Chromium Chloride

Usage

• Chromium Chloride is primarily used as a trace element supplement in total parenteral nutrition (TPN) to prevent or treat chromium deficiency in patients who are unable to obtain adequate amounts through their diet. It might help improve blood sugar control in some people with type 2 diabetes. It’s unclear if chromium helps prevent diabetes or improve blood pressure and lipid levels.

• Pharmacological Classification: Essential trace mineral/Micronutrient supplement.

• Mechanism of Action: Chromium is thought to enhance insulin action, improving glucose uptake and metabolism. The precise mechanism is not fully elucidated, but it is believed to involve a chromium-binding substance called chromodulin, which potentiates insulin signaling.

Alternate Names

• Chromic Chloride, Chromium(III) chloride, Chromium trichloride
• Brand Names: Chromic Chloride Injection, USP (Pfizer)

How It Works

• Pharmacodynamics: Chromium improves insulin sensitivity, thereby enhancing glucose uptake and utilization by cells. It may also have beneficial effects on lipid metabolism and blood pressure in some individuals.

• Pharmacokinetics:

  • Absorption: When administered intravenously in TPN solutions, chromium is directly available for utilization. Oral absorption of chromium is generally poor.
  • Metabolism: Chromium is not extensively metabolized.
  • Elimination: Primarily excreted in the urine, with some biliary excretion.

• Mode of Action: Chromium’s primary mode of action involves potentiating insulin signaling. While the details are not fully understood, it’s believed that chromium binds to chromodulin. This complex interacts with the insulin receptor, enhancing the receptor’s kinase activity and downstream signaling, ultimately increasing glucose transport into cells.

• Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: Primarily interacts with the insulin receptor pathway. No direct enzyme inhibition or neurotransmitter modulation is known.

• Elimination Pathways: Renal excretion is the major route, with a minor contribution from biliary excretion.

Dosage

Standard Dosage

Adults:

• TPN: 10-15 mcg/day intravenously (2.5–3.75 mL/day of a 4 mcg/mL solution diluted in at least 100 mL of fluid). Adults with intestinal fluid loss may require up to 20 mcg/day (5 mL/day of a 4 mcg/mL solution). Blood levels should be monitored for dosage adjustments.
• Oral Supplementation: For preventing deficiency, 50-200 mcg/day. Therapeutic doses for specific conditions (e.g., type 2 diabetes) may range from 200-1000 mcg/day, often divided into smaller doses two to three times a day.

Children:

• TPN: 0.14-0.20 mcg/kg/day intravenously (0.035-0.05 mL/kg/day of a 4 mcg/mL solution diluted in at least 100 mL of fluid).
• Oral Supplementation: Adequate Intake (AI) levels vary depending on age, starting from 0.2 mcg/day for infants 0-6 months old, increasing gradually to 21-35 mcg/day for adolescents (14-18 years old).

Special Cases:

• Elderly Patients: No specific dose adjustments are typically needed for elderly patients receiving recommended intakes. Renal function should be assessed.
• Patients with Renal Impairment: Dose reduction may be necessary, as chromium is primarily excreted renally. Careful monitoring is advised.
• Patients with Hepatic Dysfunction: No specific dose adjustments are usually required.
• Patients with Comorbid Conditions: Patients with diabetes should be monitored closely for hypoglycemia when taking chromium with insulin or other antidiabetic medications.

Clinical Use Cases Primarily for TPN administration in:

• Intubation
• Surgical Procedures
• Mechanical Ventilation
• Intensive Care Unit (ICU) Use

Dosage Adjustments

• Renal/hepatic dysfunction should be considered, with possible dose reductions depending on severity.
• Blood glucose should be monitored in diabetic patients, and doses of insulin or other antidiabetic medication may need adjustment.

Side Effects

Common Side Effects (Oral Supplementation):

• Stomach upset
• Headaches
• Insomnia
• Mood changes

Rare but Serious Side Effects:

• Liver or kidney damage (with high doses)
• Irregular heartbeat
• Allergic reactions (skin rash, itching, hives, difficulty breathing, swelling)

Long-Term Effects: Limited data are available on long-term effects of chromium supplementation. Potential kidney or liver damage with chronic high-dose use is a concern.

Adverse Drug Reactions (ADR): Rare, but include renal failure, rhabdomyolysis, hypoglycemia, and hematological abnormalities (anemia, thrombocytopenia).

Contraindications

• Absolute: Direct intramuscular or intravenous administration of undiluted Chromic Chloride Injection, USP is contraindicated due to the acidic pH of the solution, which can cause significant tissue irritation.
• Relative: Renal disease, liver disease.

Drug Interactions

• Insulin and Antidiabetic Medications: Chromium can enhance insulin action, potentially leading to hypoglycemia. Close monitoring of blood sugar is crucial.
• Levothyroxine: Chromium may decrease levothyroxine absorption, potentially reducing its effectiveness.
• Corticosteroids: May increase the risk of hyperglycemia.
• NSAIDS and Aspirin: May increase chromium levels, potentially elevating the risk of adverse effects.
• Antacids, H2 blockers, and Proton Pump Inhibitors: May decrease chromium absorption.

Pregnancy and Breastfeeding

• Pregnancy Safety Category: Information is limited. Adequate Intake (AI) levels are considered safe during pregnancy (30 mcg/day for 19-50 years old). Higher doses should be used with caution and under medical supervision.
• Breastfeeding: Adequate Intake (AI) levels are considered safe during breastfeeding (45 mcg/day for 19-50 years old).

Drug Profile Summary

• Mechanism of Action: Enhances insulin action, possibly through interaction with chromodulin, improving glucose uptake.
• Side Effects: Stomach upset, headaches, insomnia, mood changes (common); liver/kidney damage, irregular heartbeat, allergic reactions (rare but serious).
• Contraindications: Direct IM or IV administration of undiluted solution; severe renal disease.
• Drug Interactions: Insulin, antidiabetic drugs, levothyroxine, corticosteroids, NSAIDs, antacids.
• Pregnancy & Breastfeeding: Generally safe at AI levels. Higher doses require medical supervision.
• Dosage: TPN: Adults: 10-15 mcg/day; Children: 0.14-0.20 mcg/kg/day. Oral: Adults: 50-200 mcg/day for deficiency prevention. Higher therapeutic doses exist.
• Monitoring Parameters: Blood glucose (especially in diabetics), renal function tests, liver function tests (with prolonged high-dose use).

Popular Combinations Not applicable for chromium chloride injection, which is used solely in TPN.

Precautions

• Assess renal and hepatic function, especially for long-term/high-dose use.
• Monitor blood glucose closely in diabetic patients.
• Consider potential drug interactions.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Chromium Chloride in TPN?

A: Adults: 10-15 mcg/day, Children: 0.14-0.20 mcg/kg/day. Higher doses may be required for adults with intestinal fluid loss (up to 20 mcg/day), with careful blood level monitoring.

Q2: How is Chromium Chloride administered?

A: For TPN, it’s administered intravenously ONLY after dilution in at least 100 mL of fluid. Direct IM or IV injection of the undiluted solution is contraindicated.

Q3: What are the common side effects of chromium supplementation?

A: Common side effects may include stomach upset, headaches, insomnia, and mood changes.

Q4: What are the serious side effects of Chromium Chloride?

A: Rare but serious side effects include liver or kidney damage (with high doses), irregular heartbeat, and allergic reactions.

Q5: What are the contraindications for Chromium Chloride?

A: Direct IM/IV administration of undiluted Chromium Chloride Injection, USP. Caution should be exercised in patients with renal and liver disease.

Q6: Does chromium interact with other medications?

A: Yes. It can interact with insulin, antidiabetic drugs, levothyroxine, corticosteroids, NSAIDs, and antacids.

Q7: Can Chromium Chloride be used during pregnancy and breastfeeding?

A: Adequate Intake (AI) levels are considered generally safe. Higher doses need medical supervision.

Q8: How does Chromium Chloride affect blood sugar levels?

A: It can enhance insulin action and may lower blood sugar levels. Patients with diabetes taking insulin or antidiabetic medications should be monitored closely for hypoglycemia.

Q9: What is the role of chromium in the body?

A: It’s an essential trace mineral that plays a role in glucose metabolism, potentiating insulin action.

Q10: Can chromium be used for weight loss?

A: While it’s been investigated for weight loss, evidence of its effectiveness is limited and inconsistent.