Dextran 40 (LMW dextran, IV solution)

Dextran 40 is a low molecular weight dextran (LMD). On the other hand, dextran 70 is a higher molecular weight dextran.

Dextran 40 is a solution containing dextran (a polysaccharide or chained sugar) mixed with dextrose or sodium chloride solutions. It works by expanding the volume of the blood to prevent and manage signs and symptoms of hemorrhage and shock.

Uses

What is Dextran 40 used for?

It is commonly used as a plasma extended for restoring blood volume lost through hemorrhaging and treating hypovolemic shock due to surgery, trauma, injury, or other causes of bleeding.

The fundamental action of LMW dextran is the enhancement of blood flow, particularly in the microcirculation. This enhancement is due to:

1. Its primary effect of volume expansion with resultant hemodilution;
2. Maintenance of the electronegativity of red blood cells;
3. Coating of red blood cells and platelets;
4. Increase in the suspension stability of blood;
5. A decrease in the viscosity of blood.

It should be emphasized that the above effects are not exerted separately, but conjointly they result in the enhancement of blood flow.

How should I take Dextran 40?

Dextran 40 is administered through intravenous (IV) infusion by a licensed healthcare professional.

How do I store Dextran 40?

This product is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store it in the bathroom or the freezer. 

There may be different brands of this drug that may have different storage needs. So, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Dextran 40?

Before using this drug, tell your doctor if you are/have:

• Pregnant or breastfeeding.
• Taking any other medicines. This includes any prescription, OTC, and herbal remedies.
• An allergy to any of the ingredients of this product.
• Any other illnesses, disorders, or medical conditions, especially:
  • Diabetes

Is it safe during pregnancy or breastfeeding?

Unfortunately, there isn’t enough information about the safety of using this drug during pregnancy and breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking any medication.

Side effects

What side effects can occur from Dextran 40?

Like all drugs, this product may have side effects. If they occur, side effects are generally mild and resolve once treatment is finished or the dose is lowered. Some reported side effects include:

• Mild rash or skin reactions
• Chest tightening
• Wheezing
• Hypotension
• Nausea
• Vomiting

However, not everyone experiences these side effects. In addition, some people may experience other side effects. So, if you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Dextran 40?

This medication may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. 

To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist.

Does food or alcohol interact with Dextran 40?

This drug may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Dextran 40?

This drug may interact with underlying conditions. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:

• Diabetes

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

Shock

The total dosage does not exceed 20 ml/kg for adults and adolescents, during the first 24 hours. The first 10 ml/kg may be infused as rapidly as necessary to effect improvement.

It is strongly recommended that central venous pressure be monitored frequently during the initial infusion of the drug. Should therapy continue beyond 24 hours, the subsequent dosage should not exceed 10 mL/kg per day and therapy should not continue beyond five days.

Extracorporeal perfusion

The dosage of LMD used will vary with the volume of the pump oxygenator. LMD can serve as a sole primer or as an additive to other priming fluids.

For adults and adolescents, generally, 10 to 20 ml of a 10% solution (1 to 2 g) of LMD per kilogram of body weight are added to the perfusion circuit. Usually, the total dosage should not exceed 2 g/kg of body weight.

Prophylaxis of venous thrombosis and thromboembolism

The dosage of LMD for adults and adolescents should be chosen according to the risk of thromboembolic complications, e.g., type of surgery, and duration of immobilization.

In general, treatment should be initiated during surgery; 500 to 1,000 ml (approximately 10 ml/kg of body weight) should be administered on the day of operation.

Treatment should be continued at a dose of 500 ml daily for an additional two to three days; then, according to the risk of complications, 500 ml may be given every second or third day during the period of risk, for up to two weeks.

What is the dose for a child?

For infants, administer 5 mL per kg of body weight. Administer 10 mL per kg of body weight for children.

How is Dextran 40 available?

Dextran 40 is available in the following dosage forms and strengths:

• 10% LMD in 0.9% Sodium Chloride Injection
• 10% LMD in 5% Dextrose Injection

What should I do in case of an emergency or overdose?

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What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room.

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.