Reopolyglyukin indications for use reviews. Complex therapy for toxins with rheopolyglucin droppers

Dosage form: & nbspsolution for infusion Composition:

active substance: dextran (average molecular weight 30,000-40,000) (as a 10% solution in water for injection) 1 ml, (in terms of dextran (average molecular weight 30,000-40,000)) 100 mg;

excipient: sodium chloride 9 mg.

Description: Transparent, colorless or slightly yellowish liquid. Pharmacotherapeutic group:plasma replacement agent ATX: & nbsp

B.05.A.A Blood plasma preparations and plasma substitutes

Pharmacodynamics:

Dextran is a 10% colloidal solution with an average molecular weight of 30,000-40,000. It is used as a plasma-substituting anti-shock drug of hemodynamic action. It promotes an increase in the volume of blood plasma by almost 2 times compared to the volume of the administered drug, since each gram of dextrose polymer with an average molecular weight of 30,000-40,000 causes the movement of 20-25 ml of fluid from tissues into the bloodstream. Due to the high oncotic pressure, it passes very slowly through the vascular wall and long time circulates in the vascular bed, normalizing hemodynamics due to the flow of fluid along the concentration gradient - from tissues to blood vessels. As a result, blood pressure rises rapidly and remains at high level for a long time, the return of venous blood to the heart increases, cardiac output increases, tissue edema decreases. The duration of the action is from 3 to 4 hours.

Rheopolyglucin can be used as a detoxifying agent and to some extent as an agent that improves microcirculation in tissues.

With its introduction, the viscosity of blood decreases, its fluidity improves, the aggregation of formed elements decreases, which improves microcirculation in tissues. The mechanism of the antithrombotic effect is attributed, among other things, to the "coating" effect. Studies have shown that dextrans form a monomolecular film on the intima of blood vessels, as well as on the surface of platelets, which prevents both platelet aggregation and their adhesion to the vessel wall. Dextrans have also been shown to increase circulating tissue plasminogen activator (t-PA) by blocking the action of a plasminogen activator inhibitor (PAI-1). In addition, there is data on the effect on the shape of the fibrin molecule, changes in which lead to its more easy destruction with endogenous fibrinolysis, which leads to the prevention of blood clots and increases their solubility (thrombolysis). When used in dosages up to 15 ml / kg does not cause a noticeable change in bleeding time.

Dextran also stimulates diuresis by osmotic mechanisms (it is filtered in the glomeruli, creates high oncotic pressure in the primary urine and prevents the reabsorption of water in the tubules), which promotes the removal of poisons, toxins, and degradation metabolic products from the body. The pronounced volemic effect has a positive effect on hemodynamics and is simultaneously accompanied by the washing out of metabolic products from the tissues, which, together with an increase in diuresis, provides an accelerated detoxification of the body.

Pharmacokinetics:

Excretion - by the kidneys, 60% is excreted in 6 hours, and 70% in 24 hours. 30% enters the reticuloendothelial system, the liver, where it is broken down by the acid alpha-glucosidase enzyme to glucose, but is not a source of carbohydrate nutrition.

Indications:

Prevention and treatment of traumatic, operational and burn shock, replenishment of the circulating blood volume.

Arterial and venous circulation disorders, treatment and prevention of thrombosis and thrombophlebitis, endarteritis and other circulatory disorders.

To be added to perfusion fluid in heart-lung operations performed using a heart-lung machine.

To improve local circulation in vascular and plastic surgery.

For detoxification in case of burns, peritonitis, pancreatitis and other conditions requiring detoxification.

Contraindications:

Hypersensitivity to drug components; decompensated cardiovascular failure; pulmonary edema; traumatic brain injury with increasing intracranial pressure; hemorrhagic stroke; ongoing internal bleeding; hypocoagulation; thrombocytopenia; severe renal dysfunction, accompanied by oligo- and anuria; hypervolemia, overhydration and other situations in which the introduction of large volumes of fluids is contraindicated.

Carefully:In case of disorders of the blood coagulation system, dehydration, in patients with diabetes mellitus with severe hyperglycemia and hyperosmolarity, with violations of the water-electrolyte balance. Pregnancy and lactation:

During pregnancy, it is used when the expected benefit to the mother exceeds possible risk for the fetus.

You should refrain from breastfeeding during the period of use of the drug due to the lack of relevant clinical data.

Method of administration and dosage:

Intravenous jet, jet and drip.

Doses and rate of administration of the drug should be selected individually in accordance with the indications and condition of the patient, the value blood pressure, heart rate, hematocrit.

Immediately before using dextran, with the exception of emergencies, a skin test is performed.

An intradermal test is performed 24 hours before the infusion of the drug. For this, 0.05 ml of the drug is injected intradermally with the formation of a lemon crust on the inside of the forearm, shoulder or other area available for visual assessment. skin test... The doctor evaluates the reaction after 24 hours.

Redness, papules, or symptoms at the injection site general reaction in the form of nausea, dizziness or other manifestations 10-15 minutes after injection indicates hypersensitivity the patient to the drug and the impossibility of using the drug in this patient. In the absence of any reactions, the patient is injected with the required amount of the drug of the batch that was used for the intradermal test. The results of the sample are recorded in the medical history.

It should be remembered that a skin test does not reveal sensitization to dextran in 100% of patients. Therefore, in the first 5-10 minutes as the drug is administered intravenously in each case, it is necessary to closely monitor the patient's condition.

In case of emergency conditions when using the drug, it is necessary to conduct a bioassay: after the slow introduction of the first 5 drops of the drug, the administration is stopped for 3 minutes, then another 30 drops are injected and the infusion is stopped again for 3 minutes. If there is no reaction, continue the drug administration. The results of the bioassay must be recorded in the medical history.

1. In case of impaired capillary blood flow (various forms of shock), intravenous drip or jet-drip is administered in a dose of 0.5 to 1.5 liters, until the hemodynamic parameters stabilize at the life-supporting level. If necessary, the amount of coin preparation can be increased to 2 liters.

In children with different forms shock is administered at the rate of 5-10 ml / kg, the dose can be increased if necessary up to a maximum of 15 ml / kg. It is not recommended to reduce the hematocrit value below 25%.

2.With cardiovascular and plastic surgery injected intravenously, immediately before surgery, for 30-60 minutes for adults and children at a dose of 10 ml / kg, during surgery for adults - 500 ml, for children - 15 ml / kg.

After the operation, the drug is administered intravenously drip (within 60 minutes) for 5-6 days at the rate of:

adults - 10 ml / kg once;

children under 2-3 years old- 10 ml / kg once a day;

children under 8 years old - 7-10 ml / kg 1-2 times a day;

children under 13- 5-7 ml / kg 1-2 times a day.

For children over 14 years old doses are the same as for adults.

3. In operations with artificial circulation, the drug is added to the blood at the rate of 10-20 ml / kg of the patient's body weight to fill the oxygenator pump. The dextran concentration in the perfusion solution should not exceed 3%. In the postoperative period, the doses of the drug are the same as in the case of impaired capillary blood flow.

4. For the purpose of detoxification, it is administered intravenously in a single dose from 500 to 1250 ml (in children, 5-10 ml / kg) for 60-90 minutes. If necessary, another 500 ml of the drug can be administered on the first day (in children, the drug administration on the first day can be repeated in the same doses). On the following days, the drug is administered drip, for adults - in a daily dose of 500 ml, for children - at the rate of 5-10 ml / kg.

Side effects:

Allergic reactions (skin flushing, skin rash, itching; anaphylactoid reactions - lowering blood pressure, collapse, oliguria, up to the development of anaphylactic shock), nausea, fever.

May provoke bleeding and the development of acute renal failure.

Overdose:

Symptoms:if injected very quickly or in too large a volume, symptoms of volume overload may appear (for example, left ventricular heart failure, arrhythmias, pulmonary hypertension, etc.). Possible allergic reactions.

Treatment: in case of volume overload, discontinuation of the infusion is usually sufficient, but symptomatic therapeutic measures, including urgent ones, may be required.

If anaphylactic-type reactions occur during the infusion (redness and itching skin, Quincke's edema, etc.), it is necessary to immediately stop the administration of the drug and, without removing the needle from the vein, proceed with all the therapeutic measures provided for by the relevant instructions to eliminate the transfusion reaction (calcium preparations, antihistamines and cardiovascular drugs, corticosteroids, respiratory analeptics, etc. etc.) or resuscitation measures.

Plasmapheresis is possible, hemodialysis is ineffective.

Interaction:

It is necessary to pre-check for compatibility with drugs that are planned to be introduced into the infusion solution.

Can be used in conjunction with other traditional transfusion agents.

Dextran potentiates the action of anticoagulants and antiplatelet agents, therefore, their doses should be reduced.

Special instructions:

When the drug is injected into the peripheral veins, a burning sensation and soreness may appear in the limb along the vein.

Together with the drug, it is advisable to inject crystalloid solutions (0.9% sodium chloride solution, 5% dextrose solution) in such an amount to replenish and maintain water electrolyte balance... This is especially important when treating dehydrated patients and after severe surgical operations.

Should be observed extra carewhen there is a risk of overloading the circulation, especially in the case of latent or clinically overt heart failure.

Dextran reduces plasma levels of coagulation factor VIII and von Willebrand platelet factor, mainly due to dilution, which may cause bleeding, especially in patients with a deficiency of these factors when using dextrin in daily doses exceeding 1.5 g / kg body (approximately 15 ml / kg body weight). With simultaneous use with anticoagulants, a decrease in their dose is necessary.

It causes an increase in diuresis (if there is a decrease in diuresis with the release of viscous syrupy urine, this may indicate dehydration). In this case, it is necessary to enter intravenous crystalloid solutions to replenish and maintain the water-electrolyte balance. In the event of oliguria, it is necessary to intensify the ongoing therapy and prescribe. In patients with reduced filtration capacity of the kidneys, it is necessary to limit the administration of sodium chloride.

Dextrans are capable of enveloping the surface of erythrocytes, interfering with the determination of the blood group, therefore it is necessary to use washed erythrocytes.

Impact on the ability to drive vehicles. Wed and fur .:

Care should be taken when driving and performing potentially dangerous species activities requiring increased concentration of attention and speed of psychomotor reactions.

Release form / dosage:

Solution for infusion, 10%.

Packaging:

200,400 ml in glass bottles.

Each bottle, together with instructions for use, is placed in a cardboard box.

Hospital packaging: 24 bottles of 400 ml or 40 bottles of 200 ml together with equal number of instructions for use in corrugated cardboard boxes.

Storage conditions:

Store in a dry place at a temperature of 10 to 25 ° C,

The company guarantees the quality of the preparation subject to the storage and transportation temperature conditions from 10 to 25 ° C, otherwise dextran may fall out in the form of white flakes or films.

Keep out of the reach of children.

Shelf life:

4 years.

Do not use after the expiration date printed on the package.

Pharmacy dispensing conditions:On prescription Registration number:P N016167 / 01 Registration date:02.10.2009 / 04.03.2015 Marketing Authorization Holder:BELMEDPREPARATY, RUE Republic of Belarus Manufacturer: & nbsp Representative office: & nbsp"Belmedpreparaty" RUE Date of information update: & nbsp10.01.2016 Illustrated instructions

In this article, you can read the instructions for use medicinal product Reopoliglyukin... Feedback from website visitors - consumers are presented of this medicine, as well as the opinions of medical specialists on the use of Reopoliglucin in their practice. A big request is to actively add your reviews about the drug: did the medicine help or did not help get rid of the disease, what complications were observed and side effects, possibly not declared by the manufacturer in the annotation. Analogs of Reopoliglyukin in the presence of available structural analogs. Use for the treatment of shock and hypovolemia in adults, children, as well as during pregnancy and lactation.

Reopoliglyukin - solutions of high molecular weight dextran with sodium chloride, glucose or mannitol are polyfunctional plasma-substituting solutions. They normalize hemodynamics, increase the volume of fluid in the bloodstream. Solutions of low molecular weight dextran, in addition, help to improve microcirculation, reduce the aggregation of blood cells, blood viscosity. Dextran solutions containing mannitol also have an osmodiuretic effect.

It promotes the movement of fluid from tissues into the bloodstream, increases the suspension properties of blood, reduces its viscosity, helps to restore blood flow in small capillaries, prevents and reduces the aggregation of formed elements. The increase in plasma volume is most pronounced in the first 90 minutes after the administration of Rheopolyglucin. Each gram of dextran facilitates the transfer of 20-25 ml of fluid from the tissue to the bloodstream.

Composition

Dextran with a molecular weight of 30,000 to 40,000 + excipients.

Dextran with a molecular weight of 35,000 to 45,000 + excipients (Reopolyglucin 40).

Pharmacokinetics

It is excreted by the kidneys (on the first day up to 70%).

Indications

• violation of capillary blood flow;
• prevention and treatment of shock (traumatic, operational, burn);
• compression syndrome;
• prevention and treatment of thrombosis, thrombophlebitis, endarteritis;
• heart surgery performed using a heart-lung machine (to be added to the perfusion fluid);
• improving local circulation in vascular and plastic surgery;
• detoxification (for burns, peritonitis, pancreatitis, etc.);
• retinal diseases and optic nerve;
• inflammatory processes of the cornea and choroid.

Dextran with a molecular weight of 1000:

• prevention of severe allergic reactions to intravenous administration dextran solutions.

Release forms

Solution for infusions (droppers) in containers or vials of 100 ml, 200 ml, 250 ml, 400 ml, 500 ml and 1000 ml.

Instructions for use and dosage regimen

Intravenous, drip (in the form of droppers).

The dose is set individually and depends on the clinical situation and the patient's condition.

In order to prevent and treat capillary blood flow disorders associated with traumatic, operational and burn shock, intravenous infusion of 400-1000 ml per day (for at least 30-60 minutes) is used, usually 1 (less often 2) times a day.

In surgical interventions on the heart and blood vessels, 10 ml / kg are administered intravenously before the operation, 400-500 ml during the operation, and within 5-6 days after the operation - 10 ml / kg per injection.

For children, the total dose should not exceed 15 ml / kg per day.

For cardiovascular operations, children under the age of 2-3 years are administered 10 ml / kg 1 time per day (within 60 minutes), up to 8 years old - 7-10 ml / kg (1-2 times a day), up 13 years old - 5-7 ml / kg (1-2 times a day), over 14 years old - the dose for adults. For detoxification, 5-10 ml / kg is administered for 60-90 minutes.

During operations with artificial circulation, Reopolyglucin is added to the blood at the rate of 10-20 ml / kg of body weight to fill the oxygenator pump. The concentration of Rheopolyglucin in the perfusion solution should not exceed 3%. In the postoperative period, the drug is used in the same doses as in the treatment of shock conditions.

For the purpose of detoxification, intravenous drip is administered in a single dose from 500 to 1200 ml (in children, 5-10 ml / kg) for 60-90 minutes. If necessary, another 500 ml of the drug can be poured on the first day (in children, the administration of the drug on the first day can be repeated in the same doses). In the following days, the drug is administered drip, for adults - in a daily dose of 500 ml, for children - at the rate of 5-10 ml / kg. It is advisable to jointly inject crystalloid solutions (Ringer's, Ringer's acetate, etc.) in such an amount as to normalize the water-electrolyte balance (especially important in the treatment of dehydrated patients and after surgery). The drug, as a rule, causes an increase in urine output (a decrease in urine output indicates dehydration of the patient's body).

In ophthalmic practice, it is used by electrophoresis. The procedure is carried out once a day. Apply 10 ml (from the positive and negative poles; current density up to 1.5 mA / cm2).

Side effect

• allergic reactions (redness of the skin, skin rashes, nausea, fever, anaphylactic shock);
• arterial hypotension.

Contraindications

• skull trauma with increased intracranial pressure, cerebral hemorrhage and other cases when the administration of a large amount of fluid is not indicated;
• oliguria and anuria due to organic kidney disease;
• heart failure;
• disorders of coagulation and hemostasis;
• tendency to allergic reactions;
• diabetes mellitus and other disorders of carbohydrate metabolism (for solutions with glucose).

special instructions

Due to possible allergic reactions, the first 10-20 ml of infusion solution is recommended to be administered slowly, observing the patient's condition. Considering the possibility of development arterial hypertension, it should be borne in mind that appropriate intensive care products may be required.

It causes an increase in diuresis (if there is a decrease in diuresis with the release of viscous syrupy urine, this may indicate dehydration; in this case, it is necessary to inject intravenous colloidal solutions to replenish and maintain the water-electrolyte balance). In patients with reduced filtration capacity of the kidneys, it is necessary to limit the administration of sodium chloride.

Dextran with a molecular weight of 1000 should not be diluted or mixed with dextran solutions for infusion. Dextran with a molecular weight of 1000 can be injected intravenously through the Y-shaped branch or rubber tube of the infusion system, provided that there is no significant dilution of the drug during the injection.

When the temperature drops during the transportation of the drug, white films, which are dextran particles, may appear. In this case, it is necessary to dissolve the films by heating the bottle with the drug in a boiling water bath for 1 hour with periodic shaking or autoclaving at 120 degrees Celsius for 20 minutes, cool the drug to body temperature and use it as directed.

Dextrans are capable of enveloping the surface of erythrocytes, preventing the determination of the blood group; therefore, washed erythrocytes must be used for analysis.

Drug interactions

Together with the drug, it is advisable to inject crystalloid solutions (0.9% sodium chloride solution, 5% dextrose solution) in such an amount to replenish and maintain the water-electrolyte balance. This is especially important when treating dehydrated patients and after major surgery.

Analogues of the drug Reopolyglyukin

Structural analogues active substance:

• Hemostabil;
• Dextran 40;
• Dextran 70;
• Longasteril 40;
• Polyglyukin;
• Polyglyukin dry;
• Reogluman;
• Rheodex;
• Reomacrodex;
• Reopolyglucin 40;
• Reopolyglyukin dry;
• Reopolydex.

Analogs on pharmacological group (substitutes for plasma and other blood components):

• Albiomin 20%;
• Albumen;
• Albumin 10%;
• Human albumin;
• Alburex;
• Venofundin;
• Volekam;
• Voluven;
• Volulite;
• Geloplasm balance;
• Hemodez;
• Hemopyur;
• Hemostabil;
• Hemohes 10%;
• Hemohes 6%;
• Hydroxyethyl starch;
• Glucose solution for infusion;
• Dextran 40;
• Dextran 70;
• Dextrose;
• Gelatinol;
• Zenalb;
• Infukol HES;
• Ionohes;
• Krasgemodez 8000;
• Custodiol;
• Levulose;
• Longasteril 40;
• Sodium fumarate is complex;
• Neohemodesis;
• Neorondex;
• Perftoran;
• Plasbumin 20;
• Plasma for fractionation;
• Plasmaline;
• Plazmastabil 200;
• Povidone;
• Polyvinylpyrrolidone;
• Polyglyukin;
• Polyglyukin dry;
• Polyoxidine;
• Polyoxyfumarin;
• Proxanol;
• Protein;
• Pfocalin;
• Pforidin;
• Ringer's solution;
• Hartman's solution;
• Reogluman;
• Rheodex;
• Reomacrodex;
• Reopolyglucin with glucose;
• Reopolydex;
• Reosorbilact;
• Refortan HES 10%;
• Refortan HES 6%;
• Ringer;
• Ringer lactate;
• Ringer's acetate;
• Seprotin;
• Sorbilact;
• Stabizol HES 6%;
• Tetraspan;
• Uman albumin.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and see the available analogues for the therapeutic effect.

Reopoliglyukin

International non-proprietaryname

Dextran

Dosage form

solution for infusion 10%.

Composition

100 ml of solution contains

active substance-: dextran (M from 30,000 to 40,000) - 10 g

excipients:sodium chloride - 0.9 g;

water for injection - up to 100 ml.

Theoretical osmolarity ~ 311 mOsm / L.

Description

Transparent colorless or slightly yellowish liquid, odorless

Pharmacotherapeutic group

Plasma substitution and perfusion solutions. Blood plasma preparations and plasma-substituting drugs.

ATX code B05AA05

Pharmacological properties

Pharmacokinetics

Dextran, which is part of rheopolyglucin, is excreted from the body mainly by the kidneys: in the first day, approximately 70% is excreted unchanged. A certain part of dextran enters the reticuloendothelial system, where it is gradually degraded to glucose. Does not participate in carbohydrate metabolism. Very small amounts of dextran can enter the gastrointestinal tract and be excreted in the faeces.

Pharmacodynamics

Reopolyglucin is a 10% colloidal solution of glucose polymer (dextran) (C6H10O5) with a molecular weight of 30,000-40,000. It is used as a plasma-substituting, anti-shock drug of hemodynamic action. Promotes an increase in plasma volume by almost 2 times compared to the volume of the administered drug, since each gram of glucose polymer with a molecular weight of 30,000-40,000 causes the movement of 20-25 ml of fluid from the tissues into the bloodstream. Due to the high oncotic pressure, rheopolyglucin passes very slowly through the vascular wall and circulates in the vascular bed for a long time, normalizing hemodynamics due to the flow of fluid along the concentration gradient - from tissues to vessels. As a result, blood pressure quickly rises and remains at a high level for a long time, and tissue edema decreases.

Reopolyglukin can be used as a detoxifying agent. With its introduction, the blood viscosity improves, the aggregation of the formed elements decreases. It also stimulates diuresis by osmotic mechanisms (it is filtered in the glomeruli, creates high oncotic pressure in the primary urine and prevents the reabsorption of water in the tubules), which promotes (and accelerates) the removal of poisons, toxins, and degradative metabolic products from the body.

Indications for use

Impaired capillary blood flow

Prevention and treatment of traumatic, operational and burn shock

Septic shock

Arterial and venous circulation disorders

Treatment and prevention of thrombosis and thrombophlebitis, endarteritis and Raynaud's disease

Cardiac surgery performed using a heart-lung machine (to be added to the perfusion fluid)

In vascular and plastic surgery to improve local circulation (reduce the tendency to thrombosis in the graft)

Detoxification for burns, peritonitis, pancreatitis, etc.

Diseases of the retina and optic nerve (complicated myopia, retinal dystrophy, etc.)

Inflammatory processes of the cornea and choroid

Renal and renal hepatic impairment with preservation of the filtration function of the kidneys.

Method of administration and dosage

Intravenous jet, jet and drip.

Doses and rate of administration of the drug should be selected individually in accordance with the indications and condition of the patient, the value of blood pressure, heart rate, hematocrit.

When using the drug, a bioassay is mandatory: after the slow introduction of the first 5 drops of the drug, the transfusion is stopped for 3 minutes, then another 30 drops are injected and the infusion is stopped again for 3 minutes. In the absence of a reaction, the administration of the drug continues. The results of the bioassay must be recorded in the medical history.

1. In case of impaired capillary blood flow (various forms of shock), intravenous drip or jet-drip is injected in a dose of 0.5 to 1.5 l, until the hemodynamic parameters stabilize at the life-supporting level. If necessary, the amount of the drug can be increased to 2 liters.

In children with various forms of shock, it is administered at the rate of 5-10 ml / kg, the dose can be increased, if necessary, up to 15 ml / kg. It is not recommended to reduce the hematocrit value below 25%.

2. In case of cardiovascular and plastic surgeries, it is administered intravenously by drop infusion, immediately before surgery, for 30 - 60 minutes for adults and children at a dose of 10 ml / kg, during surgery for adults - 500 ml, for children - 15 ml / kg.

After the operation, the drug is administered intravenously drip (within 60 minutes) for 5-6 days at the rate of: adults - 10 ml / kg once,

children under 2 - 3 years old - 10 ml / kg once a day,

children under 8 years old - 7-10 ml / kg 1 - 2 times a day,

children under 14 years old - 5 - 7 ml / kg 1 - 2 times a day.

For children over 14 years of age, the doses are the same as for adults.

3. In operations with artificial circulation, the drug is added to the blood at the rate of 10-20 ml / kg of the patient's body weight to fill the oxygenator pump. The concentration of dextran in the perfusion solution should not exceed 3%. In the postoperative period, the doses of the drug are the same as in the case of impaired capillary blood flow.

4. For the purpose of detoxification, it is injected intravenously in a single dose of 500 to 1250 ml (in children 5-10 ml / kg) for 60 - 90 minutes. If necessary, another 500 ml of the drug can be poured on the first day (in children, the administration of the drug on the first day can be repeated in the same doses). On the following days, the drug is administered by drip, for adults - in a daily dose of 500 ml, for children - at the rate of 5-10 ml / kg. It is expedient to jointly inject crystalloid solutions (Ringer's and Ringer's acetate, etc.) in such an amount to normalize the water-electrolyte balance (especially important in the treatment of dehydrated patients and after surgery), the drug, as a rule, causes an increase in urine output (a decrease in urine output indicates for dehydration of the patient's body).

5. In ophthalmic practice, it is used by electrophoresis, which is carried out in a conventional manner. The consumption of the drug for one procedure is 10 ml. The procedure is carried out once a day, injected from both the positive and negative poles. Current density - up to 1.5 mA / cm 2. The duration of the procedure is 15-20 minutes. The course of treatment consists of 5-10 procedures.

Side effect

Allergic and anaphylactoid reactions ( itchy skin, rashes, Quincke's edema, decreased blood pressure, collapse, oliguria)

Violation of blood circulation and breathing

Acute renal failure

Nausea, chills, fever.

Contraindications

Hypersensitivity

Decompensated cardiovascular failure

Traumatic brain injury with increased intracranial pressure - hemorrhagic stroke

Internal bleeding

Hypocoagulation

Thrombocytopenia

Severe renal dysfunction, accompanied by oligo and anuria

Hypervolemia, overhydration and other situations in which the administration of massive doses of fluids is contraindicated

High blood pressure.

Drug interactions

It is necessary to pre-check for compatibility of dextran with medications that are planned to be introduced into the infusion solution. Can be used in conjunction with other traditional transfusion agents.

special instructions

Together with the drug, it is advisable to inject crystalloid solutions (0.9% sodium chloride solution, 5% dextrose solution) in such an amount to replenish and maintain the fluid and electrolyte balance. This is especially important when treating dehydrated patients and after major surgery. With simultaneous use with anticoagulants, a decrease in their dose is necessary. It causes an increase in diuresis (if there is a decrease in diuresis with the release of viscous syrupy urine, this may indicate dehydration). In this case, it is necessary to inject intravenous colloidal solutions to replenish and maintain the water-electrolyte balance. In the event of oliguria, it is necessary to enter saline solutions and furosemide. In patients with reduced filtration capacity of the kidneys, it is necessary to limit the administration of sodium chloride. Dextrans are capable of enveloping the surface of erythrocytes, interfering with the determination of the blood group, therefore it is necessary to use washed erythrocytes.

Application in children

There are no data on the safety and efficacy of Reopolyglucin in children and adolescents under 18 years of age, so it should be prescribed only in cases where the intended benefit outweighs the potential risk.

Pregnancy and lactation

The use of the drug during pregnancy is possible only if the intended benefit to the mother outweighs the potential risk to the fetus.

Features of the effect of the drug on the ability to manage vehicle or potentially dangerous machinery.

During the period of treatment, a decrease in the speed of mental and motor reactions is possible, therefore, it is necessary to refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

FROM caution Reopolyglukin with 0.9% sodium chloride solution should not be administered in cases of pathological changes in the kidneys

Overdose

Symptoms:feeling of tightness in the chest, difficulty breathing, back pain, the onset of chills, cyanosis, impaired blood circulation and breathing.

Treatment:10% calcium chloride solution (10 ml), 20 ml of 40% glucose solution are injected into the vein, cardiac drugs, antihistamines are used.

The formrelease and packaging

200 or 400 ml in glass bottles for blood, infusion and transfusion preparations with a capacity of 250 or 450 ml, respectively, sealed with rubber stoppers and crimped with aluminum caps.

Each bottle with instructions for use is placed in a cardboard box.

Reopolyglyukin is a plasma-substituting drug.

Release form and composition

Dosage form of Reopolyglucin's release - solution for infusion: transparent, colorless or slightly yellowish (in bottles of 100, 200, 400 ml for blood and blood substitutes, 1 bottle in a cardboard box, or 12, 15, 24, 28, 40 or 56 bottles in a box, or 1 bottle in a polymer bag, 1, 6, 12, 24, 36, 48, 50, 96, 144 bags in a cardboard box; in bottles of 1100, 1200, 1400 ml, 1, 12, 15, 24, 28, 56 bottles in a cardboard box).

Composition of 1 ml solution:

• active substance: dextran (average molecular weight - 30,000-40,000) - 100 mg (in the form of a 10% solution in 1 ml of water for injection);
• auxiliary component: sodium chloride - 9 mg.

Indications for use

• arterial and venous circulation disorders, thrombosis, thrombophlebitis, endarteritis and other circulatory disorders (treatment and prevention);
• replenishment of the circulating blood volume in traumatic, operational and burn shock (treatment and prevention);
• heart surgery performed using a heart-lung machine (as an addition to the perfusion fluid);
• burns, peritonitis, pancreatitis, other conditions requiring detoxification;
• vascular and plastic surgery (in order to improve local circulation).

Contraindications

• ongoing internal bleeding;
• decompensated cardiovascular failure;
• pulmonary edema;
• hemorrhagic stroke;
• craniocerebral injuries with increased intracranial pressure;
• thrombocytopenia;
• hypocoagulation;
• severe renal dysfunction, accompanied by anuria (oliguria);
• hyperhydration, hypervolemia and other conditions in which the introduction of large volumes of fluids is contraindicated;
• lactation period (the safety profile for this category of patients has not been studied);
• hypersensitivity to the components of the drug.

Reopolyglucin is prescribed with caution in the presence of the following diseases / conditions:

• disorders of the blood coagulation system;
• dehydration;
• diabetes mellitus with severe hyperosmolarity and hyperglycemia;
• violations of water and electrolyte balance.

For pregnant women, the use of Reopolyglucin is possible only after assessing the ratio of benefits to risks.

Method of administration and dosage

Reopolyglyukin is administered intravenously drip, jet, jet-drip.

The doctor determines the dosage regimen individually, based on the indications and condition of the patient, blood pressure, heart rate, hematocrit.

24 hours before the scheduled infusion, a skin test must be performed - 0.05 ml of Reopolyglucin is injected intradermally with the formation of a lemon crust on the inner side of the shoulder, forearm or other area that is accessible for its visual assessment (performed after 24 hours).

Redness, papules or the appearance of symptoms of a general reaction in the form of dizziness, nausea, or other manifestations 10-15 minutes after the test indicates the presence of a patient's hypersensitivity to Rheopolyglucin. For such patients, the appointment of the drug is contraindicated.

In the absence of any reactions, the administration of the drug of the series that was used for the intradermal test is indicated. Sample results must be recorded in the medical history.

It should be borne in mind that a skin test does not reveal sensitization to dextran in 100% of cases. In this regard, as the drug is administered intravenously in the first 5-10 minutes, the patient's condition should be carefully evaluated with each infusion.

In case of emergency conditions, before using Reopolyglyukin, it is imperative to conduct a bioassay: after the slow introduction of the first 5 drops of the solution, the procedure is interrupted for 3 minutes, then another 30 drops are injected and again take a break for 3 minutes. The introduction of the drug is possible only in the absence of a reaction. The results of the bioassay must be recorded in the medical history.

In case of impaired capillary blood flow (with various forms of shock), Reopolyglucin is administered at a dose of 0.5-1.5 liters intravenously by jet-drip or drip (until the hemodynamic parameters stabilize at the life-supporting level). It is possible to increase the injected volume up to 2 liters.

Pediatric dose of Reopolyglucin for various forms of shock is 5-10 ml / kg, if necessary, it can be increased to a maximum of 15 ml / kg. It is not recommended to reduce the hematocrit value by more than 25%.

The scheme of using the drug for plastic and cardiovascular operations:

• immediately before surgery (adults and children): 10 ml / kg intravenously for 30-60 minutes;
• during surgery: adults - 500 ml, children - 15 ml / kg.

Upon completion of the operation, within 5-6 days Reopolyglucin is injected intravenously for 30-60 minutes at the rate of:

• children under 2-3 years old: 10 ml / kg once a day;
• children under 8 years old: 7-10 ml / kg 1-2 times a day;
• children under 13 years old: 5-7 ml / kg 1-2 times a day;
• adults and children from 14 years old: 10 ml / kg once.

When performing operations with artificial circulation, Reopolyglucin is added to the blood at the rate of 10-20 ml / kg to fill the oxygenator pump. The dextran concentration in the perfusion solution should not exceed 3%. IN postoperative period the drug is prescribed in the same doses as in case of impaired capillary blood flow.

For detoxification, Reopolyglucin is injected intravenously. Single adult dose - 500-1250 ml, children dose - 5-10 ml / kg. Administration time is 60-90 minutes. If necessary, on the first day, adults can enter an additional 500 ml of the drug, children - the same dose as during the first administration. Daily doses on the following days: adults - 500 ml, children - 5-10 ml / kg.

Side effects

Possible adverse reactions: fever, nausea, manifestations of hypersensitivity (itching, skin rash, flushing of the skin; anaphylactoid reactions - collapse, decreased blood pressure, oliguria, up to the development of anaphylactic shock).

During the use of Reopolyglyukin, bleeding and acute renal failure may develop.

special instructions

Simultaneously with Rheopolyglucin, it is advisable to introduce crystalloid solutions (0.9% sodium chloride solution, 5% dextrose solution) in an amount necessary to replenish and maintain the water-electrolyte balance. This is especially important for dehydrated patients and after major surgery.

With the introduction of Rheopolyglucin into peripheral veins, pain / burning sensation along the vein may appear in the limbs.

Special care is required in situations where there is a possibility of an overload of blood circulation, especially in the case of latent or clinically overt heart failure.

Dextran, mainly due to dilution, lowers the plasma levels of coagulation factor VIII and von Willebrand platelet factor, and therefore bleeding may develop, especially if these factors are deficient when dextran is used in daily doses of more than 1.5 g / kg ( about 15 ml / kg). When combined with anticoagulants, a decrease in their dose is shown.

Treatment causes an increase in urine output. If the opposite effect is observed, accompanied by the release of viscous syrupy urine, this may be a sign of dehydration. In this situation, in order to maintain / replenish the water-electrolyte balance, intravenous administration of crystalloid solutions is indicated. Patients with reduced renal filtration capacity should be limited to sodium chloride. With the development of oliguria, it is necessary to intensify the treatment and prescribe furosemide.

Rheopolyglucin can envelop the surface of erythrocytes, which interferes with the determination of the blood group, therefore, washed erythrocytes should be used.

Care must be taken when driving and performing potentially hazardous work.

Drug interactions

Reopolyglucin potentiates the action of antiplatelet agents and anticoagulants, and therefore requires a decrease in their dose.

Before using drugs that are planned for introduction into the infusion solution, it is necessary to check them for compatibility.

Combined use with other traditional transfusion agents is permissible.

Terms and conditions of storage

Store in a dry place out of the reach of children at a temperature of 10-25 ° C.

Shelf life is 4 years.

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Reopolyglucin is a low-molecular-weight dextran drug, a plasma-substituting anti-shock drug of hemodynamic action, which promotes an increase in blood plasma volume.

Release form and composition

Reopolyglucin is produced in the form of a solution for infusion, which is a colorless or slightly yellow liquid (200 ml or 400 ml in vials for blood and blood substitutes, in a cardboard box 1 bottle, in boxes of 24 and 40 bottles for hospitals).

The active ingredient is dextran (molecular weight 30,000-40,000) in isotonic sodium chloride solution (10 g in 100 ml of solution).

Characteristics of Reopoliglyukin:

• the pH of the solution is 4.5-6.5;
• Theoretical osmolarity - 316 mOsm / L;
• Relative viscosity - 2.8-4.5 (no more than 5.5) at a temperature of 25 ° C.

Indications for use

• Prevention and treatment of capillary blood flow disorders associated with surgical, traumatic and burn shock;
• Prevention and treatment of thrombophlebitis, thrombosis and endarteritis;
• Improving local circulation in plastic and vascular surgery;
• Operations on the heart, in which a heart-lung machine is used (added to the perfusion fluid);
• Diseases of the optic nerve and retina, inflammation of the choroid and cornea;
• Detoxification (with pancreatitis, peritonitis, burns, etc.).

Contraindications

• Hemorrhage in the brain, as well as other cases in which the introduction of a large amount of fluid is prohibited;
• Skull trauma, accompanied by increased intracranial pressure;
• Heart failure;
• Anuria and oliguria due to organic kidney disease;
• Thrombocytopenia
• Violation of hemostasis and coagulation;
• History of allergic reactions to the use of dextran.

Method of administration and dosage

Reopolyglyukin is administered intravenously. The dose of the drug is set individually and depends on the patient's condition and the clinical situation.

• Prevention and treatment of capillary blood flow disorders associated with different kinds shock: 400-1000 ml (within 30-60 minutes) once or twice a day;
• Operations on the heart and blood vessels: before surgery - 10 ml / kg, during surgery - 400-500 ml, after surgery - 10 ml / kg per injection for 5-6 days;
• Detoxification: single dose - 500-1200 ml (for children - 5-10 ml / kg) for 60-90 minutes. On the first day, if necessary, another 500 ml of Reopolyglucin is injected (for children in the same doses). On the following days, the daily dose is 500 ml for adults and 5-10 ml / kg for children. It is advisable to simultaneously introduce crystalloid solutions (Ringer's acetate, Ringer's, etc.) in quantities that can normalize the water-electrolyte balance. This is especially important after surgical interventions and in the treatment of patients with dehydration;
• Operations with artificial circulation: the drug is added to the blood to fill the oxygenator pump (at the rate of 10-20 ml of solution per 1 kg of body weight). The concentration of the drug in the perfusion solution is no more than 3%. After the operation, Reopolyglyukin is used in the same doses as in shock conditions;
• Ophthalmic diseases: the drug is used in 10 ml by electrophoresis. The procedure is carried out once a day.

In children, the total dose of Reopolyglucin should be no more than 15 ml / kg per day.

During operations on cardiovascular system The recommended doses for children, depending on age, are as follows:

• 2-3 years - 10 ml / kg once a day (within 60 minutes);
• 4-8 years old - 7-10 ml / kg once or twice a day;
• 9-13 years old - 5-7 ml / kg once or twice a day;
• 14 years and older - adult dose.

For the purpose of detoxification in children, the drug is administered at a dose of 5-10 ml / kg for 60-90 minutes.

Side effects

During the administration of Reopolyglucin, allergic reactions are possible (skin rash, redness of the skin, fever, nausea, anaphylactic shock), in rare cases arterial hypotension occurs.

special instructions

because of possible development allergic reactions, the first 10-20 ml of dextran solution is injected slowly, while observing the patient's condition. If arterial hypotension occurs, intensive therapy may be required.

The temperature difference during the transportation of Rheopolyglucin can lead to the formation of white films, which are dextran particles. To dissolve the films, the bottle with the drug must be heated for 1 hour in a water bath, periodically shaking the bottle, or use a 20-minute autoclave at 120 ° C. Then cool the drug to body temperature, and then use it as directed.

Drug interactions

Before the planned introduction of drugs into the infusion solution, it is necessary to check them for compatibility with dextran.

Terms and conditions of storage

Store at a temperature of 10 to 25 ° C in a dry place, the preparation can also be frozen. Keep out of the reach of children.

Shelf life is 4 years.