hetastarch (Rx)

Brand and Other Names:Hespan, Hextend
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 6% hydroxyethyl starch in 0.9% NaCl (Hespan)
  • 6% hydroxyethyl starch in lactated electrolyte solution (Hextend)
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Hypovolemia

500-1000 mL (30-60 g) IV

Not to exceed 1500 mL/day (20 mL/kg)

Monitor: CBC with differential, Hgb, Hct, PT, PTT

Leukapheresis

250-700 mL Hespan to which citrate anticoagulant has been added

Ratio of 1:8 to 1:13 to venous whole blood

Monitor: CBC with differential, Hgb, Hct, PT, PTT

Renal Impairment

CrCl <10 mL/min: Following a regular initial dose, reduce subsequent doses by 20-50% of normal

Dosage Forms & Strengths

injectable solution

  • 6% hydroxyethyl starch in 0.9% NaCl (Hespan)
  • 6% hydroxyethyl starch in lactated electrolyte solution (Hextend)
more...

Hypovolemia (Off-label)

10 mL/kg/dose

Not to exceed 20 mL/kg

Leukapheresis (Off-label)

250-700 mL Hespan

Infused at a ratio of 1:8 to 1:13 to venous whole blood.

Other Information

Monitor: CBC with differentials, Hgb, Hct, PT, PTT

Hypovolemia

500-1000 mL (30-60 g) IV

Not to exceed 1500 mL/day (20 mL/kg)

Monitor: CBC with differential, Hgb, Hct, PT, PTT

Leukapheresis

250-700 mL Hespan to which citrate anticoagulant has been added  

Ratio of 1:8 to 1:13 to venous whole blood

Monitor: CBC with differential, Hgb, Hct, PT, PTT

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Adverse Effects

Frequency Not Defined

Anaphylaxis (periorbital edema, urticaria, wheezing, mild termperature elevation)

Chills

Flu-like symptoms

Myalgia

Peripheral edema

Headache

Pruritus

Vomitting

Salivary gland enlargement

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Warnings

Black Box Warnings

Do not use in critically ill adult patients including those with sepsis, and those admitted to the ICU

Avoid use in patients with pre-existing renal dysfunction

Discontinue use at the first sign of renal injury

Need for renal replacement therapy has been reported up to 90 days after administration; continue to monitor renal function for at least 90 days in all patients

Avoid use in patients undergoing open heart surgery in association with cardiopulmonary bypass due to excess bleeding

Discontinue at the first sign of coagulopathy

Contraindications

Hypersensitivity to hetastarch

Severe bleeding disorders, severe CHF, severe renal failure

Cautions

Allergy to corn, liver disease, renal impairment, thrombocytopenia

Risk of pulmonary edema or CHF

Potential for circulatory overload

Hetastarch in lactated solution contains potassium & sodium

Hextend not to be used in leukapheresis or lactic acidosis

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Pregnancy & Lactation

Pregnancy Category: C

Lactation: Not known if distributed into breast milk, avoid

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

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Pharmacology

Mechanism of Action

Ethoxylated amylopectins; colloidally expands plasma volume

Pharmacokinetics

Onset: 30 min

Duration: 6-36 hr

Half-life, Elimination: 17 days

Metabolism: Enzymatically degraded by reticuloendothelial system or amylases in blood

Excretion: Urine, feces (by biliary excretion)

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Administration

IV Info

IV Incompatibilities

  • Y-site: (Lactated soln) amphotericin B, diazepam; (NS soln) amikacin, cefamandole, cefazolin(?), cefoperazone, cefotaxime, cefoxitin, gentamicin, ranitidine, theophylline, tobramycin

IV Preparation

Do not use if crystalline precipitate forms or is turbid deep brown

IV Administration

Administer IV only

Infusion pump is required

May administer up to 1.2 g/kg/hr (20 mL/kg/hr)

Change IV tubing or flush copiously with NS before administering blood through same line

Change IV tubing at least every 24 hr

Do not administer Hextend with blood through same administration set

Anaphylactoid reactions can occur, have epinephrine & resuscitative equipment available

Storage

Store at room temperuature; do not freeze

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Images

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Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
  • Manage and view all your plans together – even plans in different states.
  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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