Icodextrin is a colloidal osmotic agent primarily used in peritoneal dialysis solutions. Peritoneal dialysis is a method of cleaning the blood for people with kidney failure. Instead of using a machine (as in hemodialysis), peritoneal dialysis uses the lining of the abdomen, called the peritoneal membrane, to filter the blood. A special fluid is introduced into the peritoneal cavity, and wastes and excess fluid move from the blood into this fluid, which is later drained.

Icodextrin (Adept, Extraneal) is an iso-osmotic solution used to prevent adhesions in patients undergoing gynecological surgery. It is also used as a colloid osmotic solution for peritoneal dialysis.

Adept, Extraneal (Icodextrin) Uses:

• Adept:
  • Gynecologic laparoscopic adhesiolysis uses it as a supplemental procedure to surgery to lessen post-operative adhesions.
• Extraneal:
  • It is used to regulate peritoneal dialysis (daily exchanges for the extended stay (8 to 16 hrs) during CAPD (continuous ambulatory peritoneal dialysis) or APD) (automated peritoneal dialysis)
  • Compared to 4.25% dextrose, for the enhancement of long-dwell ultrafiltration and removal of creatinine and urea nitrogen in individuals with high average or greater transport characteristics.

Adept, Extraneal (Icodextrin) Dose in Adults:

Extraneal (Icodextrin) Dose in the CAPD or APD:

• How it's given: Inside the belly (intraperitoneal).
• Frequency: Once a day.
• Dwell time: The solution stays in the belly for 8 to 16 hours.

Adept (Icodextrin) Dose in the Laparoscopic gynecologic surgery:

• How it's given: Inside the belly (intraperitoneal).
• During surgery: Pour at least 100 mL every 30 minutes.
• After surgery:
  • Suck out (aspirate) any leftover fluid.
  • Then pour 1 L into the belly cavity.

Use in Children:

Not indicated.

Pregnancy Risk Factor C

• We haven't tested this on pregnant animals.

Icodextrin use during breastfeeding:

• We don't know if icodextrin gets into breast milk.
• So, if a woman is breastfeeding, she should be careful when taking it.

Use in patients with renal disease:

It is contraindicated in acute renal failure.

Use in patients with liver disease:

The manufacturer's labeling makes no mention of changing the dose.

CAPD or APD (Extraneal®):

Common Side Effects of Extraneal (Icodextrin):

• Respiratory:
  • Upper respiratory infection
• Cardiovascular:
  • Hypertension
• Miscellaneous:
  • Peritonitis

Less Common Side Effects of Extraneal (Icodextrin):

• Central Nervous System:
  • Headache
  • Dizziness
• Cardiovascular:
  • Hypervolemia
  • Hypotension
  • Edema
  • Chest Pain
• Endocrine & Metabolic:
  • Hyperglycemia
  • Hypoproteinemia
  • Hyperphosphatemia
  • Hypokalemia
• Dermatological:
  • Rash
  • Skin Disorder
  • Pruritus
• Miscellaneous:
  • Accidental Injury
  • Flu Syndrome
  • Infection
• Gastrointestinal:
  • Abdominal Pain
  • Diarrhea
  • Vomiting
  • Nausea
  • Dyspepsia
• Neuromuscular & Skeletal:
  • Arthralgia
  • Pain
  • Weakness
• Hematologic:
  • Anemia
• Respiratory:
  • Cough Increased
  • Dyspnea

Laparoscopic surgery (Adept®):

Common Side Effects of Adept (Icodextrin):

• Endocrine & metabolic:
  • Dysmenorrhea
• Central nervous system:
  • Headache
• Gastrointestinal:
  • Nausea
  • Constipation

Less Common Side Effects of Adept (Icodextrin):

• Respiratory:
  • Nasopharyngitis
  • Cough
• Central Nervous System:
  • Pyrexia
  • Insomnia
• Neuromuscular & Skeletal:
  • Arthralgia
  • Back Pain
• Gastrointestinal:
  • Abdominal Distention
  • Vomiting
  • Flatulence
  • Abdominal Pain
  • Diarrhea
• Genitourinary:
  • Dysuria
  • Or Vaginal Swelling; Vaginal Bleeding
  • Urinary Tract Infection; Labial
  • Vulvar

Contraindications to Adept, Extraneal (Icodextrin):

You shouldn't use icodextrin if you have:

• Allergy to icodextrin, cornstarch, or any part of the medicine.
• A rare sugar intolerance (like to maltose or isomaltose).
• A condition that stores too much sugar as glycogen.
• Very high lactic acid levels (only for the "Extraneal" brand).
• An infection inside your belly, like peritonitis.
• Recently had certain surgeries like removing appendix or part of the intestine (only for the "Adept" brand).

In Canada (for the "Extraneal" brand), you also shouldn't use it if you have:

• Sudden kidney failure.
• Issues that make dialysis ineffective or risky.
• Loss of function in the belly lining or too many sticky tissues inside.
• Recent belly surgery in the past month.
• Abnormal connections in the belly, tumors, open sores, weak spots, or other problems with the belly wall or inside.

Warnings and precautions

Hypersensitivity reactions

• There have been reports of serious allergies, including:
  • Severe full-body allergic reactions.
  • Dangerous skin reactions.
  • Swelling deep under the skin.
  • Other rare but serious reactions.
• If someone shows signs of an allergic reaction, stop the treatment right away and remove the solution from inside the belly.
• Some people get a skin rash after starting the treatment. This often happens in the first few weeks and can go away if the treatment is stopped. For some, the rash goes away even if they keep using the medicine.

Peritonitis

• There have been reports of belly infections, both from germs and non-germ related causes.
• Watch out for signs of an infection.
• If you don't set up the equipment correctly, air might get into the belly. This can cause belly pain or even lead to an infection.
• If someone gets an infection in the belly, they need the right treatment.

Monitoring parameters:

Things to Keep an Eye On:

• Levels of salts in the blood.
• General blood tests.
• How much fluid is in the body and any changes in weight.

For "Extraneal" specifically:

• Check for a condition called "lactic acidosis" before and during treatment, especially in people who might be more at risk. This includes those:
  • With very low blood pressure or severe infections causing kidney issues.
  • With certain genetic disorders.
  • Taking specific HIV drugs.

How to administer Adept (Icodextrin)?

• Use this medicine only inside the belly (intraperitoneal). Don't inject it into veins or arteries.

For "Adept":

• Warm it up to body temperature before using.
• Its salt concentration (osmolarity) is 278 mOsm/L.

For "Extraneal":

• If using by hand, pour it into the belly over 10 to 20 minutes.
• For more comfort, you can warm it up to body temperature (37°C or 98.6°F) using dry heat sources like a heating pad. Make sure not to:
  • Heat it above 40°C (104°F).
  • Use water to warm it.
  • Use a microwave to heat it.
• Its salt concentration (osmolarity) is between 282 and 286 mOsm/L.
• Its acidity level (pH) is between 5.0 and 6.0.

Mechanism of action of Adept (Icodextrin):

Icodextrin's Job in Dialysis:

• It pulls water through tiny openings between cells. This helps clean the blood for longer periods.
• It also provides important salts and lactate to help keep a balance in the body.

Icodextrin's Job in Laparoscopic Surgery:

• Its thick, syrupy nature helps it stay in the belly for 3-4 days.
• This creates a temporary barrier between surfaces in the belly, which helps prevent tissues from sticking together after surgery.

Absorption:

• About 40% is taken up during a 12-hour period in CAPD. It slowly enters the bloodstream through the drainage system in the belly.

Breaking Down:

• The body mostly uses alpha-amylase to turn icodextrin into simpler sugars like maltose and others.

Peak Time in Blood:

• It reaches its highest level in the blood after 13 hours.

Getting Rid of It:

• The kidneys remove some of it, depending on how well they work. The rest is removed through the dialysis solution.

International Brands of Icodextrin:

• Adept
• Extraneal
• Extraneal Dialysis Solution

Icodextrin Brand Names in Pakistan:

No Brands Available in Pakistan.