- Use only glucose-specific monitors and test strips to measure blood glucose levels in patients using icodextrin. Do not use glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO) based methods due to falsely elevated glucose readings [US Black Box Warning]
- Plasma levels of icodextrin and its metabolites return to baseline within 14 days following discontinuation of icodextrin; therefore, falsely elevated glucose levels may be measured up to 2 wks following discontinuation when GDH-PQQ or GDO based glucose monitors and test strips are used [US Black Box Warning]
- Health care providers should carefully review the product information of the blood glucose testing system to determine if the system is appropriate for use with icodextrin. To avoid improper insulin administration, educate patients to alert health care providers of this interaction when admitted to the hospital [US Black Box Warning]
- Therapy may cause encapsulating peritoneal sclerosis (EPS), which may be fatal
- If peritonitis occurs, the choice and dose of antibiotics should be based upon the results of identification and sensitivity studies of the isolated organism(s)
- Serious hypersensitivity reactions may occur rarely; if such reaction is suspected, discontinue the therapy and initiate appropriate treatment as clinically indicated
- Do not use lactate-based peritoneal dialysis solutions to treat patients with severe lactic acidosis. Monitor for lactic acidosis prior to therapy and during treatment with lactate-based peritoneal dialysis solutions in patients with conditions known to increase the risk of lactic acidosis
- Monitor serum potassium levels carefully in patients treated with cardiac glycosides. Use of digitalis or similar drugs may cause rapid potassium removal, which may create arrhythmias in cardiac patients. Correction of electrolytes by dialysis may precipitate signs and symptoms of digitalis excess
- To reduce the possibility of infection, use aseptic technique throughout the PD procedure
- Inspect the drained fluid for the presence of fibrin or cloudiness, which might indicate the presence of peritonitis
- Overinfusion of peritoneal dialysis solution into the peritoneal cavity can be manifested as abdominal distention, feeling of fullness and/or shortness of breath
- Treatment should be performed under the supervision of a qualified physician trained in the management of patients with renal failure
- Carefully monitor patient’s volume status to avoid hyper- or hypovolemia and potentially severe consequences including CHF, volume depletion, and hypovolemic shock; maintain an accurate fluid balance record and monitor the patient's body weight
- Monitor patient’s nutritional status and provide replacement therapy if indicated
- Solutions may be warmed before use to reduce possible discomfort during administration
- Carefully monitor blood glucose levels and adjust the dose of insulin in patients with Type-II diabetes mellitus
- Reductions in serum sodium and chloride levels have been reported during icodextrin therapy
- Periodically monitor the patient's fluid, hematology, blood chemistry, electrolyte concentrations, and bicarbonate levels
- Increase in alkaline phosphatase has been observed during therapy, but returns to normal about 14 days after discontinuation of the drug
- Increase in alkaline phosphatase occurred due to elevated AST (SGOT)
Cautions: Use cautiously in
- CV disease
- Recent aortic graft placement
- Electrolyte disturbances
- Abdominal conditions such as uncorrectable mechanical defects, congenital anomalies or trauma prior to complete healing, colostomies or ileostomies, frequent episodes of diverticulitis, IBD, or other conditions that compromise the integrity of the abdominal wall, surface, or intra-abdominal cavity
- Previous abdominal surgery
- Abdominal tumors
- Abdominal wall infections
- Hernias
- Fecal fistula
- Impaired respiratory function
- Polycystic kidneys
- Potassium deficiency
- Hypercalcemia
Pregnancy Category:C
Breastfeeding: Safety unknown; manufacturer advises caution.
