INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER

Clinical safety rating: caution

Comprehensive clinical and safety monograph for INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER (INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER).

How it works

Provides osmotic gradient for peritoneal dialysis via hyperosmolar dextrose solution; dextrose is absorbed and metabolized, driving ultrafiltration of excess fluid and solutes across peritoneal membrane.

What the body does with it

Metabolism	Dextrose is absorbed into systemic circulation and metabolized primarily via glycolysis and subsequent oxidative phosphorylation in peripheral tissues; insulin-dependent glucose utilization occurs. No significant hepatic metabolism of dextrose per se.
Excretion	Renal (predominantly via dialysate effluent); peritoneal dialysis removes glucose and metabolites. Less than 5% metabolized; no significant biliary or fecal excretion.
Half-life	Not applicable as a continuous dialysis solution; systemic glucose half-life ~1.5-2 hours in normal physiology, but prolonged in renal impairment.
Protein binding	Glucose: negligible (<5%) protein binding; no significant binding to albumin or other proteins.
Volume of Distribution	Glucose Vd ~0.2-0.3 L/kg (approximates extracellular fluid volume); reflects distribution into total body water.
Bioavailability	Intraperitoneal: ~70-80% of administered dextrose is absorbed systemically during dwell; bioavailability depends on dwell time and peritoneal transport status.
Onset of Action	Intraperitoneal: ultrafiltration and glucose absorption begin within 30-60 minutes of dwell initiation.
Duration of Action	Intraperitoneal: 4-6 hours for standard dwell; longer dwells (8-12 hours) used overnight. Clinical effect depends on exchange schedule.

Classification & Brands

Dosing & administration

Intraperitoneal administration: 2 liters of 2.5% dextrose solution per exchange, 4 exchanges daily (8 liters total per day) for continuous ambulatory peritoneal dialysis (CAPD).

Dosage form	SOLUTION
Renal impairment	No dose adjustment required as drug is used for dialysis; GFR-based modifications not applicable.
Liver impairment	No specific hepatic adjustment defined; use caution in severe hepatic impairment due to potential glucose intolerance.
Pediatric use	Intraperitoneal: Initial exchange volume 10-20 mL/kg per exchange, typically 4-5 exchanges daily; dextrose concentration and frequency adjusted based on ultrafiltration needs.
Geriatric use	No specific adjustment; monitor fluid and electrolyte balance, glucose levels, and peritoneal membrane function closely.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER (INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER).

Breastfeeding	Minimal excretion into breast milk expected due to high molecular weight and intraperitoneal administration. No known adverse effects on nursing infant. M/P ratio not established.
Teratogenic Risk	No known teratogenic risk. Icodextrin and dextrose are not associated with congenital anomalies. Peritoneal dialysis is considered safe in pregnancy with appropriate monitoring.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Pre-existing severe hyperglycemia or ketoacidosis","Hypersensitivity to any component","Peritoneal fibrosis or adhesions","Uncontrolled hyperglycemia","Severe lactic acidosis"]

Clinical Precautions

Precautions

["Monitor serum glucose and electrolytes closely; hyperglycemia may occur, especially in diabetic patients. Use with caution in patients with impaired glucose tolerance, hepatic failure, or metabolic acidosis. Monitor for peritonitis, catheter malfunction, and fluid/electrolyte imbalances. Do not use in patients with pre-existing severe hyperglycemia or uncontrolled diabetes."]

Clinical Tips & Counseling

Drug interactions

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INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER

Clinical safety rating: caution

Comprehensive clinical and safety monograph for INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER (INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER).

How it works

What the body does with it

Metabolism	Dextrose is absorbed into systemic circulation and metabolized primarily via glycolysis and subsequent oxidative phosphorylation in peripheral tissues; insulin-dependent glucose utilization occurs. No significant hepatic metabolism of dextrose per se.
Excretion	Renal (predominantly via dialysate effluent); peritoneal dialysis removes glucose and metabolites. Less than 5% metabolized; no significant biliary or fecal excretion.
Half-life	Not applicable as a continuous dialysis solution; systemic glucose half-life ~1.5-2 hours in normal physiology, but prolonged in renal impairment.
Protein binding	Glucose: negligible (<5%) protein binding; no significant binding to albumin or other proteins.
Volume of Distribution	Glucose Vd ~0.2-0.3 L/kg (approximates extracellular fluid volume); reflects distribution into total body water.
Bioavailability	Intraperitoneal: ~70-80% of administered dextrose is absorbed systemically during dwell; bioavailability depends on dwell time and peritoneal transport status.
Onset of Action	Intraperitoneal: ultrafiltration and glucose absorption begin within 30-60 minutes of dwell initiation.
Duration of Action	Intraperitoneal: 4-6 hours for standard dwell; longer dwells (8-12 hours) used overnight. Clinical effect depends on exchange schedule.

Classification & Brands

Dosing & administration

Intraperitoneal administration: 2 liters of 2.5% dextrose solution per exchange, 4 exchanges daily (8 liters total per day) for continuous ambulatory peritoneal dialysis (CAPD).

Dosage form	SOLUTION
Renal impairment	No dose adjustment required as drug is used for dialysis; GFR-based modifications not applicable.
Liver impairment	No specific hepatic adjustment defined; use caution in severe hepatic impairment due to potential glucose intolerance.
Pediatric use	Intraperitoneal: Initial exchange volume 10-20 mL/kg per exchange, typically 4-5 exchanges daily; dextrose concentration and frequency adjusted based on ultrafiltration needs.
Geriatric use	No specific adjustment; monitor fluid and electrolyte balance, glucose levels, and peritoneal membrane function closely.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER (INPERSOL-ZM W/ DEXTROSE 2.5% IN PLASTIC CONTAINER).

Breastfeeding	Minimal excretion into breast milk expected due to high molecular weight and intraperitoneal administration. No known adverse effects on nursing infant. M/P ratio not established.
Teratogenic Risk	No known teratogenic risk. Icodextrin and dextrose are not associated with congenital anomalies. Peritoneal dialysis is considered safe in pregnancy with appropriate monitoring.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Pre-existing severe hyperglycemia or ketoacidosis","Hypersensitivity to any component","Peritoneal fibrosis or adhesions","Uncontrolled hyperglycemia","Severe lactic acidosis"]