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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Formulary

FormularyPatient Discounts

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Adding plans allows you to:

  • View the formulary and any restrictions for each plan.
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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.