Collagenase

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Collagenase Brand Names

Santyl | Xiaflex

What is Collagenase

Collagenase enzymatically degrades collagen and is available as an injection and as a topical ointment.

The injectable product is approved for the treatment of Dupuytren’s contracture with a palpable cord as well as for the treatment of Peyronie’s disease with a palpable plaque and curvature deformity of at least 30 degrees at the start of therapy.

The topical product is approved for the chemical debridement of acute or chronic dermal ulcers and severely burned areas. Topical collagenase should only be used on wounds associated with necrotic material.

Published comparative data of collagenase and papain-urea-based products (i.e., Accuzyme, Panafil), which are the other commercially available chemical debridement agents in the United States, are minimal. Optimal wound management is very patient specific.

Removal of devitalized tissue is considered necessary for wound healing. Although chemical debridement is a slower process than sharp (surgical) debridement, patients who have contraindications to surgery, whose wounds contain a relatively small amount of eschar, or who have a wound base of eschar mixed with granulation tissue might benefit from enzyme application.

Topical collagenase may be used alone to break down the eschar, after sharp debridement, or in conjunction with mechanical debridement. Collagenase ointment was approved by the FDA in June 1965.

The FDA approved Xiaflex (collagenase clostridium histolyticum injection) in February 2010 for the treatment of Dupuytren’s contracture with a palpable cord. In December 2013, the FDA extended approval of Xiaflex to include treatment of Peyronie’s disease; Xiaflex is the first pharmaceutical approved for this indication.

Due to the possible risk of serious penile injury, Xiaflex for the treatment of Peyronie’s disease, will only be available through a restricted Risk Evaluation and Mitigation Strategy (REMS) program.

Indications

  1. burns
  2. decubitus ulcer
  3. diabetic foot ulcer
  4. Dupuytren’s contracture
  5. Peyronie’s disease
  6. varicose ulcer

For the treatment of severe partial- or full-thickness burns

Side Effects

  1. anaphylactic shock
  2. anaphylactoid reactions
  3. antibody formation
  4. bleeding
  5. corporal rupture
  6. dyspareunia
  7. dyspnea
  8. ecchymosis
  9. edema
  10. erythema
  11. hematoma
  12. impotence (erectile dysfunction)
  13. infection
  14. injection site reaction
  15. lymphadenopathy
  16. pelvic pain
  17. penile edema
  18. penile irritation
  19. penile pain
  20. peripheral edema
  21. pruritus
  22. rash
  23. skin discoloration
  24. skin irritation
  25. skin laceration
  26. tendon rupture
  27. urticaria

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • anticoagulant therapy
  • arteriosclerosis
  • bone marrow suppression
  • breast-feeding
  • children
  • coagulopathy
  • corporal rupture
  • diabetes mellitus
  • hemophilia
  • hyperglycemia
  • immunosuppression
  • infection
  • malnutrition
  • peripheral vascular disease
  • pregnancy
  • requires an experienced clinician
  • thrombocytopenia
  • vitamin K deficiency

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Anagrelide
  • Anticoagulants
  • Antithrombin III
  • Apixaban
  • Argatroban
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Betrixaban
  • Bivalirudin
  • Cilostazol
  • Clopidogrel
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Desirudin
  • Dipyridamole
  • Edoxaban
  • Enoxaparin
  • Eptifibatide
  • Fondaparinux
  • Heparin
  • Lepirudin
  • Pentosan
  • Platelet Inhibitors
  • Povidone-Iodine
  • Prasugrel
  • Rivaroxaban
  • Silver Nitrate
  • Silver Sulfadiazine
  • Ticagrelor
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Vorapaxar
  • Warfarin

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