(icodextrin) Peritoneal Dialysis Solution
Dangerous Drug-Device Interaction
Only use glucose-specific monitors and test strips to measure blood glucose
levels in patients using Extraneal (icodextrin) Peritoneal Dialysis Solution.
Blood glucose monitoring devices using glucose dehydrogenase pyrroloquinolinequinone
(GDH-PQQ) or glucose-dye-oxidoreductase (GDO)-based methods must not be used.
In addition, some blood glucose monitoring systems using glucose dehydrogenase
flavin-adenine dinucleotide (GDH-FAD)-based methods must not be used. Use of
GDH-PQQ, GDO, and GDH-FAD-based glucose monitors and test strips has resulted
in falsely elevated glucose readings (due to the presence of maltose, see Drug/Laboratory
Test Interactions). Falsely elevated glucose readings have led patients
or health care providers to withhold treatment of hypoglycemia or to administer
insulin inappropriately. Both of these situations have resulted in unrecognized
hypoglycemia, which has led to loss of consciousness, coma, permanent neurological
damage, and death. Plasma levels of Extraneal (icodextrin) and its metabolites
return to baseline within approximately 14 days following cessation of Extraneal
(icodextrin) administration. Therefore falsely elevated glucose levels may be
measured up to two weeks following cessation of Extraneal (icodextrin) therapy
when GDH-PQQ, GDO, and GDH-FAD-based blood glucose monitors and test strips
Because GDH-PQQ, GDO, and GDH-FAD-based blood glucose monitors may be used in hospital settings, it is important that the health care providers of peritoneal dialysis patients using Extraneal (icodextrin) carefully review the product information of the blood glucose testing system, including that of test strips, to determine if the system is appropriate for use with Extraneal (icodextrin).
To avoid improper insulin administration, educate patients to alert health care providers of this interaction whenever they are admitted to the hospital.
The manufacturers) of the monitor and test strips should be contacted to determine
if icodextrin or maltose causes interference or falsely elevated glucose readings.
For a list of toll free numbers for glucose monitor and test strip manufacturers,
please contact the Baxter Renal Clinical Help Line 1-888-RENAL-HELP or visit
Extraneal (icodextrin) Peritoneal Dialysis Solution is a peritoneal dialysis
solution containing the colloid osmotic agent icodextrin. Icodextrin is a starch-derived,
water-soluble glucose polymer linked by alpha (1-4) and less than 10% alpha
(1-6) glucosidic bonds with a weight-average molecular weight between 13,000
and 19,000 Daltons and a number average molecular weight between 5,000 and 6,500
Daltons. The representative structural formula of icodextrin is:
|Each 100 mL of Extraneal contains:
|| 7.5 g
|Sodium Chloride, USP
|| 535 mg
| Sodium Lactate
|| 448 mg
|Calcium Chloride, USP
|| 25.7 mg
|Magnesium Chloride, USP
|| 5.08 mg
|Electrolyte content per liter:
|| 132 mEq/L
|| 3.5 mEq/L
|| 0.5 mEq/L
|| 96 mEq/L
|| 40 mEq/L
Water for Injection, USP qs
HCl/NaOH may have been used to adjust pH.
Extraneal (icodextrin peritoneal dialysis solution) contains no bacteriostatic or antimicrobial agents.
Calculated osmolarity: 282-286 mOsm/L; pH=5.0-6.0
Extraneal (icodextrin peritoneal dialysis solution) is available for intraperitoneal administration only as a sterile, nonpyrogenic, clear solution in AMBU-FLEXII, AMBU-FLEX III and ULTRABAG containers. The container systems are composed of poly vinyl chloride.
Solutions in contact with the plastic container can leach out certain of its chemical components in very small amounts within the expiration period, e.g., di-2-ethylhexyl phthalate (DEHP), up to 5 parts per million; however, the safety of the plastic has been confirmed in tests in animals according to USP biological tests for plastic containers as well as by tissue culture toxicity studies.
What are the possible side effects of icodextrin (LVP solution) (Extraneal)?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Stop using icodextrin and call your doctor at once if you have a serious side effect such as:
- fever, stomach pain, redness, or cloudy drained fluid;
- flu symptoms;
- chest pain;
- high blood sugar (increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss); or
- severe skin reaction -- fever, sore...
Read All Potential Side Effects and See Pictures of Extraneal »
Last reviewed on RxList: 4/29/2011
This monograph has been modified to include the generic and brand name in many instances.