Some chromium products are not for human use or ingestion. Chromium products labeled for industrial or craft use can be very toxic. A case of mistaken ingestion of a chromium-containing leather tanning solution by a patient has been reported. Patients should not take chromium products that are not labeled for use as nutritional supplements. If accidental exposure to such a product occurs, the patient should be instructed to contact a local poison control center and health care professional immediately.
Parenteral chromium products must be diluted prior to intravenous administration. Direct intravenous injection or intramuscular administration is contraindicated, as the acidic pH of the parenteral chromium solution may cause considerable tissue necrosis.
Some parenteral chromium and trace element products contain benzyl alcohol and should be avoided in patients with a history of benzyl alcohol hypersensitivity. Because benzyl alcohol has been associated with a ‘gasping syndrome’ in neonates, excessive exposure to benzyl alcohol containing products should be avoided.
Patients with diabetes mellitus should pursue chromium supplementation with products such as chromium picolinate only under the supervision and advice of a qualified health care professional. Chromium supplementation may influence serum blood glucose concentrations and hemoglobin A(1c) levels; medications used for the treatment of diabetes may need dosages adjusted during chromium use. Frequent monitoring of blood sugar and other clinical parameters is recommended. Patients with diabetes should be well-versed in the detection and management of hypoglycemia.
Chromium elimination may be decreased in patients with renal disease or renal impairment. Dosage reductions in supplemental parenteral or oral doses may be needed. Since chromium is primarily excreted via the renal route, supplementation should be approached with caution, particularly in patients maintained on dialysis or with renal failure.
There is insufficient clinical data to promote chromium’s role in obesity treatment at this time. In limited but controlled clinical trials, chromium does not appear to induce significant effects on body-fat composition or weight loss.
The use of oral chromium supplements in children, like chromium picolinate, is not recommended. If dietary intakes of chromium are judged to be insufficient, the use of a general multivitamin and mineral supplement formulated for children should provide the needed nutritional supplementation (i.e., the estimated adequate intake or AI). Chromium supplementation has only been established for children receiving maintenance nutrition with parenteral nutritional formulas (TPN) to prevent or treat chromium deficiency.
Use of chromium within the recommended daily dietary intake for lactating women is generally recognized as safe. Consider the benefits of breastfeeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breastfeeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Parenteral chromium injections are classified in FDA pregnancy category C. The use of chromium in pregnancy is only established for the prevention of chromium deficiency in patients maintained on parenteral nutritional formulas (TPN). Other claimed uses for chromium, such as the use of chromium picolinate for the adjunctive treatment of gestational diabetes, are not recommended; safety and efficacy have not been established in these patients at this time. Currently available studies have not been well controlled and have not established the safety or efficacy of chromium intake in excess of the estimated adequate intake (AI) during pregnancy. Adverse effects have not been reported with the normal daily intake of chromium within the recommended dietary daily intakes for a pregnant female. The use of chromium in excess of the recommended dietary allowance during normal pregnancy should be avoided unless, in the judgment of the physician, potential benefits in a specific, unique case outweigh the significant hazards involved.