Dextran 70

Class: Replacement Preparations
VA Class: BL800
CAS Number: 9004-54-0

Introduction

Plasma volume expander; nonprotein colloid.a b

Uses for Dextran 70

Shock

Early fluid replacement and plasma volume expansion in the adjunctive treatment of certain types of shock or impending shock (e.g., burns, surgery, hemorrhage, other trauma in which a circulating volume deficit is present) when whole blood or blood products are not available, or when the need for haste precludes the necessary cross-matching of blood.a b

Slideshow: HealthQuiz: Basics About Stroke Signs and Symptoms

May be hazardous if used in the treatment of shock not accompanied by hypovolemia because of the danger of volume overloading and resultant complications.a

Not a substitute for whole blood or plasma proteins;a b has no oxygen-carrying capacity.a

Dextran 70 Dosage and Administration

Administration

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by IV infusion.a b Preservative-free, single-use container; discard unused portion.a b

Administer 20 mL dextran 1 before administration of dextran 70.b (See Sensitivity Reactions under Cautions.)

Rate of Administration

Infusion rate is dependent on patient-specific requirements (e.g., amount of fluid loss, resultant hemoconcentration).a b

Normovolemic or nearly normovolemic patients: ≤0.24 g (4 mL) per minute.a

Emergency situations (adults): 1.2–2.4 g (20–40 mL) per minute.a b

Dosage

Pediatric Patients

Shock
IV

Adjust dosage and rate of infusion based on individual patient requirements, fluid loss amount, and resultant hemoconcentration.a b (See Rate of Administration under Dosage and Administration.)

Children: Limited use suggests basing dosage on patient body weight or surface area; maximum total dosage 20 mL/kg.a b (See Pediatric Patients under Cautions.)

Adults

Shock
IV

Adjust dosage and rate of infusion based on individual patient requirements, fluid loss amount, and resultant hemoconcentration.a b (See Rate of Administration under Dosage and Administration.)

Usual dose: 30 g (500 mL).a b Maximum total dosage (first 24 hours): 1.2 g/kg (20 mL/kg);a b thereafter, maximum total dosage of 0.6 g/kg (10 mL/kg) daily.a

Prescribing Limits

Pediatric Patients

Shock
IV

Children: Maximum total dosage 20 mL/kg.a b

Adults

Shock
IV

First 24 hours: Maximum total dosage 1.2 g/kg (20 mL/kg).a b Thereafter, maximum total dosage 0.6 g/kg (10 mL/kg) daily.a

Special Populations

Hepatic Impairment

No specific dosage recommendations at this time.b

Renal Impairment

No specific dosage recommendations at this time.b (See Contraindications under Cautions; Sodium Content under Cautions; and Renal Impairment under Cautions.)

Geriatric Patients

No specific dosage recommendations at this time.b

Cautions for Dextran 70

Contraindications

  • Known hypersensitivity to dextran or any ingredient in the formulation.a b (See Sensitivity Reactions under Cautions.)

  • Severe bleeding disorders.a b

  • Severe congestive cardiac failure.a b

  • Renal failure.a b

Warnings/Precautions

Warnings

Circulatory and/or Volume Overload

May cause circulatory overload; use with caution in patients with impaired renal function, and those at risk of developing pulmonary edema or CHF.a b (See Sodium Content under Cautions.)

May cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema.b

Risk of dilutional states is inversely proportional to the solution’s electrolyte concentration.b Risk of solute overloading, resulting in congestion with peripheral and pulmonary edema is directly proportional to the solution’s electrolyte concentration.b

Hematologic Effects

May interfere with platelet function, especially at doses of approximately 15 mL/kg; use with caution in thrombocytopenia.a b

Transient prolongation of bleeding time possible in patients receiving >1000 mL or approximately 15 mL/kg; slight increase in bleeding tendency may also occur.a b

Dextran 70 causes a marked factor VIII decrease and a greater decrease in factors V and IX than expected from the effects of hemodilution alone.a b Usually occurs at doses near 15 mL/kg.b Observe trauma and major surgery patients for early signs of bleeding complications.a b

Determine hematocrit after administration of dextran 70;a avoid depressing below 30% by volume. a b

May cause increased rouleaux formation; draw blood samples for typing and cross-matching prior to dextran infusion.a b Reserve sample for subsequent use, if necessary.a b (See Specific Drugs and Laboratory Tests under Interactions.)

Administration of large volumes of dextran solution results in lowered plasma protein concentrations.a b

Sodium Content

Each 500 mL of the commercially available solution containing 6% dextran 70 in 0.9% sodium chloride provides 77 mEq of sodium.a

Use products with sodium ions with caution in CHF, severe renal insufficiency, and in edema with sodium retention.b (See Renal Impairment under Cautions and also see Circulatory and/or Volume Overload under Cautions.)

Observe the usual precautions and contraindications associated with sodium in 6% dextran 70 in 0.9% sodium chloride.

GI Effects

Vomiting and involuntary defecation have occurred in anesthetized patients.a Use with caution in pathologic abdominal conditions or in patients undergoing bowel surgery.a

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions (e.g., urticaria, nasal congestion, wheezing, tightness of chest, mild hypotension) may occur.b May be relieved by antihistamines.a b

Dextran-Induced Anaphylactoid Reactions

Severe dextran-induced anaphylactoid reactions (DIAR) (e.g., generalized urticaria, wheezing, hypotension, severe hypotension, shock, cardiac and respiratory arrest, death) reported rarely.a b Typically occur early in the infusion period in patients with no previous exposure to dextran 70.a b Closely monitor patients with no previous exposure to dextran, especially during the first minutes of infusion.a b If severe hypotension occurs, determine whether it is the result of dextran or the shock initially present.a

Administration of 20 mL of dextran 1 prior to dextran 70 infusion decreases the likelihood of DIAR; however, serious reactions still may occur.b

Discontinue dextran at first sign of allergic reaction so long as circulation can be maintained by other means.a b Immediate medical intervention (e.g., parenteral epinephrine, antihistamines, and other supportive therapy) may relieve symptoms.a b If circulatory collapse due to anaphylaxis occurs after discontinuing dextran, begin rapid volume substitutions with another agent.b

Keep resuscitative measures readily available during dextran use.a b

Local Injection Site Reactions

Adverse local reactions caused by IV administration of dextran 70 include febrile response, infection at the injection site, venous thrombosis or phlebitis extending from the injection site, extravasation, and hypervolemia.a b If such reactions occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures, and save the remainder of the solution for examination if deemed necessary.a b

General Precautions

Diabetes Mellitus

Use with caution in patients with diabetes mellitus (subclinical or overt).b (See Specific Drugs and Laboratory Tests under Interactions.)

Observe the usual precautions and contraindications associated with dextrose in 6% dextran 70 in 5% dextrose injection.

Specific Populations

Pregnancy

Category C.b

Lactation

Not known whether dextran 70 is distributed into milk.a b Caution if used in nursing women.a b

Pediatric Use

Safety and efficacy not established in pediatric patients.a b Manufacturer provides some dosage guidelines based on limited use.b (See Pediatric Patients under Dosage and Administration.)

Renal Impairment

Use with caution in patients with impaired renal clearance of dextran; circulatory overload possible.a b Risk of sodium retention in patients with renal insufficiency.b (See Circulatory and/or Volume Overload under Cautions and see Sodium Content under Cautions.)

Common Adverse Effects

Nausea, vomiting, fever, arthralgia.a b

Interactions for Dextran 70

Blood and Laboratory Tests

Dextran may increase the formation of rouleaux; draw blood samples for typing and cross-matching prior to dextran infusion.a b Reserve samples for subsequent use, if necessary.a b

Dextran in the blood may cause turbidity; turbidity may interfere with some assays.a b

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Bilirubin assays using alcohol

Dextran in the blood may cause turbidity and interfere with assayb

Draw blood samples before initiating dextran therapyb

Blood cross-match (proteolytic enzyme techniques)

Possible interference with laboratory test; risk of rouleaux formationa b

Draw blood samples before initiating dextran therapy; reserve portions for later determinationsa b

Blood glucose (sulfuric acid or acetic acid hydrolysis)

Dextran 70 may cause falsely elevated valuesa b

Draw blood samples before initiating dextran therapya b

Blood-typing and cross-match (indirect antiglobulin method)

No interactiona b

Blood-typing and cross-match (saline agglutination method)

No interactiona b

Corticosteroids

Caution with IV fluid therapies containing sodiumb

Corticotropin

Caution with IV fluid therapies containing sodiumb

Total protein assay using biuret

Dextran in the blood may cause turbidity and interfere with assayb

Draw blood samples before initiating dextran therapyb

Dextran 70 Pharmacokinetics

Absorption

Onset

Maximum plasma volume expansion occurs approximately one hour after the end of infusion.a

Duration

Extent and duration of the expansion in plasma volume vary with the volume infused, preadministration plasma volume, and the rate of renal clearance.a

Distribution

Extent

Not known whether dextran 70 is distributed into milk.a b

Elimination

Metabolism

Large, unexcreted molecules (molecular weight ≥50,000) slowly degraded to glucose which is metabolized to carbon dioxide and water.a b

Elimination Route

Principally excreted unchanged into urine (approximately 40%) within 24 hours; small amounts eliminated in feces.a b

Stability

Storage

Parenteral

Injection for IV Infusion

Constant temperature, preferably 25°C (may be exposed briefly to temperatures up to 40°C).a b Protect from freezing and excessive heat.b

Manufacturer states do not use if crystallization has occurred.b

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Do not deliver additive medications by dextran 70 or other plasma volume expanders.b

Actions

  • Resembles human albumin in molecular weight and pharmacologic action.a b

  • Plasma volume expansion results from the colloidal osmotic effect in drawing fluid from the interstitial to the intravascular spaces; is slightly greater than the volume of dextran solution infused.a b

  • Expansion of plasma volume improves hemodynamic status for ≥24 hours.b

  • Initial rise in cardiac output, stroke volume, right atrial pressure, and venous pressure; may return to normal within a few hours.a

  • Dextrose provides calories, restores blood glucose concentrations, has a protein-sparing effect, and may help minimize liver glycogen depletion.b

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses (e.g., renal insufficiency, diabetes mellitus, CHF).b

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.b

  • Importance of informing patients of other important precautionary information.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dextran 70 in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

6% Dextran 70 in 5% Dextrose*

6% Dextran 70 in 5% Dextrose Injection

Hospira

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dextran 70 in Sodium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion only

6% Dextran 70 in 0.9% Sodium Chloride*

6% Dextran 70 in 0.9% Sodium Chloride Injection

Hospira

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions June 1, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

a. AHFS Drug Information 2008. McEvoy GK, ed. Dextran 70. Bethesda, MD: American Society of Health-System Pharmacists; 2008:2729-30.

b. Hospira, Inc. 6% Dextran 70 in 5% dextrose injection, USP and 6% dextran 70 in 0.9% sodium chlorideinjection, USP prescribing information. Lake Forest, IL; 2005 Oct.

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