From the Research
Hyaluronidase should be administered as soon as possible, ideally within 1 hour after amiodarone extravasation, as seen in a case where recombinant human hyaluronidase was used to treat contrast extravasation with marked improvement observed 4 hours later 1. The recommended approach is to inject 150-200 units of hyaluronidase diluted in 1-3 mL of normal saline subcutaneously around the extravasation site using a 25-27 gauge needle.
- Multiple small injections (0.1-0.2 mL each) should be administered in a clockwise manner around the periphery of the affected area.
- Hyaluronidase works by temporarily breaking down hyaluronic acid in the extracellular matrix, which increases tissue permeability and promotes diffusion of the extravasated amiodarone. This helps prevent tissue necrosis by reducing the local concentration of the vesicant drug. Amiodarone is particularly concerning when extravasated due to its high pH and presence of polysorbate 80, which can cause severe tissue damage. While administering hyaluronidase, other supportive measures should include stopping the infusion immediately, elevating the affected limb, and applying dry warm compresses to promote vasodilation and drug absorption. The use of hyaluronidase in such cases is supported by its properties and applications, as outlined in a review of its properties, applications, and side effects 2. Additionally, studies have shown the efficacy of hyaluronidase in preventing tissue injury from extravasation of other drugs, such as nafcillin 3 and doxorubicin 4, and its use in managing contrast media extravasation 1 and as an adjunct in subcutaneous procedures 5. However, it's crucial to note that hyaluronidase is rapidly degraded and deactivated in the body, and its effectiveness may depend on the timing and method of administration, as well as the specific characteristics of the extravasated substance 2. Given the potential for severe tissue damage from amiodarone extravasation, prompt administration of hyaluronidase is essential to minimize morbidity and improve patient outcomes.