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Molybdenum


General


Pronunciation

(mo LIB de num)


Indications


Use: Labeled Indications

Molybdenum supplement: Supplement to total parenteral nutrition (TPN) solutions


Contraindications


Undiluted administration into peripheral vein; copper-deficient patients without copper supplementation.


Dosing and Administration


Dosing: Adult

Molybdenum supplementation: IV: 20 to 120 mcg per day.

Molybdenum deficiency from prolonged TPN support: IV: 163 mcg per day for 21 days.

Dietary Reference Intake for molybdenum (IOM, 2011):

Adults: RDA: 45 mcg daily

Pregnancy and lactation: RDA: 50 mcg daily


Dosing: Geriatric

Refer to adult dosing.


Dosing: Pediatric

Dietary Reference Intake for molybdenum (IOM, 2011):

Infants 0 to 6 months: Adequate intake: 2 mcg daily

Infants 7 to 12 months: Adequate intake: 3 mcg daily

Children 1 to 3 years: RDA: 17 mcg daily

Children 4 to 8 years: RDA: 22 mcg daily

Children 9 to 13 years: RDA: 34 mcg daily

Adolescents ≥14 years: RDA: 43 mcg daily

Pregnancy and lactation: RDA: 50 mcg daily


Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer 's labeling; dosage adjustment may be needed.


Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer 's labeling; dosage adjustment may be needed in patients with bile duct obstruction.


Administration

IV: Administer only in admixtures. Do not administer undiluted into a peripheral vein.


Storage

Store at 20 ‚ °C to 25 ‚ °C (68 ‚ °F to 77 ‚ °F); excursions are permitted between 15 ‚ °C and 30 ‚ °C (59 ‚ °F and 86 ‚ °F).


Dosage Forms/Strengths


Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Generic: 30 mcg

Solution, Intravenous [preservative free]:

Generic: 25 mcg/mL (10 mL [DSC])


Drug Interactions

There are no known significant interactions.


Monitoring Parameters

Sulfur and purine metabolic profiles (eg, serum uric acid or urine uric acid, sulfite, and/or xanthine); serum copper levels and copper metabolism


Adverse Reactions


Postmarketing and/or case reports (Limited to important or life-threatening): Copper deficiency (high doses)


Warnings/Precautions


Concerns related to adverse effects:

- Copper deficiency: Molybdenum promotes tissue copper mobilization and increases urinary copper excretion; copper deficiency may occur. Frequently monitor the metabolism of copper.

Disease-related concerns:

- Hepatic impairment: Use with caution in patients with bile duct obstruction; dosage adjustment may be needed.

- Renal impairment: Use with caution in patients with renal impairment; dosage adjustment may be needed.

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.

Other warnings/precautions:

- Appropriate use: Injection solution is a hypotonic solution; administer in admixtures only.

- Purine and sulfur metabolism: Molybdenum is a cofactor in purine and sulfur metabolism; assess purine and sulfur metabolic profiles (eg, serum uric acid or urine uric acid, sulfite, and/or xanthine) frequently.


Pregnancy Risk Factor

C


Pregnancy Considerations

Animal reproduction studies have not been conducted. Molybdenum crosses the placenta. Molybdenum requirements are higher in pregnant women (IOM, 2011).


Actions


Pharmacology

Molybdenum, an essential trace element, is a cofactor for enzymes involved in the catabolism of sulfur amino acids, purines, and pyrimidines (IOM, 2011).


Excretion

Primarily though kidneys; some through bile.


Patient and Family Education


Patient Education

- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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