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Uses
EXTRANEAL (icodextrin) is indicated for a single daily exchange for the long (8- to 16- hour) dwell during continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) for the management of end-stage renal disease. EXTRANEAL is also indicated to improve (compared to 4.25% dextrose) long-dwell ultrafiltration and clearance of creatinine and urea nitrogen in patients with high average or greater transport characteristics, as defined using the peritoneal equilibration test (PET) [see Clinical Pharmacology (12), Clinical Studies (14)].
History
There is currently no drug history available for this drug.
Other Information
EXTRANEAL (icodextrin) Peritoneal Dialysis Solution is a solution intended for intraperitoneal administration that contains 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:
Icodextrin |
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:
Sodium |
132 mEq/L |
Calcium |
3.5 mEq/L |
Magnesium |
0.5 mEq/L |
Chloride |
96 mEq/L |
Lactate |
40 mEq/L |
Water for Injection, USP qs
HCl/NaOH may have been used to adjust pH.
EXTRANEAL contains no bacteriostatic or antimicrobial agents.
Calculated osmolarity: 282-286 mOsm/L; pH=5.0-6.0
EXTRANEAL is a sterile, nonpyrogenic, clear solution packaged in AMBU-FLEX II and ULTRABAG containers. The container systems are composed of polyvinyl 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.
Sources
Extraneal Manufacturers
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Baxter Healthcare Corporation
Extraneal | Baxter Healthcare Corporation
2.1 Basic Dosing InformationEXTRANEAL is intended for intraperitoneal administration only. Not for intravenous injection. Administer as a single daily exchange for the long dwell in continuous ambulatory peritoneal dialysis or automated peritoneal dialysis. The recommended dwell time is 8- to 16- hours. Administer over a period of 10-20 minutes at a rate that is comfortable for the patient.
The mode of therapy, frequency of treatment, exchange volume, duration of dwell, and length of dialysis should be initiated and supervised by the prescribing physician experienced in the treatment of end-stage renal disease with peritoneal dialysis. It is recommended that patients being placed on peritoneal dialysis should be appropriately trained in a program that is under supervision of a physician.
2.2 Directions for UseFor complete CAPD and APD system preparation, see directions accompanying ancillary equipment.
Aseptic technique should be used throughout the peritoneal dialysis procedure.
For single use only.
StorageStore in moisture barrier overwrap and in carton until ready to use [see How Supplied/Storage and Handling (16)].
WarmingFor patient comfort, EXTRANEAL can be warmed to 37°C (98.6°F). Only dry heat should be used. It is best to warm solutions within the overwrap using a heating pad. Do not immerse EXTRANEAL in water for warming. Do not use a microwave oven to warm EXTRANEAL. Do not heat above 40°C (104°F).
To OpenTo open, tear the overwrap down at the slit and remove the solution container. Some opacity of the plastic, due to moisture absorption during the sterilization process, may be observed. This does not affect the solution quality or safety and may often leave a slight amount of moisture within the overwrap.
Inspect for Container Integrity and Solution AppearanceDo not use EXTRANEAL if it is cloudy or discolored, if it contains particulate matter, or if the container is leaking.
Inspect the patient connector to ensure the pull ring is attached. Do not use if pull ring is not attached to the connector. Inspect the EXTRANEAL container for signs of leakage and check for minute leaks by squeezing the container firmly. If the container has frangible(s), inspect that they are positioned correctly and are not broken. Do not use EXTRANEAL if the frangible(s) are broken or leaks are suspected as sterility may be impaired.
For EXTRANEAL in UltraBag, inspect the tubing and drain container for presence of solution. Small droplets are acceptable, but if solution flows past the frangible prior to use, do not use and discard the units.
Adding MedicationsThe decision to add medication should be made by the physician after careful evaluation of the patient [see Drug Interactions (7), Clinical Pharmacology (12.3)].
If the re-sealable rubber plug on the medication port is missing or partly removed, do not use the product if medication is to be added.
To add a medication:
• Put on mask. Clean and/or disinfect hands. • Prepare medication port site using aseptic technique. • Using a syringe with a 1-inch long, 25- to 19-gauge needle, puncture the medication port and inject additive. • Reposition container with container ports up and evacuate medication port by squeezing and tapping it. • Mix solution and additive thoroughly. Preparation for Administration • Put on mask. Clean and/or disinfect hands. • Place EXTRANEAL on work surface. • For ULTRABAG system for manual exchange, uncoil tubing and drain bag. Ensure the patient transfer set is closed. Break the connector (Y-set) frangible. • Remove pull ring from connector of solution container. If continuous fluid flow from connector is observed, discard solution container. Once the pull ring has been removed, do not reuse the solution or container. • Immediately attach the solution container to patient connector (transfer set) or appropriate peritoneal dialysis set. • For AMBU-FLEX II, continue with therapy set-up as instructed in user manual or directions accompanying tubing sets for automated peritoneal dialysis. • For ULTRABAG, follow the below steps: • Clamp solution line and then break frangible near solution bag. Hang solution container and place the drainage container below the level of the abdomen. • Open transfer set to drain the solution from abdomen. If drainage cannot be established, contact your clinician. When drainage complete, close transfer set. • Remove clamp from solution line and flush new solution to flow into the drainage container for 5 seconds to prime the line. Clamp drain line after flush complete. • Open transfer set to fill. When fill complete, close transfer set. • Disconnect ULTRABAG from transfer set and apply MINICAP.Completion of Therapy
• Following use, the drained fluid should be inspected for the presence of fibrin or cloudiness, which may indicate the presence of peritonitis. • Discard unused portion.
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