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Selenium

Generic name: selenium systemic

Brand names: Selepen, Sele-Pak, Selenium TR

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Selenicaps-200: 200 mcg [corn free, no artificial color(s), rye free, sugar free, wheat free, yeast free]

Capsule, Oral [preservative free]:

Se-100: 100 mcg [dye free, yeast free]

Liquid, Oral:

Aqueous Selenium: 95 mcg/drop (15 mL) [contains sodium benzoate]

Solution, Intravenous:

Generic: 40 mcg/mL (10 mL)

Solution, Intravenous [preservative free]:

Generic: 60 mcg/mL (10 mL)

Tablet, Oral:

Oceanic Selenium: 50 mcg, 200 mcg [animal products free, gelatin free, gluten free, kosher certified, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Se Aspartate: 50 mcg

Se-Plus Protein: 200 mcg

Selenimin: 125 mcg [corn free, rye free, starch free, sugar free, wheat free]

Selenimin-200: 200 mcg [corn free, rye free, starch free, sugar free, wheat free, yeast free]

Generic: 50 mcg, 200 mcg

Tablet, Oral [preservative free]:

Generic: 50 mcg, 200 mcg

Tablet Extended Release, Oral [preservative free]:

Generic: 200 mcg

Pharmacology

Mechanism of Action

Part of glutathione peroxidase which protects cell components from oxidative damage due to peroxidases produced in cellular metabolism

Pharmacokinetics/Pharmacodynamics

Excretion

Urine, feces, lungs, skin

Use: Labeled Indications

Trace metal supplement

Contraindications

Undiluted administration into peripheral vein

Dosage and Administration

Dosing: Adult

Parenteral nutrition additive (Vanek 2012): IV: 60 to 100 mcg/day

Deficiency from prolonged parenteral nutrition: IV: 100 mcg/day

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Parenteral nutrition additive, maintenance requirement:

ASPEN recommendations:

Infants <10 kg: IV: 2 mcg/kg/day (ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]; ASPEN [Vanek 2012]; ASPEN [Vanek 2015]).

Infants and Children weighing 10 to 40 kg: IV: 1 to 2 mcg/kg/day (ASPEN [Corkins 2015]; ASPEN [Mirtallo 2004]); maximum daily dose: 100 mcg/day (ASPEN [Vanek 2012]; ASPEN [Vanek 2015]).

Children and Adolescents weighing >40 kg: IV: 2 mcg/kg/day; maximum daily dose: 100 mcg/day (ASPEN [Corkins 2015]; ASPEN [Vanek 2012]); ASPEN [Vanek 2015]).

ESPGHAN/ESPEN/ESPR/CSPEN recommendations (Demellöf 2018): Infants, Children, and Adolescents: IV: 2 to 3 mcg/kg/day; maximum daily dose: 100 mcg/day.

Dietary Considerations

Dietary adequate intake (AI): Note: Breast milk, formula, and food should be the only sources of selenium for infants (NIH 2019).

1 to 6 months: 15 mcg/day.

7 to 12 months: 20 mcg/day.

Dietary recommended daily allowance (RDA) (IOM 2000):

1 to 3 years: 20 mcg/day.

4 to 8 years: 30 mcg/day.

9 to 13 years: 40 mcg/day.

≥14 years: 55 mcg/day.

Pregnancy: 60 mcg/day.

Lactation: 70 mcg/day.

Storage

Prior to use, store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Drug Interactions

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Avoid combination

Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification

Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification

Dolutegravir: Selenium may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral selenium. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral selenium. Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Consider therapy modification

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Consider therapy modification

Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Consider therapy modification

Adverse Reactions

There are no adverse reactions listed in the manufacturer's labeling.

Warnings/Precautions

Disease-related concerns:

  • Gastrointestinal dysfunction: Use with caution in patients with GI impairment.
  • Renal impairment: Use with caution in patients with renal impairment.

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.

Monitoring Parameters

Plasma selenium concentration for patients receiving long-term PN (every 3 to 6 months; some patients (ie, HSCT) may require more frequent monitoring) (ASPEN Pediatric Nutrition Support Core Curriculum [Corkins 2010])

Pregnancy

Pregnancy Considerations

Adverse events were seen with high doses in animal studies. Selenium is found in the placenta and cord blood. Teratogenic effects have not been observed with nontoxic doses in humans (IOM, 2000).

Patient Education

What is this drug used for?

  • It is used to help growth and good health.

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

  • Severe injection site redness, burning, pain, or swelling
  • Signs of a significant reaction like 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. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Source: Wolters Kluwer Health. Last updated February 5, 2020.