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
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
ActionsActions
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
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
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 |
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions June 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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