hyaluronic acid and derivatives (Orthovisc, Synvisc, Synvisc-One, Monovisc, hyaluronan, hylan G-F 20)
Classes: Intra-Articular Agents; Rheumatologics, Other
Dosing and uses of Orthovisc, Synvisc (hyaluronic-acid-and-derivatives)
Adult dosage forms and strengths
intra-articular injection (prefilled syringe)
- 16mg/2mL (Synvisc)
- 30mg/2mL (Orthovisc)
- 48mg/6mL (Synvisc-One)
- 88mg/4mL (Monovisc)
Osteoarthritis of the Knee
Indicated for treatment of pain in osteoarthritis of the knee
Synvisc: Inject intra-articularly 16 mg (2 mL) to affected knee qWeek for 3 weeks
Synvisc-One: Inject intra-articularly 48 mg (6 mL) to affected knee once as a single injection
Orthovisc: Inject intr-articularly 30 mg (2 mL) to affected knee qWeek for 3 weeks
Monovisc: Inject intra-articularly 88 mg (4 mL) to affected knee once as a single injection
Administration
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 intra-articularly into 1 knee only; if treatment is bilateral, a separate syringe should be used for each knee
Pediatric dosage forms and strengths
Safety and efficacy not established
Orthovisc, Synvisc (hyaluronic-acid-and-derivatives) adverse (side) effects
>10%
Arthralgia (25%)
Tenderness (61-92%)
Swelling (81-91%)
Firmness (88-89%)
Bruising (52-87%)
Pruritus (25-36%)
Skin discoloration (33-78%)
Firmness (86-89%)
Lumps/bumps (56-83%)
1-10%
Increased blood pressure (4%)
Fatigue (1%)
Nausea (<2%)
Injection site pain (3%)
Paresthesia (1%)
Tendonitis (2%)
Limb pain (1%)
Tendonitis (2%)
Joint effusion (2%)
<1%
Angioedema
Arthritis
Herpetic eruptions
Thrombocytopenia
Peripheral edema
Vasovagal reaction
Hives
Gait disturbances
Warnings
Contraindications
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
Cautions
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
Not for injection intra-articular into synovium
Pregnancy and lactation
Pregnancy category: Not tested in pregnant women
Lactation: Unknown whether distributed in breast milk, caution advised
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 Orthovisc, Synvisc (hyaluronic-acid-and-derivatives)
Mechanism of action
When injected intra-arterially, supplements joint cushioning to temporarily provide pain relief caused by osteoarthritis
High molecular weight polysaccharide composed of repeating disaccharide units of sodium glucuronate and N-acetylglucosamine; derived from bacterial cells
