Hyaluronidase

Indications

Hyaluronidase is used for: Hypodermoclysis, Facilitate SC/IM inj, Aid in dispersal of extravasated fluids or blood, Aid in diffusion of local anesthesia in ophthalmology

Adult Dose

Skin Test 0.02 (3 units) of 150 units/mL solution intredermally; a wheal with pseudopods appearing within 5 min and persisting for 20-30 min with itching will indicate positive hypersensitivity reaction Absorption/Dispersion of Injected Drugs Add 50-300 units (typically 150 units) to the injection solution Hypodermoclysis Amphadase/Hylenex: Inject 150 units prior to SC fluid administration; this will facilitate absorption of 1000 mL or more of solution Vitrase: Inject 200 units prior to SC fluid administration; this will facilitate absorption of 1000 mL or more of solution Adjunct Subcutaneous Urography Improves resorption of radiopaque agents; indicated when intravenous administration cannot be successfully accomplished, with the patient prone Inject 75 units SC over each scapula, followed by injection of the contrast medium at the same sites

Child Dose

Skin Test 0.02 (3 units) of 150 units/mL solution intradermally; a wheal with pseudopods appearing within 5 min and persisting for 20-30 min with itching will indicate positive hypersensitivity reaction Hypodermoclysis Children > 3 years: May be added to small volumes of solution (up to 200 mL), such as or solutions of drugs for SC injection Infants and children < 3 years: Volume of a single clysis should be limited to 200 mL For premature infants or during the neonatal period: Do not exceed a daily dosage of 25 mL/kg of body weight; rate of administration should not be greater than 2 mL/min Adjunct in Subcutaneous Urography Used when IV administration cannot be successfully accomplished, particularly in infants and small children, with the patient prone Inject 75 units SC over each scapula, followed by injection of the contrast medium at the same sites

Renal Dose

Administration

Contra Indications

Hypersensitivity, malignancy. Direct application to the cornea, reduction of swelling of bites or stings. Inj into or around infected area. IV admin; unexplained premature labour.

Precautions

Impaired renal function. Infants, elderly. Patients with infections. Pregnancy, lactation. Lactation: It is not known whether hyaluronidase is excreted in human milk; caution should be exercised

Pregnancy-Lactation

Pregnancy Human studies of hyaluronidase as an aid to conception and as an aid to delivery conducted without reports of maternal or fetal harm; non-human animal reproduction studies not conducted Hyaluronidase has been used as component to aid the in vitro fertilization of human eggs; administration of hyaluronidase during labor was reported to cause no complications; no increase in blood loss or differences in cervical trauma were observed Lactation There is no information regarding presence of drug in human milk, effects on breastfed infants, or on milk production to inform risk of drug to an infant during lactation; developmental and health benefits of breastfeeding should be considered, along with the mother’s clinical need for therapy, and any potential adverse effects on breastfed infant from drug

Interactions

Action potentiated by urokinase especially in the treatment of MI. May increase absorption and toxicity of local anaesthetics. Heparin, salicylates and NSAIDs may inhibit the spreading action and efficacy of hyaluronidase.

Adverse Effects

Side effects of Hyaluronidase : <1% Angioedema, urticaria, allergic reactions (<0.1%) Frequency Not Defined Edema, Local injection site reactions Potentially Fatal: Hypersensitivity and anaphylaxis.

Mechanism of Action

Hyaluronidase is an enzyme which reduces the viscosity of ground substance, thus making the tissues more permeable to injected fluids. It facilitates distribution and absorption of locally injected substances. It also promotes resorption of excess fluids and extravasated blood in the tissues.