Reopoliglyukin

General characteristics. Structure:

Active ingredient: 10 g of a dextran with a molecular weight from 30 000 to 40 of 000.

Excipients: sodium chloride, water for injections.

It is applied as plasma substituting antishock medicine of hemodynamic action.

Pharmacological properties:

Pharmacodynamics. Reopoliglyukin - 10% colloidal solution with a molecular weight of 30000-40000. It is applied as plasma substituting antishock medicine of hemodynamic action. Promotes increase in volume of plasma almost twice in comparison with the volume of the entered medicine as each gram of polymer of glucose with a molecular weight of 30000-40000 causes movement of 20-25 ml of liquid from fabrics in a blood channel. Owing to high oncotic pressure реополиглюкин very slowly passes through a vascular wall and a long time circulates in a vascular bed, normalizing a hemodynamics at the expense of liquid current on a concentration gradient - from fabrics in vessels. As the result, quickly increases and is long arterial pressure keeps at the high level, hypostasis of fabrics decreases.

Reopoliglyukin can be used as disintoxication means. At its introduction blood flowability improves, aggregation of uniform elements decreases. It also on osmotic mechanisms stimulates a diuresis (it is filtered in balls, creates high oncotic pressure in primary urine and interferes with a water reabsorption in tubules), than promotes (and accelerates) to a conclusion from an organism of poisons, toxins, degradatsionny products of exchange.

Pharmacokinetics. The dextran which is a part of a reopoliglyukin is brought out of an organism generally by kidneys: for the first days about 70% in not changed look are excreted. A certain part of a dextran comes to reticuloendothelial system where it gradually breaks up to glucose. Does not participate in carbohydrate metabolism. Very insignificant quantities of a dextran can get into digestive tract and be removed with excrements.

Indications to use:

Reopoliglyukin apply at disturbances of a capillary blood-groove, to prevention and treatment of traumatic, operational and burn shock; disturbances of arterial and venous circulation, for treatment and prevention of thromboses and thrombophlebitises, an endarteritis; at the heart operations performed with use of the cardiopulmonary bypass (for addition to perfused liquid); in vascular and plastic surgery for improvement of local circulation; for desintoxication at burns, peritonitis, pancreatitis, etc. Reopoliglyukin appoint at diseases of a retina and optic nerve, inflammatory processes of a cornea and choroid.

Route of administration and doses:

Intravenously struyno, jet капельно and kapelno. Doses and rate of administering of drug should be chosen individually according to indications and a condition of the patient, size of arterial pressure, heart rate, hematocrit indicators.

Just before use of a reopoliglyukin, except for medical emergencies, skin test is carried out. The intracutaneous test is carried out in 24 hours prior to drug infusion. For this purpose from a bottle with Reopoliglyukin by a puncture the sterile syringe connected to it systems disposable 0,2-0,3 ml of drug which is administered vnutrikozhno in a dose of 0,05 ml with formation of a limonoy crust on the interior of a forearm, a shoulder silt of the idrugy area available to a visual estimate of skin test undertake. The doctor carries out reaction assessment in 24 hours.

Existence on site reddenings (diameter more than 1,5 mm), formation of a papule or emergence of symptoms of the general reaction in the form of nausea, dizziness or other manifestations in 10-15 minutes after an injection, testifies to the increased sensitivity of the patient to drug (risk group) and impossibility of use of drug at this patient. In the absence of any reactions to the patient administer necessary amount of the drug of that series which was used for carrying out an intracutaneous test. Result of test are registered in the history of a disease.

It is necessary to remember that skin test does not allow to reveal a sensitization to Reopoliglyukin at 100% of patients. Therefore the first 5-10 minutes in process of intravenous administration of drug in each case it is necessary to watch a condition of the patient vnimateno. 

At use of drug carrying out a biological test is obligatory: after slow introduction of the first of the 5th a cap of drug stop transfusion for 3 min., then enter still the 30th cap and again stop injection for 3 min. In the absence of reaction administration of drug continues. Results of a biological test surely are registered in the history of a disease.

1. At disturbance of a capillary blood-groove (various forms of shock) enter intravenously kapelno or jet капельно, in a dose from 0.5 to 1.5 l, before stabilization of hemodynamic indicators at the life-supporting level. If necessary the amount of drug can be increased to 2 l.

At children at various forms of shock enter at the rate of 5-10 ml/kg, the dose can be increased if necessary to 15 ml/kg. It is not recommended to reduce hematocrit size lower than 25%. 2. At cardiovascular and plastic surgeries enter intravenously kapelno, just before surgical intervention, within 30 – 60 min. to adults and children in a dose of 10 ml/kg, during operation by adult - 500 ml, to children - 15 ml/kg.

After operation the drug is administered intravenously kapelno (within 60 min.) within 5 - 6 days from calculation:

adult - 10 ml/kg once,

to children up to 2 - 3 years - 10 ml/kg of 1 times a day,

to children up to 8 years - on 7 - 10 ml/kg of 1 - 2 time a day,

to children up to 13 years - on 5 - 7 ml/kg of 1 - 2 time a day.

For children 14 years the same doses, as for adults are more senior.

3. At operations with artificial circulation drug is added to blood at the rate of 10-20 ml/kg of body weight of the patient for filling of the pump of the oxygenator. Concentration of a dextran in perfused solution should not exceed 3%. In the postoperative period of a dose of drug same, as at disturbance of a capillary blood-groove.

4. For the purpose of desintoxication enter intravenously kapelno in a single dose from 500 to 1250 ml (children have 5-10 ml/kg) within 60 - 90 min. If necessary it is possible to pour in the first days 500 more ml of drug (at children administration of drug in the first days can be repeated in the same doses). In the next days the drug is administered kapelno, the adult - in a daily dose of 500 ml, to children - at the rate of 5 – 10 ml/kg. It is jointly reasonable to enter crystalloid solutions (Ringera and Ringera-atsetata, etc.) in such quantity to normalize water and electrolytic balance (especially important at treatment of the dehydrated patients and after surgeries), drug, as a rule, causes increase in a diuresis (reduction of a diuresis indicates dehydration of an organism of the patient).

5. In ophthalmologic practice apply by an electrophoresis which is carried out by the standard way. The drug consumption on one procedure makes 10 ml. The procedure is carried out once a day, entered as from a positive, and negative pole. Current density - to 1.5 ma/kv.sm. Procedure duration - 15-20 min. The course of treatment consists of 5-10 procedures.

Features of use:

Together with drug it is reasonable to enter crystalloid solutions (0.9% solution of sodium of chloride, 5% dextrose solution) in such quantity to fill and support liquid and electrolytic balance. It is especially important at treatment of the dehydrated patients and after heavy surgeries. At simultaneous use with anticoagulants decrease in their dose is necessary.

Causes increase in a diuresis (if decrease in a diuresis with release of viscous siropoobrazny urine is observed, then it can indicate dehydration). In this case it is necessary to enter into colloidal solutions for completion and maintenance of water and electrolytic balance.

In case of an oliguria it is necessary to enter saline solutions and furosemide. At patients with reduced filtrational ability of kidneys it is necessary to limit administration of sodium of chloride.

Dextrans are capable to envelop a surface of erythrocytes, interfering with blood typing therefore it is necessary to use the washed erythrocytes.

It is necessary to be careful when driving or potentially dangerous mechanisms.

Side effects:

Complications after introduction of a reopoliglyukin usually are not observed, however allergic reactions are in rare instances possible.

In case of emergence during infusion of reactions of anaphylactic type (reddening and an itch of integuments, a Quincke's edema, etc.) it is necessary to stop immediately administration of medicine and, without taking out a needle from a vein, to start carrying out all the therapeutic actions provided by the corresponding instructions for elimination of transfusion reaction (calcium drugs, antihistaminic and cardiovascular means, corticosteroids, respiratory analeptics, etc.).

Interaction with other medicines:

It is necessary to check for compatibility of a dextran with drugs which are planned for introduction to infusion solution previously. Use together with other traditional transfusion means is allowed.

Contraindications:

Contraindications to purpose of a reopoliglyukin are: hypersensitivity, dekompensirovanny cardiovascular insufficiency; craniocereberal injuries with increase in intracranial pressure; hemorrhagic stroke; the proceeding internal bleedings; hypocoagulation; thrombocytopenia; the expressed renal failures which are followed oligo-and an anury; a hypervolemia, an overhydratation and other situations at which introduction of massive doses of liquids is contraindicated.

Reopoliglyukin from 0,9% solution of sodium of chloride it is not necessary to enter in cases of pathological changes in kidneys.

Storage conditions:

Period of validity 4 years. Drug should be used before the date specified on packaging In the place, dry, unavailable to children, at a temperature from 10 to 20 °C.

Issue conditions:

According to the recipe

Packaging:

Solution for infusions of 10% (in solution of sodium of chloride of 0,9%).

200, 400 ml in bottles glass for blood, infusional and transfusion drugs with a capacity of 250, 450 ml respectively, corked by rubber bungs and pressed out by aluminum caps.

28 bottles with a capacity of 250 ml or 15 bottles with a capacity of 450 ml place in boxes from corrugated fibreboard with an investment of application instructions.