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hetastarch (Hespan, hydroxyethyl starch)

Tradename: Hespan. Indications: - blood volume expansion for hypovolemia, shock or impending shock* - after failure of crystalloid therapy - blood products are not specifically indicated or are not available * Caution: - hydroxyethyl starch increases risks for kidney damage & mortality in critically ill patients [4] Contraindications: - hypovolemia, shock or impending shock [4,5] Benefit/risk: - hypovolemia, shock or impending shock [4,5] - number needed to treat (NNT): no benefit - number needed to harm [4] - 66 for mortality - 44 for acute renal failure requiring hemodialysis [4] Dosage: 30-60 g IV as an infusion. 500 to 1000 mL IV (6% solution). 500 mL packages. Dosage adjustment in renal failure: - creatinine clearance < 10 mL/min - administer usual initial dose, but reduce subsequent doses to 20-50% of initial dose Pharmacokinetics: 1) degraded enzymatically to glucose 2) excreted in urine 3) effects can last for 24 hours, depending upon the dose, clinical state of patient & organ function Adverse effects: - uncommon (< 1%) - vomiting, fever/chills, bleeding, hypersensitivity, itching pruritus, headaches, muscle pains, peripheral edema, heart failure, circulatory overload, prolongation of PT & PTT, prolongation of clotting time & bleeding time - risk of acute renal failure needing renal replacement therapy [7] - boxed warning - increased mortality, severe renal injury & risk of bleeding [5] Mechanism of action: 1) colloidal properties resemble those of human albumin 2) derived from amylopectin 3) plasma volume expansion is due to osmotic effects

General

carbohydrate; sugar plasma volume expander

Properties

MISC-INFO: elimination route KIDNEY pregnancy-category C safety in lactation ?

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. The NNT: Hydroxyethyl Starch for Acute Volume Resuscitation. http://www.thennt.com/nnt/hydroxyethyl-starch-for-acute-volume-resuscitation/ - Zarychanski R et al Association of Hydroxyethyl Starch Administration With Mortality and Acute Kidney Injury in Critically Ill Patients Requiring Volume Resuscitation. A Systematic Review and Meta-analysis. JAMA. 2013;309(7):678-688 PMID: 23423413 http://jama.jamanetwork.com/article.aspx?articleid=1653505
  5. FDA MedWatch. June 20, 2013 Hydroxyethyl Starch Solutions: FDA Safety Communication - Boxed Warning on Increased Mortality and Severe Renal Injury and Risk of Bleeding
  6. Deprecated Reference
  7. Mutter TC, Ruth CA, Dart AB. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev. 2013 Jul 23;7:CD007594. Review. PMID: 23881659