icodextrin

Icodextrin
Clinical data
AHFS/Drugs.com	International Drug Names
Pregnancy; category	US: C (Risk not ruled out); ;
Routes of; administration	Intraperitoneal
Legal status	℞ (Prescription only);
Pharmacokinetic data
Bioavailability	40% in 12 hours
Metabolism	Alpha-amylase
Excretion	Renal
Identifiers
CAS Number	337376-15-5
ATC code	B05DA
PubChem	SID 17397419
DrugBank	DB00702
ChemSpider	none
UNII	2NX48Z0A9G
KEGG	D03266
ChEMBL	CHEMBL1201472
Chemical data
Formula	(C6H10O5)n
Molar mass	13–19 kg/mol
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イコデキストリン

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/02/29 22:19:43」(JST)

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[Wiki en表示]

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]

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 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]

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.^[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 RxList.com: Extraneal
^ ^a ^b ^c ^d FDA: Adept (4% Icodextrin) Adhesion Reduction Solution
^ 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 Drugs.com: Extraneal

UpToDate Contents

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1. 腹膜透析液 peritoneal dialysis solutions
2. 持続的腹膜透析における溶質クリアランスおよび限外濾過の問題 problems with solute clearance and ultrafiltration in continuous peritoneal dialysis
3. 腹膜透析における溶質クリアランスおよび限外濾過の機序 mechanisms of solute clearance and ultrafiltration in peritoneal dialysis
4. 透析前慢性腎臓病または末期腎不全を伴う2型糖尿病患者における高血糖のマネージメント management of hyperglycemia in patients with type 2 diabetes and pre dialysis chronic kidney disease or end stage renal disease
5. 腎不全患者における血清酵素 serum enzymes in patients with renal failure

English Journal

Peritoneal dialysate effluent and serum CA125 concentrations in stable peritoneal dialysis patients.

Redahan L1, Davenport A2.
Journal of nephrology.J Nephrol.2016 Jun;29(3):427-34. doi: 10.1007/s40620-015-0250-9. Epub 2015 Nov 30.
INTRODUCTION: CA125 in peritoneal dialysis (PD) effluent dialysate has been used as a surrogate biomarker for the health of the peritoneum in PD patients. However CA125 is synthesised by epithelial cells and as such is not specific for the peritoneum, and most studies have only measured peritoneal C
PMID 26616639

Adhesions and Healing of Intestinal Anastomoses: The Effect of Anti-Adhesion Barriers.

Ntourakis D1, Katsimpoulas M2, Tanoglidi A3, Barbatis C3, Karayannacos PE2, Sergentanis TN4, Kostomitsopoulos N2, Machairas A4.
Surgical innovation.Surg Innov.2016 Jun;23(3):266-76. doi: 10.1177/1553350615610653. Epub 2015 Oct 15.
Background Postoperative adhesions are the result of aberrant peritoneal healing. As they are the leading cause of postoperative bowel obstruction, anti-adherence barriers are advocated for their prevention. This study looks into the effect of these biomaterials on the healing of intestinal anastomo
PMID 26474604

Impact of fill volume on ultrafiltration with icodextrin in children on chronic peritoneal dialysis.

Rousso S1,2, Banh TM3,4, Ackerman S5,3, Piva E5,3, Licht C5,3,4, Harvey EA5,3.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2016 May 13. [Epub ahead of print]
BACKGROUND: Icodextrin is a solution of glucose polymers developed to provide sustained ultrafiltration over an extended dwell. Our aim was to determine whether or not fill volume with icodextrin contributes to the ability to achieve ultrafiltration in children.METHODS: The charts of all children on
PMID 27178072

Japanese Journal

全身性強皮症にMPO-ANCA陽性の半月体形成性糸球体腎炎を合併し，腹膜透析に導入した若年女性例

日本透析医学会雑誌 45(7), 571-576, 2012
NAID 130002145581

適正透析・体液管理 APD療法別で検討した継続率とイコデキストリン透析液併用との関係

腹膜透析 2011, 316-318, 2011
NAID 40019010077

A patient with refractory nephrotic syndrome withdrawn from peritoneal dialysis

Clinical and experimental nephrology 14(4), 363-366, 2010-08-01
NAID 10027706819

Related Pictures

Extraneal (Icodextrin Peritoneal Dialysis Reduction Solution [4% Icodextrin Dextrose vs. Icodextrin Net UF Profile Sverige - EXTRANEAL (icodextrin 7,5% Baxter India - Healthcare Professionals icodextrin icodextrin inn usan is a Extraneal (icodextrin) PD Solution Baxter Österreich – Medizinische

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

[RxList-2] RxList.com: Extraneal

[FDA-3] FDA: Adept (4% Icodextrin) Adhesion Reduction Solution

[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] Drugs.com: Extraneal

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