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Trade Names:
Amphadase
- Solution for injection 150 units/mL (bovine source)

Trade Names:
Vitrase
- Powder for injection, lyophilized 6,200 units (ovine source)
- Solution for injection 200 units/mL (ovine source)

Mechanism of Action

Pharmacology

Modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid, which temporarily decreases the viscosity of the cellular cement and promotes diffusion of injected fluids or of localized transudates, thus facilitating their absorption.

Indications and Usage

As an adjunct to increase the absorption and dispersion of other injected drugs; for hypodermoclysis; as an adjunct in subcutaneous urography for improving resorption of radiopaque agents.

Unlabeled Uses

Treatment of vitreous hemorrhage and diabetic retinopathy.

Contraindications

Standard considerations.

Dosage and Administration

Subcutaneous Add 50 to 300 units (typically 150 units) to the injection solution.

Subcutaneous 150 units will facilitate absorption of 1,000 mL or more of solution.

Subcutaneous May be added to small volumes of solution (up to 200 mL), such as a small clysis for infants or solutions of drugs for subcutaneous injection. For infants and children less than 3 yr old, the volume of a single clysis should be limited to 200 mL and in premature infants or during the neonatal period, the daily dosage should not exceed 25 mL/kg and the rate of administration should not exceed 2 mL/minute. For older patients, the rate and volume should not exceed those employed for IV infusion.

Subcutaneous When IV administration cannot be successfully accomplished, particularly in infants and small children, inject 75 units over each scapula followed by injection of the contrast medium at the same site.

General Advice

• Before administration of any other drug(s) in combination with hyaluronidase, ensure that references have been reviewed to determine usual precautions regarding use of the other drug(s) and compatibility with hyaluronidase.
• Do not administer if solution is cloudy, discolored, or contains particulate matter.

• Reconstitute powder for injection by adding 6.2 mL of sodium chloride injection to vial. Reconstituted solution provides 1,000 units hyaluronidase/mL.
• Further dilute reconstituted solution with sodium chloride solution before administration following dilution guidelines in package insert. Withdraw desired volume of reconstituted solution from vial using supplied 5 micron filter needle.

• Following manufacturer's guidelines, withdraw desired amount of hyaluronidase solution into syringe to obtain target hyaluronidase activity.

Storage/Stability

Store unopened vials of powder for injection in refrigerator (36° to 46°F) After reconstitution, store at controlled room temperature (68° to 77°F) and use within 6 hr. Protect from light. Store hyaluronidase solution in refrigerator (36° to 46°F). Protect from light. Do not freeze.

Drug Interactions

Because these agents may render tissues resistant to the action of hyaluronidase, larger amounts of hyaluronidase may be required for equivalent dispersing effect.

Benzodiazepines, furosemide, and phenytoin are incompatible with hyaluronidase.

Hastens onset of analgesia and tends to reduce swelling caused by local infiltration; however, the wider spread of the local anesthetic solution increases its absorption, shortening the duration of action and increasing the incidence of systemic reaction.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Dermatologic

Local injection site reactions.

Hypersensitivity

Anaphylaxis; angioedema; urticaria.

Miscellaneous

Edema.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

See Route/Dosage section.

Skin test

Preliminary skin test may be performed by an intradermal injection of approximately 0.02 mL (3 units) of a 150 units/mL solution.

Special considerations

Do not use hyaluronidase to enhance absorption and dispersion of dopamine or alpha agonist drugs; do not inject into or around an infected or acutely inflamed area (risk of spreading of localized infection may be increased); do not use to reduce swelling of bites or stings; do not apply directly to the cornea; do not administer IV.

Overdosage

Symptoms

Chills, dizziness, erythema, hypotension, local edema or urticaria, nausea, tachycardia, vomiting.

Patient Information

• Advise patient that medication will be prepared and administered in a health care setting by a health care provider.