Parenteral nutrition additive (Vanek 2012): IV: 60 to 100 mcg/day
Deficiency from prolonged parenteral nutrition: IV: 100 mcg/day
(For additional information see "Selenium (trace element): Pediatric drug information")
Parenteral nutrition additive, maintenance requirement:
ASPEN recommendations:
Infants <10 kg: IV: 2 mcg/kg/day (ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]; ASPEN [Vanek 2012]; ASPEN [Vanek 2015]).
Infants and Children weighing 10 to 40 kg: IV: 1 to 2 mcg/kg/day (ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]); maximum daily dose: 100 mcg/day (ASPEN [Vanek 2012]; ASPEN [Vanek 2015]).
Children and Adolescents weighing >40 kg: IV: 2 mcg/kg/day; maximum daily dose: 100 mcg/day (ASPEN [Corkins 2015]; ASPEN [Vanek 2012]); ASPEN [Vanek 2015]).
ESPGHAN/ESPEN/ESPR/CSPEN recommendations (Demellöf 2018): Infants, Children, and Adolescents: IV: 2 to 3 mcg/kg/day; maximum daily dose: 100 mcg/day.
Infants, Children, and Adolescents: Use with caution; dose reduction or discontinuation may be necessary.
Infants, Children, and Adolescents: There are no dosage adjustments 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
Capsule, Oral:
Selenicaps-200: 200 mcg [DSC] [corn free, no artificial color(s), rye free, sugar free, wheat free, yeast free]
Capsule, Oral [preservative free]:
Se-100: 100 mcg [dye free, yeast free]
Liquid, Oral:
Aqueous Selenium: 95 mcg/drop (15 mL) [contains sodium benzoate]
Solution, Intravenous:
Generic: 40 mcg/mL (10 mL [DSC])
Solution, Intravenous [preservative free]:
Generic: 12 mcg/2 mL (2 mL); 60 mcg/mL (10 mL)
Tablet, Oral:
Oceanic Selenium: 50 mcg, 200 mcg [animal products free, gelatin free, gluten free, kosher certified, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]
Se Aspartate: 50 mcg
Se-Plus Protein: 200 mcg
Selenimin: 125 mcg [DSC] [corn free, rye free, starch free, sugar free, wheat free]
Selenimin-200: 200 mcg [DSC] [corn free, rye free, starch free, sugar free, wheat free, yeast free]
Generic: 50 mcg, 200 mcg
Tablet, Oral [preservative free]:
Generic: 50 mcg, 200 mcg
Tablet Extended Release, Oral [preservative free]:
Generic: 200 mcg [DSC]
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Micro-Se: 40 mcg/mL (10 mL)
Oral: Bariatric surgery: Tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. ER tablets should be swallowed whole. Do not break, crush, or chew. IR tablet, capsule, oral solution, and injectable formulations are available. If safety and efficacy can be effectively monitored, no change in formulation or administration is required after bariatric surgery. Bariatric vitamin supplementation is recommended on a lifelong basis after surgery; may consider integration of daily selenium regimen into the bariatric vitamin regimen.
IV infusion: Not for direct IV or IM injection; must be diluted; direct administration of solution causes tissue irritation.
Trace metal supplement
There are no adverse reactions listed in the manufacturer's labeling.
Undiluted administration into peripheral vein
Disease-related concerns:
• Gastrointestinal dysfunction: Use with caution in patients with GI impairment.
• Renal impairment: Use with caution in patients with renal impairment.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; 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.
None known.
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
Dolutegravir: Selenium may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral selenium. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral selenium. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Risk D: Consider therapy modification
Adverse events were seen with high doses in animal studies. Selenium is found in the placenta and cord blood. Teratogenic effects have not been observed with nontoxic doses in humans (IOM, 2000).
Selenium is found in breast milk. Concentrations vary based on maternal intake and time postpartum. Adverse events have not been observed with nontoxic maternal intake in humans (IOM, 2000).
Dietary adequate intake (AI): Note: Breast milk, formula, and food should be the only sources of selenium for infants (NIH 2019).
1 to 6 months: 15 mcg/day.
7 to 12 months: 20 mcg/day.
Dietary recommended daily allowance (RDA) (IOM 2000):
1 to 3 years: 20 mcg/day.
4 to 8 years: 30 mcg/day.
9 to 13 years: 40 mcg/day.
≥14 years: 55 mcg/day.
Pregnancy: 60 mcg/day.
Lactation: 70 mcg/day.
Plasma selenium concentration for patients receiving long-term PN (every 3 to 6 months; some patients (ie, HSCT) may require more frequent monitoring) (ASPEN Pediatric Nutrition Support Core Curriculum [Corkins 2010])
Part of glutathione peroxidase which protects cell components from oxidative damage due to peroxidases produced in cellular metabolism
Excretion: Urine, feces, lungs, skin
Liquid (Aqueous Selenium Oral)
95 mcg/drop (per mL): $0.86
Solution (Selenious Acid Intravenous)
60 mcg/mL (per mL): $41.16
Tablets (Selenium Oral)
50 mcg (per each): $0.02 - $0.04
200 mcg (per each): $0.04
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