chromic nitrate

Action and Spectrum

Actions and Spectrum: 

chromium also modulates cholesterol efflux, reduces membrane cholesterol, and upregulates sterol regulatory element-binding protein, facilitating GLUT-4 translocation.

It attenuates the activity of PTP-1B, a negative regulator of insulin signaling, and alleviates endoplasmic reticulum (ER) stress, which is known to impair insulin signaling.

Transient upregulation of AMPK by chromium further enhances glucose uptake. Overall, chromium plays a vital role in insulin sensitivity and glucose metabolism. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Methemoglobinemia 

Asthma 

Skin Sensitizer 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

N/A 

Caution: 

N/A 

Pregnancy / Lactation

Pregnancy consideration: Insufficient data available 

Lactation: Excretion of the drug in human breast milk is unknown 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence, these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

chromium is an essential nutrient crucial for glucose, insulin, and lipid metabolism. It enhances insulin signaling pathways by upregulating key molecules downstream of the insulin receptor (IR). In insulin-responsive conditions, chromium boosts insulin-stimulated signal transduction, promoting glucose transporter translocation and glucose uptake. Additionally, under insulin-resistant conditions, chromium facilitates GLUT-4 transporter translocation independently of IR, IRS-1, PI3-kinase, or Akt, leading to increased glucose uptake.  

Pharmacodynamics:  

• Glucose Tolerance Factor (GTF): Trivalent chromium is a component of the Glucose Tolerance Factor (GTF), which plays a crucial role in insulin-mediated reactions. 
• Insulin Activation: chromium acts as an essential activator of insulin-mediated reactions. It helps maintain normal glucose metabolism and peripheral nerve function. 
• Enhanced Insulin Sensitivity: chromium has been associated with increased insulin binding to cells, heightened insulin receptor density, and activation of insulin receptor kinase. These effects contribute to enhanced insulin sensitivity. 
• Normalization of Glucose Tolerance: In cases of chromium deficiency, intravenous administration of chromium has been observed to normalize the glucose tolerance curve. This is particularly noteworthy as chromium deficiency can lead to a diabetic-like glucose tolerance curve. 

Pharmacokinetics: 

Absorption 

The lungs and the gastrointestinal tract absorb chromium compounds. Oral absorption ranges from 0.5% to 10%, with hexavalent chromium (Cr VI) absorbed more efficiently than trivalent chromium (Cr III). Intestinal absorption is low (0.4% to 2.5%), and vitamin C and niacin enhance chromium absorption. 

Hexavalent chromium undergoes partial intragastric reduction to trivalent chromium, mainly mediated by sulfhydryl groups of amino acids. Chromium is found in erythrocytes and plasma after gastrointestinal absorption, with Cr VI penetrating cell membranes more readily than Cr III. Once inside cells, Cr VI is rapidly reduced to Cr III, binding to macromolecules or conjugating with proteins. Cr III may be bound to transferrin or other plasma proteins, forming complexes like glucose tolerance factor (GTF). 

Distribution 

Absorbed chromium is distributed widely in the body, with distribution influenced by species, age, and chemical form. Trivalent chromium (Cr III) from different compounds, whether administered orally or parenterally, is taken up by tissues, leading to accumulation in the liver, kidney, spleen, soft tissues, and bones. 

Metabolism 

Metabolism of hexavalent chromium (Cr VI) involves reduction by small molecules and enzymes, producing trivalent chromium (Cr III) and reactive intermediates. This process may generate free radicals, potentially causing damage to cellular components and contributing to chromium toxicity. The metabolites subsequently bind to cellular constituents. 

Elimination and Excretion 

The elimination half-life of hexavalent chromium is 15 to 41 hours. Chromium is primarily excreted via the kidneys, with excretion levels ranging from 3 to 50 μg/day. For regular human subjects, the reported 24-hour urinary excretion rates are around 0.22 μg/day. 

Adminstartion

Administration: 

It is administered intravenously 

Patient Information Leaflet

Patient information leaflet 

Generic Name: chromic nitrate 

Why do we use chromic nitrate? 

It is recommended for use as a supplement in intravenous solutions administered during total parenteral nutrition (TPN). Its purpose is to sustain chromium serum levels, prevent depletion of the body’s natural chromium stores, and avert the onset of deficiency symptoms associated with chromium.