Parenteral Nutrition Macronutrient Calculator
Parenteral Nutrition Macronutrient Calculator: Energy and Nitrogen Ratio
Energy from each macronutrient in a parenteral nutrition bag, the non-protein energy, and the nitrogen-to-energy ratio in both of the conventions it gets quoted in. Dextrose is costed at 3.4 kcal/g because intravenous dextrose is the monohydrate, and the page shows what the 4.0 kcal/g error would have cost you. Lipid can be entered as grams of oil or as millilitres of emulsion, which are not the same thing.
These figures come from published predictive equations and reference ranges. They are not a measurement of the person in front of you, and they are not a feeding prescription — they are a starting estimate for a dietitian or clinician to weigh against the patient, the local policy and, where it is available, measurement.
PN bag energy and nitrogen ratio
a bag with 80 g amino acid, 250 g dextrose and 50 g of lipid entered as grams of oil, in a 70 kg adult
Energy per macronutrient, non-protein energy, and the two nitrogen ratios
- A, D
- grams a day of amino acid and of dextrose as the bag is labelled
- 3.4
- kcal per gram of dextrose MONOHYDRATE, which is what intravenous dextrose is. Anhydrous glucose is about 3.75 kcal/g; the monohydrate carries a water of crystallisation, so the ratio of the molecular weights, 180.16/198.17 = 0.9091, brings it to 3.41. The figure is also stated directly on the dextrose injection label. Costing intravenous dextrose at 4.0 kcal/g is the classic parenteral nutrition arithmetic error and overstates it by 17.6 per cent
- G, V, ρe
- grams of oil, millilitres of emulsion, and the emulsion’s labelled energy density. The labelled density includes the glycerol and the phospholipid, so it is NOT 9 kcal/g of oil: 1.1, 2.0 and 3.0 kcal/mL for 10, 20 and 30 per cent emulsions, which is 11, 10 and 10 kcal per gram of oil
- N
- grams of nitrogen a day. The 6.25 is the same convention used on the protein requirement page and on the medical nitrogen balance page, so figures carry across between them unchanged
- + 25
- the exact offset between the two ratio conventions, and the reason this page prints both. One gram of nitrogen is 6.25 g of amino acid, which at 4 kcal/g is 25 kcal; so the total-energy ratio always exceeds the non-protein-energy ratio by exactly 25 kcal per gram of nitrogen, whatever the bag. The page prints that difference as a row, where it should always read 25.00
- GIR
- glucose infusion rate in mg/kg/min, computed on the labelled dextrose grams because that is the convention. Note the identity: mg/kg/min = (g/kg/day)/1.44, so 4 g/kg/day is 2.78 mg/kg/min and 3 g/kg/day is 2.08
Worked example
a bag with 80 g amino acid, 250 g dextrose and 50 g of lipid entered as grams of oil, in a 70 kg adult
Amino acid: 80 g × 4 kcal/g = 320 kcal.
Dextrose, and this is the step that gets it wrong: 250 g × 3.4 kcal/g = 850 kcal. At 4.0 kcal/g it would have come out at 1,000 kcal — 150 kcal a day more, which is 9.3 per cent of this bag's whole energy content. Intravenous dextrose is the monohydrate, carrying a water of crystallisation; anhydrous glucose would be about 3.75 kcal/g and the ratio of the molecular weights, 180.16/198.17, brings that to 3.41. The dextrose injection label says 3.4 kcal/g in as many words.
Lipid, entered as 50 g of oil: 50 × 9 = 450 kcal. Hold that thought, because it is an under-count — see the last step.
Total: 320 + 850 + 450 = 1,620 kcal a day, of which the non-protein energy is 850 + 450 = 1,300 kcal. The shares are 19.8 per cent amino acid, 52.5 per cent dextrose and 27.8 per cent lipid, and carbohydrate is supplying 850/1,300 = 65.4 per cent of the non-protein energy, close to the 60 per cent usually aimed for.
Nitrogen: 80/6.25 = 12.8 g N a day. Now the ratio, and the reason this page prints two of them. Non-protein energy per gram of nitrogen is 1,300/12.8 = 101.6, comfortably inside the 100 to 150 classically proposed for anabolism. Total energy per gram of nitrogen is 1,620/12.8 = 126.6. The difference is exactly 25.0, and it always is: one gram of nitrogen is 6.25 g of amino acid at 4 kcal/g, which is 25 kcal. So the same bag can be quoted as 1 g N per 102 kcal or 1 g N per 127 kcal depending on which convention the source used, and a reader who does not know which is being used cannot tell a nitrogen-rich bag from an energy-rich one.
Per kilogram, for the 70 kg adult: amino acid 1.14 g/kg/day, dextrose 3.57 g/kg/day, lipid 0.71 g/kg/day, total energy 23.1 kcal/kg/day. The dextrose figure is just above the 3.0 to 3.5 g/kg/day the German and Swiss guidelines name as preferred, so the page says so — though it is still below their 4 g/kg/day ceiling.
Glucose infusion rate: 250 g × 1,000 mg/g ÷ (70 kg × 1,440 min) = 2.48 mg/kg/min. The shortcut is that mg/kg/min is g/kg/day divided by 1.44: 3.57/1.44 = 2.48. The adult ceiling of 4 g/kg/day is 2.78 mg/kg/min on the same arithmetic. The neonatal case, where the numbers are several times higher and the thresholds different, belongs on the neonatal glucose infusion rate page and not here.
NOW ENTER THE LIPID THE OTHER WAY, which is where the second classic error lives. Fifty grams of oil as a 20 per cent emulsion is 250 mL. The label says a 20 per cent emulsion is 2.0 kcal/mL — total caloric value including fat, phospholipid and glycerin — so 250 mL is 500 kcal, not 450. Ten kcal per gram of oil rather than nine. The glycerol and the egg phospholipid are energy and the manufacturer counts them. Switch the selector and the total rises from 1,620 to 1,670 kcal a day. It is worse at 10 per cent strength: the glycerol and phospholipid load is almost the same whatever the oil content, so a 10 per cent emulsion is labelled 1.1 kcal/mL, which is 11 kcal per gram of oil — 22 per cent above the 9 kcal/g figure.
Two pages this one deliberately does not duplicate. Measured nitrogen balance, from a urine collection, is a lab interpretation and lives on the medical nitrogen balance page; what this page does is composition arithmetic on a bag whose contents are already known. And the protein target the bag is trying to meet is on the protein requirement page, which uses the same 6.25 factor so the nitrogen figure carries across unchanged.
Energy yields this page uses, and where each comes from
| Component | Yield used | Why that figure | The wrong figure, and what it costs |
|---|---|---|---|
| Amino acid | 4 kcal/g | Atwater protein factor, as in the FAO conversion factors | Omitting amino acid energy from the total understates a typical bag by about 20 per cent |
| Dextrose, intravenous | 3.4 kcal/g | Intravenous dextrose is the monohydrate. Anhydrous glucose is about 3.75 kcal/g and the molecular weight ratio 180.16/198.17 = 0.9091 gives 3.41. The injection label states 3.4 kcal/g directly | 4.0 kcal/g overstates dextrose energy by 17.6 per cent — 150 kcal/day on 250 g |
| Lipid, as grams of oil | 9 kcal/g | Atwater fat factor, for the triglyceride alone | Applied to a real emulsion it UNDER-counts, because glycerol and phospholipid are energy too |
| Lipid emulsion, 10% | 1.1 kcal/mL | Manufacturer’s labelled total caloric value | 11.0 kcal per gram of oil — 22 per cent above the 9 kcal/g figure |
| Lipid emulsion, 20% | 2.0 kcal/mL | Manufacturer’s labelled total caloric value, stated as including fat, phospholipid and glycerin | 10.0 kcal per gram of oil — 11 per cent above the 9 kcal/g figure |
| Lipid emulsion, 30% | 3.0 kcal/mL | Manufacturer’s labelled total caloric value | 10.0 kcal per gram of oil |
| Nitrogen from amino acid | divide by 6.25 | Protein averages about 16 per cent nitrogen; 1/0.16 = 6.25 | A convention, not a constant: real nitrogen content runs 13 to 19 per cent |
The nitrogen-to-energy ratio in the two conventions it gets quoted in
| Source of the figure | Quoted as | Non-protein kcal per g N | Total kcal per g N |
|---|---|---|---|
| Classic figure for anabolism | 100 to 150 non-protein kcal per g N | 100 to 150 | 125 to 175 |
| German and Swiss PN guidelines, normal metabolism | 1 g N per 130 to 170 kcal, convention not stated | 105 to 145 if total; 130 to 170 if already non-protein | 130 to 170 if total; 155 to 195 if non-protein |
| ESPEN-derived range, as collated in a published critique | 71 to 100 non-protein kcal per g N | 71 to 100 | 96 to 125 |
| ASPEN-derived range, as collated in the same critique | 37.5 to 105 non-protein kcal per g N | 37.5 to 105 | 62.5 to 130 |
| Major burns, flow phase | at least 100:1, the study itself ran 93:1 | 93 to 100 | 118 to 125 |
Loads per kilogram, and the ceilings quoted for an adult
| Quantity | Usual adult figure | Ceiling quoted | Equivalent |
|---|---|---|---|
| Dextrose | 3.0 to 3.5 g/kg/day | 4 g/kg/day | 2.08 to 2.43, ceiling 2.78 mg/kg/min |
| Dextrose, critically ill or diabetic start | 1 to 2 g/kg/day | build up on glucose monitoring | 0.69 to 1.39 mg/kg/min |
| Glucose oxidative capacity, normal metabolism | about 4 to 5 g/kg/day | beyond it, lipogenesis and raised carbon dioxide | 2.78 to 3.47 mg/kg/min |
| Lipid, as oil | about 1 g/kg/day | 1 to 1.5 g/kg/day | 20 to 30 per cent of total energy |
| Amino acid, normal metabolism | 0.8 g/kg/day | 1.2 to 1.5, exceptionally 2.0 to 2.5 | 0.13 to 0.40 g N/kg/day |
| Carbohydrate share of non-protein energy | about 60 per cent | — | the rest from lipid |
3.4 not 4.0, 10 not 9, and two nitrogen ratios that differ by exactly 25
Parenteral nutrition arithmetic goes wrong in three specific places, and this page is built around all three. The first is the dextrose factor. Intravenous dextrose is dextrose monohydrate — the injection label names it as D-glucose monohydrate and states 3.4 kcal per gram — because the crystal carries a water of crystallisation that contributes mass and no energy. Anhydrous glucose is about 3.75 kcal/g, and multiplying by the ratio of the molecular weights, 180.16 over 198.17, gives 3.41. Cost it at the familiar carbohydrate figure of 4.0 kcal/g instead and you overstate it by 17.6 per cent, because 4.0 divided by 3.4 is 1.176. On a bag carrying 250 g of dextrose that is 150 kcal a day that is not there. This page uses 3.4 throughout and prints the size of the 4.0 error as its own row, so the mistake is visible rather than merely avoided.
The second is the lipid, and it goes wrong in the opposite direction. Nine kilocalories per gram is the Atwater factor for fat and it is correct for triglyceride. A lipid emulsion is not triglyceride: it also contains glycerol and egg phospholipid, and the manufacturers’ labelled energy counts them. The label for a 20 per cent emulsion says the total caloric value, including fat, phospholipid and glycerin, is 2.0 kcal per mL — and 2.0 kcal/mL at 0.2 g of oil per mL is 10 kcal per gram of oil, not 9. The effect is far larger at low strengths, because the glycerol and phospholipid load is almost the same whatever the oil content: a 10 per cent emulsion is labelled 1.1 kcal/mL, which is 11 kcal per gram of oil, 22 per cent above the Atwater figure. A 30 per cent emulsion is 3.0 kcal/mL and back to 10 kcal per gram. This page lets you enter lipid either way, tells you which under-counts, and prints the energy per gram of oil so the discrepancy is on the screen.
The third is the nitrogen-to-energy ratio, where the problem is not the arithmetic but the convention. The ratio is quoted two ways — non-protein kilocalories per gram of nitrogen, and total kilocalories per gram of nitrogen — and sources frequently do not say which. The two differ by exactly 25, every time, for every bag: one gram of nitrogen is 6.25 grams of amino acid, which at 4 kcal/g is 25 kcal of protein energy, so the total-energy ratio always exceeds the non-protein one by 25 and converting between them is addition. The published ranges do not agree either. The classic proposal for anabolism was 100 to 150 non-protein kcal per gram of nitrogen; a recent critique collated ESPEN-derived guidance at 71 to 100 and ASPEN-derived guidance at 37.5 to 105, a factor of nearly three across the two; and the German and Swiss parenteral nutrition guidelines name 1 g N per 130 to 170 kcal without stating whether those kcal are total or non-protein, with the surrounding text pointing both ways. Faced with that, printing one number and calling it the ratio would be inventing a consensus. This page prints both conventions, prints the difference between them as a row that should always read exactly 25.00, and flags when the non-protein ratio falls outside 71 to 170. It is also worth saying out loud that the parameter runs backwards from intuition: the higher the number, the less protein the bag holds relative to its energy.
Why grams, and not volumes and concentrations. The page takes grams of amino acid, grams of dextrose and either grams of oil or millilitres of emulsion. Grams were chosen because that is the form in which a compounded bag’s composition is actually stated — on the label, on the pharmacy worksheet and in the prescription — and because a volume-and-percentage interface would require a separate pair of fields for every component and would still end in the same multiplication. The one exception is the lipid, where millilitres are offered precisely because the millilitre figure is the one that carries the manufacturer’s real energy density, and the gram figure is the one that invites the 9 kcal/g error. If your worksheet gives dextrose as a volume and a percentage, multiply first: 500 mL of 50 per cent dextrose is 250 g.
What this page is not, and what it will not do. It is composition arithmetic on a bag whose contents are known, which is a different question from measured nitrogen balance. Nitrogen balance is calculated from a urine collection and the measured urinary urea nitrogen, it is an interpretation of a laboratory result, and it lives on the medical nitrogen balance page — a reader who lands on one of the two pages wanting the other should be able to tell within a sentence, which is why both say so. The glucose infusion rate here is the adult case; the neonatal case, where the rates are several times higher and the thresholds different, is on the neonatal glucose infusion rate page. This page does not decide what a bag should contain, does not set an energy or protein target — those belong to the energy requirement page and the protein requirement page — and says nothing about how fast parenteral nutrition may be started, which is governed by refeeding risk and is assessed on the refeeding syndrome risk interpreter. It also refuses to answer on a bag with nothing in it, and it drops the nitrogen rows rather than printing an infinity when there is no amino acid. For the protein target the bag is trying to meet, and for the same 6.25 factor used consistently, see the protein requirement page; for the enteral route, the enteral feed rate page.
Frequently asked questions
Why 3.4 kcal/g for dextrose rather than 4?
Because intravenous dextrose is the monohydrate. The injection label designates it D-glucose monohydrate and states 3.4 kcal per gram outright. The reason is that the crystal carries a water of crystallisation: anhydrous glucose is about 3.75 kcal/g, and multiplying by the molecular weight ratio 180.16/198.17 = 0.9091 gives 3.41. Using 4.0 kcal/g overstates dextrose energy by 17.6 per cent, which on 250 g a day is 150 kcal that is not being delivered. This page uses 3.4 and prints the size of the 4.0 error as a row, so you can see what the substitution would have cost.
Is a 20 per cent lipid emulsion really 2.0 kcal/mL and not 1.8?
Yes, and the label says so in those words: the total caloric value, including fat, phospholipid and glycerin, is 2.0 kcal per mL. Twenty grams of oil per 100 mL at 9 kcal/g would be 1.8 kcal/mL; the extra 0.2 comes from the glycerol and the egg phospholipid, which are energy and which the manufacturer counts. That means 2.0 kcal/mL is 10 kcal per gram of oil. The effect is bigger at lower strengths because the non-oil load barely changes: a 10 per cent emulsion is labelled 1.1 kcal/mL, which is 11 kcal per gram of oil, and a 30 per cent one is 3.0 kcal/mL, back to 10.
Should the nitrogen ratio use non-protein or total energy?
Both are in use and this page prints both, because the sources genuinely do not agree. The classic figure of 100 to 150 for anabolism is non-protein kilocalories per gram of nitrogen. The German and Swiss parenteral nutrition guidelines name 1 g N per 130 to 170 kcal without saying which kind of kilocalorie, and their surrounding text points both ways. The two conventions differ by exactly 25 for any bag — one gram of nitrogen is 6.25 g of amino acid at 4 kcal/g — so the page prints the difference as a row that should always read 25.00, and you can match whichever convention your own source uses.
Why does the page refuse to show a ratio when there is no amino acid?
Because the ratio divides by the nitrogen, and with no nitrogen there is no ratio — not a very large one, none. Printing an enormous number, or the word Infinity, would look like an answer and would be read as one. The row simply disappears and a note says why. All the energy rows remain valid, so a pure lipid infusion or a glucose-only bag still gets its full energy breakdown.
How is the glucose infusion rate worked out, and which grams does it use?
Grams of dextrose as the bag is labelled — that is, the monohydrate — divided by weight and time: mg/kg/min is grams per day times 1,000, divided by weight in kg times 1,440 minutes. The useful shortcut is that mg/kg/min equals g/kg/day divided by 1.44, so 4 g/kg/day is 2.78 mg/kg/min. Using anhydrous grams instead would give a figure about 9 per cent lower, which is not the convention. This is the adult case; neonatal glucose infusion rates are several times higher with different thresholds and are calculated on the medical neonatal page.
How is this different from the nitrogen balance calculator?
They answer different questions from different inputs. This page does composition arithmetic: you know what is in the bag, and it tells you the energy, the shares and the nitrogen-to-energy ratio. Nitrogen balance works from a measurement — the urinary urea nitrogen in a 24-hour collection — and tells you whether the patient is in positive or negative balance, which is an interpretation of a laboratory result. One is what you are giving, the other is what is happening. Both use the same 6.25 factor, so the nitrogen figure from this page is the intake figure that one takes.
Can I enter the bag as volumes and concentrations instead of grams?
Not for amino acid and dextrose, by design. Grams are how a compounded bag’s composition is stated on the label, on the pharmacy worksheet and in the prescription, and a volume-and-percentage interface would need two fields per component and end in the same multiplication anyway. Convert first: 500 mL of 50 per cent dextrose is 250 g. Lipid is the exception and can be entered as millilitres of emulsion, precisely because the millilitre figure carries the manufacturer’s real energy density while the gram figure invites the 9 kcal/g under-count.
What does it mean when the ratio is flagged as too high?
That the bag is energy-rich relative to its nitrogen — and note that this parameter runs backwards from intuition, so a high number means less protein, not more. The page flags a non-protein ratio above 170, the top of the German and Swiss range for normal metabolism, and below 71, the bottom of the ESPEN-derived range. Neither flag is a verdict. A deliberately lipid-weighted or nitrogen-sparing bag can sit outside those bounds for good clinical reasons, and the published ranges disagree with each other by a factor of nearly three in any case. The flag says the arithmetic has left the range the literature quotes, and nothing more.
Related calculators
References
- Dextrose Injection USP prescribing information (Pfizer / Hospira), description and clinical pharmacology sections. Primary source for the two facts this page turns on: “Dextrose, USP is chemically designated D-glucose monohydrate, (C6H12O6 · H2O)”, and that a 25 per cent solution contains “0.25 grams of dextrose, hydrous, which delivers 3.4 kcal/gram (0.85 kcal/mL)”. The 0.85 kcal/mL figure is an internal cross-check: 0.25 g/mL × 3.4 kcal/g = 0.85.
- Food and Agriculture Organization of the United Nations, Food energy — methods of analysis and conversion factors (FAO Food and Nutrition Paper 77, 2003), chapters 2 and 3. Source for the 4 kcal/g protein and 9 kcal/g fat factors, for available carbohydrate expressed as monosaccharide equivalents at 3.75 kcal/g, and for the nitrogen-to-protein factor of 6.25 together with its limits (protein averages about 16 per cent nitrogen but ranges from 13 to 19 per cent). The 3.75 kcal/g monosaccharide figure is what, multiplied by 180.16/198.17 = 0.9091, independently reproduces the labelled 3.4 kcal/g for the monohydrate: 3.75 × 0.9091 = 3.409.
- Intralipid Injectable Emulsion prescribing information, 10%, 20% and 30% (Fresenius Kabi / Baxter), as published in the FDA-approved labelling. Source for the emulsion energy densities and for the explicit statement that they include the non-triglyceride components: “The total caloric value, including fat, phospholipid and glycerin, is 2.0 kcal per mL of Intralipid 20%”, with 1.1 kcal/mL for the 10 per cent and 3.0 kcal/mL for the 30 per cent emulsion. Compositions: soybean oil 10, 20 and 30 g per 100 mL, egg yolk phospholipids 1.2 per cent throughout, glycerin 2.25 per cent in the 10 and 20 per cent emulsions and 1.7 per cent in the 30 per cent. SMOFlipid 20 per cent, a four-oil emulsion of entirely different composition, is also labelled 2,000 kcal/L, which is the cross-check that 2.0 kcal/mL is a property of a 20 per cent emulsion rather than of one brand.
- DGEM, AKE and GESKES guidelines on parenteral nutrition, amino acids chapter (German Medical Science, 2009, doi:10.3205/000083), open access. Source for the nitrogen-to-energy ratio range: “A nitrogen calorie ratio of 1:130 to 1:170 (g N/kcal) or 1:21 to 1:27 (g AA/kcal) is recommended under normal metabolic conditions.” Also the amino acid doses quoted in the loads table: 0.8 g/kg/day in normal metabolism, 1.2 to 1.5 where requirements are increased, 2.0 to 2.5 in exceptional cases. Noted on the page, and in the report accompanying this batch, that the guideline does NOT state whether the kcal in that ratio are total or non-protein, which is why this page prints both conventions rather than choosing one.
- DGEM, AKE and GESKES guidelines on parenteral nutrition, carbohydrates chapter (German Medical Science, 2009, doi:10.3205/000082), open access. Source for the glucose figures in the loads table: a preferred intake of “3.0–3.5 g/kg body weight/day (2.1–2.4 mg/kg body weight/min)”, an upper limit of “4 g/kg body weight/day (2.8 mg/kg/min)”, an initial 1 to 2 g/kg/day in critically ill, diabetic, septic or steroid-treated patients, glucose oxidation of “approximately 4–5 g/kg body weight/day” in normal metabolism, and “approximately 60% of non-protein energy should be supplied as carbohydrates”. Their own g/kg/day to mg/kg/min conversions reproduce the 1.44 identity this page uses exactly.
- BAPEN, Parenteral Nutrition Formulation (education resource). Independent cross-check on the loads table: nitrogen 0.17 to 0.3 g/kg/day depending on metabolic stress — which at 6.25 is 1.06 to 1.88 g protein/kg/day — lipid not to exceed 1 to 1.5 g/kg/day and supplying 20 to 30 per cent of daily energy, and glucose up to 60 per cent of total energy.
- A published critique of the non-protein calorie to nitrogen ratio in Nutrición Hospitalaria (2024), collating the ranges in use: ESPEN-derived guidance at 71 to 100 non-protein kcal per gram of nitrogen, ASPEN-derived guidance at 37.5 to 105, about 37.5 for hospitalised patients, and the classic 100 to 150 proposed to permit anabolism during convalescence. It also states the identity this page is built on, that an energy-to-nitrogen ratio converts to a non-protein one “by just subtracting 25”. Cited for the spread between the published ranges, which is a factor of nearly three and is the reason this page flags rather than judges.
- A burns study of the non-protein calorie to nitrogen ratio at the flow phase in major burn injuries, which references a standard recommendation of 100:1 to 150:1 and itself maintained 93:1 across 54 patients. Used as a third independent source for the non-protein convention and for the 100 to 150 figure.
- Derivation performed for this page rather than taken from a source: the two nitrogen-ratio conventions differ by exactly 25 kcal per gram of nitrogen for every possible bag, because 1 g N is 6.25 g of amino acid and 6.25 × 4 kcal/g = 25 kcal. The page prints that difference as a row so it can be checked; it should always read 25.00. Likewise mg/kg/min = (g/kg/day) × 1000/1440 = (g/kg/day)/1.44 exactly, so the 4 g/kg/day glucose ceiling is 2.78 mg/kg/min. And the energy per gram of oil in an emulsion is the labelled kcal/mL divided by the oil content in g/mL, giving 11.0, 10.0 and 10.0 kcal per gram of oil for 10, 20 and 30 per cent emulsions against the 9 kcal/g the triglyceride alone would yield — so entering emulsion lipid as grams of oil understates it by 18, 10 and 10 per cent respectively. All three are arithmetic, not opinion.
CalcEngines health calculators are for education and for checking arithmetic that has already been decided elsewhere. They are not medical advice, they do not decide what to give, and they do not replace the judgement of a doctor, nurse, midwife or dietitian who knows the person in front of them. Every figure depends on the values you enter and on the assumptions stated on the page — check it against the prescription, the product label and your local policy before acting on it.