Indications and
Important Risk Information (IRI)

WARNING

Potential For Incorrect Blood Glucose Reading

Patients using EXTRANEAL (icodextrin) for peritoneal dialysis may have incorrect blood glucose results when using particular blood glucose monitors and testing strips.

ONLY use glucose-specific monitors and test strips on peritoneal dialysis patients using EXTRANEAL (icodextrin). Some glucose monitors are not glucose-specific and cannot tell the difference between glucose and other sugars in the blood (e.g., maltose, a metabolite of icodextrin). Use laboratory-based methods, if available or a glucose-specific monitor and test strips.

The term "glucose-specific" applies to monitors or test strips that are not affected by the presence of maltose or certain other sugars. Because EXTRANEAL (icodextrin) Peritoneal Dialysis solution results in elevated blood levels of maltose, only glucose-specific monitors and test strips must be used.

DO NOT use monitors or test strips that utilize the enzyme glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase. In addition, some but not all monitors and test strips that use glucose dehydrogenase flavin adenine dinucleotide (GDH-FAD) must not be used. Use of these methods may result in falsely elevated blood glucose readings in patients using EXTRANEAL (icodextrin) due to maltose interference. Falsely elevated blood glucose readings may mask true hypoglycemia or lead to the erroneous diagnosis of hyperglycemia. Treatment decisions based on incorrect blood glucose readings may lead to life-threatening events.

To determine what type of method is used for monitoring glucose levels, review the labeling for BOTH the glucose monitor and the test strips used. If in doubt, contact the manufacturer of the glucose monitors and test strips to determine the method that is used.

For important information about EXTRANEAL (icodextrin) or glucose monitors and test strips, please see the links below. Details about glucose monitor manufacturers and product compatibility with EXTRANEAL (icodextrin) are included in the Country-Specific Glucose Monitor List (under “Additional Links”).


Product Labeling	Additional Information	Additional Links
Full Prescribing Information	Warning for Interference with Glucose Monitors Letter for Clinicians	Country-Specific Glucose Monitor List Video-Important Risk Information regarding EXTRANEAL PD Solution Dangerous Drug-Device Interaction

EXTRANEAL (icodextrin) PD Solution Indications and Important Risk Information (IRI)

Indications:

EXTRANEAL (icodextrin) is indicated for a single daily exchange for the long (8- to 16- hour) dwell during continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD) for the management of end-stage renal disease. EXTRANEAL is also indicated to improve (compared to 4.25% dextrose) long-dwell ultrafiltration and clearance of creatinine and urea nitrogen in patients with high average or greater transport characteristics, as defined using the peritoneal equilibration test (PET).

Important Risk Information:

EXTRANEAL is contraindicated in patients with a known allergy to cornstarch or icodextrin, in patients with maltose or isomaltose intolerance, in patients with glycogen storage disease, and in patients with severe lactic acidosis.

When measuring blood glucose levels in patients using EXTRANEAL, do not use blood glucose monitoring devices using glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ)-, glucose-dye-oxidoreductase (GDO)-, and some glucose dehydrogenase flavin-adenine dinucleotide (GDH-FAD)-based methods because these systems may result in falsely elevated glucose readings (due to the presence of maltose). Falsely elevated glucose readings have led patients or health care providers to withhold treatment of hypoglycemia or to administer insulin inappropriately leading to unrecognized hypoglycemia. Falsely elevated glucose levels may be measured up to two weeks following cessation of EXTRANEAL therapy when GDH-PQQ, GDO, and GDH-FAD-based blood glucose monitors and test strips are used. Additionally, other glucose-measuring technologies, such as continuous glucose monitoring systems, may or may not be compatible with EXTRANEAL. Always contact the device manufacturer for current information regarding compatibility and intended use of the device in the dialysis patient population.

EXTRANEAL is intended for intraperitoneal administration only. Not for intravenous or intra-arterial administration. Aseptic technique should be used throughout the peritoneal dialysis procedure.

Encapsulating peritoneal sclerosis (EPS), sometimes fatal, is a complication of peritoneal dialysis therapy and has been reported in patients using EXTRANEAL.

Serious hypersensitivity reactions to EXTRANEAL have been reported such as toxic epidermal necrolysis, angioedema, serum sickness, erythema multiforme and vasculitis. Anaphylactic or anaphylactoid reactions may occur. If a serious reaction is suspected, discontinue EXTRANEAL immediately and institute appropriate therapeutic countermeasures.

Overinfusion of peritoneal dialysis solution volume into the peritoneal cavity may be characterized by abdominal distention, feeling of fullness and/or shortness of breath. Drain the peritoneal dialysis solution from the peritoneal cavity to treat overinfusion.

Patients with insulin-dependent diabetes may require modification of insulin dosage following initiation of treatment with EXTRANEAL. Monitor blood glucose and adjust insulin, if needed.

Peritoneal dialysis may affect a patient’s protein, water-soluble vitamin, potassium, sodium, chloride, bicarbonate, and magnesium levels and volume status. Monitor electrolytes and blood chemistry periodically. Monitor fluid status to avoid hyper- or hypovolemia and potentially severe consequences including congestive heart failure, volume depletion, and hypovolemic shock. Abnormalities in any of these parameters should be treated promptly under the care of a physician.

In clinical trials, the most frequently reported adverse events occurring in ≥10% of patients and more common in EXTRANEAL PD solution patients than in control patients, were peritonitis, upper respiratory infection, hypertension, and rash. The most common treatment‐related adverse reaction for EXTRANEAL PD solution patients was skin rash.

Please see Package Insert for full Prescribing Information.

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