What are the guidelines for preparing and administering Hyalase (Hyaluronidase) 1500 international units (iu)?

Hyaluronidase 1500 IU Preparation and Administration Guidelines

Hyaluronidase 1500 IU should be prepared as a solution with a concentration of 150 USP units/mL, requiring 10 mL of diluent for reconstitution, and administered according to the specific clinical indication with appropriate monitoring for hypersensitivity reactions. 1

Preparation Instructions

Reconstitution

• Use 10 mL of appropriate diluent (sterile water or normal saline) to reconstitute 1500 IU of hyaluronidase powder to achieve the standard concentration of 150 USP units/mL 1
• Ensure complete dissolution by gently swirling the vial (avoid shaking to prevent protein denaturation)
• The reconstituted solution should be clear and colorless
• The solution should be used immediately after reconstitution for optimal efficacy

Storage Considerations

• Store unopened vials in a refrigerator at 2°C to 8°C (36°F to 46°F) 1
• DO NOT FREEZE the product
• Discard any unused portion of reconstituted solution as it contains no preservatives

Administration Guidelines

Dosing by Clinical Indication

1. For dispersion and absorption of other injected drugs:

   • Pre-administer hyaluronidase or add 50-300 units (most typically 150 USP units) to the injection solution 1
   • Can be used for infiltration, interstitial, intramuscular, intraocular, retrobulbar, soft tissue, or subcutaneous administration

2. For subcutaneous fluid administration (hypodermoclysis):

   • Add 150 USP units to each 1000 mL of solution
   • For pediatric patients: Daily dosage should not exceed 25 mL/kg of body weight 2
   • Administration rate should not exceed 2 mL per minute in pediatric patients

3. For extravasation management:

   • Typical dosing ratio is 1 mL of hyaluronidase solution (150 USP units/mL) for 1 mL of extravasated drug 2
   • Administer through existing IV line or directly into affected area as soon as possible

Administration Techniques

• Inject hyaluronidase before the medication or mixed with it depending on clinical indication
• For hypodermoclysis, volumes up to 3000 mL have been safely delivered over 24 hours 3
• For subcutaneous urography: With patient prone, inject 75 USP units subcutaneously over each scapula, followed by contrast medium at the same sites 1

Monitoring and Precautions

Contraindications

• Known hypersensitivity to hyaluronidase or any excipients 1
• Do not inject into or around infected or acutely inflamed areas 1
• Do not use to reduce swelling of bites or stings 1
• Do not apply directly to the cornea 1

Drug Interactions and Incompatibilities

• Incompatible with: Furosemide, benzodiazepines, phenytoin 1
• Incompatible with 2% lidocaine containing 1:100,000 or 1:200,000 epinephrine due to sodium metabisulfite 1
• Do not use to enhance absorption of dopamine or alpha agonist drugs 1

Special Patient Considerations

• Patients on certain medications: Those receiving large doses of salicylates, cortisone, ACTH, estrogens, or antihistamines may require larger amounts of hyaluronidase for equivalent effect 1
• Allergy considerations: Cross-reactivity exists between bee venom and hyaluronidase; do not administer to patients with history of bee sting allergy 3
• Pediatric use: Monitor carefully to avoid overhydration, especially in premature infants or neonates 1

Adverse Reactions

• Most common: Mild local injection site reactions (erythema and pain) 1
• Allergic reactions (urticaria or angioedema) reported in less than 0.1% of patients 1
• Anaphylactic-like reactions following retrobulbar block or intravenous injections have occurred rarely 1

Documentation Requirements

• Patient information
• Date and time of administration
• Drug concentration used
• Clinical response to treatment
• Any adverse reactions observed 2

By following these guidelines, healthcare providers can safely and effectively prepare and administer hyaluronidase 1500 IU for various clinical indications while minimizing the risk of adverse events.