Fructose10%w/v

Fructose is a naturally occurring simple sugar (monosaccharide) with the following pharmaceutical and clinical uses:

Established/well-recognized uses

• Parenteral (intravenous) fluid and caloric supplementation: Fructose solutions (e.g., 10% w/v) have been used as an alternative carbohydrate energy source to dextrose (glucose) in intravenous fluid and short-term nutritional support, particularly in situations where an insulin-independent carbohydrate source was historically preferred.
• Pharmaceutical excipient/sweetening agent: Fructose is widely used as a sweetener, flavoring agent, and inactive ingredient in oral liquids, tablets, and nutritional/rehydration formulations.

Adjunct/supportive use

• As a component of some oral rehydration or nutritional supplement formulations, usually in combination with other carbohydrates or electrolytes rather than as a sole therapeutic agent.

Note: Because of safety concerns (see Precautions and Warnings), intravenous Fructose has been largely superseded by dextrose-based solutions in many countries, though it may still be available and used in specific clinical or regional contexts.

Fructose (also called levulose or fruit sugar) is a hexose monosaccharide, chemically related to but structurally distinct from glucose. Pharmaceutical preparations containing Fructose include:

• Intravenous infusion solutions, typically as Fructose 10% w/v in water for injection (concentration varies by manufacturer/region).
• Fructose as an excipient/sweetening agent in oral solutions, syrups, and tablet formulations, usually in small, non-therapeutic quantities.

Fructose is a simple, naturally occurring sugar (a ketohexose monosaccharide) found in fruits, honey, and root vegetables, and produced commercially from sucrose or corn starch. In medicine, Fructose is used pharmaceutically as an intravenous carbohydrate source for fluid and caloric support, and as an excipient/sweetening agent in oral pharmaceutical and nutritional products.

Unlike glucose, intestinal and cellular uptake of Fructose does not primarily depend on insulin, which historically made it of interest for use in patients with impaired glucose tolerance. However, its hepatic metabolism can generate metabolic by-products (lactate, uric acid) that carry specific safety concerns, particularly with rapid intravenous administration (see Precautions and Warnings, Side Effects).

Intravenous carbohydrate/caloric and fluid-replacement agent; pharmaceutical excipient and sweetening agent. Fructose is not an antimicrobial, hormonal, or receptor-targeted drug.

Mode of action

Fructose is absorbed from the intestine mainly via the GLUT5 transporter, a process that is largely independent of insulin. Once absorbed or infused intravenously, Fructose is taken up predominantly by the liver, where it is phosphorylated by fructokinase to fructose-1-phosphate, then cleaved by aldolase B into glyceraldehyde and dihydroxyacetone phosphate. These products enter glycolytic and gluconeogenic pathways, ultimately providing glucose and energy substrates without requiring the rate-limiting, insulin-sensitive phosphofructokinase step used by glucose metabolism.

Pharmacodynamic/clinical relevance

This insulin-independent pathway was the original rationale for using Fructose as an intravenous energy source in patients with glucose intolerance. However, rapid hepatic phosphorylation of Fructose can transiently deplete intracellular inorganic phosphate and ATP, promoting excess lactate production (risk of lactic acidosis) and increased purine degradation (risk of hyperuricemia), especially with rapid intravenous infusion. In individuals with hereditary fructose intolerance (deficient aldolase B) or fructose-1,6-diphosphatase deficiency, fructose-1-phosphate (or related intermediates) accumulates abnormally, causing severe hypoglycemia and metabolic derangement — the basis for the absolute contraindication in these conditions.

Fructose intravenous solutions must be administered by slow intravenous infusion only, never as a rapid bolus, and only under medical/nursing supervision with appropriate monitoring. It should not be administered to patients with known hereditary Fructose intolerance or Fructose-1,6-diphosphatase deficiency (see Contraindications). Oral products containing Fructose as an excipient are used per their specific labeled directions (e.g., swallowed with or without food, as directed).

Fructose has relatively few clinically significant drug interactions, but the following are well-recognized:

• Alcohol (ethanol): Concurrent ethanol (including intravenous alcohol) can worsen the risk of lactic acidosis and hypoglycemia associated with Fructose metabolism, as both compete for hepatic metabolic capacity (NAD+/phosphate depletion); concurrent use should be avoided.
• Agents affecting uric acid/gout therapy: Because Fructose metabolism can raise uric acid levels, its use should be undertaken cautiously in patients on uric acid-lowering therapy or with gout, as it may counteract therapeutic control (see also Precautions and Warnings).
• Other intravenous fluids/electrolytes: As with any IV carbohydrate solution, co-administration with other IV fluids should be managed to avoid fluid or electrolyte imbalance; no specific pharmacokinetic drug-interaction data beyond general fluid management is established.

Adverse effects associated with Fructose depend on the route and rate of administration:

With intravenous use

• Lactic acidosis (particularly with rapid or high-dose infusion)
• Hyperuricemia (may precipitate or worsen gout)
• Mild hyperglycemia (via hepatic conversion of Fructose to glucose)
• Infusion-site reactions (phlebitis, pain, irritation)
• Fluid overload if infused in excessive volume

With oral use (as excipient/sweetener, at higher intake)

• Gastrointestinal discomfort — bloating, abdominal pain, diarrhea (more likely in individuals with Fructose malabsorption, a distinct and less severe condition than hereditary Fructose intolerance)

Hypersensitivity reactions are rare. Seek medical attention if severe or unexpected symptoms occur.

Fructose is a normal dietary sugar and, in ordinary nutritional amounts, is not known to pose a specific risk in pregnancy or lactation. However, when used as a pharmaceutical/intravenous agent, Fructose should be used in pregnancy only if clearly needed and if the potential benefit justifies the potential risk to the fetus; a physician should always be consulted before use in pregnant patients, especially for intravenous administration. Similarly, use during breastfeeding should be discussed with a physician, weighing clinical necessity against any theoretical risk, particularly for intravenous formulations. Formal controlled studies in pregnant/lactating women for pharmaceutical Fructose preparations are limited.

The following precautions apply to the use of Fructose, particularly intravenous formulations:

• Rate of infusion: Rapid intravenous infusion increases the risk of lactic acidosis and hyperuricemia; infusion should always be slow and monitored (see Dosage and Administration).
• Diabetes mellitus: Although Fructose uptake is less insulin-dependent than glucose, it is still ultimately converted to glucose in the liver and can raise blood glucose; use with caution and appropriate glucose monitoring in patients with diabetes mellitus.
• Hyperuricemia/gout: Fructose metabolism increases uric acid production; use cautiously in patients with gout or hyperuricemia, with monitoring as appropriate.
• Renal impairment: Use with caution, as impaired clearance may increase the risk of fluid overload, hyperuricemia, and metabolic disturbance.
• Undiagnosed infants/neonates: Because hereditary Fructose intolerance may not be diagnosed at birth, Fructose-containing intravenous fluids or formulas should be avoided in neonates and young infants unless hereditary Fructose intolerance and Fructose-1,6-diphosphatase deficiency have been excluded (see Contraindications).
• Critically ill/stressed patients: Such patients may have reduced capacity to metabolize Fructose safely; extra caution and monitoring (lactate, glucose, uric acid) are advised.

Excessive or too-rapid administration of Fructose, especially intravenously, can cause severe lactic acidosis, marked hyperuricemia, and — particularly in individuals with unrecognized hereditary Fructose intolerance or Fructose-1,6-diphosphatase deficiency — profound, life-threatening hypoglycemia and organ dysfunction (liver, kidney). If overdose or a severe reaction is suspected, discontinue the infusion immediately and seek emergency medical attention or contact a poison control center without delay. Do not attempt to manage a suspected overdose at home; specific treatment must be provided under medical supervision.

Store Fructose-containing oral/excipient products at room temperature (below 30°C), away from light and moisture. Keep out of reach of children. Intravenous Fructose solutions should be stored as directed on the product label — typically at room temperature, protected from light and freezing — and should not be used if the container is damaged, the solution is discolored, or it contains visible particles.

• Neonates and infants: Fructose exposure (IV or via formula) should be avoided until hereditary Fructose intolerance and Fructose-1,6-diphosphatase deficiency are excluded, given the risk of severe, potentially fatal reactions in undiagnosed cases.
• Children: Use only under medical supervision for clinical (e.g., IV fluid) indications; safety and efficacy of routine Fructose IV use in children is not as well established as in adults, and dosing must be individualized.
• Elderly: May have reduced renal/hepatic reserve; use with caution and monitor for fluid overload, hyperglycemia, and hyperuricemia.
• Renal or hepatic impairment: Use cautiously, with monitoring, due to altered clearance and metabolism of Fructose and its by-products.
• Diabetes mellitus: See Precautions and Warnings; Fructose still raises blood glucose despite an insulin-independent uptake mechanism.

Fructose used as an intravenous fluid/caloric supplement is typically given for as long as clinically indicated by the patient's fluid, nutritional, or metabolic needs (often short-term, until oral/enteral intake is adequate), and is not prescribed as a fixed "course" of treatment like an antibiotic. When Fructose is present only as an excipient/sweetener in an oral product, its "duration" simply follows that of the product it is contained in. The treating physician determines duration based on ongoing clinical assessment.

Intravenous carbohydrate/caloric agent; fluid and nutritional support agent; pharmaceutical excipient/sweetening agent (monosaccharide sugar).

Fructose is absorbed/utilized via the insulin-independent GLUT5 transporter and hepatic fructokinase/aldolase B pathway, entering glycolysis and gluconeogenesis to yield energy and glucose without relying on the insulin-sensitive phosphofructokinase step used by glucose metabolism. See Pharmacology for full mechanistic detail, including the basis of its specific safety risks (lactic acidosis, hyperuricemia, and severe reactions in hereditary fructose intolerance/fructose-1,6-diphosphatase deficiency).

Fructose should not be given to neonates or infants until hereditary Fructose intolerance and Fructose-1,6-diphosphatase deficiency have been ruled out, because undiagnosed cases can suffer severe, potentially fatal hypoglycemia and organ injury on exposure (see Contraindications, Precautions and Warnings). Beyond this specific screening concern, the safety and efficacy of routine Fructose use in children for general clinical indications is not as well established as in adults, and formal pediatric dosing has not been standardized; any pediatric use should be individualized and supervised by a physician.