Icodextrin: Difference between revisions

Icodextrin
Clinical data
AHFS/Drugs.com	International Drug Names
Routes of; administration	Intraperitoneal
ATC code	B05DA (WHO) ;
Legal status
Legal status	In general: ℞ (Prescription only);
Pharmacokinetic data
Bioavailability	40% in 12 hours
Metabolism	Alpha-amylase
Excretion	Renal
Identifiers
CAS Number	337376-15-5 ;
PubChem SID	17397419;
DrugBank	DB00702 ;
ChemSpider	none;
UNII	2NX48Z0A9G;
KEGG	D03266 ;
ChEMBL	ChEMBL1201472 ;
CompTox Dashboard (EPA)	DTXSID70872514 ;
Chemical and physical data
Formula	(C6H10O5)n
Molar mass	13–19 kg/mol
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Latest revision as of 16:02, 21 November 2023

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

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

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

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

Icodextrin is contraindicated in patients with cornstarch allergy, maltose or isomaltose intolerance, glycogen storage disease, or severe lactic acidosis.^[5]

Adverse effects

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

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

^ 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.

[maltod-1] American College of Physicians--American Society of Internal Medicine (2005). Clinical evidence, Issue 14. BMJ Pub. Group. p. 1046.

[RxList-2] "Extraneal". RxList.com.

[FDA-3] "Adept (4% Icodextrin) Adhesion Reduction Solution" (PDF). FDA.

[4] 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.

[Drugs.com-5] "Extraneal". Drugs.com.

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
+{{short description|Pharmaceutical drug}}
 {{Drugbox
 | Verifiedfields = changed
+| Watchedfields = changed
-| verifiedrevid = 419621102
+| verifiedrevid = 461936512
-| IUPAC_name        =
+| IUPAC_name =
-| image             = Icodextrin skeletal.svg
+| image =Dextrin_skeletal.svg
-| synonyms          =
+<!-- Clinical data -->
-| CAS_number        = 337376-15-5
+| tradename =
-| CAS_supplemental  =
+| Drugs.com = {{drugs.com|international|icodextrin}}
-| ATC_prefix        = B05
-| ATC_suffix        = DA
+| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
-| ATC_supplemental  =
+| pregnancy_US = C
+| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled -->
-| PubChemSubstance  = 17397419
+| legal_CA = <!-- Schedule I, II, III, IV, V, VI, VII, VIII -->
-| DrugBank          = DB00702
+| legal_UK = <!-- GSL, P, POM, CD, or Class A, B, C -->
+| legal_US = <!-- OTC / Rx-only / Schedule I, II, III, IV, V -->
+| legal_status = Rx
+| routes_of_administration = [[Intraperitoneal]]
+<!-- Pharmacokinetic data -->
+| bioavailability = 40% in 12 hours
+| protein_bound =
+| metabolism = [[Alpha-amylase]]
+| elimination_half-life =
+| excretion = [[Renal]]
+<!-- Identifiers -->
+| CAS_number_Ref = {{cascite|correct|??}}
+| CAS_number = 337376-15-5
+| ATC_prefix = B05
+| ATC_suffix = DA
+| ATC_supplemental =
+| PubChemSubstance = 17397419
+| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
+| DrugBank = DB00702
+| UNII_Ref = {{fdacite|correct|FDA}}
+| UNII = 2NX48Z0A9G
+| KEGG_Ref = {{keggcite|changed|kegg}}
+| KEGG = D03266
 | ChEMBL_Ref = {{ebicite|changed|EBI}}
 | ChEMBL = 1201472
+| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}
-| KEGG_Ref = {{keggcite|correct|kegg}}
+| ChemSpiderID = none
-| KEGG              = D03266
+<!-- Chemical data -->
-| chemical_formula  = (C<sub>6</sub>H<sub>10</sub>O<sub>5</sub>)<sub>n</sub>
+| chemical_formula = (C<sub>6</sub>H<sub>10</sub>O<sub>5</sub>)<sub>n</sub>
-| molecular_weight  = 13–19 [[kDa]]
+| molecular_weight = 13–19 kg/mol
-| smiles            =
+| smiles =
-| bioavailability   = 40% in 12 hours
-| protein_bound     =
+| synonyms =
-| metabolism        = [[Alpha-amylase]]
-| elimination_half-life =
-| excretion         = [[Renal]]
-| pregnancy_AU      =  <!-- A / B1 / B2 / B3 / C / D / X -->
-| pregnancy_US      =  C
-| legal_AU =  <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled-->
-| legal_CA =  <!-- Schedule I, II, III, IV, V, VI, VII, VIII -->
-| legal_UK =  <!-- GSL, P, POM, CD, or Class A, B, C -->
-| legal_US =  <!-- OTC / Rx-only / Schedule I, II, III, IV, V -->
-| legal_status      = Rx
-| routes_of_administration = [[Intraperitoneal]]
 }}
-'''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" />
+==Chemistry==
-==Physical and chemical properties==
-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" />
+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" />
 ==Mechanism of action==
@@ Line 43: / Line 56: @@
 [[File:DP branchement.svg|thumb|left|upright|[[Peritoneal dialysis]]]]
-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>{{pmid|12962523}}</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>
 ==Pharmacokinetics==
-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: [http://www.rxlist.com/extraneal-drug.htm Extraneal]</ref><ref name="FDA">FDA: [http://www.accessdata.fda.gov/cdrh_docs/pdf5/P050011c.pdf Adept (4% Icodextrin) Adhesion Reduction Solution]</ref>
+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>
 ==Contraindications==
-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: [http://www.drugs.com/pro/extraneal.html Extraneal]</ref>
+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>
 ==Adverse effects==
 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" />
-==Interactions==
+== Interactions ==
 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" />
-==References==
+== References ==
 {{reflist}}
+{{Blood substitutes and perfusion solutions}}
-{{B03, B05, B06}}
 [[Category:Renal dialysis]]

v t e Blood substitutes and perfusion solutions (B05)
Blood and related products (B05A)	Serum albumin Dextran Gelatin agents Hemoglobin crosfumaril Hemoglobin raffimer Hydroxyethyl starch Erythrocytes Thrombocytes Blood plasma Stem cells from umbilical cord blood
Intravenous solutions (B05B)	Amino acids Lipid emulsions Carbohydrates Protein hydrolysates Electrolytes Trometamol Mannitol Carbamide
Irrigating solutions (B05C)	Cetylpyridinium Chlorhexidine Nitrofural Sulfamethizole Taurolidine Mandelic acid Noxytiolin Ethacridine lactate Neomycin Sodium chloride Sodium citrate Magnesium citrate Sodium bicarbonate Glucose Sorbitol Glycine Mannitol
Others (B05D, B05X)	Peritoneal dialysis solutions Potassium chloride Sodium bicarbonate Sodium chloride Ammonium chloride Magnesium sulfate Potassium phosphate Calcium chloride Sodium acetate Sodium phosphate Magnesium phosphate Magnesium chloride Zinc chloride Hydrochloric acid Sodium glycerophosphate Potassium lactate Cardioplegia solutions Potassium acetate Arginine Alanyl glutamine Lysine