To reduce possible discomfort during administration, solutions may be warmed prior to use. (See DOSAGE AND ADMINISTRATION, Directions for Use).

EXTRANEAL should be administered over a period of 10-20 minutes at a rate that is comfortable for the patient.

Do not use EXTRANEAL if it is cloudy or discolored, if it contains particulate matter, or if the container is leaky.

Following use, the drained fluid should be inspected for the presence of fibrin or cloudiness, which may indicate the presence of peritonitis.

For single use only. Discard unused portion.

Addition of Potassium
Potassium is omitted from EXTRANEAL solutions because dialysis may be performed to correct hyperkalemia. In situations where there is a normal serum potassium level or hypokalemia, the addition of potassium chloride (up to a concentration of 4 mEq/L) may be indicated to prevent severe hypokalemia. The decision to add potassium chloride should be made by the physician after careful eva luation of serum potassium.

Addition of Insulin
Addition of insulin to EXTRANEAL was eva luated in 6 insulin-dependent diabetic patients undergoing CAPD for end stage renal disease. No interference of EXTRANEAL with insulin absorption from the peritoneal cavity or with insulin’s ability to control blood glucose was observed. (See PRECAUTIONS, Drug/Laboratory Test Interactions). Appropriate monitoring of blood glucose should be performed when initiating EXTRANEAL in diabetic patients and insulin dosage adjusted if needed (See PRECAUTIONS).

Addition of Heparin
No human drug interaction studies with heparin were conducted. In vitro studies demonstrated no evidence of incompatibility of heparin with EXTRANEAL.

Addition of Antibiotics
No formal clinical drug interaction studies have been performed. In vitro compatibility studies with EXTRANEAL (icodextrin) and the following antibiotics have demonstrated no effects with regard to minimum inhibitory concentration (MIC): vancomycin, cefazolin, ampicillin, ampicillin/flucoxacillin, ceftazidime, gentamicin, and amphotericin. However, aminoglycosides should not be mixed with penicillins due to chemical incompatibility.

Patients undergoing peritoneal dialysis should be under careful supervision of a physician experienced in the treatment of end-stage renal disease with peritoneal dialysis. It is recommended that patients being placed on peritoneal dialysis should be appropriately trained in a program that is under supervision of a physician.

Directions for Use
For complete CAPD and APD system preparation, see directions accompanying ancillary equipment.

Aseptic technique should be used.

Warming
For patient comfort, EXTRANEAL can be warmed to 37°C (98°F). Only dry heat should be used. It is best to warm solutions within the overwrap using a heating pad. Do not immerse EXTRANEAL in water for warming. Do not use a microwave oven to warm EXTRANEAL. Heating above 40°C (104°F) may be detrimental to the solution.

To Open
To open, tear the overwrap down at the slit and remove the solution container. Some opacity of the plastic, due to moisture absorption during the sterilization process, may be observed. This does not affect the solution quality or safety and may often leave a slight amount of moisture within the overwrap.

Inspect for Container Integrity
Inspect the container for signs of leakage and