Etherified Starch

What it is and how it works

Hydroxyethyl starch is a modified amylopectin polymer that remains in the intravascular space and exerts colloid oncotic pressure, expanding plasma volume. The degree of substitution and molecular weight determine the duration of volume effect and the rate of elimination by amylase and renal excretion.

Indications

Treatment of hypovolaemia due to acute blood loss when crystalloids alone are considered insufficient; use is restricted by regulatory authorities (EMA restricted and subsequently recommended suspension of HES solutions in the EU).

Dosage and administration (summary)

By intravenous infusion, at the lowest effective dose for the shortest period (generally no longer than 24 hours), guided by continuous haemodynamic monitoring and not exceeding the maximum daily dose in the product information (for 6% HES 130/0.4, 30 mL/kg).

Contraindications

Sepsis, critical illness, burns, renal impairment or renal replacement therapy, severe liver disease, intracranial or cerebral haemorrhage, severe coagulopathy, fluid overload, pulmonary oedema, dehydration, organ transplantation and hypersensitivity to starch.

Warnings and precautions

HES increases the risk of acute kidney injury, need for renal replacement therapy and mortality in critically ill and septic patients, and can impair coagulation; renal function and coagulation should be monitored. Anaphylactoid reactions, pruritus and tissue accumulation may occur.

Pregnancy

Use only if clearly needed, as safety data are limited.

Storage and supply

Store below 25 °C; do not freeze.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.