From the FDA Drug Label
Hyaluronidase is a dispersion agent, which modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid, a polysaccharide found in the intercellular ground substance of connective tissue, and of certain specialized tissues, such as the umbilical cord and vitreous humor Hyaluronidase hydrolyzes hyaluronic acid by splitting the glucosaminidic bond between C1 of an N-acetylglucosamine moiety and C4 of a glucuronic acid moiety This temporarily decreases the viscosity of the cellular cement and promotes dispersion of injected fluids or of localized transudates or exudates, thus facilitating their absorption.
Hyaluronidase works by breaking down hyaluronic acid in the connective tissue, which allows for the dispersion and absorption of injected fluids or localized transudates or exudates. In the context of amiodarone extravasation, hyaluronidase can help to facilitate the absorption of the extravasated drug. However, if a patient refuses hyaluronidase, it is not absolutely necessary, as the decision to use hyaluronidase should be based on a clinical evaluation of the individual patient's situation 1. Key considerations include:
- The severity of the extravasation
- The potential benefits and risks of hyaluronidase treatment
- The patient's overall medical condition and history.
From the Research
Hyaluronidase is not absolutely necessary for amiodarone extravasation if a patient refuses, and its use is not routinely recommended for this specific condition. Hyaluronidase works by temporarily breaking down hyaluronic acid in connective tissue, which increases tissue permeability and helps disperse extravasated medications 2. However, for amiodarone extravasation specifically, standard management includes stopping the infusion immediately, elevating the affected limb, applying dry warm compresses, and monitoring the site. Amiodarone is a vesicant that can cause tissue damage, but there is limited evidence supporting hyaluronidase use specifically for amiodarone extravasations.
Some studies have shown the effectiveness of hyaluronidase in managing extravasation injuries, such as the one reported in 3, where recombinant human hyaluronidase was used to treat contrast media extravasation. However, these findings may not be directly applicable to amiodarone extravasation. Other studies, like 4 and 5, have explored the use of hyaluronidase in preventing skin injury associated with extravasations, but again, the context is different from amiodarone extravasation.
If a patient refuses hyaluronidase, focus on the other management strategies:
- Discontinue the infusion
- Document the event
- Elevate the extremity
- Apply warm compresses
- Provide pain management as needed Close monitoring of the site for signs of tissue necrosis, compartment syndrome, or infection is essential. In severe cases with significant tissue damage, surgical consultation may be necessary regardless of whether hyaluronidase was administered. It's also important to note that hyaluronidase can have side effects, including allergic reactions, as mentioned in 2 and 6.
Given the most recent and highest quality evidence, such as the review in 6, which discusses the various uses of hyaluronidase in plastic surgery, including the treatment of extravasation injury, but also highlights its limitations and potential risks, the decision to use hyaluronidase in amiodarone extravasation should be made on a case-by-case basis, considering the potential benefits and risks.