View source for Chemistry:Icodextrin

{{short description|Pharmaceutical drug}}
{{Drugbox
| Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 461936512
| IUPAC_name =  
| image =Dextrin_skeletal.svg
<!-- Clinical data -->
| tradename =  
| Drugs.com = {{drugs.com|international|icodextrin}}
| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
| pregnancy_US = C
| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled -->
| legal_CA = <!-- Schedule I, II, III, IV, V, VI, VII, VIII -->
| legal_UK = <!-- GSL, P, POM, CD, or Class A, B, C -->
| legal_US = <!-- OTC / Rx-only / Schedule I, II, III, IV, V -->
| legal_status = Rx
| routes_of_administration = Intraperitoneal
<!-- Pharmacokinetic data -->
| bioavailability = 40% in 12 hours
| protein_bound =  
| metabolism = [[Biology:Alpha-amylase|Alpha-amylase]]
| elimination_half-life =  
| excretion = Renal
<!-- Identifiers -->
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 337376-15-5
| ATC_prefix = B05
| ATC_suffix = DA
| ATC_supplemental =  
| PubChemSubstance = 17397419
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00702
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 2NX48Z0A9G
| KEGG_Ref = {{keggcite|changed|kegg}}
| KEGG = D03266
| ChEMBL_Ref = {{ebicite|changed|EBI}}
| ChEMBL = 1201472
| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}
| ChemSpiderID = none
<!-- Chemical data -->
| chemical_formula = (C<sub>6</sub>H<sub>10</sub>O<sub>5</sub>)<sub>n</sub>
| molecular_weight = 13–19 kg/mol
| smiles =  
| synonyms =  
}}

'''Icodextrin''' (INN, USAN) is a [[Physics:Colloid|colloid]] osmotic agent, derived from [[Chemistry:Maltodextrin|maltodextrin]],<ref name="maltod">{{cite book |title=Clinical evidence, Issue 14 |pages=1046 |author=American College of Physicians--American Society of Internal Medicine |year=2005 |publisher=BMJ Pub. Group}}</ref> used in form of an [[Chemistry:Aqueous|aqueous]] solution for [[Medicine:Peritoneal dialysis|peritoneal dialysis]] under the trade name '''Extraneal''',<ref name="RxList" /> and after gynecological laparoscopic surgery for the reduction of post-surgical [[Medicine:Adhesion|adhesion]]s (fibrous bands that form between tissues and organs) under the trade name '''Adept'''.<ref name="FDA" />

==Chemistry==
Icodextrin is a [[Chemistry:Starch|starch]]-derived, branched, water-soluble [[Chemistry:Glucose|glucose]] [[Chemistry:Polymer|polymer]] linked by α-(1→4) and less than 10% α-(1→6) [[Chemistry:Glycosidic bond|glycosidic bond]]s, making it a type of [[Chemistry:Dextrin|dextrin]]. Its weight-average molecular weight is between 13,000 and 19,000 [[Dalton (unit)|dalton]]s and its number-average molecular weight between 5,000 and 6,500 daltons. The substance is a white to off-white solid, and the solution is clear and colourless to pale yellow.<ref name="FDA" />

==Mechanism of action==
The osmotic activity of icodextrin keeps the solution inside the peritoneum for three to four days, separating tissues and thus reducing adhesion between them when [[Biology:Fibrin|fibrin]] is formed after a surgery. In other words, the tissues are kept from gluing together.<ref name="FDA" />

[[File:DP branchement.svg|thumb|left|upright|[[Medicine:Peritoneal dialysis|Peritoneal dialysis]]]]
When used for peritoneal dialysis, the icodextrin solution absorbs waste products from the blood, and is removed from the peritoneum after a few hours together with the waste.<ref>{{cite journal | vauthors = Frampton JE, Plosker GL | title = Icodextrin: a review of its use in peritoneal dialysis | journal = Drugs | volume = 63 | issue = 19 | pages = 2079–105 | year = 2003 | pmid = 12962523 | doi = 10.2165/00003495-200363190-00011 }}</ref>

==Pharmacokinetics==
Icodextrin is not significantly metabolised inside the peritoneum. Instead, it is absorbed slowly (40% after 12 hours) into the bloodstream via the lymph vessels. There it is broken down into [[Chemistry:Oligosaccharide|oligosaccharide]]s by the enzyme [[Biology:Alpha-amylase|alpha-amylase]]. In patients with intact kidney function, both icodextrin and its fragments are excreted via the kidney by glomerular filtration.<ref name="RxList">{{cite web | work = RxList.com | url = http://www.rxlist.com/extraneal-drug.htm | title = Extraneal }}</ref><ref name="FDA">{{cite web | work = FDA | url = http://www.accessdata.fda.gov/cdrh_docs/pdf5/P050011c.pdf | title = Adept (4% Icodextrin) Adhesion Reduction Solution }}</ref>

==Contraindications==
Icodextrin is contraindicated in patients with cornstarch allergy, [[Chemistry:Maltose|maltose]] or [[Chemistry:Isomaltose|isomaltose]] intolerance, [[Medicine:Glycogen storage disease|glycogen storage disease]], or severe lactic acidosis.<ref name="Drugs.com">{{cite web | work = Drugs.com | url = https://www.drugs.com/pro/extraneal.html | title = Extraneal }}</ref>

==Adverse effects==
Adverse effects include [[Medicine:Peritonitis|peritonitis]], respiratory infection, [[Medicine:Hypertension|hypertension]] (high blood pressure), rashes, and headache. Of these side effects, only hypertension and rashes occurred significantly more often than under glucose solution; the other events seem to be related to peritoneal dialysis in general.<ref name="Drugs.com" />

== Interactions ==

Icodextrin can mimic increased blood glucose levels, depending on the used testing system. Specifically, glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO) based tests can erroneously show high blood glucose in patients that have been treated with icodextrin.<ref name="Drugs.com" />

== References ==
{{reflist}}

{{Blood substitutes and perfusion solutions}}

[[Category:Polysaccharides]]

{{Sourceattribution|Icodextrin}}