Recommended Dosing Regimen for Voluven (Hydroxyethyl Starch)
The recommended dosing regimen for Voluven (6% hydroxyethyl starch 130/0.4) is a maximum of 50 mL/kg/day, administered intravenously according to the patient's clinical condition, with careful monitoring of renal function. 1
Indications and Administration
- Voluven is indicated for the treatment of hypovolemia when plasma volume expansion is desired 1
- It should be administered intravenously only 1
- The infusion rate can safely be given at 0.5 mg/kg/min (e.g., 7.5 mg/kg over 15 minutes) 2
- Typical dosing is 500 mL (30g of hetastarch in 500 mL 0.9% sodium chloride) 1
Contraindications
- Do NOT use in critically ill patients, including those with sepsis, due to increased risk of mortality and need for renal replacement therapy 1, 3
- Contraindicated in patients with:
Monitoring Requirements
- Monitor renal function before administration and regularly during treatment 1
- Discontinue at the first sign of renal injury 1
- Continue monitoring renal function in hospitalized patients for at least 90 days after administration 1
- Monitor liver function in patients receiving HES products 1
- Monitor for signs of coagulopathy and discontinue at first sign 1
Special Considerations
- Avoid use in patients with pre-existing renal dysfunction 1
- Not recommended for use as a cardiac bypass pump prime 1
- The blood volume expansion by Voluven is more effective than crystalloids - studies show only 16% of Voluven escapes from the intravascular space during the first hour of infusion, compared to 68% of normal saline 4
- While there is a common belief that 3-4 times more crystalloid than colloid volume is needed for similar hemodynamic effects, research suggests the actual ratio is lower (mean 1.8) 5
Adverse Effects
- Most common adverse reactions include hypersensitivity reactions, coagulopathy, hemodilution, circulatory overload, and metabolic acidosis 1
- Serious adverse events reported in clinical trials include increased mortality and need for renal replacement therapy in critically ill patients 1, 3
- Pruritis and skin rash are common adverse events 3
Efficacy Considerations
- Voluven has been shown to be beneficial for maintaining hemodynamic stability and balancing cerebral oxygen supply and consumption during resuscitation of acute hemorrhagic shock 6
- As the Voluven molecule is smaller than other available hydroxyethyl starch products, it is associated with less plasma accumulation 7
Important Cautions
- Use with caution with drugs that negatively influence the coagulation system 1
- The safety and compatibility of other additives have not been established 1
- Despite numerous clinical studies, there remains debate about the overall safety profile of HES 130/0.4, particularly in critically ill patients 3, 5