sodium hyaluronate (Rx)

Brand and Other Names:Amvisc, Hyalgan, more...Amvisc Plus, Euflexxa, Healon, Healon GV, Healon5, Supartz, Gelsyn-3, Durolane, TriVisc, Triluron
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intra-articular injection

  • 8.4mg/mL; 16.8mg/2mL syringe (Gelsyn-3)
  • 10mg/mL; 20mg/2mL syringe (Euflexxa, Hyalgan, Triluron)
  • 10mg/mL; 25mg/2.5mL syringe (Supartz, TriVisc)
  • 20mg/mL; 60mg/3mL syringe (Durolane)

intraocular injection solution

  • 1%; 10mg/mL (Healon)
  • 1.2%; 12mg/mL (Amvisc)
  • 1.4%; 14mg/mL (Healon GV)
  • 1.6%; 16mg/mL (Amvisc Plus)
  • 2.3%; 23mg/mL (Healon5)

Osteoarthritis of Knee

Indicated for treatment of pain in osteoarthritis of the knee

Administer by intra-articular injection into the affected knee(s)

Dose per knee

  • Durolane: Inject 60 mg (3 mL) as a one-time single dose
  • Euflexxa or Triluron: Inject 20 mg (2 mL) qWeek for 3 weeks
  • Gelysin-3: Inject 16.8 mg (2 mL) qWeek for 3 weeks
  • Hyalgan: Inject 20 mg (2 mL) qWeek for 3-5 weeks
  • Supartz: Inject 25 mg (2.5 mL) qWeek for 5 weeks
  • TriVisc: Inject 25 mg (2.5 mL) qWeek for 3 weeks

Dosing considerations

  • 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 into 1 knee only; if treatment is bilateral, a separate syringe should be used for each knee

Ophthalmic Viscoelastic Devices (OVDs)

Surgical aid to protect corneal endothelium during anterior segment and vitreous procedures (eg, cataract extraction, intraocular lens implantation, corneal transplant, glaucoma filtration, retinal attachment surgery)

Amvisc, Amvisc Plus, Healon, Healon GV, Healon5: Inject sufficient amount slowly (using cannula or needle) into anterior chamber or vitreous cavity of eye; some procedures/products require removal of the sodium hyaluronate following surgical completion

Safety and efficacy not established

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Adverse Effects

>10%

Intradermal Injection

  • Erythema (75-93%)
  • Swelling (91-03%)
  • Tenderness (61-92%)
  • Lumps/bumps (56-83$)
  • Discoloration (33-78%)
  • Pruritus (25-36%)

1-10%

Increased blood pressure (4%)

Fatigue (1%)

Pain at injection site (intra-articular) (3%)

Nausea (<2%)

Infection (1%)

Tendonitis (6%)

Limb pain (2%)

Parasthesia (1%)

Frequency Not Defined

Intra-articular injection

  • Arthralgia
  • Headache
  • Injection site pain
  • Anaphylactoid reaction

Intraocular administration

  • Increased IOP
  • Keratitis
  • Cystoid macular edema
  • Conjunctival hemorrhage
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Warnings

Contraindications

Intra-articular use

  • 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

Ophthalmic use

  • No known contraindications

Cautions

Intra-articular use

  • 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

Ophthalmic use

  • Use only if solution is clear
  • Monitor intraocular pressure
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Pregnancy & Lactation

Pregnancy Category: N/A

Lactation: Not known if excreted in breast milk; not recommended

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.

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Pharmacology

Mechanism of Action

Sodium hyaluronate and its derivatives form a viscoelastic solution in water suitable for aqueous and vitreous humor in ophthalmic surgery; works as a lubricant, which plays an important role in managing interactions between adjacent tissues

Protects sking against friction and abrassion in the management of wounds and ulcers

Pharmacokinetics

Distribution: Slow (intravitreous injection)

Excretion: Canal of Schlemm (ophthalmic)

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Images

BRAND FORM. UNIT PRICE PILL IMAGE
GenVisc 850 intra-articular
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10 mg/mL solution
Hyalgan intra-articular
-
10 mg/mL solution
EUFLEXXA intra-articular
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10 mg/mL(mw 2.4 -3.6 million) solution
ORTHOVISC intra-articular
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30 mg/2 mL solution
Gelsyn-3 intra-articular
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16.8 mg/2 mL solution

Copyright © 2010 First DataBank, Inc.

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Patient Handout

Patient Education
sodium hyaluronate intra-articular

HYALURONATE - INJECTION

(HYE-a-loo-RON-ate)

COMMON BRAND NAME(S): Hyalgan, Synvisc

USES: This medication is used to treat knee pain in patients with joint inflammation (osteoarthritis). It is usually used in patients who have not responded to other treatments such as acetaminophen, exercise, or physical therapy. Hyaluronate (also known as hyaluronan) is similar to a substance that occurs naturally in the joints. It may work by acting as a lubricant and shock absorber in the joint, helping the knee to move smoothly, thereby lessening pain.

HOW TO USE: Read the Patient Information Leaflet provided by your health care professional before you start using hyaluronate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Your doctor will give this medication by injection into the affected joint, usually once a week. Skin disinfectants that contain ammonium salts (such as benzalkonium chloride) should not be used to prepare the injection site. Your doctor may need to remove extra fluid from the joint before injecting the medicine. Dosage is based on your medical condition and response to treatment.Hyaluronate should not be injected into a vein or artery because increased side effects may occur.After receiving an injection of hyaluronate, you should avoid any activities that put stress on your knee (such as jogging, tennis, heavy lifting, standing on your feet for more than an hour) for 48 hours.Also, after the injection, you may experience increased pain and swelling in the knee at first. If the pain or swelling continues or worsens, talk to your doctor promptly.It is important to have this medication injected on schedule. It may take up to 3 injections before the full benefits of this medication occur.Tell your doctor if your condition persists or worsens.

SIDE EFFECTS: See also How to Use section.Pain, swelling, redness/warmth/bruising at the injection site, or headache may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: back pain, severe headache, fast/pounding heartbeat, fever, tingling skin.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using hyaluronate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. For some brands, also tell your doctor or pharmacist if you are allergic to bird proteins, feathers, or egg products. This product may contain inactive ingredients (such as latex found in the rubber syringe cap of some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: knee joint infections, skin infections/problems in the area around the injection site, circulation problems in the legs.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown whether this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Non-drug treatments for osteoarthritis include exercising, doing physical therapy, losing weight, having extra fluid removed from the knee, and avoiding activities that cause pain in your knee.

MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule.

STORAGE: Not applicable. This medication is given in a clinic and will not be stored at home.

Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
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  • Compare formulary status to other drugs in the same class.
  • Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

Tier Description
1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC NOT COVERED – Drugs that are not covered by the plan.
Code Definition
PA Prior Authorization
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL Quantity Limits
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST Step Therapy
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR Other Restrictions
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.