- Hydroxyethyl starch
Drugbox
IUPAC_name =
CAS_number =
ATC_prefix =
ATC_suffix =
PubChem =
DrugBank =
chemical_formula =
molecular_weight = 130 kDa (mean)
bioavailability =
protein_bound =
metabolism =
elimination_half-life = 1.4 hrs
excretion = Renal
pregnancy_AU =
pregnancy_US =
pregnancy_category=
legal_AU =
legal_CA =
legal_UK =
legal_US =
legal_status =
routes_of_administration = IntravenousHydroxyethyl starch (HES/HAES) is a nonionic
starch derivative. It is one of the most frequently usedblood plasma substitutes under the trade names Hespan byB. Braun Medical Inc. and Voluven byFresenius Kabi . It is also used inoil drilling .Therapeutic use
An intravenous solution of hydroxyethyl starch is used to prevent shock following severe
blood loss caused by trauma,surgery , or some other problem. It increases theblood volume , allowingred blood cell s to continue to deliveroxygen to the body.Contraindications
* This product should not be used in people who are hypersensitive or allergic to hydroxyethyl starch.
* Patients with kidney failure not related to low blood volume and patients ondialysis should avoid this product in high doses which are used for volume expansion.
* Use is contraindicated in people with severe increases in blood levels ofsodium orchloride .
* Patients withbleeding inside the head should not use this product.Pharmacokinetics
The elimination depends on molar substitution degree. Molecules smaller than the renal threshold (60–70 kDa) are readily excreted in the urine while the larger ones are metabolized by plasma α–
amylase before the degradation products are renally excreted.Adverse effects
Anaphylactoid reactions: hypersensitivity, mild influenza-like symptoms, bradycardia, tachycardia, bronchospasm and non-cardiogenic pulmonary edema.
Decrease in hematocrit and disturbances in coagulation. May be associated with covering the use of anabolic steroids/EPO for endurance athletes.
HES derivatives with a higher molecular weight (200 kDa) have been demonstrated to have increased rates of acute renal failure and need for renal replacement therapy and to decrease long-term survival when used alone in cases of severe sepsis compared with Ringer Lactate solution (Brunkhorst 2008). [cite journal |author=Brunkhorst FM, Engel C, Bloos F, "et al" |title=Intensive insulin therapy and pentastarch resuscitation in severe sepsis |journal=N. Engl. J. Med. |volume=358 |issue=2 |pages=125–39 |year=2008 |month=Jan |pmid=18184958 |doi=10.1056/NEJMoa070716 |url=] This study specifically used 10% HES with 0.45-0.55 substitution grade and molecular weight of 200 kDa (Hemohes). It also used a regimen without any crystalloids and was critized for its study design [cite journal |author=Zander R, Boldt J, Engelmann L, Mertzlufft F, Sirtl C, Stuttmann R |title= [The design of the VISEP trial. Critical appraisal] |language=German |journal=Anaesthesist |volume=56 |issue=1 |pages=71–7 |year=2007 |month=January |pmid=17192828 |doi=10.1007/s00101-006-1122-4 |url=http://www.springerlink.com/content/q3053v24116050k2/] . The same effects have not been observed with HES 130kDa/0.4.
References
* [http://www.drugs.com/cdi/hespan.html Information on Hespan]
* [http://www.fda.gov/bbs/topics/NEWS/2007/NEW01765.html FDA press release approving Voluven]
Wikimedia Foundation. 2010.