Rheogluman (solution for infusion)

Rheoglumanum

Pharmacotherapy group

Rehydrants. Regulators of water-salt balance and ABB.

Composition

1 l of solution contains dextrane 100 g with molecular mass 40.000±10.000; mannitol 50 g and sodium chloride 9 g..

Pharmacological action

Pharmacodynamics

Rheogluman is a blood substitute of polyfunctional action. The preparation reduces blood viscosity, provides the blood flow regeneration in small capillaries; prevents, eliminates and inhibits the aggregation of blood formed elements, has a detoxication, diuretic and hemodynamic action. Each gram of dextran contained in the preparation contributes to penetration of 20—25 ml of liquid from the tissue into the circulatory bed.

Pharmacokinetics

In 2 hours after infusion of rheogluman the dextran concentration reduces up to 60% of the administered amount and in 4 hours – up to 32%. On the first day 70—80% of the preparation is excreted, and on the second one -- 3—5% more. Small amount of dextran is accumulated in the lien red pulp, medullary zone of lymphatic nodes. Mannitol is completely excreted from blood in 4 hours, and in 24 hours it is not observed in blood.

The majority of rheogluman is excreted by the kidney, the rest amount gets into the system cells of the monocytic macrophage where it splits in glucose.

Indication

Rheogluman is used as a preparation for intensifying capillary blood flow for prophylaxis and treatment of diseases accompanied by microcirculation disturbances of local and general nature that are associated with liquid retention in the organism. The preparation is indicated on capillary blood flow disturbances (traumatic, operational, cardiogenis, burn shock, arterial and vein blood circulation disturbances (thrombosis, thrombophlebitis, endarteritis, Raynaud’s disease), in the vascular and plastic surgery (for improvement of local circulation and reducing the disposition to thrombosis in the transplant), in patients with kidney and kidney-liver failure with preserved filtration function of the kidney, on post-transfusion complications induced by infusion of non-compatible blood, for detoxication on burns, peritonitis, pancreatitis.

Route and dosage

Rheogluman is administered intravenously drop-by-drop. Administration of rheogluman should be started with 5—10 drops per minute during 10—15 days. After administration of 5—10 drops and then that of 30 drops there follow breaks 2 – 3 minutes for bioassay. In the absence of reaction the preparation is administered at the speed of 40 drops per minute. In the complex shock therapy on capillary blood flow disturbance the preparation is administered intravenously drop-by-drop in the quantity of 400 to 800 ml for 30—60 minutes under monitoring of hemodynamic parameters (volume of circulating blood, central venous pressure), hourly and daily diuresis. In cardiovascular and plastic surgery rheogluman is administered immediately before the operation (30—60 minutes before) in the dose of 10 ml/kg, during the operation – in the dose 400—500 ml and after operation – every days during 5 – 6 days drop-by-drop in the dose of 10 ml/kg per administration. On burn shock it is advisable to administer rheogluman 2—3 times for first 24 hours from the moment of injury. The first dose of the preparation 400 ml should be administered drop-by-drop 2 hours before, and the second one – after 7 hours at the same speed. In case the administration of rheogluman is combined with administration of polyglucin, the general dose of the preparations administered should exceed 1600 ml/day (dextran 100—130 g) in order to provide a satisfactory metabolism in the patient’s organism. On the second day of the burn shock, circulating blood volume, the central venous pressure and diuresis being stabilized, rheogluman is administered in the dose of 200—400 ml at the speed up to 40 drops per minute with interval 7 – 12 hours. In the period of the burn toxemia rheogluman can be used each day and every other day in the doses of 200—400 ml drop-by-drop at the speed of 40 drops per minute under monitoring the daily diuresis, hemoglobin and hematocrin parameters. In the period of septicotoxemia the administration of rheogluman in the same doses and at the same speed is recommended in the terms of the patient’s preparation for autoplastic operation and during the two days followed after the operation. On acute kidney and liver failure with preserved filtration and post-transfusion complications rheogluman is administered once in the dose of 400—800 ml. The infusion of the preparation should be repeated every day during 3—5 days in the dose 10 mg/kg under monitoring of water-electrolytic acid-base balance and blood coagulating system.

Special indications

The preparation affects the results of glucose concentration test for sulphuric and acetic acid solutions due to dextrane hydrolyze (higher glucose concentration in blood). The presence of dextrane affects the laboratory results of bilirubin and protein concentration. Therefore, it is recommended to take blood samples for bilirubin and protein concentration before the administration of rheogluman.

Side effects

Reactions after rheogluman transfusion are not observed. Nevertheless, allergic reactions are not excluded (urtical eruption, itching, Quicke’s edema, etc.), cardiac acceleration, blood pressure drop. In such case rheogluman infusion should be stopped. Antihistaminic, cardio-vascular and corticosteroid agents should be immediately administered.

Contraindications

The administration of rheogluman is contraindicated on excessive hemodilution (hematocrite lower than 25 l/l), on hemorrhagic diathesis (thrombocytopenia), on circulatory inefficiency with distinct hydrosarca, on kidney failure accompanied by anuria, on significant dehydration, on severe allergic conditions of unclear aetimilogy.

Interaction with other medications

In order to keep liquid and electrolytic the administration of rheogluman can be combined with solutions containing sodium and potassium.

Aminocapronic acid, hydralazin, warfarin, ethanol 95%, dexamethasone and other medicines are not compatible with dextran.

Product form

Solution for infusions in a bottle for blood 400 ml.