Version May 2024
Volume expansion/shock: Note: Crystalloids (eg, sodium chloride or balanced solutions) are recommended as the initial fluid of choice in the resuscitation of sepsis and septic shock (Ref).
IV: Dextran 40: Infuse 500 to 1,000 mL (~10 mL/kg) as rapidly as possible (maximum: 20 mL/kg/day for first 24 hours; 10 mL/kg/day thereafter); therapy should not be continued beyond 5 days.
Pump prime: Dextran 40: Varies with the volume of the pump oxygenator; generally, the solution is added in a dose of 10 to 20 mL/kg (or 1 to 2 g/kg); usual maximum total dose: 20 mL/kg (or 2 g/kg)
Use with extreme caution.
Use with extreme caution.
Refer to adult dosing.
(For additional information see "Dextran: Pediatric drug information")
Note: Dose and infusion rate are dependent upon the patient's fluid status and must be individualized.
Volume expansion (nonshock like conditions):
Infants: IV: Infuse 5 mL/kg as rapidly as necessary; maximum daily dose: 20 mL/kg/day for first 24 hours, then 10 mL/kg/day thereafter; therapy should not be continued beyond 5 days.
Children and Adolescents <50 kg: IV: Infuse 10 mL/kg as rapidly as necessary; maximum daily dose: 20 mL/kg/day for first 24 hours, then 10 mL/kg/day thereafter; therapy should not be continued beyond 5 days.
Adolescents ≥50 kg: IV: Infuse 500 to 1,000 mL (~10 mL/kg) as rapidly as necessary; maximum daily dose: 20 mL/kg/day for first 24 hours, then 10 mL/kg/day thereafter; therapy should not be continued beyond 5 days.
Pump prime: Note: Dose will vary with the volume of the pump oxygenator; doses usually added to the perfusion circuit.
Infants: IV: 5 mL/kg; usual maximum total dose: 20 mL/kg/day.
Children: IV: 10 mL/kg; usual maximum total dose: 20 mL/kg/day.
Adolescents: IV: 10 to 20 mL/kg; usual maximum total dose: 20 mL/kg/day.
Use with extreme caution.
Use with extreme caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Chest tightness, hypotension
Dermatologic: Urticaria
Gastrointestinal: Nausea, vomiting
Hematologic & oncologic: Prolonged bleeding time (dose-related), wound hemorrhage (dose-related), wound hematoma (dose-related)
Hepatic: Abnormal liver function tests
Hypersensitivity: Anaphylactoid reaction
Renal: Acute renal failure
Respiratory: Pulmonary edema (dose-related), wheezing
Hypersensitivity to dextran or any component of the formulation; marked hemostatic defects (eg, thrombocytopenia, hypofibrinogenemia) of all types including those caused by medications (eg, heparin, warfarin); marked cardiac decompensation; renal disease with severe oliguria or anuria
Concerns related to adverse effects:
• Fluid overload: Administration may cause fluid overload; use with caution in patients at risk from overexpansion of blood volume (eg, very young, elderly patients, or those with heart failure).
• Hematologic: Large volumes of dextran (doses >1000 mL) may cause reduction in hemoglobin concentration and excessive dilution of plasma proteins due to hemodilution; transient prolongation of bleeding time or an increase in bleeding tendency may occur with large volumes; use caution to prevent a decrease in hematocrit <30%.
• Hypersensitivity: Severe and fatal anaphylactoid reactions have been reported; discontinue use immediately with signs of hypersensitivity and administer appropriate therapy.
• Renal failure: Has been reported with use; fluid status including urine output should be monitored closely.
Disease-related concerns:
• Heart failure: Use with caution in heart failure patients; monitor closely for fluid overload.
• Hemorrhage: Use with caution in patients with active hemorrhage;. may increase the risk of more bleeding.
• Renal impairment: Use with caution in patients with renal impairment; fluid status including urine output should be monitored closely. Excessive dosing may precipitate renal failure in patients with advanced renal disease. Use in severe oliguria or anuria is contraindicated.
• Thrombocytopenia: Use with caution in patients with thrombocytopenia; doses >1000 mL may interfere with platelet function and transiently prolong bleeding time. Observe for bleeding.
Other warnings/precautions:
• Appropriate use: Not a substitute for blood or blood components.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
LMD in D5W: 10% Dextran 40 (500 mL) [latex free]
LMD in NaCl: 10% Dextran 40 (500 mL) [latex free]
No
Solution (LMD in D5W Intravenous)
10-5% (per mL): $0.09
Solution (LMD in NaCl Intravenous)
10-0.9% (per mL): $0.10
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
LMD in D5W: 10% Dextran 40 (500 mL)
LMD in NaCl: 10% Dextran 40 (500 mL)
IV: Do not use if crystalline precipitate forms. For IV infusion only (use an infusion pump or pressure infusion); administer through a filter. For volume expansion/shock, may infuse initial volume as rapidly as possible. Monitor closely for anaphylactic reaction; have epinephrine and resuscitative equipment available.
Parenteral: Do not use if crystalline precipitate forms. For IV infusion only (use an infusion pump or pressure infusion); administer through a filter. For volume expansion/shock, may infuse initial volume as rapidly as possible. Monitor closely for anaphylactic reaction; have epinephrine and resuscitative equipment available.
Blood volume expander used in treatment of shock or impending shock when blood or blood products are not available; also used as a priming fluid in pump oxygenators during cardiopulmonary bypass.
Dextran may be confused with Dexedrine
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Abciximab: Dextran may enhance the anticoagulant effect of Abciximab. Risk X: Avoid combination
Arbekacin: Dextran may enhance the nephrotoxic effect of Arbekacin. Risk X: Avoid combination
Desirudin: Dextran may enhance the anticoagulant effect of Desirudin. More specifically, dextran may increase hemorrhagic risk during desirudin treatment. Management: Discontinue treatment with dextran prior to desirudin initiation when possible. If concomitant use cannot be avoided, monitor patients receiving these combinations closely for clinical and laboratory evidence of excessive anticoagulation. Risk X: Avoid combination
Animal reproduction studies have not been conducted.
It is not known if dextran is excreted in breast milk. The manufacturer recommends that caution be exercised when administering dextran to nursing women.
Blood pressure, heart rate, CVP, RAP, MAP, capillary refill time; if pulmonary artery catheter in place, monitor cardiac index, PCWP, SVR, and PVR; hemoglobin and hematocrit, electrolytes, serum protein, coagulation parameters, renal function, urine output, acid-base balance; observe patients closely during the first minute of infusion and have other means of maintaining circulation should dextran therapy result in an anaphylactoid reaction
Produces plasma volume expansion by virtue of its highly colloidal starch structure.
Duration: Plasma expanding effect lasts 3-4 hours
Excretion: Urine (~75%) within 24 hours
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