Dosing and uses of Gentran, LMD (dextran)
Adult dosage forms and strengths
injectable solution
- 6% (Dextran 70)
- 10% (Dextran 40)
Shock
No more than 20 mL/kg IV during first 24 hours; THEN 10 mL/kg/day
Same mL dosage for both 10% & 6%
10% Solution
- No more than 5 days
- First 500 mL infused rapidly, then slow infusion
Surgery (DVT/PE Prophylaxis)
10% Solution: 500-1000 mL (~10 mL/kg) on day of surgery; THEN 500 mL/day for 2-3 days; THEN 500 mL q2-3Days PRN up to 2 weeks
6% Solution: Not approved but used
Priming Fluid in Pump Oxygenators, Uterine Cavity Distention
Add 10-20 mL/kg (or 1-2 g/kg); not to exceed 20 mL/kg (2g/kg); dose varies with volume of pump oxygenator
Renal Impairment
Extreme caution
Hepatic Impairment
Extreme caution
Progenitor Cell Mobilization (Orphan)
Treatment to mobilze progenitor cells prior to stem cell transplantation
Orphan indication sponsor
- TikoMed AB; P.O. Box 81 (Karlsfaltsvagen 349); SE-263 03, Viken, Sweden
Pancreatic Islet Transplantation (Orphan)
LMW dextran sulfate (Ibsolvmir): Prevention of graft rejection during pancreatic islet transplantation
Orphan indication sponsor
- TikoMed AB; P.O. Box 81 (Karlsfaltsvagen 349); SE-263 03, Viken, Sweden
Pediatric dosage forms and strengths
injectable solution
- 6%
- 10%
10% Solution
Initial dose: 10 mL/kg IV infused rapidly, no more than 20 mL/kg/24 hours, THEN no more than 10 mL/kg/day, no more than 5 days
Geriatric dosage forms and strengths
Shock
No more than 20 mL/kg IV during first 24 hours; THEN 10 mL/kg/day
Same mL dosage for both 10% & 6%
10% solution: No more than 5 days; First 500 mL infused rapidly, then slow infusion
Surgery (DVT/PE prophylaxis)
10% Solution: 500-1000 mL (~10 mL/kg) on day of surgery; THEN 500 mL/day for 2-3 days; THEN 500 mL q2-3Days PRN up to 2 weeks
6% Solution: Not approved but used
Priming fluid in pump oxygenators, uterine cavity distention
Add 10-20 mL/kg (or 1-2 g/kg); not to exceed 20 mL/kg (2g/kg); dose varies with volume of pump oxygenator
Gentran, LMD (dextran) adverse (side) effects
Frequency not defined
Congestive heart failure
Mild hypotension
Tightness of chest
Thrombocytopenia
Anaphylaxis
Injection site infection/phlebitis
Acute renal failure
Acidosis (if NaCl soln used)
Pulmonary edema
Wheezing
Warnings
Contraindications
Hypersensitivity to dextran or corn products
Pulmonary edema, severe bleeding disorders, severe CHF, severe oliguria/anuria due to renal disease, significant hemostatic defects, cardiac decompensation
10%: Marked thrombocytopenia or hypofibrinogenemia
Cautions
Decreased urinary output 2nd to shock, bowel surgery, dehydration, active hemorrhage, hypernatremia, pathological abdominal conditions, thrombocytopenia
Monitor urinary output
Contains no preservatives, discard unused portions
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if distributed into breast milk, avoid
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Gentran, LMD (dextran)
Mechanism of action
Branched polysaccharide volume expander through highly colloidal starch structure; lowers platelet & RBC adhesiveness
Pharmacokinetics
Elimination half-life: 40 min
Duration: 3-4hr (plasma expanding effects)
Distribution half-life: 12 min
Vd: 6.5 L
Metabolism: Minimally in tissues; liver, kidney, spleen
Excretion: urine 75%
Dialyzable: HD: No
Administration
IV Incompatibilities
Do not dilute or admix with other drugs
IV Administration
Infuse first 500 mL over 15-30 min, then slow infusion
Storage
Protect from freezing
