Hextend (hetastarch/electrolyte solution,lactated)
Plasma Expanders Intravenous Plastic Bag, Injection (Ml)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Hetastarch, a nonprotein synthetic colloid, is a plasma volume expander.
Hetastarch, a hydroxyethyl starch (HES), is a synthetic colloid derived from a waxy starch composed mainly of amylopectin. Hydroxyethyl ether groups are introduced into glucose units of the starch, and the resultant material is hydrolyzed to yield a product with a molecular weight suitable for use as a plasma volume expander and for use in leukapheresis to promote erythrocyte sedimentation and thereby enhance granulocyte yield. Hetastarch resembles glycogen, and the polymerized d-glucose units in the hetastarch polymer are primarily joined by alpha-1-4-glycosidic linkages with occasional alpha-1-6 linkages.
Hetastarch is characterized by its molecular weight and molar substitution. The average molecular weight of hetastarch is approximately 600 (6% hetastarch in 0.9% sodium chloride injection (Hespan(R))) or 670 (6% hetastarch in lactated electrolyte injection (Hextend(R))); while the average molecular weight of hetastarch ranges from 450-800, at least 80% of the polymers have molecular weights ranging from 200-2600. The molar substitution of hetastarch is approximately 0.75 (i.e., there are 75 hydroxyethyl groups per 100 glucose units).
Hetastarch is commercially available as premixed solutions containing 6 g of hetastarch per 100 mL of 0.9% sodium chloride injection (e.g., Hespan(R)) or lactated electrolyte injection (Hextend(R)). Hespan(R) and Hextend(R) are designated as 6% HES 450/0.7.
Hetastarch exhibits colloidal oncotic effects. The drug retains intravascular fluid, resulting in plasma volume expansion. The degree of plasma volume expansion and improvement in hemodynamic state depend on the intravascular status of the patient.
Plasma volume expansion produced by hetastarch is comparable to that of albumin human 5% solution. Maximum plasma volume expansion in hypovolemic patients is reached within a few minutes after the end of infusion; the extent and duration of the expansion in plasma volume vary with the volume of solution infused and depend on the preadministration plasma volume, the distribution of hetastarch through body water, and the rate of renal clearance of the drug. Following IV infusion, plasma volume expansion diminishes over 24-36 hours.
In hypovolemic patients, hetastarch causes a temporary increase in arterial and venous pressures, cardiac index, stroke work index, and pulmonary wedge pressure. When added to whole blood, 6% hetastarch in 0.9% sodium chloride injection increases the erythrocyte sedimentation rate.
Hetastarch is not completely metabolized. The hydroxyethyl group is not cleaved during metabolism but remains intact and attached to glucose units when excreted; therefore, metabolism of hetastarch does not produce substantial amounts of glucose. Hetastarch is primarily excreted by the kidneys; molecules with a molecular weight of less than 50 are rapidly excreted, while larger molecules are retained for varying periods depending on their size and ease of breakdown.
Following IV infusion of a single 30-g (500-mL) dose of 6% hetastarch in 0.9% sodium chloride injection, about 33% of the dose is excreted in urine within 24 hours. Although excretion of hetastarch is variable, intravascular concentration of the drug decreases to less than 10% of the total administered dose within 2 weeks following IV infusion. Biliary excretion of hetastarch accounts for less than 1% of the dose.
Hetastarch is not removed by hemodialysis; it is not known whether hetastarch is removed by other extracorporeal elimination techniques.
Each liter of 6% hetastarch in 0.9% sodium chloride injection provides 154 mEq each of sodium and chloride. Each liter of 6% hetastarch in lactated electrolyte injection provides 143 mEq of sodium, 124 mEq of chloride, 28 mEq of lactate, 5 mEq of calcium, 3 mEq of potassium, and 0.9 mEq of magnesium; the electrolyte content of 6% hetastarch in lactated electrolyte injection resembles that of the principal ionic constituents of normal plasma. Commercially available hetastarch solutions have a pH of approximately 5.9 and a calculated osmolarity of approximately 307-309 mOsm/L.
Generic name: hetastarch/electrolyte solution,lactated
Drug class: Plasma Expanders
Therapeutic class: Hematological Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
The following indications are listed for Hextend:
- Hypovolemia
Dosing
When hetastarch is used for the treatment of hypovolemia, total dosage and rate of infusion depend on the amount of blood or plasma lost, the resultant hemoconcentration, and the patient's age, weight, and clinical condition. The usual adult dose of hetastarch is 30-60 g (500-1000 mL of 6% hetastarch in 0.9% sodium chloride injection or 6% hetastarch in lactated electrolyte injection). Hetastarch doses up to 90 g (1500 mL) have been used during surgery, generally without a need for blood or blood products. The manufacturers state that daily dosages exceeding 1.2 g/kg (20 mL/kg) or 90 g (1500 mL) usually are not required; however, such dosages have been used when severe blood loss has occurred (e.g., in postoperative or trauma patients), although generally only in conjunction with the administration of blood and blood products.
When used as an adjunct in leukapheresis, a citrate anticoagulant should be added to 250-700 mL of 6% hetastarch in 0.9% sodium chloride injection and mixed thoroughly. The resultant solution should be aseptically added to the input line of the centrifugation apparatus and infused at a ratio of 1:8 to 1:13 to venous whole blood.
Hetastarch solutions are administered by IV infusion.
When used as an adjunct in leukapheresis, 6% hetastarch in 0.9% sodium chloride injection should be thoroughly mixed with a citrate anticoagulant prior to IV infusion. (See Dosage and Administration: Dosage.) Hetastarch volumes of 500-560 mL are compatible with citrate concentrations up to 2.5% for 24 hours at room temperature. The safety and compatibility of additives other than citrate have not been established.
Because 6% hetastarch in lactated electrolyte injection contains calcium, it should not be administered simultaneously with blood through the same administration set due to the potential risk of coagulation.
Hetastarch solutions contain no preservatives and are intended for single use only; partially used containers of the drug should be discarded.
Hetastarch solutions should be stored at room temperature (25degreesC); brief exposure to temperatures up to 40degreesC does not adversely affect the preparation. Hetastarch solutions should not be frozen or exposed to excessive heat.
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Drug interactions
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There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
Hydroxyethyl starch (HES) preparations, including hetastarch, are contraindicated in critically ill adult patients, including those with sepsis, because of the increased risk of mortality and renal replacement therapy in such patients. (See Increased Mortality and Severe Renal Injury under Warnings/Precautions: Warnings, in Cautions.) HES preparations also are contraindicated in patients with severe liver disease, preexisting coagulation or bleeding disorders, and/or clinical conditions that may be exacerbated by volume overload (e.g., congestive heart failure, renal disease with oliguria or anuria not related to hypovolemia). The drug also is contraindicated in patients with known hypersensitivity to HES.
Because 6% hetastarch in lactated electrolyte injection contains lactate, the solution is contraindicated in the treatment of lactic acidosis.
- Anuria
- Cardiopulmonary bypass for CABG
- Chronic heart failure
- Hemorrhage
- Increased risk of bleeding
- Invasive surgical procedure
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Major traumatic injury
- Oliguria
- Sepsis
- Disease of liver
- Pulmonary edema
There are no moderate contraindications for this drug.
Adverse reactions
Adverse effects reported in patients receiving hetastarch include hypersensitivity reactions, coagulopathy, hemodilution, circulatory overload, metabolic acidosis, congestive heart failure, pulmonary edema, bleeding, vomiting, peripheral edema, submaxillary and parotid glandular enlargement, mild influenza-like symptoms, headache, and muscle pain.
More Frequent
- Fluid volume disorder
Rare or Very Rare
- Anaphylaxis
- Angioedema
- Bronchospastic pulmonary disease
- Chronic heart failure
- Erythema multiforme
- Hemorrhage
- Hepatic failure
- Hyperbilirubinemia
- Hypersensitivity drug reaction
- Hypotension
- Increased risk of bleeding due to coagulation disorder
- Intracranial bleeding
- Laryngeal edema
- Metabolic acidosis
- Pulmonary edema
- Renal failure
- Shock
More Frequent
- Elevated serum amylase
- Lymphadenopathy
- Pruritus of skin
Less Frequent
- Chills
- Fever
- Flu-like symptoms
- Vomiting
Rare or Very Rare
- Bradycardia
- Chest pain
- Cough
- Facial edema
- Flushing
- Headache disorder
- Myalgia
- Nervousness
- Periorbital edema
- Peripheral edema
- Stridor
- Tachycardia
- Tachypnea
- Urticaria
- Wheezing
Precautions
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Safety and efficacy of hetastarch have not been established in pediatric patients. However, in a small double-blind study in which a limited number of pediatric patients (1-15.5 years of age) were randomized to receive either hetastarch (i.e., 6% hetastarch in 0.9% sodium chloride injection) or albumin as a postoperative volume expander during the first 24 hours after surgery for repair of congenital heart disease, no differences in coagulation parameters or amount of required replacement fluids were found between pediatric patients receiving 1.2 g/kg (20 mL/kg) or less of hetastarch compared with those receiving albumin. However, an increase in PT was observed among patients receiving more than 1.2 g/kg of hetastarch.
Category C. (See Users Guide.)
It is not known whether hetastarch is distributed into milk in humans. Caution is advised if the drug is administered to nursing women.
In clinical trials of 6% hetastarch in lactated electrolyte injection, 30% of patients were 65 years of age or older, and 12% were 70 years of age or older. Experience with 6% hetastarch in 0.9% sodium chloride injection has not revealed overall differences in response relative to younger adults, but increased sensitivity in some older individuals cannot be ruled out.
Because hetastarch is primarily excreted by the kidneys and geriatric patients are more likely to have decreased renal function, caution should be exercised in dosage selection, and renal function should be monitored for at least 90 days in hospitalized patients receiving HES. (See Increased Mortality and Severe Renal Injury under Warnings/Precautions: Warnings and also see Renal Impairment under Warnings/Precautions: Specific Populations, in Cautions.)
ICD codes
| Code | Type | Description |
|---|---|---|
| Hypovolemia | ||
| E86.1 | ICD10CM | Hypovolemia |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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