Icodextrin

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Icodextrin
Dextrin skeletal.svg
Clinical data
AHFS/Drugs.com International Drug Names
Pregnancy cat.
Legal status
  • Prescription only
Routes Intraperitoneal
Pharmacokinetic data
Bioavailability 40% in 12 hours
Metabolism Alpha-amylase
Excretion Renal
Identifiers
CAS number 337376-15-5 YesY
ATC code B05DA
PubChem SID17397419
DrugBank DB00702
UNII 2NX48Z0A9G YesY
KEGG D03266 N
ChEMBL CHEMBL1201472 N
Chemical data
Formula (C6H10O5)n
Mol. mass 13–19 kDa
 N (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]

Physical and chemical properties[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]

  1. ^ American College of Physicians--American Society of Internal Medicine (2005). Clinical evidence, Issue 14. BMJ Pub. Group. p. 1046. 
  2. ^ a b RxList.com: Extraneal
  3. ^ a b c d 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.  edit
  5. ^ a b c Drugs.com: Extraneal