Extraneal
Extraneal (icodextrin) is a solution that's used in peritoneal dialysis (PD). It helps to absorb waste from the circulation for people whose kidneys aren't working properly. Extraneal (icodextrin) is given through the peritoneum (the lining of your belly) and is usually exchanged after 8 to 16 hours. Before receiving this medication at home, your provider will train you on how to prepare and use it.
What is Extraneal (icodextrin)?
What is Extraneal (icodextrin) used for?
- Continuous ambulatory peritoneal dialysis (CAPD), which is done by hand during the day
- Automated peritoneal dialysis (APD), which is done through a machine called a cycler at night
- Improve waste filtering in certain people on PD
How Extraneal (icodextrin) works
Extraneal (icodextrin) is a dialysis solution that's used in PD. It helps to remove waste and extra water from the blood of people with serious kidney problems. Extraneal (icodextrin) is made from cornstarch, which is a large chain of glucose (a simple sugar) molecules linked together. As the solution gets washed in and out of your belly, these large sugar molecules draw out waste and fluid from your circulation. This helps your body eventually get rid of these harmful products once Extraneal (icodextrin) is drained from your belly.
Drug facts
Side effects of Extraneal (icodextrin)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Peritonitis (stomach lining inflammation; 26%)
- Upper respiratory infection (i.e., common cold; 15%)
- High blood pressure (13%)
- Rash (6-10%)
- Headache (9%)
- Belly pain (8%)
- Flu symptoms (7%)
- Nausea (7%)
- Cough (7%)
- Swelling (6%)
- Chest pain (5%)
- Indigestion (5%)
- High blood sugar (5%)
Less Common Side Effects
- Feeling weak
- Back pain
- Dizziness
- Diarrhea
- Vomiting
- Joint pain
- Itching
- Low blood pressure
- Catheter-related infections (e.g., pus or skin redness around catheter, fever or chills)
Extraneal (icodextrin) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe skin conditions: skin peeling and pain, hives, blisters
- Peritoneal infection: cloudy dialysis solution, fever, pain, swelling, or drainage at the exit site
- Heart failure: trouble breathing, swelling in the arms or legs
- Serious allergic reaction: rash, trouble breathing, swelling of lips, tongue, or throat
Pros and cons of Extraneal (icodextrin)
Pros
- Only needs to be exchanged every 8-16 hours, so it's convenient for people with a busy schedule
- Might reduce the risk of heart failure in people on PD
- Might work well for people who didn’t see benefits with dextrose-based dialysis solutions
- Less weight gain compared to glucose-based solutions
Cons
- Only available as a brand medication so it might be expensive
- Interacts with certain blood glucose monitoring devices, so it might not be convenient for people with diabetes
- Can't be used in people who are allergic to cornstarch
- Risk of stomach infection
Pharmacist tips for Extraneal (icodextrin)
- Don't start your dialysis at home using Extraneal (icodextrin) until you understand how to prepare the medication for administration. Your provider will show you how to drain and refill the dialysate.
- Store Extraneal (icodextrin) at room temperature before using. Keep the medication in its original wrap and container until you're ready to use it to protect it from moisture.
- Always wear a mask and clean your hands before and after preparing Extraneal (icodextrin) for dialysis. Doing so can help you avoid infections.
- Check the appearance of Extraneal (icodextrin) before using. Don't use the medication if it's cloudy, has particles, or is leaking.
- Throw away any unused Extraneal (icodextrin) solution, or if any damage has been done to it.
- Write down your weight and blood pressure every day while receiving Extraneal (icodextrin). Changes in weight or blood pressure can be a sign of too much or too little fluid in your body, which can cause serious health problems. Let your provider know right away if you have symptoms of overhydration (shortness of breath, feeling confused, vomiting) and dehydration (feeling dizzy or weak).
- Extraneal (icodextrin) can affect the amount of certain medications in your body, how well these medications work, and the risk of side effects. Please let your provider and pharmacist know about all your medications, including over-the-counter products and supplements, so they can make sure your medications are safe for you to take.
- Make sure to get your routine blood tests done on time while you’re receiving Extraneal (icodextrin) so your provider can make sure it's working for you. Your dose might change depending on these test results, so always follow your provider's most updated instructions on how much Extraneal (icodextrin) to receive.
Common questions about Extraneal (icodextrin)
Since this medication contains a type of sugar, it can sometimes interfere with blood sugar readings on some monitors. This can result in falsely high blood sugar readings. If you monitor your blood sugar at home, make sure to use only blood sugar monitoring devices that specifically measure glucose. In addition, if you're using insulin, your provider will monitor your blood sugar and adjust your dose of insulin if needed.
No, Extraneal (icodextrin) isn't a cure for CKD. Currently, all available treatments or medications for CKD can only slow down its progression. But studies show that PD helps people with CKD to live longer. In particular, people who use Extraneal (icodextrin) are 12% less likely to have technique problems with PD in the first year compared to other dialysis solutions. Ask your provider if you have more questions about CKD and its treatment.
Extraneal (icodextrin) can lower the levels of potassium in your body, but not as much compared with other types of glucose dialysate. Extraneal (icodextrin) can lower potassium levels because the body doesn't retain much potassium as it gets filtered out along with waste from the body. Your provider might ask you to get blood tests done regularly to make sure this medication is safe for you. Tell your provider right away if you have symptoms of low potassium, such as cramping, muscle weakness, skipped heartbeat, or muscle twitching.
Extraneal (icodextrin) and dextrose dialysis solution are both used for people on PD. One main difference between the two dialysis solutions is the amount of waste that gets filtered. In one study, Extraneal (icodextrin) removed more waste, such as urea nitrogen and creatinine, from the body within 3 months of starting PD. Another main difference is the side effects. While Extraneal (icodextrin) and dextrose dialysate have many similar side effects, dextrose dialysate is more likely to cause weight gain and high blood sugar. Talk with your provider to determine which dialysate is best for you.
Extraneal (icodextrin) is given directly into your peritoneum through a catheter. Before your first dialysis session, you'll have surgery to place a catheter into your belly. After surgery, it's important to keep your catheter and the surrounding area clean and dry to prevent infections. Check with your provider if you have questions about how to take care of your catheter at home. If the skin around the catheter is red, painful, feels hard, or there is pus, let your provider know right away. These could be signs and symptoms of an infection.
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Risks and warnings for Extraneal (icodextrin)
Extraneal (icodextrin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Interference with blood sugar monitoring devices
Extraneal (icodextrin) contains a sugar called maltose, which can cause inaccurate blood sugar readings in certain blood sugar monitoring devices. It's not recommended to use blood sugar monitors and test strips that don't specifically detect glucose while using Extraneal (icodextrin). False high blood sugar readings in these devices can last up to 2 weeks after stopping Extraneal (icodextrin). For people with diabetes, this can be dangerous because these falsely high readings can cause you to use more insulin than you need. This might lead to unrecognized low blood sugar. For more information, visit www.glucosesafety.com or talk with your provider.
Swelling in the lining of the stomach (peritoneum)
- Risk factors: People not using aseptic (sterile) techniques for PD | Air introduced into the peritoneum
Extraneal (icodextrin) can raise the risk of inflammation (swelling) of the peritoneum (peritonitis), even if there's no infection. The risk is higher if air was introduced into the peritoneum while preparing for PD. Make sure to always follow your provider's instructions on how to drain and refill the dialysate. Wear a mask and clean your hands before and after dialysis to help avoid infections. If the solution you drained is cloudy after dialysis, or if you have symptoms of fever, pain, redness, or drainage at the exit site, let your provider know right away.
Buildup of acid in the body (lactic acidosis)
- Risk factors: People with very low blood pressure | People with blood infection caused by sudden kidney failure | Problems with breaking down carbohydrates, fatty acids, or proteins | People who use certain antiviral medications
Extraneal (icodextrin) contains lactate, which can worsen a rare but serious medical condition called lactic acidosis. Lactic acidosis happens when the body has a buildup of lactate or lactic acid. This can happen when there's a short supply of oxygen in the body. If you have one of the risk factors for this condition, please talk with your provider before and while receiving this medication. Please seek medical attention right away if you notice symptoms such as dizziness, confusion, or fast breathing.
Serious allergic reaction
In some rare cases, Extraneal (icodextrin) can cause allergic reactions, which can be life-threatening. Watch out for signs and symptoms of allergic reactions, such as wheezing, dizziness, fainting, fever, rash, itching, hives, peeling skin, and swelling of the tongue or throat. Get medical help right away and drain the solution from your body if any of these signs or symptoms occur.
Too much solution in the body
Sometimes, you can have too much Extraneal (icodextrin) in your body, which can lower the levels of certain important vitamins and minerals. To prevent this from happening, your provider will ask you to do blood tests regularly to make sure this medication is safe for you. If you infused too much Extraneal (icodextrin) into your body, you might feel bloated, full, or experience shortness of breath. If this happens, drain the solution and contact your provider.
Extraneal (icodextrin) dosage
Typical dosage for Extraneal (icodextrin)
Extraneal (icodextrin) can be given at home by yourself or by a healthcare provider. The typical dosing for this medication can vary depending on your body size, the amount of waste in your body, and the severity of your kidney problems. Your provider will give you exact instructions on how to perform your dialysis at home before you start.
- In general, Extraneal (icodextrin) is given through the peritoneum over 10-20 minutes. The solution then stays in your belly for 8-16 hours before being drained and refilled.
Extraneal (icodextrin) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Extraneal (icodextrin) will not be safe for you to take.
- History of allergy to cornstarch
- Severe lactic acidosis (life-threatening medical condition that leads to low blood pressure and low oxygen levels in the body)
- A group of medical conditions that prevent certain sugars from breaking down (e.g., maltose or isomaltose intolerance, glycogen storage disease)