'''Dextran''' is a complex, branched [[polysaccharide]] made of many [[glucose]] molecules joined into chains of varying lengths, used as an antithrombotic (anti-platelet), and to reduce blood viscosity.
* Dosing Information
The straight chain consists of α1->6 [[glycosidic]] linkages between glucose molecules, while branches begin from α1->3 linkages (and in some cases, α1->2 and α1->4 linkages as well). (For information on the numbering of [[carbon]] [[atom]]s in glucose, see the [[glucose]] article.) Dextran is synthesized from sucrose by certain lactic-acid bacteria, the best-known being ''Leuconostoc mesenteroides'' and ''Streptococcus mutans''. [[Dental plaque]] is rich in dextrans.
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==Uses==
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===Microsurgery uses===
* Dosing Information
These agents are used commonly by microsurgeons to decrease vascular [[thrombosis]]. The antithrombotic effect of dextran is mediated through its binding of [[erythrocytes]], [[platelets]], and vascular [[endothelium]], increasing their [[electronegativity]] and thus reducing [[erythrocyte]] aggregation and [[platelet]] adhesiveness. Dextrans also reduce factor VIII-Ag [[Von Willebrand factor]], thereby decreasing platelet function. Clots formed after administration of dextrans are more easily lysed due to an altered thrombus structure (more evenly distributed platelets with coarser [[fibrin]]). By inhibiting α-2 antiplasmin, dextran serves as a [[plasminogen]] activator and therefore possesses [[thrombolytic]] features. Outside from these features, larger dextrans, which do not pass out of the vessels, are potent osmotic agents, and thus have been used urgently to treat [[hypovolemia]]. The hemodilution caused by volume expansion with dextran use improves blood flow, thus further improving patency of microanastomoses and reducing thrombosis. Still, no difference has been detected in antithrombotic effectiveness in comparison of intraarterial and intravenous administration of dextran.
:* Dosage
Dextrans are available in multiple molecular weights ranging from 10,000 Da to 150,000 Da. The larger dextrans are excreted poorly from the kidney and therefore remain in the blood for as long as weeks until they are metabolized. Subsequently, they have prolonged antithrombotic and [[colloidal]] effects. In this family, dextran-40 (MW: 40,000 Da), has been the most popular member for anticoagulation therapy. Close to 70% of dextran-40 is excreted in urine within the first 24 hours after intravenous infusion while the remaining 30% will be retained for several more days.
Although there are relatively few side-effects associated with dextran use, these side-effects can be very serious. These include [[anaphylaxis]], volume overload, [[pulmonary edema]], [[cerebral edema]], or platelet dysfunction. An uncommon but significant complication of dextran osmotic effect is [[acute renal failure]]. The pathogenesis of this renal failure is the subject of many debates with direct toxic effect on tubules and [[glomerulus]] versus intraluminal hyperviscosity being some of the proposed mechanisms. Patients with history of [[diabetes mellitus]], [[renal insufficiency]], or vascular disorders are most at risk. Brooks and others recommend the avoidance of dextran therapy in patients with [[chronic renal insufficiency]] and CrCl<40 cc per minute.
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===Other medical uses===
* Dosing Information
* It is used in some [[eye drop]]s as a lubricant, and in certain intravenous fluids to solubilise other factors, e.g. iron ([[iron dextran]]).
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* Dextran in intravenous solution provides an osmotically neutral fluid that once in the body is digested by cells into glucose and free water. It is occasionally used to replace lost [[blood]] in emergency situations, when replacement blood is not available, but must be used with caution as it does not provide necessary electrolytes and can cause [[hyponatremia]] or other [[electrolyte]] disturbances.
* It also increases blood sugar levels.[http://www.drugdigest.org/DD/DVH/Uses/0,3915,7971%7CDextran,00.html]
* It is also an oral bacteria waste product that is sticky and adheres to the tooth, creating a film called plaque.
==Laboratory uses==
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Dextran is used in the [[osmotic stress technique]] for applying [[osmotic pressure]] to biological molecules.
* Dosing Information
It is also used in some size-exclusion chromatography matrices; an example is [[Sephadex]]'''®'''.
:* Dosage
Dextran has also been used in bead form to aid in bioreactor applications.
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==External links==
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*[http://www.dextran.net/dextran-properties.html Resource on dextran properties and structure of dextran polymers]
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* Developed by:
* Class of Recommendation:
[[Category:Biotechnology products]]
* Strength of Evidence:
[[category:carbohydrates]]
[[de:Dextrane]]
* Dosing Information
[[it:Destrano]]
[[pl:Dekstran]]
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Black Box Warning
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See full prescribing information for complete Boxed Warning.
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Content
Overview
Dextran is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
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Dosing Information
Dosage
Condition2
Dosing Information
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Dosing Information
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Condition4
Dosing Information
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Off-Label Use and Dosage (Adult)
Guideline-Supported Use
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Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Dextran in adult patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Dextran in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding FDA-Labeled Use of Dextran in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Condition1
Developed by:
Class of Recommendation:
Strength of Evidence:
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Dextran in pediatric patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Dextran in pediatric patients.
Contraindications
Condition1
Warnings
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Description
Precautions
Description
Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Dextran in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Dextran in the drug label.
