1.5% GLYCINE IRRIGATION SOLUTION USP Irrigation/Solution for

What is 1.5% GLYCINE IRRIGATION SOLUTION USP

1.5% Glycine Irrigation Solution U.S.P. is a sterile, non-electrolyte solution used primarily for irrigation during surgical procedures. It contains glycine 1.5% w/v, an amino acid that acts as a hypotonic irrigating fluid. This solution is especially useful in urological surgeries, such as transurethral resection of the prostate (TURP), where continuous bladder irrigation is necessary to maintain visibility and flush out blood or tissue fragments.

• Form: Sterile irrigation solution for external use only (not for intravenous or oral administration).
• Packaging: Supplied in a 250 ml plastic bag, designed for use in sterile operating environments.
• Composition: Each 100 ml contains 1.5 grams of glycine (an amino acid with osmotic and buffering properties).
• Purpose: Used to irrigate body cavities during surgical procedures, especially those involving mucous membranes.
• Compatibility: Lacks electrolytes, which prevents interference with electrosurgical instruments and minimizes the risk of electrical burns.

It is widely employed due to its non-toxic, non-hemolytic, and clear fluid nature, allowing effective visualization during endoscopic interventions. Its osmolarity (~200 mOsm/L) is lower than that of plasma, aiding in tissue hydration and preventing clot formation during procedures.

How to use 1.5% GLYCINE IRRIGATION SOLUTION USP

1.5% Glycine Irrigation Solution U.S.P. should be administered only by trained healthcare professionals in a sterile surgical setting. It is not intended for injection or oral use. Proper technique and handling are essential to ensure safety and efficacy.

• Preparation: Inspect the plastic bag for integrity before use. Do not use if the bag is damaged or if the solution appears cloudy or contains particulates.
• Administration route: Irrigation only. The solution is typically delivered through specialized equipment such as irrigation sets, endoscopic pumps, or gravity-fed systems.
• Application: Used to flush cavities like the bladder or uterus during procedures such as TURP, hysteroscopy, or other endoscopic surgeries.
• Volume: Varies according to the surgical procedure, duration, and extent of bleeding or debris.
• Post-procedure: Any residual fluid should be drained properly. Monitor the patient for signs of fluid absorption or electrolyte imbalance.

Do not mix this solution with other medications unless compatibility is established. Ensure aseptic technique to avoid contamination. Overuse or improper administration may lead to systemic absorption and complications such as hyponatremia.

Mode of Action 1.5% GLYCINE IRRIGATION SOLUTION USP

Glycine is a naturally occurring, non-essential amino acid. In the context of this irrigation solution, its primary function is mechanical rather than pharmacological. However, some systemic effects may occur if absorbed in significant amounts.

• Osmotic Properties: The hypotonic nature of glycine helps in cell hydration and tissue swelling, which can help clear blood and debris during endoscopic procedures.
• Non-electrolytic: The absence of ions (such as sodium or chloride) makes it ideal for use with monopolar electrosurgical instruments, as it reduces the risk of electrical conduction to unintended tissues.
• Clear Visualization: It maintains a transparent operative field, essential for safe and effective endoscopic surgeries.
• Absorption: If absorbed into systemic circulation, glycine can act as an inhibitory neurotransmitter and may affect the central nervous system in large amounts, although this is rare with proper use.

Glycine's inert profile and non-electrolytic character make it a preferred choice for irrigation during procedures requiring monopolar diathermy, minimizing adverse reactions and maintaining patient safety during extended operative times.

1.5% GLYCINE IRRIGATION SOLUTION USP Interactions 1.5% GLYCINE IRRIGATION SOLUTION USP

While 1.5% Glycine Irrigation Solution U.S.P. is not typically associated with pharmacologic drug interactions due to its topical, non-systemic route, certain considerations must be made:

• Systemic Absorption: If large volumes are absorbed (e.g., via open venous sinuses), there may be interactions with medications affecting the CNS, such as sedatives or anesthetics.
• Electrosurgery Compatibility: Safe for use with monopolar instruments. Avoid using electrolyte-containing solutions, as they can cause current dispersion and tissue damage.
• Antihypertensives or Diuretics: If systemic absorption occurs, interactions with drugs affecting fluid balance may increase the risk of hypotension or hyponatremia.
• Nephrotoxic Drugs: Caution is advised in patients on medications that affect renal function, such as NSAIDs or aminoglycosides, as glycine accumulation may impact renal excretion.

Always review the patient’s medication history and comorbidities before use. Though interaction risks are low, systemic absorption—especially during prolonged procedures—can amplify the effects of other drugs, particularly CNS depressants or those affecting fluid-electrolyte balance.

Dosage of 1.5% GLYCINE IRRIGATION SOLUTION USP

The dosage of 1.5% Glycine Irrigation Solution U.S.P. is determined by the surgical requirement, the type of procedure, and patient-specific factors. Since it's not administered systemically, the concept of "dosage" primarily refers to the volume used for irrigation.

• Standard Use: For urological procedures like TURP, volumes can range from 1 to several liters, depending on the surgical field’s needs.
• Rate of Irrigation: Usually controlled by gravity or irrigation pumps, adjusted to maintain clear visibility without causing overdistension of the cavity.
• Duration of Use: As needed, based on procedure length. Monitor total volume to prevent excessive absorption, especially in lengthy surgeries.
• Pediatric or Special Populations: Caution in renal impairment or cardiac conditions. Use the minimum effective volume and monitor fluid balance.

Because glycine may be absorbed during procedures, especially when venous sinuses are exposed, limit exposure duration and monitor fluid input/output carefully to avoid complications like TURP syndrome or fluid overload.

Possible side effects of 1.5% GLYCINE IRRIGATION SOLUTION USP

When used correctly, 1.5% Glycine Irrigation Solution U.S.P. is generally safe. However, systemic absorption can lead to adverse reactions, particularly during long surgeries or if large volumes are used.

• TURP Syndrome: Characterized by nausea, vomiting, bradycardia, hypertension or hypotension, confusion, and visual disturbances due to fluid overload and hyponatremia.
• CNS Symptoms: Glycine can act as an inhibitory neurotransmitter; excessive absorption may result in somnolence, seizures, or coma in severe cases.
• Electrolyte Imbalance: Dilutional hyponatremia may occur due to the hypotonic nature of the solution.
• Renal Effects: Excessive glycine may transiently affect renal function in predisposed individuals.

Postoperative monitoring is essential, especially in prolonged endoscopic surgeries. Symptoms such as mental status changes or cardiovascular instability should be promptly addressed.

1.5% GLYCINE IRRIGATION SOLUTION USP Contraindications 1.5% GLYCINE IRRIGATION SOLUTION USP

Although widely used, 1.5% Glycine Irrigation Solution U.S.P. is contraindicated in certain clinical situations where its use could pose serious health risks.

• Known Hypersensitivity: Patients with known allergy to glycine or any of the formulation components.
• Intravenous Use: Not for injection. Systemic administration is strictly contraindicated.
• Electrolyte Imbalance: Avoid in patients already suffering from hyponatremia or hypo-osmolality.
• Severe Cardiopulmonary or Renal Conditions: May exacerbate fluid overload and increase risk of complications.
• Closed System Blockage: Avoid use if outflow from the irrigated cavity is compromised, increasing absorption risk.

Pre-procedure evaluation of the patient’s electrolyte balance, renal function, and fluid status is essential to prevent complications. This solution should only be used under controlled surgical settings with appropriate monitoring.

Storage of 1.5% GLYCINE IRRIGATION SOLUTION USP

Proper storage ensures the safety, sterility, and efficacy of 1.5% Glycine Irrigation Solution U.S.P.. It should be stored under recommended conditions until ready for use.

• Temperature: Store at 15°C to 30°C (59°F to 86°F). Avoid excessive heat or freezing.
• Light Exposure: Keep away from direct sunlight. Store in original packaging to protect from light.
• Container Integrity: Do not use if the plastic bag is damaged or shows signs of leakage or discoloration.
• Sterility: Single-use only. Once opened, the contents must be used immediately; discard any unused portion.
• Expiration: Check expiry date on the label before use. Do not use past the expiration date.

Maintain a clean, dry storage area in clinical or hospital settings to prevent contamination. Follow institutional protocols for proper disposal after use.