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: 25% albumin: 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).
Cirrhotic ascites, therapeutic paracentesis (adjunct treatment):
25% albumin: IV: 5 to 10 g for every liter removed (usual dose cited: 8 g for every liter removed) (Bernardi 2012; Moore 2003; AASLD [Runyon 2013]) 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).
Hepatorenal syndrome (type 1) (adjunctive therapy) (off-label use):
Note: Used in combination with terlipressin (not available in the United States) or midodrine plus octreotide (Runyon 2021a).
25% albumin: IV: Initial: 1 g/kg daily for 2 days (maximum: 100 g/day), followed by 20 to 50 g daily until terlipressin or midodrine plus octreotide is discontinued (Angeli 1999; Cavallin 2015; Runyon 2021a).
Hypovolemia: Note: For replacement of volume deficit, 5% albumin is generally preferred.
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.
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, therapeutic: 5% albumin: IV: Titrate dose to plasma volume removed during procedure.
Spontaneous bacterial peritonitis, treatment (off-label use):
Note: Some experts reserve for patients with creatinine >1 mg/dL, BUN >30 mg/dL, or bilirubin >4 mg/dL (Runyon 2021b; Sigal 2007; Sort 1999).
25% albumin: IV: Initial: 1.5 g/kg within 6 hours of diagnosis in combination with appropriate antimicrobial therapy, followed by 1 g/kg on day 3 (AASLD [Biggins 2021]; Abd Elaal 2012; Sigal 2007; Sort 1999); a possible alternative dose is 1 g/kg once daily for 2 days but it is not well studied (AASLD [Biggins 2021]). While the maximum albumin dose varies in clinical practice, some experts suggest not exceeding 100 g per dose (Runyon 2021b).
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
(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).
There are no dosing adjustments provided in the manufacturer's labeling; use with caution.
There are no dosing adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
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])
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)
Yes
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)
IV: For IV administration only. Note: Some products may require a filter; refer to product labeling. Rate of infusion is dependent upon use and clinical condition. See indication for specific rates in dosing or refer to institutional protocol. Too rapid infusion may result in vascular overload. In emergencies, may administer as rapidly as necessary to improve clinical condition.
Manufacturer's recommended maximum administration rates:
5%, 25%: Typically, not recommended to exceed 1 to 2 mL/minute in patients without shock.
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. Do not use with ethanol or protein hydrolysates (precipitation may form).
Parenteral: IV: Note: Some products may require a filter; refer to product labeling. Rate of infusion is dependent upon use and clinical condition. See indication-specific rates in dosing or refer to institutional protocol. Too rapid infusion may result in vascular overload. In emergencies, may administer as rapidly as necessary to improve clinical condition.
Manufacturer recommended maximum administration rates:
5%: Do not exceed 1 mL/minute in patients with normal plasma volume (manufacturer's labeling).
25%: Do not exceed 1 to 2 mL/minute in patients without shock (manufacturer's labeling).
Acute respiratory distress syndrome (25% solution only): To correct interstitial pulmonary edema (in combination with diuretics) and hypoproteinemia associated with acute respiratory distress syndrome.
Cirrhotic ascites, therapeutic paracentesis (adjunct treatment): To maintain intravascular volume following removal of large-volume paracentesis in cirrhotic patients.
Hypovolemia: Plasma volume expansion and maintenance of intravascular volume in select patients for the treatment of hypovolemia (with or without shock). For replacement of volume deficit, 5% solution is generally preferred.
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.
Plasma exchange, therapeutic: 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.
Hepatorenal syndrome (type 1); Spontaneous bacterial peritonitis, treatment
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
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
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).
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). Avoid use for resuscitation in patients with traumatic brain injury due to increased mortality when used in this population (Myburgh 2007).
• 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.
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.
None known.
There are no known significant interactions.
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).
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.
Some products may contain potassium and/or sodium.
Monitor electrolytes, hemoglobin/hematocrit, and urine output regularly; monitor hemodynamic parameters, blood pressure, heart rate, central venous pressure, pulmonary artery occlusion pressure.
Provides increase in intravascular oncotic pressure and causes mobilization of fluids from interstitial into intravascular space
Half-life: 15 to 20 days
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
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