hetastarch

Absorption: IV administration results in complete bioavailability.

Distribution: Distributes into intravascular space.

Metabolism/Excretion: Molecules with a molecular weight of 50,000 or less are excreted unchanged by the kidneys. Larger molecules are slowly degraded before excretion.

Half-Life: 90% has half-life of 17 days; remaining 10% has half-life of 48 days.

Time/Action Profile ⬆ ⬇

(volume expansion)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	24 hr or longer

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Severe bleeding disorders;
HF;
Pulmonary edema;
Oliguric or anuric renal failure;
OB: Early pregnancy.

Use Cautiously in:

Thrombocytopenia;
Severe renal impairment (if CCr <10 mL/min, initial dose may be the same; subsequent doses should be ↓ to 25–50% of usual dose);
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children;
Geri: ↑risk of adverse reactions in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: HF, peripheral edema

EENT: parotid and submaxillary gland enlargement

GI: vomiting

Derm: pruritus, urticaria

F and E: fluid overload

Hemat: ↓hematocrit, ↓platelet function

MS: myalgia

Neuro: headache

Resp: pulmonary edema

Misc: chills, fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

None reported.

Route/Dosage ⬆ ⬇

IV (Adults ): Plasma volume expansion: 30–60 g (500–1000 mL of 6% solution), may be repeated; not to exceed 90 g (1500 mL/day). In acute hemorrhagic shock, up to 20 mL/kg/hr may be used; leukapheresis: 250–700 mL infused at a constant fixed ratio of 1:8 to 1:13 to venous whole blood.

Availability ⬆ ⬇

Premixed infusion: 30 g/500 mL 0.9% NaCl (6% solution)

Assessment ⬆ ⬇

Monitor vital signs, CVP, cardiac output, pulmonary capillary wedge pressure, and urinary output before and frequently throughout therapy. Assess patient for signs of vascular overload (elevated CVP, rales/crackles, dyspnea, hypertension, jugular venous distention) during and after administration.
If fever, wheezing, flu-like symptoms, urticaria, periorbital edema, or submaxillary and parotid gland enlargement occurs, stop infusion and notify health care professional immediately. Antihistamines, epinephrine, corticosteroids, and airway management may be required to suppress this response.
Assess surgical patients for increased bleeding after administration caused by interference with platelet function and clotting factors (large volumes only).

Lab Test Considerations:

Monitor CBC with differential, hemoglobin, hematocrit, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and clotting time throughout therapy. Large volumes of hetastarch may cause hemodilution; do not allow hematocrit to drop below 30% by volume. May cause ↑ erythrocyte sedimentation rate, prolonged bleeding time, and prolonged PT, aPTT, and clotting times.
- May cause ↑ indirect serum bilirubin and amylase concentrations.
- During leukapheresis, monitor CBC, total leukocyte and platelet counts, leukocyte differential count, hemoglobin, hematocrit, PT, and aPTT.

Implementation ⬆ ⬇

Do not confuse Hespan with heparin.
Available in a 6% solution diluted with 0.9% NaCl. Solution is clear pale yellow to amber; do not administer solution that is cloudy or that contains a precipitate. Store at room temperature. Discard unused solution.
- There is no danger of serum hepatitis or AIDS from hetastarch. Crossmatching is not required.

IV Administration:

Intermittent Infusion: For leukapheresis, 250–700 mL are infused at a constant ratio of 1:8–1:13 to venous whole blood.
Continuous Infusion: Administer hetastarch undiluted by IV infusion.
Rate: Rate of administration is determined by blood volume, indication, and patient response.
- In acute hemorrhagic shock, hetastarch may be administered up to 1.2 g/kg (20 mL/kg) per hr. Slower rates are generally used with burns and septic shock.

Patient/Family Teaching ⬆ ⬇

Explain to patient the rationale for use of this solution.
Instruct patient to notify health care professional if dyspnea, itching, or flu-like symptoms occur.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes ⬆ ⬇

Increase in BP, circulating volume, and urinary output when used to treat shock and burns.
Improved harvesting and increased yield of granulocytes during leukapheresis.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0409- Hospira, Inc.
- 0409-1555- Hextend
  - 0409-1555-54- 12 BAG in 1 CASE (0409-1555-54) > 500 mL in 1 BAG (0409-1555-64)

0409- Hospira, Inc.
- 0409-7248- Hetastarch in Sodium Chloride
  - 0409-7248-03- 12 CONTAINER in 1 CASE (0409-7248-03) > 500 mL in 1 CONTAINER (0409-7248-13)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇