AMMONUL (sodium phenylacetate and sodium benzoate) Injection 10%/10% is a combination of sodium phenylacetate and sodium benzoate, which are metabolically active compounds that can serve as alternatives to urea for the excretion of waste nitrogen.

• Phenylacetate conjugates with glutamine in the liver and kidneys to form phenylacetylglutamine, via acetylation. Phenylacetylglutamine is excreted by the kidneys via glomerular filtration and tubular secretion. The nitrogen content of phenylacetylglutamine per mole is identical to that of urea (both contain two moles of nitrogen).
• Similarly, preceded by acylation, benzoate conjugates with glycine to form hippuric acid (hippurate), which is rapidly excreted by the kidney through glomerular filtration and tubular secretion. One mole of hippuric acid contains one mole of waste nitrogen.

Important Safety Information for AMMONUL Injection 10% / 10%

• IMPORTANT: Filtration required. Due to the possibility that particulate matter may impact the safe use of this product and to ensure optimal patient care, you are instructed to use the Millex^® Durapore GV 33 mm Sterile Syringe Filter (0.22 μm) during the admixture process when injecting AMMONUL into the 10% dextrose IV bag. Note that particulate matter may not be readily seen on visual inspection, so this filter must be employed in all cases regardless of whether particulate matter is seen in the vial.
• The most common adverse reactions are vomiting (9%), hyperglycemia (7%), hypokalemia (7%), convulsions (6%), and mental impairment (6%).
• Dilute AMMONUL with sterile 10% Dextrose Injection (D10W) before administration. Use a central venous catheter line; use of a peripheral line may cause burns.
• Monitor patients for prolonged exposure to elevated plasma ammonia levels as this can rapidly result in injury to the brain or death. Promptly use any therapies necessary to reduce plasma ammonia levels.
• Monitor plasma potassium levels carefully and treat as necessary.
• Use caution if AMMONUL is administered to patients with congestive heart failure, severe renal insufficiency, or with a condition in which there is sodium retention with edema.
• Monitor the infusion site for possible tissue infiltration since extravasation of AMMONUL into the perivenous tissues during high flow bolus infusion may lead to skin necrosis, especially in infants.
• Do not administer repeat loading doses because of prolonged plasma levels achieved by phenylacetate in pharmacokinetic studies.
• Monitor patient blood chemistry profiles and perform frequent blood pH and pCO₂ measurements because AMMONUL may cause side effects typically associated with salicyclate overdose such as hyperventilation and metabolic acidosis.
• Administration of valproic acid to patients with urea cycle disorders may exacerbate their condition and antagonize the efficacy of AMMONUL.

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