Hetastarch

Hetastarch is used to treat low blood volume (hypovolemia) and to remove leukocytes from drawn blood (leukapheresis).

Hetastarch is available under the following different brand names: Hespan and Hextend.

Dosage Forms and Strengths

Injectable Solution

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

Dosage Considerations – Should be Given as Follows:

Hypovolemia, Adult and Geriatric

• 500-1000 mL (30-60 g) IV
• Not to exceed 1500 mL/day (20 mL/kg)
• Monitor: CBC with differential, Hgb, Hct, PT, PTT

Hypovolemia, Pediatric (Off-label)

• 10 mL/kg/dose
• Not to exceed 20 mL/kg

Leukapheresis, Adult and Geriatric

• 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

Leukapheresis, Pediatric (Off-label)

• 250-700 mL Hespan
• Infused at a ratio of 1:8 to 1:13 to venous whole blood
• Monitor: CBC with differentials, Hgb, Hct, PT, PTT

Renal Impairment

• CrCl less than 10 mL/minute: Following a regular initial dose, reduce subsequent doses by 20-50% of normal

Common side effects of Hetastarch include:

• Anaphylaxis (swelling around the eyes, hives, wheezing, mild temperature elevation)
• Chills
• Flu-like symptoms
• Muscle pain
• Swelling of extremities
• Headache
• Itching
• Vomiting
• Salivary gland enlargement

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Hetastarch has no listed severe interactions with other drugs.
• Hetastarch has no listed serious interactions with other drugs.
• Hetastarch has no listed moderate interactions with other drugs.
• Hetastarch has no listed mild interactions with other drugs.

Warnings

This medication contains hetastarch. Do not take Hespan or Hextend if you are allergic to hetastarch or any ingredients contained in this drug.

Black Box Warnings

• 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 congestive heart failure, severe renal failure

Effects of Drug Abuse

• No information available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Hetastarch?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Hetastarch?"

Cautions

• Allergy to corn, liver disease, renal impairment, thrombocytopenia
• Risk of pulmonary edema or congestive heart failure
• Potential for circulatory overload
• Hetastarch in lactated solution contains potassium and sodium
• Hextend not to be used in leukapheresis or lactic acidosis

Pregnancy and Lactation

Use hetastarch with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.

It is not known if hetastarch is distributed into breast milk. Avoid use of hetastarch while breastfeeding.