Adult: Adjunctive therapy of shock due to burns, haemorrhage, surgery or other trauma: As 10% dextran 40 in 0.9% NaCl or 5% dextrose inj: Initially, 10 mL/kg via rapid infusion. Recommended Max: 20 mL/kg during the 1st 24 hours. If treatment continues beyond 24 hours, subsequent doses of up to 10 mL/kg daily may be given for up to 5 days.
Intravenous Prophylaxis of venous thromboembolism during surgical procedures
Adult: As 10% dextran 40 in 0.9% NaCl or 5% dextrose inj: Initially, 500-1,000 mL (approx 10 mL/kg) via infusion given on the day of surgery. Continue treatment of 500 mL daily dose for 2-3 days, then according to the risk of complications for up to 2 weeks (e.g. may give 500 mL every 2nd or 3rd day during period of risk).
Contraindications
Hypersensitivity to dextran. Renal disease with severe oliguria or anuria; marked cardiac decompensation, all types of marked haemostatic defects (e.g. thrombocytopenia, hypofibrinogenaemia) including those induced by drugs (e.g. heparin, warfarin).
Special Precautions
Patients with or at risk of heart failure; active haemorrhage, diabetes mellitus, chronic liver failure, risk of pulmonary oedema. Correct dehydration prior to administration. Not intended as a replacement for whole blood or blood components. Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Fluid overload, transient prolongation of bleeding time, increased bleeding tendency, acute renal failure, abnormal renal (e.g. specific gravity of urine) and hepatic (e.g. serum AST and ALT) function values; pulmonary oedema, wound haematoma, seroma, or bleeding (dose-related). Cardiac disorders: Chest tightness. Gastrointestinal disorders: Nausea, vomiting. Musculoskeletal and connective tissue disorders: Joint pain. Respiratory, thoracic and mediastinal disorders: Wheezing, nasal congestion. Skin and subcutaneous tissue disorders: Urticaria. Vascular disorders: Hypotension. Potentially Fatal: Rarely, severe anaphylactoid reactions (including marked hypotension or cardiac and respiratory arrest).
Monitor blood pressure, heart rate, central venous pressure, right atrial pressure, mean arterial pressure, and capillary refill time; cardiac index, pulmonary capillary wedge pressure, systemic vascular resistance, and pulmonary vascular resistance (if pulmonary artery catheter is in place); Hb and haematocrit, serum electrolytes, serum protein, coagulation parameters, renal function, urine output, acid-base balance. Closely monitor for signs of anaphylactoid reaction during the 1st minutes of infusion; fluid overload, and bleeding.
Drug Interactions
May enhance anticoagulant effects of heparin, abciximab, or desirudin. May enhance nephrotoxic effect of arbekacin.
Lab Interference
May result in false elevation of serum glucose when tested by methods using high levels of acid (e.g. sulfuric acid, acetic acid). May interfere with bilirubin assays (using alcohol) and total protein assays (using biuret reagents) due to the development of turbidity. High molecular weight dextran (dextran 70) may produce erythrocyte aggregation which may interfere with blood-typing and cross-matching.
Action
Description: Mechanism of Action: Dextran produces plasma volume expansion due to its highly colloidal starch structure. It decreases blood viscosity, peripheral resistance and enhances peripheral blood flow, thus increasing venous return to the heart. Furthermore, it simultaneously inhibits vascular stasis and platelet adhesiveness which are essential to thrombus formation. Duration: Plasma expanding effect: 3-4 hours. Pharmacokinetics: Metabolism: Dextrans with molecular weight ≥50,000 are slowly metabolised by dextranase to form glucose. Excretion: Via urine (within 24 hours: approx 75% as unchanged dextran 40; approx 50% as unchanged dextran 70); faeces (small amounts).
Chemical Structure
Dextran_01 Source: National Center for Biotechnology Information. PubChem Database. Dextran, CID=4125253, https://pubchem.ncbi.nlm.nih.gov/compound/Dextran (accessed on Apr. 27, 2020)
B05AA05 - dextran ; Belongs to the class of blood substitutes and plasma protein fractions. Used as blood substitutes.
References
Anon. Dextran 40. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 14/11/2019.Anon. Dextran. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 14/11/2019.Buckingham R (ed). Dextran 40. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 14/11/2019.Buckingham R (ed). Dextran 70. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 14/11/2019.LMD in Dextrose Injection, Solution; LMD in Sodium Chloride Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 14/11/2019.
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