- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Injections of hyaluronidase
Enhance permeation of local anaesthetics
Enhance permeation of subcutaneous / intramuscular injections
Enhance permeation of subcutaneous infusions (hypodermoclysis)
Extravasation dispersal (when localisation is not indicated)
Promote reabsorption of excess fluids and blood in the tissues
Subcutaneous infusions (Hypodermoclysis)
1500 units dissolved in 1 ml water for injection or normal saline.
Inject into site before infusion is set up or inject into tubing of infusion set about 2 cm back from the needle at the start of infusion.
1500 units hyaluronidase allows administration of 500 to 1000 units of most fluids.
Subcutaneous / Intramuscular injections
1500 units dissolved directly into solution to be injected.
1500 units mixed directly with the quantity of local anaesthetic solution to be used.
Ophthalmology local anaesthetic
15 units of hyaluronidase per ml of local anaesthetic to be used.
(0.01 ml of the solution reconstituted in 1 ml of solvent = 15 unit)
Extravasation (Where dispersal rather than localisation is indicated)
1500 units in 1 ml of water for injection or normal saline infiltrated into affected area as soon as possible after extravasation noted.
1500 units in 1 ml of water for injection or normal saline infiltrated into affected area as soon as possible.
(See Dosage; Adult)
(See Dosage; Adult)
For subcutaneous injection and infusion or intramuscular injection.
Use immediately after reconstitution.
Precautions and Warnings
Administer reconstituted solution immediately
Do not administer at site where infection is present
Do not administer at site where malignancy is present
Do not mix with other drugs/substances unless compatibility known
Not to be used to reduce the swelling of bites or stings
Do not apply direct to cornea
Extravasation or haematoma: administer as soon as possible
Do not use in anaesthetic procedures in unexplained premature labour.
Hyaluronidase should not be used to enhance the absorption and dispersion of dopamine and/or alpha agonist drugs.
Pregnancy and Lactation
Avoid use during pregnancy unless safer alternative.
There is limited evidence at the time of writing on hyaluronidase's safety in pregnancy in humans or animals.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Use hyaluronidase with caution in breastfeeding.
At the time of writing it is not known whether hyaluronidase is secreted in breast milk, although it is unlikely to harm the breastfed infant.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Hypersensitivity reactions including anaphylaxis
Local infection at injection site
Oedema (associated with hypodermoclysis)
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: November 2014
Joint Formulary Committee. British National Formulary(online) London: BMJ Group and Pharmaceutical Press Accessed on 11 November 2014.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
Summary of Product Characteristics: Hyaluronidase 1500 I.U. Powder for Solution for Injection/Infusion. Wockhardt UK Ltd. Revised April 2014.
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