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Home > Medications (Drugs) > Hetastarch > More information about Hetastarch

More information about Hetastarch

Pronunciation

(HET a starch)


U.S. Brand Names

Hespan®; Hextend®

Synonyms

HES; Hydroxyethyl Starch

Generic Available

Yes: Sodium chloride infusion

Canadian Brand Names

Hextend®

Use

Blood volume expander used in treatment of hypovolemia

Hespan®: Adjunct in leukapheresis to improve harvesting and increasing the yield of granulocytes by centrifugal means

Use - Unlabeled/Investigational

Hextand®: Priming fluid in pump oxygenators during cardiopulmonary bypass, and as a plasma volume expander during cardiopulmonary bypass

Pregnancy Risk Factor

C

Lactation

Excretion in breast milk unknown/use caution

Contraindications

Hypersensitivity to hydroxyethyl starch or any component of the formulation; severe bleeding disorders, renal failure with oliguria or anuria, or severe congestive heart failure; per the manufacturer, Hextend® is also contraindicated in the treatment of lactic acidosis and in leukapheresis

Warnings/Precautions

Anaphylactoid reactions have occurred; use caution in patients allergic to corn (may have cross allergy to hetastarch); use with caution in patients with thrombocytopenia (may interfere with platelet function); large volume may cause drops in hemoglobin concentrations; use with caution in patients at risk from overexpansion of blood volume, including the very young or aged patients, those with CHF or pulmonary edema; volumes >1500 mL may interfere with platelet function and prolong PT and PTT times; use with caution in patients with history of liver disease; note electrolyte content of Hextend® including calcium, lactate, and potassium; use caution in situations where electrolyte and/or acid-base disturbances may be exacerbated (renal impairment, respiratory alkalosis). Safety and efficacy in pediatric patients have not been established, but limited data available.

Adverse Reactions

Frequency not defined.

Cardiovascular: Circulatory overload, heart failure, peripheral edema

Central nervous system: Chills, fever, headache, intracranial bleeding

Dermatologic: Itching, pruritus, rash

Endocrine & metabolic: Amylase levels increased, parotid gland enlargement, indirect bilirubin increased, metabolic acidosis

Gastrointestinal: Vomiting

Hematologic: Bleeding, factor VIII:C plasma levels decreased, decreased plasma aggregation decreased, von Willebrand factor decreased, dilutional coagulopathy; prolongation of PT, PTT, clotting time, and bleeding time; thrombocytopenia, anemia, disseminated intravascular coagulopathy (rare), hemolysis (rare)

Neuromuscular & skeletal: Myalgia

Miscellaneous: Anaphylactoid reactions, hypersensitivity, flu-like symptoms (mild)

Overdosage/Toxicology

Symptoms of overdose include heart failure, nausea, vomiting, circulatory overload, and bleeding. Treatment is supportive. Hetastarch is not eliminated by hemodialysis.

Stability

Store at room temperature; do not freeze. Do not use if crystalline precipitate forms or is turbid deep brown. In leukapheresis, admixtures of 500-560 mL of Hespan® with citrate concentrations up to 2.5% are compatible for 24 hours.

Compatibility

Hespan®:

Y-site administration: Compatible:   Cimetidine, diltiazem, doxycycline, enalaprilat. Incompatible:   Amikacin, cefamandole, cefoperazone, cefotaxime, cefoxitin, gentamicin, ranitidine, theophylline, tobramycin. Variable (consult detailed reference):   Ampicillin, cefazolin

Compatibility when admixed: Compatible:   Fosphenytoin, Citrate

Hextend®:

Y-site administration: Compatible:   Alatrofloxacin, alfentanil, amikacin, aminophylline, amiodarone, ampicillin, ampicillin-sulbactam, atracurium, azithromycin, bumetanide, butorphanol, calcium gluconate, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftizoxime, ceftriaxone, cefuroxime, chlorpromazine, cimetidine, ciprofloxacin, cisatracurium, clindamycin, dexamethasone, digoxin, diltiazem, diphenhydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, erythromycin, esmolol, famotidine, fentanyl, fluconazole, furosemide, gentamicin, granisetron, haloperidol, heparin, hydrocortisone, hydromorphone, hydroxyzine, inamrinone, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, lorazepam, magnesium, mannitol, meperidine, methylprednisolone, metoclopramide, metronidazole, midazolam, milrinone, mivacurium, morphine, nalbuphine, nitroglycerin, norepinephrine, ofloxacin, ondansetron, pancuronium, phenylephrine, piperacillin, piperacillin-tazobactam, potassium chloride, procainamide, prochlorperazine, promethazine, ranitidine, rocuronium, sodium nitroprusside, succinylcholine, sufentanil, theophylline, thiopental, ticarcillin, ticarcillin-clavulanate, tobramycin, trimethoprim-sulfamethoxazole, vancomycin, vecuronium, verapamil. Incompatible:   Amphotericin B, diazepam, sodium bicarbonate

Mechanism of Action

Produces plasma volume expansion by virtue of its highly colloidal starch structure, similar to albumin

Pharmacodynamics/Kinetics

Onset of action: Volume expansion: I.V.: ~30 minutes

Duration: 24-36 hours

Metabolism: Molecules >50,000 daltons require enzymatic degradation by the reticuloendothelial system or amylases in the blood

Excretion: Urine (~40%) within 24 hours; smaller molecular weight molecules readily excreted

Dosage

I.V. infusion (requires an infusion pump):

Children: Safety and efficacy have not been established

Plasma volume expansion:

Adults: 500-1000 mL (up to 1500 mL/day) or 20 mL/kg/day (up to 1500 mL/day); larger volumes (15,000 mL/24 hours) have been used safely in small numbers of patients

Leukapheresis: 250-700 mL; Note:   Citrate anticoagulant is added before use.

Dosing adjustment in renal impairment:   Clcr<10 mL/minute: Initial dose is the same but subsequent doses should be reduced by 20% to 50% of normal

Administration

Administer I.V. only; infusion pump is required. May administer up to 1.2 g/kg/hour (20 mL/kg/hour). Change I.V. tubing or flush copiously with normal saline before administering blood through the same line. Change I.V. tubing at least every 24 hours. Do not administer Hextend® with blood through the same administration set. Anaphylactoid reactions can occur, have epinephrine and resuscitative equipment available.

Leukapheresis: Mix Hespan® and citrate well. Administer to the input line of the centrifuge apparatus at a ration of 1:8 to 1:13 to venous whole blood.

Monitoring Parameters

Volume expansion: Blood pressure, heart rate, capillary refill time, CVP, RAP, MAP, urine output; if pulmonary artery catheter in place, monitor PCWP, SVR, and PVR; hemoglobin, hematocrit, cardiac index

Leukapheresis: CBC, total leukocyte and platelet counts, leukocyte differential count, hemoglobin, hematocrit, PT, PTT

Patient Education

Report immediately any respiratory difficulty, acute headache, muscle pain, or abdominal cramping. Pregnancy/breast-feeding precautions:   Inform prescriber if you are pregnant. Consult prescriber if breast-feeding.

Nursing Implications

Anaphylactoid reactions can occur, have epinephrine and resuscitative equipment available

Additional Information

Hetastarch is a synthetic polymer derived from a waxy starch composed of amylopectin.

Hespan®: 6% hetastarch in 0.9% sodium chloride

Molecular weight: 450,000

Sodium: 154 mEq/L

Chloride: 154 mEq/L

Hextend®: 6% hetastarch in lactated electrolyte injection

Molecular weight: 670,000

Sodium: 143 mEq/L

Chloride: 124 mEq/L

Calcium: 5 mEq/L

Potassium: 3 mEq/L

Magnesium: 0.9 mEq/L

Lactate: 28 mEq/L

Dextrose: 0.99 g/L

Anesthesia and Critical Care Concerns/Other Considerations

Hetastarch is a synthetic polymer derived from a waxy starch composed of amylopectin.

Hespan®: 6% hetastarch in 0.9% sodium chloride

Molecular weight: 450,000

Sodium: 154 mEq/L

Chloride: 154 mEq/L

Hextend®: 6% hetastarch in lactated electrolyte injection

Molecular weight: 670,000

Sodium: 143 mEq/L

Chloride: 124 mEq/L

Calcium: 5 mEq/L

Potassium: 3 mEq/L

Magnesium: 0.9 mEq/L

Lactate: 28 mEq/L

Dextrose: 0.99 g/L

Both Hextend® and Hespan® will expand the intravascular volume the same as an equal volume of 5% albumin. Hetastarch will increase the intravascular volume up to 24-36 hours. Hetastarch does not have oxygen-carrying capacity and is not a substitute for blood or plasma. Large volumes of Hespan® or Hextend® may interfere with platelet function, prolong PT and PTT times and cause hemodilution, however, clinically Hextend® has not been associated with coagulation abnormalities in doses >20 mL/kg up to a total of 5000 mL.

Hextend®: Formulated with near physiologic levels of sodium, chloride, calcium, potassium, magnesium; may be associated with less electrolyte abnormalities than Hespan®; not to be used for the treatment of lactic acidosis; should not be administered through the same line as blood products; use with caution in patients with congestive heart failure.

Hespan®: Intraoperative use in patients undergoing cardiac surgery with cardiopulmonary bypass may increase bleeding; each 500 mL provides 77 mEq sodium chloride and may cause hyperchloremic metabolic acidosis in large volumes; critically-ill patients receiving hetastarch infusions (goal: PCWP 12-18 mm Hg) had an increase in cardiac index, oxygen delivery and consumption.

Hextend® and Hespan®: May increase serum amylase temporarily without an association with pancreatitis; not eliminated by hemodialysis.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Dosage Forms

Infusion [premixed in lactated electrolyte injection] (Hextend®): 6% (500 mL)

Infusion, solution [premixed in NaCl 0.9%] (Hespan®): 6% (500 mL)

References

Abbott Laboratories, Hextend® Product Labeling, Revised January, 1999.

Bick RL, "Evaluation of a New Hydroxyethyl Starch Preparation (Hextend™) on Selected Coagulation Parameters,"Clin Appl Thrombosis/Hemostasis, 1995, 1(3):215-29.

Boldt J, Heesen M, M&uuml;ller M, et al, "The Effects of Albumin Versus Hydroxyethyl Starch Solution on Cardiorespiratory and Circulatory Variables in Critically Ill Patients,"Anesth Analg, 1996, 83(2):254-61.

Brutocao D, Bratton SL, Thomas JR, et al, "Comparison of Hetastarch With Albumin for Postoperative Volume Expansion in Children After Cardiopulmonary Bypass,"J Cardiothoracic Vasc Anesth, 1996, 10(3):348-51.

Gan TJ, Bennett-Guerrero E, Phillips-Bute B, et al "Hextend®, a Physiologically Balanced Plasma Expander for Large Volume Use in Major Surgery: A Randomized Phase III Clinical Trial,"Anesth Analg, 1999, 88(5):992-8.

Gan TJ, Wright D, Robertson C, et al, "Randomized Comparison of the Coagulation Profile When Hextend® or 5% Albumin is Used for Intraoperative Fluid Resuscitation,"Anesthesiology, 2001, 95:A193.

Knutson JE, Deering JA, Hall FW, et al, "Does Intraoperative Hetastarch Administration Increase Blood Loss and Transfusion Requirements After Cardiac Surgery?"Anesth Analg, 2000, 90(4):801-7.

University Health System Consortium. Technology Assessment: Albumin, Nonprotein Colloid, and Crystalloid Solutions, May 2000.

Wilkes NJ, Woolf RL, Powanda MC, et al, "Hydroxyethyl Starch in Balanced Electrolyte Solution (Hextend®) - Pharmacokinetic and Pharmacodynamic Profiles in Healthy Volunteers,"Anesth Analg, 2002, 94(3):538-44.

International Brand Names

Elohaes® (GB, HR, NL); Eloh&auml;st® (AT); Elo Hes® (ES); Expafusin® (ES); Expahes® (AT, CH); Haes Esteril® (ES); HAES-steril® (AR, AT, BE, BG, CH, CZ, DE, DK, HR, HU, ID, IL, LU, MX, NL, PL, SE, SI, TR); Heafusine® (FR); Hemohes® (CH, CL, LU, NL, NO, SI); Hespander® (JP); Hesteril® (ES, FR); Hextend® (CA); Hidroxietilamin CLNA BAX® (ES); Hydroksyetyloskrobia® (PL); Hyperhes® (FR); Infukoll HES® (PL); Isohes® (AT, CH); Osmohes® (AT, HU); Plasmasteril® (AT, BE, PL, TR); Stabizol® (RU); Varihes® (AT, CH); Voluven® (AR, AT, CH, DK, ES, GB, ZA)

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