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Clinical Overview
Brand Name
hylenex recombinant
Generic Name
Hyaluronidase human injection
Therapeutic Class
Tissue Permeability Modifier
Pharmacology
Hyaluronidase is a spreading or diffusing enzyme that increases the permeability of connective tissue through the hydrolysis of hyaluronan (hyaluronic acid), a polysaccharide found in the intercellular matrix of connective tissue. Hyaluronan acts as a barrier to drug and fluid dispersion. Hyaluronidase hydrolyzes hyaluronan by splitting the glucosaminidic bond between C1 of an N-acetylglucosamine moiety and C4 of a glucuronic acid moiety. The hydrolysis of hyaluronan temporarily decreases the viscosity of the intercellular matrix and promotes diffusion of injected fluids or of localized transudates or exudates.1
Hyaluronidase increases dispersion in the interstitial matrix provided local pressure is adequate to furnish the necessary mechanical impulse. Such impulse is normally initiated by injected solutions. The rate of diffusion is proportionate to the amount of enzyme. The extent of diffusion is proportionate to the volume of solution.1
At 24 hours, the restoration of the hyaluronan barrier is incomplete and inversely related to the dosage of the enzyme. At 48 hours, the barrier is completely restored.1
1hylenex recombinant (hyaluronidase human injection) [Prescribing Information]. Deerfield, IL: Baxter Healthcare Corporation.
Important Risk Information for Healthcare Professionals
Indications
HYLENEX recombinant (hyaluronidase human injection) is indicated as an adjuvant to increase the absorption and dispersion of other injected drugs; for subcutaneous fluid administration; and as an adjunct in subcutaneous urography for improving resorption of radiopaque agents.
Important Risk Information
- Hypersensitivity to hyaluronidase or any other ingredient in the formulation is a contraindication to the use of this product.
- Discontinue HYLENEX recombinant (hyaluronidase human injection) if sensitization occurs.
- Hyaluronidase should not be used to enhance the absorption and dispersion of dopamine and/or alpha agonist drugs.
- Hyaluronidase should not be injected into or around an infected or acutely inflamed area because of the danger of spreading a localized infection.
- Hyaluronidase should not be used to reduce the swelling of bites or stings.
- Hyaluronidase should not be applied directly to the cornea.
- Hyaluronidase should not be used for intravenous injections because the enzyme is rapidly inactivated.
- Furosemide, the benzodiazepines and phenytoin have been found to be incompatible with hyaluronidase.
- The most frequently reported adverse experiences have been mild local injection site reactions, such as erythema and pain.
- Hyaluronidase has been reported to enhance the adverse events associated with co-administered drug products.
- Allergic reactions (urticaria or angioedema) have been reported in less than 0.1% of patients receiving hyaluronidase.
- Anaphylactic-like reactions following retrobulbar block or intravenous injections have occurred, rarely.
- When hyaluronidase is added to a local anesthetic agent, it hastens the onset of analgesia and tends to reduce the swelling caused by local infiltration, but the wider spread of the local anesthetic solution increases its absorption; this shortens its duration of action and tends to increase the incidence of systemic reaction.
- Edema has been reported most frequently in association with subcutaneous fluid administration.
- The rate and volume of subcutaneous fluid administration should not exceed those employed for intravenous infusion. As with all parenteral fluid therapy, use the same precautions for restoring fluid and electrolyte balance.
- During subcutaneous fluid administration, special care must be taken in pediatric patients to avoid over hydration by controlling the rate and total volume of the infusion.
- When solutions devoid of inorganic electrolytes are given subcutaneously, hypovolemia may occur.
