Dextran (DB09255): A Comprehensive Pharmacological and Clinical Monograph

Executive Summary

Dextran is a complex, variable molecular weight polysaccharide of microbial origin, characterized by a dual pharmacological profile as both a plasma volume expander and an antithrombotic agent. Its primary structure, consisting of an α-1,6 linked D-glucose backbone with periodic branches, dictates its physicochemical properties and, consequently, its therapeutic applications and risks. The clinical utility of Dextran is fundamentally governed by its molecular weight, with two principal fractions, Dextran 40 and Dextran 70, exhibiting distinct pharmacokinetic and pharmacodynamic profiles.

As a plasma volume expander, Dextran exerts a colloid osmotic pressure within the intravascular space, drawing fluid from the interstitium to restore circulating volume. This hemodynamic effect is central to its indication for the adjunctive treatment of hypovolemic shock arising from hemorrhage, surgery, or trauma. Concurrently, Dextran modulates hemostasis by reducing erythrocyte aggregation, decreasing platelet adhesiveness, lowering levels of key coagulation factors, and promoting fibrinolysis. These antithrombotic properties underpin its use in the prophylaxis of venous thromboembolism during high-risk surgical procedures.

Beyond these primary roles, Dextran serves as a critical carrier molecule in the Iron Dextran complex, a parenteral formulation for treating iron-deficiency anemia in patients who cannot tolerate or respond to oral iron. In this capacity, the Dextran shell stabilizes the ferric hydroxide core, enabling a controlled release of iron and mitigating toxicity. Dextran is also a ubiquitous component in ophthalmic lubricating solutions and has emerged as a versatile platform technology in biomedical research and advanced drug delivery systems, including nanoparticles, hydrogels, and chromatography matrices.