Hepamerz Infusion Protocol
Critical Clarification
Hepamerz is L-ornithine L-aspartate (LOLA), used for hepatic encephalopathy treatment, NOT hepatitis B immunoglobulin (HBIG). The evidence provided addresses hepatitis B post-exposure prophylaxis with HBIG, which appears to be a mismatch with your query about "Hepamerz."
If You Are Asking About HBIG (Hepatitis B Immunoglobulin) Post-Exposure Protocol:
Immediate Administration for HBsAg-Positive Exposure
For unvaccinated or incompletely vaccinated persons exposed to HBsAg-positive blood, administer HBIG 0.06 mL/kg intramuscularly as soon as possible (preferably within 24 hours) along with hepatitis B vaccine at a separate anatomic site. 1, 2
Dosing by Clinical Scenario
Percutaneous/Mucosal Exposure to HBsAg-Positive Source:
- Unvaccinated persons: HBIG 0.06 mL/kg IM immediately + initiate HepB vaccine series 1, 2
- Vaccinated persons with inadequate antibody (<10 mIU/mL): HBIG 0.06 mL/kg IM immediately + HepB vaccine booster dose 1, 2
- Vaccinated persons with documented immunity (anti-HBs ≥10 mIU/mL): No HBIG or additional vaccination needed 3
Timing Window:
- Optimal: Within 24 hours of exposure 1, 3, 2
- Acceptable: Up to 7 days for percutaneous exposure 1, 3
- Maximum for sexual exposure: Up to 14 days 1
- Effectiveness decreases markedly beyond these timeframes 3, 2
Perinatal Exposure (Infants Born to HBsAg-Positive Mothers):
- HBIG 0.5 mL IM within 12 hours of birth (preferably), efficacy decreases markedly if delayed beyond 48 hours 2
- Administer HepB vaccine (0.5 mL, 10 μg) within 7 days at separate site 2
- Complete vaccine series at 1 and 6 months 2
Sexual Exposure to HBsAg-Positive Person:
- HBIG 0.06 mL/kg IM as single dose within 14 days of last sexual contact 2
- Initiate HepB vaccine series simultaneously at separate site 2
Administration Technique
- Route: Intramuscular only; never administer intravenously 2
- Site: Separate anatomic site from vaccine (e.g., different limbs) 1, 3
- Inspection: Visually inspect for particulate matter and discoloration before administration 2
- Aspiration: Aspirate prior to injection to confirm needle is not in vein or artery 2
Special Considerations for Unknown Immunity Status
When a healthcare worker with unknown anti-HBs status has high-risk exposure to HBsAg-positive source, administer HBIG immediately without waiting for blood test results, as the risk of delaying treatment outweighs the cost of potentially treating someone already immune 3
- Draw blood for baseline anti-HBs testing at time of exposure, but do not delay treatment 3
- If HBIG is given, delay postvaccination testing for anti-HBs until 4-6 months after HBIG administration to avoid detecting passively acquired antibodies 3
Common Pitfalls to Avoid
- Do not delay HBIG beyond 24 hours when indicated for HBsAg-positive exposure; effectiveness decreases significantly after 7 days 1, 3, 2
- Do not restart vaccine series if patient already began vaccination; simply complete the series 1
- Do not administer HBIG intravenously; it must be given intramuscularly 2
- Do not assume immunity without documented serologic testing showing anti-HBs ≥10 mIU/mL after complete vaccine series 1, 3
- Do not test for anti-HBs immediately after HBIG; wait 4-6 months to avoid detecting passive antibodies 3
Alternative Regimen for Vaccine Refusal
If the exposed person refuses hepatitis B vaccine, administer a second dose of HBIG 1 month after the first dose 2
If You Are Actually Asking About Hepamerz (L-ornithine L-aspartate):
The evidence provided does not address Hepamerz/LOLA infusion protocols. Please clarify your question, as Hepamerz is typically used for hepatic encephalopathy at doses of 20-40g daily via IV infusion over 2-6 hours, which is an entirely different medication and indication than what the evidence addresses.