Icodextrin

Legal statusLegal status Pharmacokinetic dataBioavailability40% in 12 hoursMetabolismAlpha-amylaseExcretionRenalIdentifiersCAS NumberPubChem SIDDrugBankChemSpiderUNIIKEGGChEMBLCompTox Dashboard (EPA)Chemical and physical dataFormula(C₆H₁₀O₅)_nMolar mass13–19 kg/mol ^NY (what is this?)  (verify)

Icodextrin (INN, USAN) is a colloid osmotic agent, derived from maltodextrin,^[1] used in form of an aqueous solution for peritoneal dialysis under the trade name Extraneal,^[2] and after gynecological laparoscopic surgery for the reduction of post-surgical adhesions (fibrous bands that form between tissues and organs) under the trade name Adept.^[3]

Icodextrin is a starch-derived, branched, water-soluble glucose polymer linked by α-(1→4) and less than 10% α-(1→6) glycosidic bonds, making it a type of dextrin. Its weight-average molecular weight is between 13,000 and 19,000 daltons 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.^[3]

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 fibrin is formed after a surgery. In other words, the tissues are kept from gluing together.^[3]

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.^[4]

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 oligosaccharides by the enzyme alpha-amylase. In patients with intact kidney function, both icodextrin and its fragments are excreted via the kidney by glomerular filtration.^[2][3]

Icodextrin is contraindicated in patients with cornstarch allergy, maltose or isomaltose intolerance, glycogen storage disease, or severe lactic acidosis.^[5]

Adverse effects include peritonitis, respiratory infection, 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.^[5]

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.^[5]