitor patient for adverse reactions such as dizziness, headache, or confusion if a urinary alkalinizer is required. The memantine or amantadine dose may need to be adjusted when a urinary alkalinizer is started or stopped.(1,2)
DISCUSSION: The clearance of memantine was reduced by about 80% under alkaline urine conditions at pH 8. Urine alkalinization may lead to an accumulation of memantine with a possible increase in adverse effects. Urine pH is also altered by diet and clinical state of the patient (e.g., renal tubular acidosis or severe infections of the urinary tract). Hence, memantine should be used with caution under these conditions.(1) A study in rats showed that concomitant administration of sodium bicarbonate with amantadine caused a decrease in amantadine renal clearance (1.16 vs. 0.76). Amantadine's area-under-the-curve (AUC) was increased approximately 78%.(3) A study in 12 healthy subjects showed that plasma concentrations of memantine are dependent on urine pH. Alkaline urine pH caused a 79% reduction in renal clearance.(4)
Urinary Alkalinizers/Quinidine
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Quinidine elimination is impaired by urinary alkalinization.
CLINICAL EFFECTS: Potentiation of quinidine effects may be observed.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Monitoring quinidine levels and cardiac function may be indicated. The quinidine dose may need to be adjusted when a urinary alkalinizer is started or stopped.
DISCUSSION: Additional documentation is necessary to confirm this potential interaction.
Urinary Alkalinizers/Sympathomimetics
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Unionized sympathomimetic amines will be reabsorbed into systemic circulation from the distal tubules of the kidneys.
CLINICAL EFFECTS: Enhanced sympathomimetic activity and increased risk of sympathomimetic toxicity.
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Watch patient for enhanced sympathomimetic side effects when urinary alkalinizers are concomitantly used. A lower dose of certain sympathomimetics may be required.
DISCUSSION: Signs and symptoms of sympathomimetic toxicity include euphoria, confusion, delirium, hallucinations and nervousness.
Contraindications
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- Anuria
- Salicylate intoxication
- Uremia
- Hyperkalemia
- Respiratory depression
- Hypoglycemic disorder
- Kidney disease with reduction in glomerular filtration rate (GFr)
Adverse reactions
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Rare or Very Rare
- Extravasation injury
- Hepatocellular damage
- Respiratory depression
Rare or Very Rare
- Hypoglycemic disorder
Precautions
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ICD codes
| Code | Type | Description |
|---|---|---|
| Metabolic acidosis | ||
| E08.1 | ICD10CM | Diabetes mellitus due to underlying condition with ketoacidosis |
| E08.10 | ICD10CM | Diabetes mellitus due to underlying condition with ketoacidosis without coma |
| E08.11 | ICD10CM | Diabetes mellitus due to underlying condition with ketoacidosis with coma |
| E09.1 | ICD10CM | Drug or chemical induced diabetes mellitus with ketoacidosis |
| E09.10 | ICD10CM | Drug or chemical induced diabetes mellitus with ketoacidosis without coma |
| E09.11 | ICD10CM | Drug or chemical induced diabetes mellitus with ketoacidosis with coma |
| E10.1 | ICD10CM | Type 1 diabetes mellitus with ketoacidosis |
| E10.10 | ICD10CM | Type 1 diabetes mellitus with ketoacidosis without coma |
| E10.11 | ICD10CM | Type 1 diabetes mellitus with ketoacidosis with coma |
| E11.1 | ICD10CM | Type 2 diabetes mellitus with ketoacidosis |
| E11.10 | ICD10CM | Type 2 diabetes mellitus with ketoacidosis without coma |
| E11.11 | ICD10CM | Type 2 diabetes mellitus with ketoacidosis with coma |
| E13.1 | ICD10CM | Other specified diabetes mellitus with ketoacidosis |
| E13.10 | ICD10CM | Other specified diabetes mellitus with ketoacidosis without coma |
| E13.11 | ICD10CM | Other specified diabetes mellitus with ketoacidosis with coma |
| E87.2 | ICD10CM | Acidosis |
| E87.20 | ICD10CM | Acidosis, unspecified |
| E87.21 | ICD10CM | Acute metabolic acidosis |
| E87.22 | ICD10CM | Chronic metabolic acidosis |
| E87.29 | ICD10CM | Other acidosis |
| P19 | ICD10CM | Metabolic acidemia in newborn |
| P19.0 | ICD10CM | Metabolic acidemia in newborn first noted before onset of labor |
| P19.1 | ICD10CM | Metabolic acidemia in newborn first noted during labor |
| P19.2 | ICD10CM | Metabolic acidemia noted at birth |
| P19.9 | ICD10CM | Metabolic acidemia in newborn, unspecified |
| P74.0 | ICD10CM | Late metabolic acidosis of newborn |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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