There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
<!--Non–Guideline-Supported Use (Adult)-->
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* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
<!--Pediatric Indications and Dosage-->
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
<!--Off-Label Use and Dosage (Pediatric)-->
<!--Guideline-Supported Use (Pediatric)-->
|offLabelPedGuideSupport======Condition1=====
* Developed by:
* Class of Recommendation:
* Strength of Evidence:
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
<!--Non–Guideline-Supported Use (Pediatric)-->
|offLabelPedNoGuideSupport======Condition1=====
* Dosing Information
:* Dosage
=====Condition2=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
<!--Contraindications-->
|contraindications=* Condition1
<!--Warnings-->
|warnings=* Description
====Precautions====
* Description
<!--Adverse Reactions-->
<!--Clinical Trials Experience-->
|clinicalTrials=There is limited information regarding <i>Clinical Trial Experience</i> of {{PAGENAME}} 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-->
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} 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=====
<!--Drug Interactions-->
|drugInteractions=* Drug
:* Description
<!--Use in Specific Populations-->
|useInPregnancyFDA=* '''Pregnancy Category'''
|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
<!--Administration and Monitoring-->
|administration=* Oral
* Intravenous
|monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
* Description
<!--IV Compatibility-->
|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
<!--Overdosage-->
|overdose====Acute Overdose===
====Signs and Symptoms====
* Description
====Management====
* Description
===Chronic Overdose===
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
<!--Pharmacology-->
<!--Drug box 2-->
|drugBox=<!--Mechanism of Action-->
|mechAction=*
<!--Structure-->
|structure=*
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
'''Hydroxyethyl starch''' (HES/HAES) is a nonionic [[starch]] [[modified starch|derivative]]. It is one of the most frequently used [[volume expander]]s under the trade names '''Hespan''' by [[B. Braun Medical Inc.]] '''Voluven''' or '''Volulyte''' by [[Fresenius Kabi]] and '''Tetrahes''' or '''Hestar''' by [[Claris Lifesciences Ltd]].
<!--Pharmacodynamics-->
HES is a general term and can be sub-classified according to average molecular weight, molar substitution, concentration, C2/C6 ratio and Maximum Daily Dose.<ref name="Westphal, M. 2009">{{cite journal | last1 = Westphal | first1 = M. | last2 = James | first2 = M. | last3 = Kozek-Langenecker | first3 = S. | last4 = Stocker | first4 = R. | last5 = Guidet | first5 = B. | last6 = Van Aken | first6 = H. | year = 2009 | title = Hydroxyethyl starches: different products--different effects. [Review] [140 refs] | url = | journal = Anesthesiology | volume = 111 | issue = 1| pages = 187–202 | doi=10.1097/aln.0b013e3181a7ec82}}</ref>
|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
Its use in those who are very ill is associated with an increased risk of death and kidney problems.<ref name=Zar2013>{{cite journal|last=Zarychanski|first=R|author2=Abou-Setta, AM |author3=Turgeon, AF |author4=Houston, BL |author5=McIntyre, L |author6=Marshall, JC |author7= Fergusson, DA |title=Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis.|journal=JAMA: the Journal of the American Medical Association|date=Feb 20, 2013|volume=309|issue=7|pages=678–88|pmid=23423413|doi=10.1001/jama.2013.430}}</ref> The [[European Medicines Agency]] commenced in June 2013 the process of agreeing reduced indications which was completed in October 2013.<ref name="EMEAOCT">{{cite press release | url = http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Hydroxyethyl_starch-containing_solutions/human_referral_prac_000012.jsp&mid=WC0b01ac05805c516f | title = Hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients | date = 2013-10-23 | publisher = [[European Medicines Agency]]}}</ref>
<!--Pharmacokinetics-->
|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
== Medical uses ==
<!--Nonclinical Toxicology-->
[[File:Hetastarch Ph.png|upright|left|200px]]
|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
An intravenous solution of hydroxyethyl starch is used to prevent [[Shock (circulatory)|shock]] following severe [[blood]] loss caused by [[Physical trauma|trauma]], [[surgery]], or other problem. It however appears to have greater risk of a poor outcome compared to other intravenous solutions<ref name=Zar2013/> and may increase the risk of death.<ref>{{cite journal|last=Perel|first=P|author2=Roberts, I |author3=Ker, K |title=Colloids versus crystalloids for fluid resuscitation in critically ill patients.|journal=The Cochrane database of systematic reviews|date=Feb 28, 2013|volume=2|pages=CD000567|pmid=23450531|doi=10.1002/14651858.CD000567.pub6}}</ref>
== Adverse effects ==
<!--Clinical Studies-->
HES can cause anaphylactoid reactions: hypersensitivity, mild influenza-like symptoms, bradycardia, tachycardia, bronchospasm and non-cardiogenic pulmonary edema. It is also linked to a decrease in hematocrit and disturbances in coagulation. One liter of 6% solution (Hespan) reduces [[factor VIII]] level by 50% and will prolong [[aPTT]].<ref>Miller: Anesthesia, 6th ed, p 1787</ref>
|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
HES derivatives have been demonstrated to have increased rates of acute renal failure and need for renal replacement therapy and to decrease long-term survival when used alone in cases of severe sepsis compared with [[Ringer lactate]] solution.<ref>{{cite journal |author=Brunkhorst FM |title=Intensive insulin therapy and pentastarch resuscitation in severe sepsis |journal=N. Engl. J. Med. |volume=358 |issue=2 |pages=125–39 |date=January 2008 |pmid=18184958 |doi=10.1056/NEJMoa070716 |url= |author-separator=, |author2=Engel C |author3=Bloos F |display-authors=3 |last4=Meier-Hellmann |first4=Andreas |last5=Ragaller |first5=Max |last6=Weiler |first6=Norbert |last7=Moerer |first7=Onnen |last8=Gruendling |first8=Matthias |last9=Oppert |first9=Michael}}</ref> The effects were tested on HES 130kDa/0.42 in people with severe sepsis; analysis showed increased rates of renal failure and increased mortality when compared to LR.{{citation needed|date=February 2014}} It has been recommended that, since medium-MW HES solutions may be associated with harm, these solutions should not be used routinely for patients with septic shock.<ref>{{cite journal | first = James | last = Downar | first2 = Stephen E | last2 = Lapinsky | title = Pro/con debate: Should synthetic colloids be used in patients with septic shock? | journal = Critical Care | volume = 13 | issue = 1 | page = 203 | date = 29 January 2009 | doi = 10.1186/cc7147 | pmc=2688101 | pmid=19226441}}</ref>
<!--How Supplied-->
|howSupplied=*
|packLabel=<!--Patient Counseling Information-->
|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
During 2010/11 a large number of research papers associated with a single author were retracted for ethical reasons, and this may have an impact on clinical guidelines referring to HES preparations prepared before this date.<ref>{{citation | url = http://www.oxfordjournals.org/our_journals/jac/eic%20joint%20statement%20on%20retractions%204mar2011.pdf | title = Editors-in-Chief Statement Regarding Published Clinical Trials Conducted without IRB Approval by Joachim Boldt | date = March 4, 2011}}</ref>
<!--Precautions with Alcohol-->
|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
=== Contraindications ===
<!--Brand Names-->
* This product should not be used in people who are hypersensitive or [[allergy|allergic]] to hydroxyethyl starch.
|brandNames=* ®<ref>{{Cite web | title = | url = }}</ref>
* Patients with kidney failure not related to low blood volume and patients on [[dialysis]] should avoid this product in high doses which are used for volume expansion.
* Use of hydroxyethyl starch with normal saline in its preparation is contraindicated in people with severe increases in blood levels of [[sodium]] or [[chloride]].
* Patients with intracranial bleeds should not use this product.
* Do not use HES solutions in critically ill adult patients including those with sepsis, and those admitted to the ICU.<ref name="FDA2013"/>
* Avoid use in patients with pre-existing renal dysfunction.<ref name="FDA2013"/>
* Discontinue use of HES at the first sign of renal injury.<ref name="FDA2013"/>
* Need for renal replacement therapy has been reported up to 90 days after HES administration. Continue to monitor renal function for at least 90 days in all patients.<ref name="FDA2013"/>
* Avoid use in patients undergoing open heart surgery in association with cardiopulmonary bypass due to excess bleeding.<ref name="FDA2013"/>
* Discontinue use of HES at the first sign of coagulopathy.<ref name="FDA2013"/>
===Safety concerns===
<!--Look-Alike Drug Names-->
High molecular weight HES has been linked to coagulopathy, pruritus, as well as nephrotoxicity, acute renal failure and mortality.<ref name="dx.doi.org.mutex.gmu.edu">Hartog, C., & Reinhart, K. (2009). CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients. Intensive Care Medicine, 35(8), 1337–42. {{DOI|10.1007/s00134-009-1521-5}}</ref><ref name="Perner, A. 2011">Perner, A., Haase, N., Wetterslev, J., Åneman, A., Tenhunen, J., Guttormsen, A. B., Klemenzson, G., et al. (2011). Comparing the effect of hydroxyethyl starch 130/0.4 with balanced crystalloid solution on mortality and kidney failure in patients with severe sepsis (6S - Scandinavian Starch for Severe Sepsis/Septic Shock trial): Study protocol, design and rationale for a double-blinded, randomised clinical trial. Trials, 12, 24. {{DOI|10.1186/1745-6215-12-24}}</ref> On the other hand, low molecular weight HES seems not to demonstrate such adverse effects.<ref name="Westphal, M. 2009"/> However, some suggest that low molecular weight HES poses significant safety concerns. They posit that studies concluding otherwise are not reliable for a number of reasons including “unsuitable comparators, too short observation periods, low cumulative dose and low-risk patients.” (Hartog & Reinhart, 2009, p 1340).<ref name="dx.doi.org.mutex.gmu.edu"/> Recent results of 6S trial seem to confirm these concerns (see below).
|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>
In June 2012 a 6S paper was published in the ''[[New England Journal of Medicine]]'' raising concerns regarding the use of hydroxyethyl starch in [[sepsis]]. Specifically, the authors showed that resuscitation with hydroxyethyl starch (as opposed to [[Ringer's acetate]]) resulted in an increased risk of death or end stage renal failure.<ref name="Perner 124–34">{{cite journal|last=Perner|first=A|coauthors=Haase, N; Guttormsen, AB; Tenhunen, J; Klemenzson, G; Åneman, A; Madsen, KR; Møller, MH; Elkjær, JM; Poulsen, LM; Bendtsen, A; Winding, R; Steensen, M; Berezowicz, P; Søe-Jensen, P; Bestle, M; Strand, K; Wiis, J; White, JO; Thornberg, KJ; Quist, L; Nielsen, J; Andersen, LH; Holst, LB; Thormar, K; Kjældgaard, AL; Fabritius, ML; Mondrup, F; Pott, FC; Møller, TP; Winkel, P; Wetterslev, J; 6S Trial, Group; Scandinavian Critical Care Trials, Group|title=Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis.|journal=The New England Journal of Medicine|date=July 12, 2012 | volume=367 | issue=2 | pages=124–34 | pmid=22738085 | doi=10.1056/NEJMoa1204242}}</ref> This study used Tetraspan (HES 130/0.42) of the pharmaceutical company B.Braun but the original version of the publication contained the product specification HES 130/0.4.<ref name="Perner 124–34"/> The pharmaceutical company, [[Fresenius Kabi]], that makes a similar product but with the specification HES 130/0.4 is threatening to bring legal action against the author, Anders Perner, as they wanted the misleading use of their product specification to be corrected.<ref name=Newpaper2012>{{cite news|last=Wojcik|first=Jeppe|title=Pharma giant threatens Danish scientist|url=http://sciencenordic.com/pharma-giant-threatens-danish-scientist|accessdate=13 August 2012|newspaper=ScienceNordic|date=July 24, 2012}}</ref> The academic community has raised concerns regarding this sort of behavior by a corporation although Fresenius Kabi did not doubt the results of the study.<ref name=Newpaper2012/>
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The Chest study compared Hes130/0.40 with Saline in 7000 patients. The study was performed in patients that were less sick than in 6s; however, the increase in mortality was similar to 6s. There has also been a significant increase in dialysis rate overall. The increase in creatinine confirmed the pathophysiological rationale. Furthermore, the patients needed more blood products, had significant more liver failure and itching. The study was published in the ''NEJM'' in October 2012.<ref>[http://www.nejm.org/doi/full/10.1056/NEJMoa1209759 Myburgh, John A.; et al. 2012. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care" ''N Engl J Med'' 367:1901-1911.]</ref>
As a consequence, in November 2012 the European Regulatory Agency (EMA) started an Official Procedure to Assess the Safety of all HES Products. The FDA in September 2012 conducted a Public Workshop addressing Safety concerns of HES,<ref>{{citation | url = http://www.fda.gov/BiologicsBloodVaccines/NewsEvents/WorkshopsMeetingsConferences/ucm313370.htm | title = Public Workshop: Risks and Benefits of Hydroxyethyl Starch Solutions | publisher = [[Food and Drug Administration|U.S. Food and Drug Administration]] | work = Vaccines, Blood & Biologics}}</ref> which according to the majority of participants should be addressed by regulators. The Surviving Sepsis Campaign decided to ban HES from treatment in sepsis patients.
<ref>{{cite journal | url = http://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2013&issue=02000&article=00024&type=abstract | journal = Critical Care Medicine | date = February 2013 | volume = 41 | issue = 2 | pages = 580–637 | doi = 10.1097/CCM.0b013e31827e83af | title = Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 | last = Dellinger | first = R. Phillip | last2 = Levy | first2 = Mitchell M. | last3 = Rhodes | first3 = Andrew MB | last4 = Annane | first4 = Djillali | last5 = Gerlach | first5 = Herwig | last6 = Opal | first6 = Steven M. | last7 = Sevransky | first7 = Jonathan E. | last8 = Sprung | first8 = Charles L. | last9 = Douglas | first9 = Ivor S. | last10 = Jaeschke | first10 = Roman | last11 = Osborn | first11 = Tiffany M. | last12 = Nunnally | first12 = Mark E. | last13 = Townsend | first13 = Sean R. | last14 = Reinhart | first14 = Konrad | last15 = Kleinpell | first15 = Ruth M. | last16 = Angus | first16 = Derek C. | last17 = Deutschman | first17 = Clifford S. | last18 = Machado | first18 = Flavia R. | last19 = Rubenfeld | first19 = Gordon D. | last20 = Webb | first20 = Steven A. | last21 = Beale | first21 = Richard J. | last22 = Vincent | first22 = Jean-Louis | last23 = Moreno | first23 = Rui | last24 = the Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup | publisher = Society of Critical Care Medicine and Lippincott Williams & Wilkins | pmid=23353941}}</ref>
On June 14, 2013, PRAC, which is the safety committee of EMA, the European regulatory agency, published on their official website the recommendation to suspend the marketing authorisation of all HES products in Europe. The risk benefit ratio is negative based on results of 3 megatrials (VISEP, 6S, CHEST). A clinical benefit could not be demonstrated in any patient population, and there was ample evidence of harm, especially kidney failure due to long-term storage of the product in vital organs severely restricting its potential indications.<ref name="EMEAOCT">{{citation | url = http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Hydroxyethyl_starch-containing_solutions/human_referral_prac_000012.jsp&mid=WC0b01ac05805c516f | publisher = [[European Medicines Agency]] | title = Solutions for infusion containing hydroxyethyl starch: Hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients – CMDh endorses PRAC recommendations | date = 2013-10-25}}</ref>
<!--Label Display Image-->
The FDA followed on June 24. MHRA recalled the HES products on June 27 as the risks outweigh potential benefits and safer and cheaper alternatives are available.<ref name=FDA2013>{{citation | url = http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm358271.htm | title = FDA Safety Communication: Boxed Warning on increased mortality and severe renal injury, and additional warning on risk of bleeding, for use of hydroxyethyl starch solutions in some settings | date = November 25, 2013 | publisher = [[Food and Drug Administration|U.S. Food and Drug Administration]] | work = Vaccines, Blood & Biologics}}</ref><ref name=MHRA2013>{{citation | url = http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON287028 | title = Press release: MHRA suspends use of hydroxyethyl starch (HES) drips | date = 27 June 2013 | publisher = [[Medicines and Healthcare Products Regulatory Agency]]}}</ref>
== Pharmacokinetics ==
Different types of hydroxyethyl starches are typically described by their average molecular weight, typically around 130 to 200 kDa (bearing in mind that there will be a range of different-sized molecules in any given solution); and their degree of molar substitution (what proportion of the glucose units on the starch molecule have been replaced by hydroxyethyl units), typically around 0.35 to 0.5. A solution of hydroxyethyl starch may further be described by its concentration in % (i.e. grams per 100ml). So for example, one commercially available hydroxyethyl starch (Voluven) is described as 6% HES 130 / 0.4.
The elimination depends on molar substitution degree. Molecules smaller than the renal threshold (60–70 kDa) are readily excreted in the urine while a small part of the larger ones are metabolized by plasma α–[[amylase]] before those degradation products are renally excreted. However HES is only partly degraded and excreted, while for a large amount the metabolism remains unclear. Approximately one-third to two-thirds of administered HES cannot be accounted for by 24-h urinary excretion. In one study the cumulative excretion over 72 h was 50% of the administered dose. HES has remained detectable in plasma 4 months after infusion, and in skin tissue up to 54 months after HES infusion. Administered HES accumulates in large quantities within diverse tissues where it can persist for periods of several years.<ref>{{cite journal | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2004.06272.x/abstract | journal = British Journal of Dermatology | volume = 152 | issue = 1 | title = Pruritus precipitated by hydroxyethyl starch: a review | first = K. | last = Bork | date = January 2005 | pages = 3–12 | doi= 10.1111/j.1365-2133.2004.06272.x}}</ref> Therefore HES should not be administered for longer than 24 hours.<ref>{{cite press release | title = PRAC confirms that hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients | date = October 11, 2013 | url = http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/10/news_detail_001917.jsp&mid=WC0b01ac058004d5c1 | publisher = Pharmacovigilance Risk Assessment Committee, [[European Medicines Agency]]}}</ref>
== See also ==
* [[Hydroxyethyl starch-induced pruritus]]
* [[Pentastarch]]
== References ==
{{reflist|2}}
== External links ==
<!--Category-->
* [http://www.drugs.com/cdi/hespan.html Information on Hespan]
* [http://www.fda.gov/bbs/topics/NEWS/2007/NEW01765.html FDA press release approving Voluven]
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Black Box Warning
ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
Content
Overview
Hydroxyethyl starch is a {{{drugClass}}} that is FDA approved for the treatment 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)
Condition1
Dosing Information
Dosage
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Dosing Information
Dosage
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Dosing Information
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Dosing Information
Dosage
Off-Label Use and Dosage (Adult)
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 Hydroxyethyl starch in adult patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Hydroxyethyl starch 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 Hydroxyethyl starch 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 Hydroxyethyl starch in pediatric patients.
Non–Guideline-Supported Use
Condition1
Dosing Information
Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Hydroxyethyl starch 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 Hydroxyethyl starch 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 Hydroxyethyl starch in the drug label.
