sodium hyaluronate (Amvisc, Hyalgan, Amvisc Plus, Euflexxa, Healon, Healon GV, Healon5, AMO Vitrax, Nuflexxa, Supartz)
Classes: Ophthalmics, Other; Intra-Articular Agents; Rheumatologics, Other
Dosing and uses of Amvisc, Hyalgan (sodium hyaluronate)
Adult dosage forms and strengths
intra-articular injection
- 10mg/mL
- 15mg/mL
cream topicaL
- 0.2%
gel topicaL
- 0.2%
- 2.5%
transdermal gel injection
- 20mg/mL
intraocular injection solution
- 12mg/mL
- 16mg/mL
- 10mg/mL
Osteoarthritis of Knee
Indicated for treatment of pain in osteoarthritis of the knee
Administer by intra-articular injection into the affected knee(s)
Euflexxa: Inject 20 mg (2 mL) qWeek for 3 weeks
Hyalgan: Inject 20 mg (2 mL) qWeek for 3-5 weeks
Supartz: Inject 25 mg (2.5 mL) qWeek for 5 weeks
Other information
- Concomitant use of disinfectants containing quaternary ammonium salts (eg, benzalkonium chloride) for skin preparation can precipitate in presence of hyaluronic acid
- Use strict aseptic injection technique
- Inject the full contents of single syringe into 1 knee only; if treatment is bilateral, a separate syringe should be used for each knee
Ophthalmic Viscoelastic Devices (OVDs)
Surgical aid to protect corneal endothelium during anterior segment and vitreous procedures (eg, cataract extraction, intraocular lens implantation, corneal transplant, glaucoma filtration, retinal attachment surgery)
AMO Vitrax, Amvisc, Amvisc Plus, Healon, Healon GV, Healon5: Inject sufficient amount slowly (using cannula or needle) into anterior chamber or vitreous cavity of eye; some procedures/products require removal of the sodium hyaluronate following surgical completion
Skin Ulcers and Wounds
Cream: Apply a thin layer to wound or ulcer that have been cleaned and desinfected
Gel: Apply liberally once daily to ulcer cavity or wound and surrounding areas
Lip Augmentation
<21 years: Safety and efficacy not established
>21 years: 1.5 mL per lip (upper or lower) per treatment session
Pediatric dosage forms and strengths
Safety & efficacy not established
Amvisc, Hyalgan (sodium hyaluronate) adverse (side) effects
>10%
Intradermal Injection
- Erythema (75-93%)
- Swelling (91-03%)
- Tenderness (61-92%)
- Lumps/bumps (56-83$)
- Discoloration (33-78%)
- Pruritus (25-36%)
1-10%
Increased blood pressure (4%)
Fatigue (1%)
Pain at injection site (intra-articular) (3%)
Nausea (<2%)
Infection (1%)
Tendonitis (6%)
Limb pain (2%)
Parasthesia (1%)
Frequency not defined
Intra-articular injection
- Arthralgia
- Headache
- Injection site pain
- Anaphylactoid reaction
Intraocular administration
- Increased IOP
- Keratitis
- Cystoid macular edema
- Conjunctival hemorrhage
Warnings
Contraindications
Intra-articular use
- Hypersensitivity to hyaluronate preparations, avian-derived products (eg, eggs, feathers, poultry), gram-positive bacterial proteins
- Do not inject in knees with infection or skin diseases in area of injection site or joint
Ophthalmic use
- No known contraindications
Cautions
Intra-articular use
- Transient increased inflammation in injected knee may occur
- Avoid strenuous activity or prolonged (>1 hr) weight-bearing activities (eg, running, tennis) within 48 hr following injection
- Pain relief may not be evident until after 3rd injection
- Remove joint effusion, if present, before injection
Ophthalmic use
- Use only if solution is clear
- Monitor intraocular pressure
Pregnancy and lactation
Pregnancy category: N/A
Lactation: Not known if excreted in breast milk; not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Amvisc, Hyalgan (sodium hyaluronate)
Mechanism of action
Sodium hyaluronate and its derivatives form a viscoelastic solution in water suitable for aqueous and vitreous humor in ophthalmic surgery; works as a lubricant, which plays an important role in managing interactions between adjacent tissues
Protects sking against friction and abrassion in the management of wounds and ulcers
Pharmacokinetics
Distribution: Slow (intravitreous injection)
Excretion: Canal of Schlemm (ophthalmic)