Dosing and uses of Hespan, Hextend (hetastarch)
Adult dosage forms and strengths
injectable solution
- 6% hydroxyethyl starch in 0.9% NaCl (Hespan)
- 6% hydroxyethyl starch in lactated electrolyte solution (Hextend)
Hypovolemia
500-1000 mL (30-60 g) IV
Not to exceed 1500 mL/day (20 mL/kg)
Monitor: CBC with differential, Hgb, Hct, PT, PTt
Leukapheresis
250-700 mL Hespan to which citrate anticoagulant has been added
Ratio of 1:8 to 1:13 to venous whole blood
Monitor: CBC with differential, Hgb, Hct, PT, PTt
Renal Impairment
CrCl <10 mL/min: Following a regular initial dose, reduce subsequent doses by 20-50% of normaL
Pediatric dosage forms and strengths
injectable solution
- 6% hydroxyethyl starch in 0.9% NaCl (Hespan)
- 6% hydroxyethyl starch in lactated electrolyte solution (Hextend)
Hypovolemia (Off-label)
10 mL/kg/dose
Not to exceed 20 mL/kg
Leukapheresis (Off-label)
250-700 mL Hespan
Infused at a ratio of 1:8 to 1:13 to venous whole blood.
Other Information
Monitor: CBC with differentials, Hgb, Hct, PT, PTt
Geriatric dosage forms and strengths
Hypovolemia
500-1000 mL (30-60 g) IV
Not to exceed 1500 mL/day (20 mL/kg)
Monitor: CBC with differential, Hgb, Hct, PT, PTt
Leukapheresis
250-700 mL Hespan to which citrate anticoagulant has been added
Ratio of 1:8 to 1:13 to venous whole blood
Monitor: CBC with differential, Hgb, Hct, PT, PTt
Hespan, Hextend (hetastarch) adverse (side) effects
Frequency not defined
Anaphylaxis (periorbital edema, urticaria, wheezing, mild termperature elevation)
Chills
Flu-like symptoms
Myalgia
Peripheral edema
Headache
Pruritus
Vomitting
Salivary gland enlargement
Warnings
Black box warnings
Do not use in critically ill adult patients including those with sepsis, and those admitted to the ICU
Avoid use in patients with pre-existing renal dysfunction
Discontinue use at the first sign of renal injury
Need for renal replacement therapy has been reported up to 90 days after administration; continue to monitor renal function for at least 90 days in all patients
Avoid use in patients undergoing open heart surgery in association with cardiopulmonary bypass due to excess bleeding
Discontinue at the first sign of coagulopathy
Contraindications
Hypersensitivity to hetastarch
Severe bleeding disorders, severe CHF, severe renal failure
Cautions
Allergy to corn, liver disease, renal impairment, thrombocytopenia
Risk of pulmonary edema or CHF
Potential for circulatory overload
Hetastarch in lactated solution contains potassium & sodium
Hextend not to be used in leukapheresis or lactic acidosis
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 Hespan, Hextend (hetastarch)
Mechanism of action
Ethoxylated amylopectins; colloidally expands plasma volume
Pharmacokinetics
Onset: 30 min
Duration: 6-36 hr
Half-life, Elimination: 17 days
Metabolism: Enzymatically degraded by reticuloendothelial system or amylases in blood
Excretion: Urine, feces (by biliary excretion)
Administration
IV Info
IV Incompatibilities
- Y-site: (Lactated soln) amphotericin B, diazepam; (NS soln) amikacin, cefamandole, cefazolin(?), cefoperazone, cefotaxime, cefoxitin, gentamicin, ranitidine, theophylline, tobramycin
IV Preparation
Do not use if crystalline precipitate forms or is turbid deep brown
IV Administration
Administer IV only
Infusion pump is required
May administer up to 1.2 g/kg/hr (20 mL/kg/hr)
Change IV tubing or flush copiously with NS before administering blood through same line
Change IV tubing at least every 24 hr
Do not administer Hextend with blood through same administration set
Anaphylactoid reactions can occur, have epinephrine & resuscitative equipment available
Storage
Store at room temperuature; do not freeze
