Icodextrin: Difference between revisions
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{{short description|Pharmaceutical drug}} |
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| image = Icodextrin skeletal.svg |
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| image =Dextrin_skeletal.svg |
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| Drugs.com = {{drugs.com|international|icodextrin}} |
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| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled --> |
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| legal_US = <!-- OTC / Rx-only / Schedule I, II, III, IV, V --> |
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| routes_of_administration = [[Intraperitoneal]] |
| routes_of_administration = [[Intraperitoneal]] |
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| UNII = 2NX48Z0A9G |
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| KEGG = D03266 |
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| ChEMBL_Ref = {{ebicite|changed|EBI}} |
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| ChEMBL = 1201472 |
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'''Icodextrin''' ([[International Nonproprietary Name|INN]], [[United States Adopted Name|USAN]]) is a [[colloid]] [[osmotic]] agent used in form of an [[aqueous]] solution for [[peritoneal dialysis]] under the trade name '''Extraneal''',<ref name="RxList" /> and after gynecological [[laparoscopic]] surgery for the reduction of post-surgical [[adhesion (medicine)|adhesion]]s (fibrous bands that form between tissues and organs) under the trade name '''Adept'''.<ref name="FDA" /> |
'''Icodextrin''' ([[International Nonproprietary Name|INN]], [[United States Adopted Name|USAN]]) is a [[colloid]] [[osmotic]] agent, derived from [[maltodextrin]],<ref name="maltod">{{cite book |title=Clinical evidence, Issue 14 |pages=1046 |author=American College of Physicians--American Society of Internal Medicine |year=2005 |publisher=BMJ Pub. Group}}</ref> used in form of an [[aqueous]] solution for [[peritoneal dialysis]] under the trade name '''Extraneal''',<ref name="RxList" /> and after gynecological [[laparoscopic]] surgery for the reduction of post-surgical [[adhesion (medicine)|adhesion]]s (fibrous bands that form between tissues and organs) under the trade name '''Adept'''.<ref name="FDA" /> |
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==Chemistry== |
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==Physical and chemical properties== |
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Icodextrin is a starch-derived, branched, water-soluble [[glucose]] [[polymer]] linked by α-( |
Icodextrin is a [[starch]]-derived, branched, water-soluble [[glucose]] [[polymer]] linked by α-(1→4) and less than 10% α-(1→6) [[glycosidic bond]]s, making it a type of [[dextrin]]. Its weight-average molecular weight is between 13,000 and 19,000 [[Dalton (unit)|dalton]]s and its number-average molecular weight between 5,000 and 6,500 daltons. The substance is a white to off-white solid, and the solution is clear and colourless to pale yellow.<ref name="FDA" /> |
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==Mechanism of action== |
==Mechanism of action== |
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The osmotic activity of icodextrin keeps the solution inside the [[peritoneum]] for three to four days, reducing adhesion between |
The osmotic activity of icodextrin keeps the solution inside the [[peritoneum]] for three to four days, separating tissues and thus reducing adhesion between them when [[fibrin]] is formed after a surgery. In other words, the tissues are kept from gluing together.<ref name="FDA" /> |
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[[File:DP branchement.svg|thumb|left|upright|[[Peritoneal dialysis]]]] |
[[File:DP branchement.svg|thumb|left|upright|[[Peritoneal dialysis]]]] |
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When used for peritoneal dialysis, the icodextrin solution absorbs waste products from the blood, and is removed from the peritoneum after a few hours together with the waste.<ref>{{ |
When used for peritoneal dialysis, the icodextrin solution absorbs waste products from the blood, and is removed from the peritoneum after a few hours together with the waste.<ref>{{cite journal | vauthors = Frampton JE, Plosker GL | title = Icodextrin: a review of its use in peritoneal dialysis | journal = Drugs | volume = 63 | issue = 19 | pages = 2079–105 | year = 2003 | pmid = 12962523 | doi = 10.2165/00003495-200363190-00011 }}</ref> |
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==Pharmacokinetics== |
==Pharmacokinetics== |
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Icodextrin is not significantly metabolised inside the peritoneum. Instead, it is absorbed slowly (40% after 12 hours) into the bloodstream via the [[lymph vessel]]s. There it is broken down into [[oligosaccharide]]s by the enzyme [[alpha-amylase]]. In patients with intact kidney function, both icodextrin and its fragments are excreted via the kidney by [[glomerular filtration]].<ref name="RxList">RxList.com |
Icodextrin is not significantly metabolised inside the peritoneum. Instead, it is absorbed slowly (40% after 12 hours) into the bloodstream via the [[lymph vessel]]s. There it is broken down into [[oligosaccharide]]s by the enzyme [[alpha-amylase]]. In patients with intact kidney function, both icodextrin and its fragments are excreted via the kidney by [[glomerular filtration]].<ref name="RxList">{{cite web | work = RxList.com | url = http://www.rxlist.com/extraneal-drug.htm | title = Extraneal }}</ref><ref name="FDA">{{cite web | work = FDA | url = http://www.accessdata.fda.gov/cdrh_docs/pdf5/P050011c.pdf | title = Adept (4% Icodextrin) Adhesion Reduction Solution }}</ref> |
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==Contraindications== |
==Contraindications== |
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Icodextrin is contraindicated in patients with cornstarch allergy, [[maltose]] or [[isomaltose]] intolerance, [[glycogen storage disease]], or severe [[lactic acidosis]].<ref name="Drugs.com">Drugs.com |
Icodextrin is contraindicated in patients with cornstarch allergy, [[maltose]] or [[isomaltose]] intolerance, [[glycogen storage disease]], or severe [[lactic acidosis]].<ref name="Drugs.com">{{cite web | work = Drugs.com | url = https://www.drugs.com/pro/extraneal.html | title = Extraneal }}</ref> |
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==Adverse effects== |
==Adverse effects== |
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Adverse effects include [[peritonitis]], [[respiratory infection]], [[hypertension]] (high blood pressure), [[rash]]es, and headache. Of these side effects, only hypertension and rashes occurred significantly more often than under glucose solution; the other events seem to be related to peritoneal dialysis in general.<ref name="Drugs.com" /> |
Adverse effects include [[peritonitis]], [[respiratory infection]], [[hypertension]] (high blood pressure), [[rash]]es, and headache. Of these side effects, only hypertension and rashes occurred significantly more often than under glucose solution; the other events seem to be related to peritoneal dialysis in general.<ref name="Drugs.com" /> |
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==Interactions== |
== Interactions == |
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Icodextrin can mimic increased [[blood glucose]] levels, depending on the used testing system. Specifically, glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO) based tests can erroneously show high blood glucose in patients that have been treated with icodextrin.<ref name="Drugs.com" /> |
Icodextrin can mimic increased [[blood glucose]] levels, depending on the used testing system. Specifically, glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO) based tests can erroneously show high blood glucose in patients that have been treated with icodextrin.<ref name="Drugs.com" /> |
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==References== |
== References == |
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{{reflist}} |
{{reflist}} |
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{{Blood substitutes and perfusion solutions}} |
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{{B03, B05, B06}} |
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[[Category:Renal dialysis]] |
[[Category:Renal dialysis]] |
Latest revision as of 16:02, 21 November 2023
Clinical data | |
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AHFS/Drugs.com | International Drug Names |
Routes of administration | Intraperitoneal |
ATC code | |
Legal status | |
Legal status |
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Pharmacokinetic data | |
Bioavailability | 40% in 12 hours |
Metabolism | Alpha-amylase |
Excretion | Renal |
Identifiers | |
CAS Number | |
PubChem SID | |
DrugBank | |
ChemSpider |
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UNII | |
KEGG | |
ChEMBL | |
CompTox Dashboard (EPA) | |
Chemical and physical data | |
Formula | (C6H10O5)n |
Molar mass | 13–19 kg/mol |
(what is this?) (verify) |
Icodextrin (INN, USAN) is a colloid osmotic agent, derived from maltodextrin,[1] used in form of an aqueous solution for peritoneal dialysis under the trade name Extraneal,[2] and after gynecological laparoscopic surgery for the reduction of post-surgical adhesions (fibrous bands that form between tissues and organs) under the trade name Adept.[3]
Chemistry
[edit]Icodextrin is a starch-derived, branched, water-soluble glucose polymer linked by α-(1→4) and less than 10% α-(1→6) glycosidic bonds, making it a type of dextrin. Its weight-average molecular weight is between 13,000 and 19,000 daltons and its number-average molecular weight between 5,000 and 6,500 daltons. The substance is a white to off-white solid, and the solution is clear and colourless to pale yellow.[3]
Mechanism of action
[edit]The osmotic activity of icodextrin keeps the solution inside the peritoneum for three to four days, separating tissues and thus reducing adhesion between them when fibrin is formed after a surgery. In other words, the tissues are kept from gluing together.[3]
When used for peritoneal dialysis, the icodextrin solution absorbs waste products from the blood, and is removed from the peritoneum after a few hours together with the waste.[4]
Pharmacokinetics
[edit]Icodextrin is not significantly metabolised inside the peritoneum. Instead, it is absorbed slowly (40% after 12 hours) into the bloodstream via the lymph vessels. There it is broken down into oligosaccharides by the enzyme alpha-amylase. In patients with intact kidney function, both icodextrin and its fragments are excreted via the kidney by glomerular filtration.[2][3]
Contraindications
[edit]Icodextrin is contraindicated in patients with cornstarch allergy, maltose or isomaltose intolerance, glycogen storage disease, or severe lactic acidosis.[5]
Adverse effects
[edit]Adverse effects include peritonitis, respiratory infection, hypertension (high blood pressure), rashes, and headache. Of these side effects, only hypertension and rashes occurred significantly more often than under glucose solution; the other events seem to be related to peritoneal dialysis in general.[5]
Interactions
[edit]Icodextrin can mimic increased blood glucose levels, depending on the used testing system. Specifically, glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO) based tests can erroneously show high blood glucose in patients that have been treated with icodextrin.[5]
References
[edit]- ^ American College of Physicians--American Society of Internal Medicine (2005). Clinical evidence, Issue 14. BMJ Pub. Group. p. 1046.
- ^ a b "Extraneal". RxList.com.
- ^ a b c d "Adept (4% Icodextrin) Adhesion Reduction Solution" (PDF). FDA.
- ^ Frampton JE, Plosker GL (2003). "Icodextrin: a review of its use in peritoneal dialysis". Drugs. 63 (19): 2079–105. doi:10.2165/00003495-200363190-00011. PMID 12962523.
- ^ a b c "Extraneal". Drugs.com.