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R-GENE® 10 Warnings and Precautions (arginine HCl)

WARNINGS

There have been reports of overdosage of R-Gene 10 in pediatric patients leading to death. EXTREME CAUTION MUST BE EXERCISED WHEN INFUSING R-GENE 10 INTO PEDIATRIC PATIENTS. OVERDOSAGE OF R-GENE 10 IN PEDIATRIC PATIENTS CAN RESULT IN HYPERCHLOREMIC METABOLIC ACIDOSIS, CEREBRAL EDEMA, OR POSSIBLY DEATH.

Hypersensitivity reactions, including anaphylaxis have been reported. Appropriate medical support should be available during R-Gene 10 administration. If anaphylaxis or other serious hypersensitivity reaction occurs, R-Gene 10 should be discontinued and appropriate medical treatment initiated.

R-Gene 10 should always be administered by intravenous infusion because of its hypertonicity.

R-Gene 10 is a diagnostic aid and is not intended for therapeutic use.


PRECAUTIONS

General

R-Gene 10 is a hypertonic (950 mOsmol/liter) and acidic (average pH of 5.6) solution that can cause irritation and damage to tissues. Care should be used to ensure administration of R-Gene 10 through a patent catheter within a patent vein. Excessive rates of infusion may result in local irritation and in flushing, nausea, or vomiting. Inadequate dosing or prolongation of the infusion period may diminish the stimulus to the pituitary and nullify the test.

The arginine in R-Gene 10 can be metabolized resulting in nitrogen-containing products for excretion. The effect of an acute amino acid or nitrogen burden upon patients with impairment of renal function should be considered when R-Gene 10 is to be administered.

The chloride content of R-Gene 10 is 47.5 mEq per 100 mL of solution, and the effect of infusing this amount of chloride into patients with electrolyte imbalance should be evaluated before the test is undertaken.

It should be noted that the basal and post stimulation levels of growth hormone are elevated in patients who are pregnant or are taking oral contraceptives.

Carcinogenesis, mutagenesis, and impairment of fertility

Long term animal studies have not been performed to evaluate the carcinogenic potential, the mutagenic potential or the effect on fertility of intravenously administered R-Gene 10.

Pregnancy

Reproduction studies have been performed in rabbits and mice at doses 12 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus due to R-Gene 10 (10% Arginine Hydrochloride Injection, USP). There have been no adequate or well controlled studies for the use of R-Gene 10 in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should not be used during pregnancy.

Nursing Mothers

It is not known whether intravenous administration of R-Gene 10 could result in significant quantities of arginine in breast milk. Systemically administered amino acids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when R-Gene 10 is to be administered to nursing women.

Geriatric Use

Clinical studies of arginine did not include a sufficient number of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.

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