Dextran 40

Mechanism-of-action classes: Osmotic Activity; Structural Macromolecules.

• LMD (dextran 40) is indicated for use in the adjunctive treatment of shock or impending shock due to hemorrhage, burns, surgery or other trauma. It is not indicated as a replacement for whole blood or blood components if they are available.

• LMD (dextran 40) is contraindicated in patients with known hypersensitivity to dextran, in those with marked hemostatic defects of all types (thrombocytopenia, hypofibrinogenemia, etc.) including those caused by drugs (heparin, warfarin, etc.), marked cardiac decompensation and in renal disease with severe oliguria or anuria.contraindicated

LMD (dextran 40) is administered by I.V. infusion only. Dextran 1 should be administered prior to administration of clinical dextran solutions. 1. In shock, it is suggested that total dosage not exceed 20 mL/kg for adults and adolescents, during the first 24 hours. The first 10 mL/kg may be infused as rapidly as necessary to effect improvement. It is strongly recommended that central venous pressure be monitored frequently during the initial infusion of the drug. Should therapy continue beyond 24 hours, subsequent dosage should not exceed 10 mL/kg per day and therapy should not continue beyond five days. 2. In extracorporeal perfusion, the dosage of LMD used will vary with the volume of the pump oxygenator. LMD can serve as a sole primer or as an additive to other priming fluids. For adults and adolescents, generally 10 to 20 mL of a 10% solution (1 to 2 g) of LMD per kilogram of body weight are added to the perfusion circuit. Usually total dosage should not exceed 2 g/kg of body weight. 3. In prophylaxis of venous thrombosis and thromboembolism, the dosage of LMD for adults and adolescents, should be chosen according to the risk of thromboembolic complications, e.g., type of surgery and duration of immobilization. In general, treatment should be initiated during surgery; 500 to 1,000 mL (approximately 10 mL/kg of body weight) should be administered on the day of operation.

Although infrequent, severe and fatal anaphylactoid reactions consisting of marked hypotension or cardiac and respiratory arrest have been reported, most of these reactions have occurred in patients not previously exposed to intravenous dextran and early in the infusion period. It is strongly recommended, therefore, that patients not previously exposed to dextran be observed closely during the first minutes of the infusion period. Anaphylactoid Reactions There have been rare reports of serious and life-threatening dextran-induced anaphylactoid reactions (DIAR) associated with Dextran 40 and Dextran 70 administration. To reduce the likelihood of DIAR, 20 mL dextran 1 should be administered prior to infusion of Dextran 40 or Dextran 70 consistent with the dextran 1 package insert. 1-5 See DOSAGE AND ADMINISTRATION . Investigators have reported a 35-fold decrease (from 1:2000 to 1:70,000) in the incidence of DIAR following prophylactic use of dextran 1. 6 However, serious and life-threatening reactions may still occur following initiation of an infusion of any clinical dextran (see ADVERSE REACTIONS ). Because of the seriousness of anaphylactoid reactions, it is recommended that the infusion of intravenous dextran be stopped at the first sign of an allergic reaction provided that other means of sustaining the circulation are available. Resuscitative measures should be readily available for emergency administration in the event such a reaction occurs. In circulatory collapse due to anaphylaxis, rapid volume substitutions with an agent other than dextran should be instituted.

Antigenicity of dextrans is directly related to their degree of branching. Since LMD (dextran 40) has a low degree of branching, it is relatively free of antigenic effect. However, a few individuals have experienced mild urticarial reactions. More severe reactions, consisting of severe anaphylactoid reaction, generalized urticaria, tightness of the chest, wheezing, hypotension, nausea and vomiting may occur in rare instances. Symptoms and signs of adverse systemic reaction may be relieved by parenteral administration of antihistamines, ephedrine or epinephrine, while other means of shock therapy are instituted. The route of administration and dosages of the therapeutic agent selected will depend upon the severity and rapidity of progression of the reaction. Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures, and save the remainder of the fluid for examination if deemed necessary (see WARNINGS for treatment of anaphylactic shock). Post Marketing Severe reactions have been observed with Dextran 40 and Dextran 70. Reported reactions include: generalized urticaria, nausea and vomiting, wheezing, hypotension, shock and cardiac arrest (dextran-induced anaphylactoid reactions, DIAR). FDA has received 94 reports of severe DIAR since 1964.

1. 1Pneumonia1217%
2. 2Central Nervous System Lesion1014%
3. 3Disease Progression913%
4. 4Endometriosis913%
5. 5Epilepsy913%
6. 6Hepatitis913%
7. 7Neutropenia913%
8. 8Palmar-plantar Erythrodysaesthesia Syndrome913%
9. 9Papillary Thyroid Cancer913%
10. 10Radiculopathy913%
11. 11Thoracic Vertebral Fracture913%
12. 12Breast Cancer811%
13. 13Metastases To Bone811%
14. 14Metastases To Central Nervous System811%
15. 15Metastases To Liver811%

Recent PubMed references pinned to Dextran 40 as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

• A PSMA-targeted dextran-based conjugate eradicates PSMA-overexpressing prostate tumors while abolishing cabazitaxel toxicity.
  Theranostics · 2026 · Yang L, Liu T, Huo M, et al.
  PMID 42244979DOI 10.7150/thno.124663
• Texture Engineering of Nondairy Yogurt Alternatives: Ingredient Selection, Processing Strategies, and the Role of In Situ Dextrans.
  Comprehensive reviews in food science and food safety · 2026 · Xu Y, Maina NH, Wang Y, et al.
  PMID 42212401DOI 10.1111/1541-4337.70517
• Butyrate improves dextran sulfate sodium-induced enterotoxicity in broilers.
  Molecular immunology · 2026 · Bai X, Li R, Quan T, et al.
  PMID 42190407DOI 10.1016/j.molimm.2026.04.017
• Hybrid dextran/fibronectin nanogels for brain-targeted mitophagy inducer delivery to alleviate neuroinflammation and neuronal loss of Parkinson's disease.
  Carbohydrate polymers · 2026 · Qin M, Sun H, Ji Y, et al.
  PMID 42173608DOI 10.1016/j.carbpol.2026.125410
• Rosmarinic acid-derived micelles potentiated dextran hydrogel for concurrent mechanical reinforcement and inflammatory microenvironment remodeling in chronic diabetic wound healing.
  Carbohydrate polymers · 2026 · Zhang H, Wang J, Hu H, et al.
  PMID 42173580DOI 10.1016/j.carbpol.2026.125375
• Comparative Analysis of Intravitreal Diffusion Patterns Across Ex Vivo Human and In Vivo/Ex Vivo Animal Models.
  Investigative ophthalmology & visual science · 2026 · Ayalon A, Beryozkin A, Davoli KA, et al.
  PMID 42159438DOI 10.1167/iovs.67.5.56
• Herbal micelles loaded oxidized dextran/gelatin hydrogel with enhanced antibacterial and microenvironment reconstruction capacity for MRSA-infected wound healing.
  International journal of biological macromolecules · 2026 · Liu F, Shi C, He S, et al.
  PMID 42155737DOI 10.1016/j.ijbiomac.2026.152595
• Study on HSA and Dex-40 Mitigating Osmotic Damage in NK Cells During CPA Loading.
  Macromolecular bioscience · 2026 · Lin X, Tang Z, Cui M, et al.
  PMID 42149568DOI 10.1002/mabi.70196

The 10 most recently updated of 23 ClinicalTrials.gov registrations naming Dextran 40 as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• Gastrodin Acupoint Injection for Sensorineural Hearing Loss With Vertigo
  Completed · Interventional · 100 enrolled · The First Hospital of Hebei Medical University
  NCT07283562updated 2025-12-16
• Mesenchymal Stromal Cells For Acute Respiratory Distress Syndrome
  Completed · Phase 2 · Interventional · 120 enrolled · Michael A. Matthay
  NCT03818854updated 2025-12-04
• E-CEL UVEC Cells as an Adjunct Cell Therapy for the Arthroscopic Rotator Cuff Repair in Adults
  Enrolling by invitation · Phase 1 · Interventional · 20 enrolled · Hospital for Special Surgery, New York
  NCT04057833updated 2025-11-26
• Feasibility Study of Personalized Ultra-fractionated Stereotactic Ablative Radiotherapy (PULSAR) for Cancers of the Central Lung
  Recruiting · Early phase 1 · Interventional · 30 enrolled · University of Texas Southwestern Medical Center
  NCT06712745updated 2025-11-10
• Efficacy of Treatment of Postpartum Anaemia With Intravenous Iron Versus Oral Iron in a Tertiary Hospital in South East, Nigeria.
  Completed · Phase 1 · Phase 2 · Interventional · 290 enrolled · Federal Teaching Hospital Abakaliki
  NCT07110935updated 2025-08-08
• Puberty, Diabetes, and the Kidneys, When Eustress Becomes Distress (PANTHER Study)
  Recruiting · Observational · 100 enrolled · Petter Bjornstad
  NCT05008276updated 2025-03-24
• Dextran 40 Plus Ringer's Lactate Vs. Ringer's Lactate Alone for Fluid Resuscitation in Acute Pancreatitis
  Recruiting · Interventional · 100 enrolled · Satu Mare County Emergency Hospital
  NCT06835023updated 2025-02-20
• Multiple Dosing of Mesenchymal Stromal Cells in Patients With ARDS (COVID-19)
  Completed · Phase 2 · Interventional · 8 enrolled · Masonic Cancer Center, University of Minnesota
  NCT04466098updated 2025-01-29
• Renal Hemodynamics, Energetics and Insulin Resistance: A Follow-up Study
  Enrolling by invitation · Observational · 100 enrolled · University of Colorado, Denver
  NCT05530356updated 2022-11-02
• Optical Imaging Measurement of Intravascular Solution Efficacy Trial
  Completed · Interventional · 23 enrolled · University Hospitals Cleveland Medical Center
  NCT01743872updated 2022-09-21

Frequently asked questions

How does Dextran 40 work?

Mechanism-of-action classes: Osmotic Activity; Structural Macromolecules.

What is Dextran 40 used for?

According to FDA labeling, Dextran 40 carries indications including: LMD (dextran 40) is indicated for use in the adjunctive treatment of shock or impending shock due to hemorrhage, burns, surgery or other trauma. It is not indicated as a replacement for whole blood or blood components if they are available.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Dextran 40?

Dextran 40 is classified as Plasma Volume Expander, Osmotic Activity, Structural Macromolecules, Decreased Blood Viscosity, Increased Intravascular Volume.

What are the contraindications for Dextran 40?

Dextran 40 labeling lists contraindications including: LMD (dextran 40) is contraindicated in patients with known hypersensitivity to dextran, in those with marked hemostatic defects of all types (thrombocytopenia, hypofibrinogenemia, etc.) including those caused by drugs (heparin, warfarin, etc.), marked cardiac decompensation and in renal disease with severe oliguria or anuria.. Always consult the full prescribing information and a clinician.