INPERSOL-LC/LM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for INPERSOL-LC/LM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER (INPERSOL-LC/LM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER).
The mechanism of action of INPERSOL-LC/LM W/ DEXTROSE 2.5% is based on peritoneal dialysis. Dextrose creates an osmotic gradient across the peritoneal membrane, facilitating the removal of waste products (e.g., urea, creatinine) and excess fluid from the blood into the dialysate. Lactate or low magnesium buffer corrects metabolic acidosis by providing bicarbonate precursors.
| Metabolism | Dextrose is metabolized systemically via glycolysis and oxidative phosphorylation, providing calories. Lactate is converted to bicarbonate in the liver via gluconeogenesis and the Cori cycle. Buffer metabolism is primarily hepatic. |
| Excretion | Primarily renal elimination through peritoneal dialysis; approximately 60-80% of dextrose absorbed is metabolized to CO2 and water, with the remainder eliminated via the kidneys. Non-dextrose components are removed via peritoneal dialysis outflow. |
| Half-life | Intraperitoneal dextrose has a terminal elimination half-life of approximately 1-2 hours, reflecting rapid absorption from the peritoneal cavity followed by systemic metabolism and distribution. |
| Protein binding | <10% bound to plasma proteins; primarily to albumin. |
| Volume of Distribution | Dextrose distributes into total body water, approximately 0.55-0.65 L/kg, reflecting its hydrophilic nature. |
| Bioavailability | Intraperitoneal: Approximately 60-80% of administered dextrose is absorbed systemically; non-absorbed fraction is removed with dialysate outflow. |
| Onset of Action | Intraperitoneal: Ultrafiltration begins within 10-15 minutes of instillation, with peak glucose absorption occurring at 30-60 minutes. |
| Duration of Action | Intraperitoneal: Dwell time of 4-6 hours for standard exchanges; clinical effects (fluid removal, glucose absorption) persist throughout the dwell, with diminishing effect over time. |
Intraperitoneal administration: 2 liters of 2.5% dextrose solution per exchange, typically 4-5 exchanges per day, as part of continuous ambulatory peritoneal dialysis (CAPD). For automated peritoneal dialysis (APD): 2 liters per cycle, 4-6 cycles per night, with a daytime dwell as prescribed.
| Dosage form | SOLUTION |
| Renal impairment | Not applicable; this is a dialysis solution used specifically for renal replacement therapy in patients with end-stage renal disease (ESRD) or acute kidney injury requiring peritoneal dialysis. Dosing is adjusted based on peritoneal membrane transport characteristics and adequacy targets (total Kt/V >1.7/week), not GFR. |
| Liver impairment | No specific dosing adjustment required for hepatic impairment. Use with caution in severe hepatic disease due to risk of lactic acidosis from dextrose absorption. Monitor blood glucose and lactate levels. Peritoneal dialysis may be less effective in patients with ascites or portosystemic shunts. |
| Pediatric use | Initiate with 10-20 mL/kg per exchange, titrating to 30-40 mL/kg per exchange based on tolerance and adequacy. Exchange frequency: typically 4-5 exchanges per day for CAPD, or 5-10 cycles per night for APD. Adjust fill volume to avoid intra-abdominal pressure exceeding 15-20 cm H2O. Target weekly Kt/V >1.8 for children. |
| Geriatric use |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for INPERSOL-LC/LM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER (INPERSOL-LC/LM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER).
| Breastfeeding | No data in breastmilk. Icodextrin metabolites (maltose, maltotriose) likely too large to transfer significantly. Dextrose is endogenous. M/P ratio unknown; caution advised. Monitor infant for gastrointestinal effects. |
| Teratogenic Risk | Limited data; Icodextrin and dextrose are not known human teratogens. No structural anomalies reported in animal studies. Intraperitoneal administration may cause maternal metabolic disturbances; fetal effects secondary to maternal acidosis or hypoglycemia are possible. First trimester: theoretical risk; second/third trimesters: may cause fetal hypoglycemia if maternal glucose rises. Avoid unless benefit outweighs risk. |
■ FDA Black Box Warning
None explicitly listed in standard prescribing information; however, use of peritoneal dialysis solutions requires careful monitoring for peritonitis, fluid and electrolyte imbalances, and mechanical complications.
| Serious Effects |
["Pre-existing severe hyperglycemia or hyperosmolality","Severe lactic acidosis (relative, as lactate-containing solutions may worsen acidosis)","Documented allergy to any component","Absence of peritoneal membrane (e.g., prior peritonectomy, severe adhesions)","Recent abdominal surgery or trauma with increased risk of leaks/hernias","Inability to perform dialysis exchanges (e.g., severe cognitive impairment)"]
| Precautions | ["Monitor for peritonitis (cloudy effluent, abdominal pain, fever)","Risk of fluid overload, dehydration, and electrolyte disturbances (e.g., hypokalemia, hypernatremia)","Hyperglycemia and hyperosmolality due to dextrose absorption, especially in diabetic patients","Mechanical complications: catheter dysfunction, leakage, hernias, and encapsulating peritoneal sclerosis","Use with caution in patients with severe liver disease due to lactate metabolism","Protein-calorie malnutrition may occur due to protein loss in dialysate"] |
Loading safety data…
| Start with lower fill volumes (1-1.5 L) to minimize intra-abdominal pressure and risk of hernia, leakage, or protein loss. Increase as tolerated. Monitor for hyperglycemia and dehydration, particularly with higher dextrose concentrations. Adjust exchange number and dwell times to maintain ultrafiltration and adequacy targets. |
| Fetal Monitoring | Monitor maternal electrolytes, glucose, acid-base status. Fetal surveillance: nonstress test or biophysical profile if used near term. Assess for peritoneal infection (cloudy effluent). |
| Fertility Effects | No known direct effects on fertility. End-stage renal disease may impair fertility; peritoneal dialysis can improve overall health and potentially restore fertility in women. |