Hemohes (Solution) Instructions for Use

ATC Code

B05AA07 (Hydroxyethyl starch)

Active Substance

Pentastarch

Pentastarch (USAN)

Clinical-Pharmacological Group

Plasma substitute

Pharmacotherapeutic Group

Plasma substitute

Pharmacological Action

A plasma substitute, hydroxyethyl starch (HES). HES is a high-molecular-weight compound consisting of polymerized glucose residues, obtained by hydroxyethylation of amylopectin, a natural polysaccharide contained in potato starch and waxy corn starch. Amylopectin is rapidly hydrolyzed in the blood; its presence in the bloodstream is about 20 minutes. To increase stability and duration of action, amylopectin is subjected to hydroxyethylation. The depth of this process is characterized by the degree of substitution.

The intensity and duration of the volume-replacing effect of HES preparations are determined by the molecular weight and degree of substitution of the HES substance. The higher the degree of substitution, the longer HES remains in the circulating blood. With a C₂/C₆ ratio greater than 8, HES is metabolized in the body significantly slower than with a ratio of less than 8.

Pentastarch has a molecular weight of about 200,000 daltons and a degree of substitution of about 0.5; the C₂/C₆ ratio, which determines the substitution features, is 6.

It improves the rheological properties of blood by reducing hematocrit, reduces plasma viscosity, reduces erythrocyte aggregation, and promotes the restoration of impaired microcirculation.

It is deposited in the cells of the reticuloendothelial system, which has no clinical significance.

Pharmacokinetics

After IV infusion, pentastarch undergoes intensive metabolism, breaking down (under the action of serum amylase) into low-molecular-weight fragments. Metabolites with a molecular weight of less than 50,000 daltons are rapidly excreted by the kidneys. About 70% of the dose is excreted in the urine within 24 hours and about 80% within a week.

Indications

As a plasma substitute for hypovolemia and shock associated with surgical interventions, injuries, infectious diseases, and burns; microcirculation disorders; therapeutic hemodilution.

ICD codes

Dosage Regimen

Solution

It is set individually, depending on the severity of hemodynamic disorders and the clinical situation. The daily dose and rate of administration are calculated depending on the amount of blood loss, hemoglobin and hematocrit levels. Administered IV, drip.

The minimum effective dose should be used. Treatment should be carried out with constant hemodynamic monitoring; upon reaching the target hemodynamic parameters, the infusion should be stopped.

Adverse Reactions

From the blood coagulation system: very often – decrease in hematocrit and development of dilutional hypoproteinemia; often (frequency depends on the administered dose) – increased bleeding time and aPTT, decrease in the content of coagulation factor VIII complex and von Willebrand factor.

From the immune system: very rarely – anaphylactic reactions of varying severity.

From the skin and subcutaneous tissues: rarely – persistent but reversible skin itching.

From the liver and biliary tract: frequency not established – liver damage.

From the urinary system: rarely – pain in the kidney area; frequency not established – impaired renal function.

From laboratory parameters: often – increased activity of plasma alpha-amylase, not associated with impaired pancreatic function; possible – changes in the concentration of glucose, protein, fatty acids, cholesterol, sorbitol dehydrogenase in plasma, ESR, biuret test, specific gravity of urine.

Contraindications

Hypersensitivity to HES; burns, sepsis, intracranial hypertension, arterial hypertension, ongoing intracranial or intracerebral bleeding, chronic heart failure, renal failure or renal replacement therapy, severe hepatic failure, pulmonary edema, condition after organ transplantation, overhydration, hypervolemia, dehydration, severe coagulopathy, severe hyperchloremia or severe hypernatremia, hypokalemia, hemodialysis; children and adolescents under 18 years of age; first trimester of pregnancy.

Do not use for open heart surgery under cardiopulmonary bypass.

Contraindicated for use in intensive care patients (usually in the intensive care unit).

With caution compensated chronic heart failure, chronic liver diseases, blood coagulation disorders, von Willebrand disease, hemorrhagic diathesis, hypofibrinogenemia, patients who have undergone surgery and/or have trauma, elderly age, second and third trimesters of pregnancy; breastfeeding period.

Use in Pregnancy and Lactation

Contraindicated in the first trimester of pregnancy. In the second and third trimesters of pregnancy, use is possible only for vital indications, in cases where the potential benefit to the mother outweighs the potential risk to the fetus. When using pentastarch during pregnancy, the risk of anaphylactic reactions and the possible risk of fetal brain damage must be considered. If it is necessary to use during lactation, the issue of discontinuing breastfeeding should be decided.

Use in Hepatic Impairment

Contraindicated in severe hepatic failure. It should be used with caution in chronic liver diseases.

Use in Renal Impairment

Contraindicated in renal failure or during renal replacement therapy.

Pediatric Use

Contraindicated in children and adolescents under 18 years of age.

Geriatric Use

It should be used with caution in elderly patients (over 65 years of age). To prevent complications from the cardiovascular system and kidneys caused by hypervolemia, elderly patients require careful dose selection and monitoring during treatment.

Special Precautions

To prevent complications from the cardiovascular system and kidneys caused by hypervolemia, elderly patients, who are more likely to have heart and/or kidney failure, require careful dose selection and monitoring during treatment.

Particular caution should be exercised when using HES solutions in patients with blood coagulation disorders, with impaired liver function. The appropriateness of using HES to treat hypovolemia should be carefully assessed and hemodynamic parameters should be monitored to control the achievement of the desired effect and determine the HES dose. Volume overload associated with overdose of the agent or high infusion rate should be avoided. The dose must be selected with caution, especially in patients with lung and cardiovascular diseases.

The appointment of high doses of pentastarch to patients with hypovolemia should be avoided due to possible pronounced hemodilution. In case of repeated use of pentastarch, blood coagulation parameters must be carefully monitored.

If hypersensitivity reactions develop, the administration of pentastarch should be stopped immediately and the necessary emergency measures should be taken. Patients should be under continuous medical supervision, additional therapeutic measures should be taken depending on the condition of the patients.

When using pentastarch, blood volume, electrolyte concentration, leukocytes, platelets, hemoglobin, and blood coagulation parameters should be monitored. At the first signs of coagulopathy, the use of the agent should be discontinued.

During open-heart surgery involving cardiopulmonary bypass, there is an increased risk of bleeding, so the use of HES is contraindicated.

Before starting and during the use of HES, it is necessary to check kidney function, constantly monitor serum creatinine levels, water-electrolyte balance, as well as urine retention indicators. At the first signs of kidney damage during treatment, the use of pentastarch should be discontinued. Kidney function monitoring should be carried out for 90 days after the use of pentastarch (risk of kidney damage in the long term).

Impaired renal function during therapy with HES solution may exacerbate the initial hepatic failure (with portal hypertension) and may lead to mechanical obstruction of the bile ducts.

During treatment, it is necessary to ensure sufficient fluid intake (at least 2-3 liters of fluid per day).

When treating patients whose blood type is not established, it should be borne in mind that the introduction of large volumes of HES may complicate the interpretation of the results of the agglutination reaction.

Pentastarch may give a positive result during doping control.

Drug Interactions

When used simultaneously with aminoglycosides, the risk of nephrotoxicity increases, so it is recommended to avoid simultaneous long-term use of pentastarch and aminoglycosides.

When used simultaneously with anticoagulants, an increase in bleeding time is possible.

Pentastarch is incompatible with solutions of other medicinal products.

Storage Conditions

Store at 2°C (36°F) to 25°C (77°F). Keep in original packaging, protected from light. Keep out of reach of children.

Dispensing Status

Rx Only

Important Safety Information

This information is for educational purposes only and does not replace professional medical advice. Always consult your doctor before use. Dosage and side effects may vary. Use only as prescribed.