Hyaluronidase

Hyaluronidase Brand Names

Amphadase | Hydase | Hylenex | Vitrase | Wydase

What is Hyaluronidase

Hyaluronidase is a parenteral enzyme that hydrolyzes hyaluronic acid in connective tissue allowing greater permeation of local tissues.

All hyaluronidase products are approved for use as adjunct therapy to increase the absorption and dispersion of other injected drugs, particularly local anesthetics; for use in hypodermoclysis rehydration, a method of subcutaneous fluid replacement; and for use as an adjunct in subcutaneous urography for improving resorption of radiopaque agents.

Beyond FDA-approved indications, hyaluronidase has been used as an adjunct to non-pharmacologic management of extravasation of certain drugs, as an adjunct to intravitreally injected anesthetics to enhance anesthetic effect, and as an aid to hasten intravitreal hemorrhage clearance; specialized knowledge and training are required for such uses.

Anaphylactic reactions have occurred rarely with hyaluronidase following intravenous administration; an intradermal test for hyaluronidase hypersensitivity can be performed before hyaluronidase administration.

Hyaluronidase was FDA-approved in 1950.

Indications

  1. diabetic retinopathy
  2. extravasation
  3. hypodermoclysis
  4. infiltration anesthesia
  5. local anesthesia
  6. ophthalmic anesthesia
  7. urography
  8. vitreous hemorrhage

Side Effects

  1. anaphylactoid reactions
  2. angioedema
  3. antibody formation
  4. edema
  5. erythema
  6. hypovolemia
  7. infection
  8. injection site reaction
  9. iritis
  10. ocular hemorrhage
  11. optic neuritis
  12. seizures
  13. skin irritation
  14. testicular atrophy
  15. urticaria

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • breast-feeding
  • children
  • extravasation
  • hyaluronidase hypersensitivity
  • hypervolemia
  • infants
  • infection
  • intravenous administration
  • ocular exposure
  • ocular surgery
  • pregnancy
  • viral infection

Interactions

  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Amide local anesthetics
  • Aminosalicylate sodium, Aminosalicylic acid
  • Articaine; Epinephrine
  • 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
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bupivacaine
  • Bupivacaine Liposomal
  • Bupivacaine; Lidocaine
  • Chloroprocaine
  • Choline Salicylate; Magnesium Salicylate
  • Cocaine
  • Conjugated Estrogens
  • Conjugated Estrogens; Bazedoxifene
  • Conjugated Estrogens; Medroxyprogesterone
  • Corticotropin, ACTH
  • Cortisone
  • Dienogest; Estradiol valerate
  • Diethylstilbestrol, DES
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Elagolix; Estradiol; Norethindrone acetate
  • Ester local anesthetics
  • Esterified Estrogens
  • Esterified Estrogens; Methyltestosterone
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Estradiol; Levonorgestrel
  • Estradiol; Norethindrone
  • Estradiol; Norgestimate
  • Estradiol; Progesterone
  • Estrogens
  • Estropipate
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Levobupivacaine
  • Lidocaine
  • Lidocaine; Prilocaine
  • Magnesium Salicylate
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Mestranol; Norethindrone
  • Prilocaine
  • Prilocaine; Epinephrine
  • Procaine
  • Ropivacaine
  • Salicylates
  • Salsalate
  • Sedating H1-blockers
  • Segesterone Acetate; Ethinyl Estradiol
  • Tetracaine
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