Comparison of Patient Experience with Commercial Versus Compounded Amino Acid Infusion for 177Lu-DOTATATE Therapy

Objectives: A variety of medications are given to 177Lu-DOTATATE peptide receptor radionuclide therapy patients as a preventative measure to alleviate nausea and protect kidney function during therapy sessions. Amino acid infusions containing the charged amino acids lysine and arginine are used during administration to protect kidney function. These amino acids can cause significant nausea in patients, which are often treated with anti-emetics. In the United States, the FDA approved amino acids formulations (commercial) contain a large number of amino acids in addition to lysine and arginine and this can result in high rates of nausea. Compounded amino acids that contain only lysine and arginine must be made by a compounding pharmacy but potentially result in significantly less nausea.

Methods: Data was compiled and reviewed for patients that received commercial (Clinisol II) and compounded amino acid infusion protocols within the medical center. Analysis between the two amino acid protocols was then done regarding the following: 1) duration of infusion; 2) reported frequency of nausea; 3) reported administration of medications including Zofran (Ondansetron Hcl), Ativan (lorazepam), Emend (aprepitant), and Phenergan (promethazine). 18 patients who received 36 number of treatments over six months were reviewed. 14 treatments were performed using the commercial amino acids and 22 treatments were performed after the introduction of compounded amino acids.

Results: Analysis revealed the following between the commercial acid protocol and the compounded amino acid protocol: 1) duration of administration was reduced for patients receiving the compounded amino acid protocol (263 minutes versus 379 minutes; p < 0.001); 2) reports of nausea was reduced for patients receiving compounded amino acid protocol (5% of compounded amino acid patients versus 71% of commercial amino acid patients); 3) administration of Zofran was needed less frequently for patients receiving compounded amino acid protocol (41% versus 86% of commercial amino acid patients); 4) administration of Ativan, Emend, and Phenergan was not used in patients receiving compounded amino acids versus 86% of the patients receiving commercial amino acids (71% Ativan, 100% Emend, and 92% Phenergan, respectively).

Conclusions: Overall patient experience is markedly improved with compounded amino acids in comparison with commercially available products. Patient side-effects during treatment are greatly reduced, resulting in fewer antiemetics used and an overall reduction in infusion times.