Hydroxyethyl starch
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| Trade names | Hespan, Voluven, Volulyte, Tetrahes, Hestar |
| Routes of administration |
Intravenous |
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| Biological half-life | 1.4 hrs |
| Excretion | Renal |
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| ECHA InfoCard | 100.120.749 |
| Chemical and physical data | |
| Molar mass | 130–200 kg/mol (typical) |
| 3D model (Jmol) | |
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Hydroxyethyl starch (HES/HAES), sold under the brandname Voluven among others, is a nonionic starch derivative. It is a volume expanders. Its use in those who are very ill is associated with an increased risk of death and kidney problems.
HES is a general term and can be sub-classified according to average molecular weight, molar substitution, concentration, C2/C6 ratio and Maximum Daily Dose. The European Medicines Agency commenced in June 2013 the process of agreeing to reduced indications which was completed in October 2013.
An intravenous solution of hydroxyethyl starch is used to prevent shock following severe blood loss caused by trauma, surgery, or other problem. It however appears to have greater risk of a poor outcome compared to other intravenous solutions and may increase the risk of death.
HES can cause anaphylactoid reactions: hypersensitivity, mild influenza-like symptoms, bradycardia, tachycardia, bronchospasm and non-cardiogenic pulmonary edema. It is also linked to a decrease in hematocrit and disturbances in coagulation. One liter of 6% solution (Hespan) reduces factor VIII level by 50% and will prolong aPTT.
HES derivatives have been demonstrated to have increased rates of acute renal failure and need for renal replacement therapy and to decrease long-term survival when used alone in cases of severe sepsis compared with Ringer lactate solution. The effects were tested on HES 130kDa/0.42 in people with severe sepsis; analysis showed increased rates of renal failure and increased mortality when compared to LR. It has been recommended that, since medium-MW HES solutions may be associated with harm, these solutions should not be used routinely for patients with septic shock.
During 2010/11 a large number of research papers associated with a single author were retracted for ethical reasons, and this may affect clinical guidelines referring to HES preparations prepared before this date.
Prescribing information contains the following contraindications:
On November 25, 2013, following a public workshop to discuss new information on the risks and benefits of HES solution, the USFDA announced the addition of a black box warning to the prescribing information which includes the following recommendations to health professionals:
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