Ammonium Chloride (NH₄Cl, ammonium muriate)

Uses

Uses of ammonium chloride

Ammonium chloride, after dilution in isotonic sodium chloride injection, may be indicated in the treatment of patients with low chlorine (hypochloremic) states and metabolic alkalosis. Some conditions that can cause hypochloremia include vomiting, gastroenteritis, diabetic ketoacidosis, and low dietary intake.

Ammonium chloride is an inorganic compound with the formula NH4Cl and a white crystalline salt that is highly soluble in water. Occasionally, it is referred to as ammonium muriate.

How should I take ammonium chloride?

Ammonium chloride injection, USP is administered intravenously. Because it is a potentially corrosive at high concentrations, dilute a vial containing 5 mEq/mL with NaCl 0.9% solution. For safety, solutions for intravenous infusion should not exceed a concentration of 1% to 2% of ammonium chloride.

How do I store ammonium chloride?

Store at room temperature, away from moisture and direct sunlight. To prevent drug damage, you should not store it in the bathroom or the freezer. There may be different brands of this drug that may have different storage needs. Therefore, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush it down the toilet or pour them into a drain unless instructed to do so. Additionally, do not use it if expired. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using ammonium chloride?

Before using this drug, tell your doctor if you:

• Are pregnant or breastfeeding
• Are taking other medications
• Have ever had an allergic reaction to any medication
• Have any allergies to any ingredient in the preparation
• Currently have other conditions, especially kidney or liver disease

Is it safe during pregnancy or breastfeeding?

There are no adequate studies in women for determining risk when using this medication during pregnancy or while breastfeeding. Therefore, always consult with your doctor to weigh the potential benefits and risks before taking this medication. In addition, this medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

• A=No risk,
• B=No risk in some studies,
• C=There may be some risk,
• D=Positive evidence of risk,
• X=Contraindicated,
• N=Unknown.

Side effects

What are the side effects of ammonium chloride?

Side effects include:

• Pain and irritation at the injection site or along the venous route if the rate of IV admin is too rapid;
• Rash;
• Headache;
• Progressive drowsiness;
• Mental confusion;
• Hyperventilation;
• Bradycardia and phases of excitement alternating with coma.

Not everyone experiences these side effects. Additionally, there may be some side effects not listed above. If you have any concerns about a side effect, please consult your doctor or pharmacist.

Know the interactions

What drugs may interact with ammonium chloride?

Ammonium chloride is known to interact with drugs that contain carbonates, alkalis (bases), and lead or silver salts. In addition, other known drug interactions may occur with the following:

• Potassium-sparing diuretics
• Chlorpropamide
• Salicyclates (e.g. aspirin)
• Amantadine
• Amphetamines
• Mecamylamine
• Alpha and beta-agonists (e.g. salbutamol)

These drugs should not be taken together. However, if necessary, the doses of each may need to be increased or taken at different intervals. Discuss with your doctor and pharmacist regarding any drug interactions.

Does food or alcohol interact with ammonium chloride?

There are no notable food interactions with this drug. Discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with ammonium chloride?

Ammonium chloride may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have.

Do not take this drug if you have any of the following conditions:

• Pulmonary insufficiency
• Cardiac edema
• High total carbon dioxide level
• Primary respiratory acidosis
• Mild-to-moderate renal impairment
• Hypochloremia accompanied by hyponatremia

Understand the Dosage

The information provided is not a substitute for medical advice. Always consult your doctor or pharmacist before using this medication.

What is the dose for an adult?

As an acidifying agent

Dosage depends on severity of the condition and tolerance of the patient. Solution should be diluted before use and rate of IV infusion should not exceed 5 mL per minute. In addition, monitor dosage by repeating serum bicarbonate determinations.

Reconstitution: Dilute before use. The final concentration should not exceed 1-2% ammonium chloride. Solutions containing 100-200 mEq of ammonium chloride should be diluted with 500 or 1000 ml of 0.9% NaCl solution prior to administration.

What is the dose for a child?

The dosage has not been established in pediatric patients. Therefore, it may be unsafe for your child. Additionally, consult with your doctor or pharmacist for more information.

How is ammonium chloride available?

This drug is available in the following dosage forms and strengths:

• Solution for injection: 100 mEq (5 mEq/mL)

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

Overdosing may lead to serious metabolic acidosis, disorientation, confusion and coma. Treatment: Administer an alkalinizing solution such as sodium bicarbonate or sodium lactate to correct the acidosis.

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.