Hyaluronidase Injection: Dosing and Usage Guidelines
For extravasation of vinca alkaloids, the recommended dose of hyaluronidase is 1-6 ml of 150 U/ml solution, with the typical dose being 1 ml of hyaluronidase solution for each 1 ml of extravasated drug. 1
Clinical Applications and Dosing
Extravasation Management
- Vinca alkaloid extravasation: 150 U/ml solution, 1 ml hyaluronidase per 1 ml of extravasated drug 1
- Inject through the existing IV line
- Efficacy demonstrated in preventing skin necrosis in clinical studies with 50-60% reduction in ulcer rate and up to 50% reduction in ulcer size 1
Dermatologic Surgery Applications
- Concentration: Typically 7.2 IU mixed with local anesthetic 1
- Purpose: Enhances diffusion of anesthetic solution and may reduce tissue distortion during infiltration 1
- Safety: Mixing hyaluronidase with infiltrative anesthesia has been demonstrated to be safe 1
Hypodermoclysis (Subcutaneous Fluid Administration)
- Adult dosing: 150 U per 500 ml of infusion fluid is effective and well-tolerated 2
- Pediatric dosing: Special considerations apply:
- Daily dosage should not exceed 25 ml/kg of body weight
- Rate of administration should not exceed 2 ml per minute 3
Filler Complication Management
- Used to dissolve hyaluronic acid-based dermal fillers 4
- Dosing varies based on area and amount of filler to be dissolved
Important Considerations
Contraindications
- Absolute contraindication: History of bee venom allergy due to cross-reactivity 1
- When allergy to hyaluronidase is suspected, prick testing may be used for confirmation 1
Pregnancy Considerations
- Pregnancy Category C 3
- Should be given to pregnant women only if clearly needed 3
- No evidence of teratogenicity in animal studies, but reduced fetal weight and increased resorptions were observed at very high doses 3
Nursing Considerations
- Unknown if excreted in human milk; caution advised 3
Mechanism of Action
- Depolymerizes hyaluronic acid in the extracellular matrix
- Increases tissue permeability and diffusion of injected substances 5
- Reduces viscosity of the interstitial barrier 6
Safety Profile
- Generally well-tolerated with few adverse effects 7
- Potential for allergic reactions (usually mild but can rarely cause anaphylaxis) 7
- Other adverse effects may include localized bruising and swelling 7
Clinical Pearls
- Hyaluronidase should not be administered intravenously (labeled "NOT FOR IV USE") 3
- For dermatologic procedures, there are insufficient data to support routine use, though it may help minimize tissue distortion 1
- When used for extravasation management, prompt administration improves outcomes
- Store refrigerated as indicated on product labeling 3
By understanding the appropriate dosing and applications of hyaluronidase, clinicians can effectively utilize this agent to prevent tissue damage from extravasation, enhance anesthetic diffusion, and manage complications from hyaluronic acid-based products.