Hyaluronidase (Hyalase) Preparation and Concentration Guidelines
The recommended preparation for hyaluronidase is 150 USP units/mL, which can be diluted with normal saline according to the specific clinical application. 1
Standard Preparation and Concentration
Hyaluronidase is available as a sterile, clear, colorless solution that requires proper preparation for clinical use:
- Standard concentration: 150 USP units/mL 1
- Common dilution: 1-6 mL of 150 USP units/mL solution depending on application 2
- Typical dosing ratio: 1 mL of hyaluronidase solution for 1 mL of extravasated drug 2
Preparation Guidelines by Clinical Application
1. For Extravasation Management
- Concentration: 150 USP units/mL
- Volume: 1-6 mL depending on extravasation volume
- Administration: Inject through existing IV line or directly into affected area
- Timing: Administer as soon as possible after extravasation is detected 2
2. For Vascular Complications with Dermal Fillers
- High-dose protocol: 500 units in 10 mL normal saline (higher dilution)
- Administration: Pulsed dosing (repeated hourly until resolution)
- Monitoring: Assess for improvement in capillary refill, skin color, and pain 3, 4
3. For Enhancement of Local Anesthetic Effects
- Standard concentration: 150 USP units/mL
- Caution: When added to local anesthetics, hyaluronidase hastens onset but may increase systemic absorption 1, 5
- Incompatibility note: 2% lidocaine with 1:100,000 or 1:200,000 epinephrine is incompatible with hyaluronidase due to sodium metabisulfite 1
Important Clinical Considerations
Storage and Stability
- Hyaluronidase is rapidly degraded in the body, requiring adequate dosing and proximity to target tissue 6
- Follow manufacturer guidelines for storage of reconstituted solution
Drug Interactions and Incompatibilities
- Incompatible with: Furosemide, benzodiazepines, phenytoin, and lidocaine with epinephrine (containing sodium metabisulfite) 1
- Caution with: Dopamine and alpha agonist drugs 1
- Increased dosing may be required: When patients are receiving salicylates, cortisone, ACTH, estrogens, or antihistamines 1
Safety Precautions
- Allergic reactions: Occur in <0.1% of patients but can include urticaria, angioedema, and rarely anaphylaxis 1
- Skin testing: Consider skin testing before use due to risk of immediate hypersensitivity reactions 6
- Documentation: Each use of hyaluronidase should be properly documented, including patient information, date/time, drug concentration, and clinical response 2
Pediatric Considerations
- For pediatric patients, special care must be taken to avoid overhydration when hyaluronidase is used to facilitate subcutaneous fluid administration
- For premature infants or neonates, daily dosage should not exceed 25 mL/kg of body weight, with administration rate not exceeding 2 mL per minute 1
Hyaluronidase is an essential agent for managing complications related to hyaluronic acid fillers and drug extravasations, but proper preparation and administration are critical for safety and efficacy.