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NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS

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About the medicine

How to use NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS

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This page provides general information and does not replace a doctor’s consultation. Always consult a doctor before taking any medication. Seek urgent medical care if symptoms are severe.

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Introduction

Package Leaflet: Information for the User

Nutrineal PD4 with 1.1% amino acids, solution for peritoneal dialysis

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.Keep this leaflet. You may need to read it again.

  • Keep this leaflet, as you may need to read it again.
  • If you have any further questions, ask your doctor.
  • If you experience any side effects, talk to your doctor, even if you think they might be unrelated to this medicine. See section 4.

Contents of the pack

  1. What Nutrineal is and what it is used for.
  2. What you need to know before you start using Nutrineal.
  3. How to use Nutrineal.
  4. Possible side effects.
  5. Storage of Nutrineal.
  1. Contents of the pack and further information.

1. What Nutrineal is and what it is used for

Nutrineal is a peritoneal dialysis solution that does not contain glucose. It removes water and waste products from the blood and corrects abnormal levels of various blood components.

Nutrineal may be prescribed to you:

  • if you have kidney failure that requires peritoneal dialysis.
  • especially if you are malnourished.
Doctor consultation

Not sure if this medicine is right for you?

Discuss your symptoms and treatment with a doctor online.

2. What you need to know before you start using Nutrineal

Your doctor will assess whether Nutrineal is a suitable solution for your peritoneal dialysis treatment. They will consider any factors in your medical history that may exclude the use of peritoneal dialysis solutions.

Do not use Nutrineal

You must not use Nutrineal:

  • if you are allergic to the active substances or to any of the other ingredients of this medicine (listed in section 6).
  • if your blood urea level is higher than 38 mmol/l.
  • if you have a disorder that affects amino acid metabolism.
  • if your blood potassium level is too low.
  • if you show symptoms of hyperuremia such as loss of appetite, nausea, or vomiting.
  • if your blood bicarbonate levels are too low.
  • if you have liver failure.
  • if you have severe lactic acidosis (too much acid in the blood).
  • if you have any uncorrectable surgical condition that affects your abdominal wall or cavity, or an uncorrectable condition that increases the risk of abdominal infections.

Warnings and precautions

Talk to your doctor before starting Nutrineal:

  • if you notice loss of appetite, nausea, or vomiting. Your doctor may need to reduce the number of Nutrineal exchanges or interrupt treatment with Nutrineal.
  • if you experience abdominal pain or notice that the drainage fluid is cloudy, has clumps, or contains particles. This may be a sign of peritonitis (inflamed peritoneum) or infection. You should contact your medical team urgently. Note the batch number and take it along with the drained fluid bag to the medical team. The medical team will decide whether to interrupt treatment or start corrective treatment. For example, if you have an infection, your doctor may perform several tests to determine which antibiotic is most suitable for you. Your doctor may give you a broad-spectrum antibiotic that is effective against a wide range of different bacteria until they know what infection you have.
  • if you experience a hypersensitivity reaction (an allergic reaction) – see also section 4. Your doctor may need to stop treatment with Nutrineal.
  • during peritoneal dialysis, your body may lose proteins, amino acids, and vitamins. Your doctor will determine whether you need to replace these losses.
  • if you have problems that affect the integrity of the abdominal wall or cavity. For example, in the case of a hernia or chronic infection or inflammatory disease that affects the intestines.
  • if you have had an aortic graft.
  • if you have severe lung disease, such as emphysema.
  • if you have breathing difficulties.
  • if you use insulin or any other treatment to correct hyperglycemia. Your doctor may need to adjust your dose.
  • if you are receiving treatment for secondary hyperparathyroidism, your doctor will decide whether you can use a dialysis solution with low calcium content.
  • You should also be aware that a disorder called encapsulating peritoneal sclerosis (EPS) is a rare and known complication of peritoneal dialysis therapy. You, probably together with your doctor, should be aware of this possible complication. EPS causes:
  • abdominal inflammation (belly).
  • growth of the layers of fibrous tissue that cover and connect the organs, which will affect their normal movement. In rare cases, it has been fatal.
  • your doctor will regularly check your potassium levels. If they drop too low, you may be given potassium chloride to compensate.
  • Your doctor will inform you of the specific precautions for you. Your doctor will monitor your blood parameters at regular intervals and ensure they are suitable during treatment.
  • You, probably together with your doctor, will keep a record of your dietary protein intake, fluid balance, and body weight.

Using Nutrineal with other medicines

  • Tell your doctor if you are using, have recently used, or might use any other medicines. If you use other medicines, your doctor may need to increase your dose since peritoneal dialysis treatment increases the elimination of certain medicines.
  • Be careful if you use heart medicines called cardiac glycosides (e.g., digoxin). Your heart medicines may not be as effective, or their toxicity may increase. You may:
  • need potassium and calcium supplements.
  • develop heart rhythm disturbances (arrhythmia).
  • Your doctor will closely monitor you during treatment, especially your potassium and magnesium levels.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor before using this medicine. The use of Nutrineal is not recommended during pregnancy or breastfeeding unless your doctor advises you otherwise.

Driving and using machines

This treatment can cause weakness, general discomfort, or decreased fluid volume in your body (hypovolemia). Do not drive or use machines if you are affected.

3. How to use Nutrineal

Nutrineal should be administered into your peritoneal cavity. This cavity is located in the abdomen (belly) between the skin and the peritoneum. The peritoneum is the membrane that surrounds the internal organs, such as the intestines or liver.

Nutrineal is not for intravenous use.

Follow your doctor's instructions for administering this medicine exactly. If in doubt, ask your doctor.If the bag is damaged, it must be discarded.

Dose and frequency

Your doctor will tell you the appropriate number of bags to use. Normally, it varies between one 2.0-liter bag and one 2.5-liter bag per day.

Use in children and adolescents

If you are under 18 years old, your doctor will carefully evaluate whether you should be given Nutrineal.

Your doctor will re-evaluate the treatment after 3 months if your nutritional status does not improve.

Method of administration

Before use:

  • Warm the bag to 37 °C. Use the specially designed heating plate for this purpose. Never submerge the bag in water to warm it. Never use a microwave oven to warm the bag.
  • Remove the overbag and administer the solution immediately.
  • Only use the solution if it is transparent and the packaging is not damaged.
  • Use each bag only once. Discard any unused solution.

You must use an aseptic technique during the entire administration of the solution, as you have been taught.

Compatibility with other medicines

Your doctor may prescribe other injectable medicines to be added directly to the Nutrineal bag. In this case, add the medicine through the medication addition site. Use the product immediately after adding the medicine. Consult your doctor if you are unsure.

If you use more than one bag of Nutrineal in 24 hours

If you are given too much Nutrineal, you may experience:

  • abdominal distension.
  • stomach heaviness.

Contact your doctor immediately. They will inform you of what to do.

If you stop treatment with Nutrineal

Do not stop peritoneal dialysis without your doctor's consent. Stopping treatment can have life-threatening consequences.

If you have any further questions about using this medicine, ask your doctor.

Medicine questions

Started taking the medicine and have questions?

Discuss your symptoms and treatment with a doctor online.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

If you experience side effects, talk to your doctor, even if you think they might be unrelated to this medicine.

If you notice any of the following side effects, tell your doctor or peritoneal dialysis unit immediately:

  • Abdominal pain.

Very common side effects (affect more than 1 in 10 patients treated with Nutrineal):

  • Nausea, vomiting.
  • Anorexia (prolonged eating disorder due to loss of appetite).
  • Gastritis (stomach inflammation).
  • Feeling of weakness.
  • Increased fluid volume in the body (hypervolemia).
  • High levels of acidic substances in the body (acidosis).

Common side effects (affect more than 1 in 100 patients treated with Nutrineal):

  • Anemia.
  • Depression.
  • Breathing difficulties.
  • Abdominal pain.
  • Decreased fluid volume in the body (hypovolemia).
  • Decreased potassium levels in the blood (hypokalemia).
  • Infection.

Uncommon side effects (affect an unknown number of patients treated with Nutrineal):

  • Peritonitis.
  • Cloudy peritoneal effluent.
  • Abdominal discomfort.
  • Fever.
  • General discomfort.
  • Itching.
  • Hypersensitivity reaction (an allergic reaction).
  • Severe allergic reactions that cause inflammation of the face or throat (angioedema).

Other side effects related to the peritoneal dialysis procedure:

  • Infection around the catheter exit site.
  • Catheter-related complications.
  • Decreased calcium levels (hypocalcemia) in the blood.

Reporting of side effects

If you experience any side effects, talk to your doctor, pharmacist, or nurse, even if you think they might be unrelated to this medicine. You can also report side effects directly through the Spanish Medicines Monitoring System for Human Use*. By reporting side effects, you can help provide more information on the safety of this medicine.

5. Storage of Nutrineal

  • Keep this medicine out of the sight and reach of children.
  • Store in the original package.
  • Store below 30 °C and protect from light.
  • Do not use this medicine after the expiry date stated on the carton and on the bag after EXP. The expiry date is the last day of the month indicated.

Discard Nutrineal as instructed.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the pack and further information

This leaflet does not contain all the information about this medicine. If you have any further questions, ask your doctor.

Composition of Nutrineal PD4 with 1.1% amino acids

The active substances are:

Nutrineal PD4 with 1.1% amino acids

Composition in mg/l

Amino acid mixture:

Alanine

951

Arginine

1071

Glycine

510

Histidine

714

Isoleucine

850

Leucine

1020

Lysine, HCl

955

Methionine

850

Phenylalanine

570

Proline

595

Serine

510

Threonine

646

Tryptophan

270

Tyrosine

300

Valine

1393

Sodium chloride

5380

Calcium chloride dihydrate

184

Magnesium chloride hexahydrate

51

Sodium lactate

4480

Composition in mmol/l

Amino acids

87.16

Sodium

132

Calcium

1.25

Magnesium

0.25

Lactate

40

Chloride

105

The other ingredients are:

  • Water for injections.
  • Concentrated hydrochloric acid.

Appearance of the product and pack contents

Nutrineal is packaged in a 2.0, 2.5, 3.0, or 5.0-liter PVC plastic bag.

Each bag is wrapped in an overbag and supplied in cardboard boxes.

Volume

Number of units per box

Product presentation

2.0 l

5

Single bag

2.5 l

4

Single bag

3.0 l

3

Single bag

5.0 l

2

Single bag

Not all bag types may be marketed.

Marketing authorization holder and manufacturer

Marketing authorization holder:

VANTIVE HEALTH S.L.

Calle Pouet de Camilo, 2 - Polígono Industrial Sector 14.

46394 Ribarroja del Turia (Valencia) Spain.

Manufacturer:

Vantive Manufacturing Limited.

Moneen Road.

Castlebar.

County Mayo, Ireland.

Date of last revision of this leaflet: May 2016

Detailed and updated information on this medicine is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS).

http://www.aemps.gob.es/

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Tarek Agami

General medicine 11 years exp.

Dr. Tarek Agami is a general practitioner registered in both Portugal and Israel, with broad experience in family and preventive medicine. He offers online consultations for adults and children, providing personalised support for primary care needs, chronic disease management, and everyday health concerns.

Dr. Agami received clinical training and worked in leading medical institutions in Israel (Kaplan Medical Center, Barzilai Medical Center, Wolfson Medical Center) and Portugal (European Healthcare City, Viscura Internacional, Hospital Dr. José Maria Grande, Hospital Vila Franca de Xira). His approach combines international medical standards with individualised attention to each patient.

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  • Medical support during travel or after relocation
  • Treatment adjustments and lifestyle recommendations based on your personal history
Dr. Agami provides medical support for patients using GLP-1 medications (such as Ozempic or Mounjaro) as part of a weight loss strategy. He offers individualised treatment planning, regular follow-up, dose adjustment, and advice on combining medication with sustainable lifestyle changes. Consultations follow the medical standards accepted in Portugal and Israel.

Dr. Agami is committed to evidence-based, patient-centred care, ensuring that each person receives trusted medical support tailored to their health goals.

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Nuno Tavares Lopes

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Dr. Nuno Tavares Lopes is a licensed physician in Portugal with 17 years of experience in emergency medicine, family and general practice, and public health. He is the Director of Medical and Public Health Services at an international healthcare network and serves as an external consultant for the WHO and ECDC.

  • Emergency care: infections, fever, chest/abdominal pain, minor injuries, paediatric emergencies
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Dr. Nuno Tavares Lopes provides medical support for patients using GLP-1 medications (Mounjaro, Wegovy, Ozempic, Rybelsus) as part of a weight loss strategy. He offers individualised treatment planning, regular follow-up, dose adjustment, and advice on combining medication with sustainable lifestyle changes. Consultations follow the medical standards accepted in Europe.

Dr. Lopes also provides interpretation of medical tests, follow-up care for complex patients, and multilingual support. Whether for urgent concerns or long-term care, he helps patients act with clarity and confidence.

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Anastasiia Shalko

Family medicine 13 years exp.

Dr. Anastasiia Shalko is a general practitioner with a background in both paediatrics and general medicine. She graduated from Bogomolets National Medical University in Kyiv and completed her paediatric internship at the P.L. Shupyk National Medical Academy of Postgraduate Education. After working as a paediatrician in Kyiv, she relocated to Spain, where she has been practising general medicine since 2015, providing care for both adults and children.

Her work focuses on urgent, short-term medical concerns – situations where patients need quick guidance, symptom assessment and clear next steps. She helps people understand whether their symptoms require in-person evaluation, home management or a change in treatment. Common reasons for booking an online consultation include:

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Dr. Shalko works specifically with urgent and short-term problems, providing practical recommendations and helping patients determine the safest next step. She explains symptoms clearly, guides patients through decision-making and offers straightforward medical advice for everyday acute issues.

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With clinical experience in both paediatrics and general medicine, Dr. Shalko confidently supports adults and children. Her communication style is clear, simple and reassuring, helping patients feel informed and supported throughout the consultation.

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Daniel Cichi

Family medicine 24 years exp.

Dr Daniel Cichi is a family medicine doctor with over 20 years of clinical experience. He provides online consultations for adults, supporting patients with acute symptoms, chronic conditions, and everyday health concerns that require timely medical guidance.

His background includes work in emergency care, ambulance services, and family medicine, which allows him to assess symptoms quickly, identify warning signs, and help patients choose the safest next steps – whether that means home care, treatment adjustment, or in-person evaluation.

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Dr Cichi’s consultations are structured and practical. He focuses on clear explanations, risk assessment, and actionable recommendations, helping patients understand their symptoms and make informed decisions about their health.
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Frequently Asked Questions

Is a prescription required for NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS?
NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS requires a prescription in Spain. You can check with a doctor online whether this medicine may be appropriate for your situation.
Who manufactures NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS?
NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS is manufactured by Vantive Health S.L.. Pharmacy brands and packaging may differ depending on the distributor.
Which doctors can assess the use of NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS online?
Doctors such as Family doctors, Psychiatrists, Dermatologists, Cardiologists, Endocrinologists, Gastroenterologists, Pulmonologists, Nephrologists, Rheumatologists, Hematologists, Infectious disease physicians, Allergists, Geriatricians, Paediatricians, Oncologists may assess whether NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS is appropriate, depending on your situation and local regulations. You can book an online consultation to discuss your symptoms and possible next steps.
What are the alternatives to NUTRINEAL PD4 WITH 1.1% AMINO ACIDS, SOLUTION FOR PERITONEAL DIALYSIS?
Other medicines with the same active substance () include NUTRINEAL PD4 with 1.1% Amino Acids with Integrated Disconnect System, Solution for Peritoneal Dialysis, BICAVERA GLUCOSA 1.5%, Calcium 1.75 mmol/l SOLUTION FOR PERITONEAL DIALYSIS, BICAVERA GLUCOSA 2.3%, Calcium 1.75 mmol/l SOLUTION FOR PERITONEAL DIALYSIS. These may have different brand names or formulations but contain the same therapeutic ingredient. Always consult a doctor before switching or starting a new medicine.
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