hyaluronidase

hye-al-yoor-ON-i-dase

Therapeutic Classification: antidotes

Pharmacologic Classification: enzymes

REMS

As adjuvant therapy to increase the dispersion and absorption of other injected drugs.
As adjuvant therapy in subcutaneous fluid administration for achieving hydration.

Unlabeled Use:

Extravasation management.

Enzymatically modifies the permeability of connective tissue through hydrolysis of hyaluronic acid. It increases the distribution/dispersion and absorption of locally injected or extravasated IV medications.

Therapeutic effects:

Decreased extravasation/infiltration of certain drugs.

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

(↓ in swelling associated with extravasation)

ROUTE	ONSET	PEAK	DURATION
SUBQ	15–30 min	unknown	24–48 hr

Contraindicated in:

Hypersensitivity;
Acutely inflamed area of injection;
Extravasation of vasoconstrictors (e.g., dopamine, norepinephrine).

Use Cautiously in:

OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding.

Local: injection site reactions

Drug-drug:

None reported.

To Increase Dispersion and Absorption of Injected Drugs

SUBQ (Adults and Children ): 50–300 units (usual dose: 150 units) either injected prior to drug administration or added to injection solution.

Subcutaneous Fluid Administration

SUBQ (Adults and Children ): 150 units followed by SUBQ isotonic fluid administration ≥1000 mL or may be added to small volumes (≤200 mL) of SUBQ replacement fluid.

Extravasation

Aminophylline, amiodarone, calcium solutions, nafcillin, parenteral nutrition/amino acid (4.25%), potassium solutions, sodium chloride (>1%), sodium bicarbonate, dextrose 10–<50%, or mannitol extravasation
SUBQ Intradermal (Adults and Children ): Inject a total of 1 mL (15 units/mL) as five separate 0.2-mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer through the infiltrated IV catheter; may repeat in 30–60 min if no resolution.
Contrast media extravasation
SUBQ Intradermal (Adults and Children ): Inject a total of 5–250 units (~100 mL contrast reabsorbed per 15 units of hyaluronidase) around the site of extravasation
Dextrose 50% extravasation
SUBQ Intradermal (Adults and Children ): Inject a total of 1 mL (15 units/mL) as five separate 0.2-mL injections (using a tuberculin syringe) administered along the leading edge of erythema.
Paclitaxel extravasation
SUBQ (Adults and Children ): If needle/cannula still in place: Administer 1–6 mL (150 units/mL) into existing IV line. Usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug; may repeat several times over the next 3–4 hr. If needle/cannula removed: Administer 1–6 mL (150 units/mL) in a clockwise manner around area of extravasation. Usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug; may repeat several times over the next 3–4 hr.
Vinca alkaloid extravasation
SUBQ (Adults and Children ): If needle/cannula still in place: After gently aspirating to remove extravasated vesicant, administer 1–6 mL hyaluronidase (150 units/mL) into existing IV line. Usual dose is 1 mL hyaluronidase for each 1 mL of extravasated drug. If needle/cannula removed: Inject 1–6 mL (150 units/mL) in a clockwise manner using 1 mL for every 1 mL of drug extravasated or administer 1 mL (150 units/mL) as five separate 0.2-mL injections into the extravasation site.

Solution for injection: 150 units/mL

Assess extravasation and nonextravasated site prior to, during, and after injection for skin integrity and therapy effectiveness. Do not inject into or near an infection to minimize spreading infection.
Monitor for enhanced adverse reactions of coadministered medications.
Monitor for hypersensitivity reaction during therapy. If reaction occurs, hold and treat as clinically indicated.

SUBQ: Subcutaneous Fluid Administration: Prior to clysis, insert needle so tip is free and movable between skin and muscle; fluid should start readily without pain or lump. Inject hyaluronidase into rubber tubing close to needle; alternately, inject under the skin prior to clysis. Subcutaneous Urography If IV contrast is not possible, particularly in infants or small children, place the patient in prone position and inject hyaluronidase SUBQ over each scapula, followed by injection of contrast medium to the same sites. ExtravasationMay be injected through existing needle/cannula at extravasation site. See Route/Dosage section for detailed instructions.

Explain purpose and side effects of medication.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Decreased extravasation/infiltration of certain drugs.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆