Reopolyglucin

Rheopolyglucin is a fluid for perfusion procedures and also a blood substitute.

The drug is a plasma-substituting colloidal liquid based on dextran (glucose polymer), whose therapeutic activity is manifested as an improvement in the rheological parameters of the blood. The drug reduces blood viscosity, restores microcirculatory blood circulation, and in addition prevents and eliminates the aggregation of some formed components. The drug also stabilizes venous and arterial blood flow. [ 1 ]

Indications Reopolyglucin

It is used in the treatment or prevention of distributive or hypovolemic shock. In addition, it is prescribed in the case oftransplant- related plastic and vascular surgeries.

It is used as an additional element to the perfusion present inside artificial blood flow machines and applied during operations in the cardiac area.

Release form

The therapeutic component is released in the form of an infusion liquid, inside glass bottles with a capacity of 0.2 or 0.4 l.

Pharmacodynamics

The introduction of the drug at high speed leads to an increase in the volume of blood plasma by an amount almost twice the volume of the substance used, because every 10 ml causes a redistribution of 20-25 ml of the drug into the bloodstream from the tissues. [ 2 ]

Pharmacokinetics

The half-life is 6 hours. Excretion is mostly via the kidneys: approximately 60% in the first 6 hours; 70% is excreted within 24 hours. The remainder passes into the macrophage system and liver, where it undergoes gradual breakdown from α-glucosidase into glucose, while not being a carbohydrate nutrient source.

Dosing and administration

The procedures are carried out through a drip, intravenously. Before starting the injection, the liquid must be heated to 35-37°C. The portion size and the speed of the injection are selected individually.

If there is a disorder of capillary circulation (various types of shock), an adult can be given no more than 20 ml/kg per day, and a child – 5-10 ml/kg (if necessary, a maximum of 15 ml/kg).

During operations using artificial blood flow, the drug is added to the blood at a dosage of 10-20 ml/kg to fill the oxygenator pump; the level of dextran inside the perfusion fluid can be a maximum of 3%. During the postoperative period, the drug is used in portions used for disorders of capillary blood circulation.

Rheopolyglucin must not be mixed with other medications. In the presence of strict indications, the medication can be administered at high speed, even by jet method, in a portion of 15 ml/kg.

People with TBI or hemorrhagic stroke can use the drug in a dosage of no more than 10-15 ml/kg.

• Application for children

The medication is used in pediatrics; the dosage is selected taking into account the child’s weight.

Use Reopolyglucin during pregnancy

Rheopolyglucin can be prescribed only according to strict indications, taking into account the benefit-risk ratio of its use.

Contraindications

Among the contraindications:

• hypervolemia and -hydration;
• thrombocytopenia (platelet count is less than 80×109/l);
• renal lesions characterized by anuria and oliguria;
• insufficiency of the cardiovascular system function, which is decompensated in nature (stages 2-3);
• DIC syndrome;
• tendency to develop signs of allergy;
• dextran related intolerance;
• conditions during which the introduction of large amounts of liquid is prohibited.

Dextran in combination with 0.9% NaCl is prohibited in case of kidney diseases; combination with 5% glucose is prohibited in case of carbohydrate metabolism disorders (especially in case of diabetes mellitus).

Side effects Reopolyglucin

Main side effects:

• signs of allergy: fever, anaphylaxis, heat, Quincke's edema, itching, rashes, manifestations of intolerance and hyperhidrosis;
• lesions affecting the cardiovascular system: tachycardia, edema, changes in blood pressure and dyspnea;
• disorders associated with digestive function: vomiting, pain in the abdominal area, xerostomia and nausea;
• problems with the functioning of the nervous system: tremors, headaches and dizziness;
• urinary dysfunction: often, especially in case of hypovolemia, the drug leads to increased diuresis. But sometimes its use causes a weakening of diuresis; in this case, urine becomes viscous, from which it can be concluded that dehydration is observed inside the patient's body. In such a case, intravenous injection of crystalloid fluids is performed, which allows restoring and maintaining plasma osmoticity. The introduction of 15 ml/kg of the substance leads to the appearance of hyperosmolarity, which can provoke a tubular burn with the subsequent development of acute renal failure. In this case, diuresis also weakens, and urine becomes viscous;
• damage to the blood system: hyperemia, acrocyanosis and weakening of platelet activity. The drug also complicates the process of identifying the blood group;
• Others: swelling affecting the limbs, cramps, systemic weakness, pain in the chest and lumbar region, as well as a feeling of lack of air.

If negative symptoms appear (taking into account the clinical picture), it is necessary to immediately stop using the drug, and then, without removing the needle from the vein, carry out all the emergency procedures required in such cases to help eliminate transfusion manifestations (GCS, cardiovascular substances, antihistamines, crystalloid fluids are used; in case of collapse, cardiotonics and vasopressors are used).

Overdose

In case of intoxication, hypocoagulation or hypervolemia may develop.

Symptomatic actions are carried out.

Interactions with other drugs

Administration together with anticoagulants requires a reduction in their dosage portion.

The presence of dextran in the blood may alter the results of tests regarding protein and bilirubin levels, as well as blood typing. For this reason, such tests must be performed before using the drug.

Storage conditions

Reopolyglucin must be stored in a place inaccessible to children. Temperature values - no more than 25°C.

Shelf life

Rheopolyglucin can be used for a period of 4 years from the date of production of the therapeutic agent.

Analogues

The analogues of the drug are the substances Reogluman and Polyglucin.