What is the recommended dosing for elective hyaluronidase (e.g. Vitrase (ovine testicular hyaluronidase) or Hylenex (recombinant human hyaluronidase)) administration in patients with a history of allergies or bleeding disorders?

Elective Hyaluronidase Dosing

For elective hyaluronidase administration, use 150 U as the standard dose for most applications, with dose adjustments based on the specific clinical indication: 50-300 U for enhancing drug dispersion, 1-6 mL of 150 U/mL solution (150-900 U total) for chemotherapy extravasation, and 7.2 IU when mixed with local anesthetics for dermatologic procedures. 1, 2

Standard Dosing by Clinical Indication

For Subcutaneous Fluid Administration

• Inject 150 U of hyaluronidase prior to starting subcutaneous fluid administration to facilitate absorption of up to 1,000 mL or more of solution 1
• This dose may be added to small volumes of replacement solutions or drug solutions for subcutaneous injection 1

For Enhancing Drug Dispersion and Absorption

• Use 50-300 U hyaluronidase, with 150 U being the most typical dose, either by pre-administration or by adding directly to the injection solution 1
• This applies to infiltration, interstitial, intramuscular, intraocular, retrobulbar, soft tissue, or subcutaneous use 1

For Chemotherapy Extravasation (Vinca Alkaloids)

• Inject 1-6 mL of 150 U/mL solution through the existing IV line 2
• The usual dose is 1 mL of hyaluronidase solution for every 1 mL of extravasated drug 2
• This provides 150-900 U total dose depending on volume of extravasation 2

For Dermatologic Surgery with Local Anesthesia

• Mix 7.2 IU of hyaluronidase with local anesthetic when used for skin surgeries 2
• However, the American Academy of Dermatology notes insufficient data to support routine use in dermatologic surgery, as benefits remain unclear 2

Critical Safety Considerations in Patients with Allergies

Absolute Contraindication: Bee Venom Allergy

• Do not administer hyaluronidase to patients with a history of bee sting allergy due to cross-reactivity between bee venom and hyaluronidase 2
• When allergy to hyaluronidase is in question, perform prick testing for confirmation before administration 2

General Hypersensitivity Precautions

• Aside from bee venom cross-reactivity, adverse events from hyaluronidase are rare, with hypersensitivity reactions being the primary concern 2
• The mixing of hyaluronidase with infiltrative anesthesia is safe as demonstrated by controlled trials 2

Administration in Patients with Bleeding Disorders

No Specific Contraindications Identified

• The available guideline evidence does not identify bleeding disorders as a contraindication to hyaluronidase use 2, 1
• Standard precautions for any injection in patients with bleeding disorders should apply, but hyaluronidase itself does not increase bleeding risk based on available evidence 2, 1

Route of Administration

Critical Administration Rule

• Never administer hyaluronidase intravenously—the enzyme is rapidly inactivated when given IV and will not produce the intended effects 1
• Approved routes include: subcutaneous, intramuscular, infiltration, interstitial, intraocular, peribulbar, retrobulbar, and soft tissue use 1

Technique for Subcutaneous Administration

• Lightly pinch the skin into a small mound and insert the needle/catheter into the subcutaneous space 1
• Inject hyaluronidase through the catheter hub or injection port closest to the needle/catheter 1
• Always use aseptic precautions and visually inspect for particulate matter and discoloration prior to administration 1

Special Populations

Pediatric Dosing for Subcutaneous Fluids

• For premature infants or neonates, daily dosage should not exceed 25 mL/kg and rate should not exceed 2 mL per minute 1
• The standard 150 U dose applies, but fluid volume and rate must be carefully controlled 1

Common Pitfalls to Avoid

• Do not confuse hyaluronidase dosing for aesthetic filler dissolution with elective therapeutic use—filler dissolution requires different, often higher doses (2.5-20 U per 0.2 mL of filler) than standard therapeutic applications 3, 4
• Do not administer to patients with bee venom allergy without prior allergy testing 2
• Do not give intravenously, as this route renders the enzyme ineffective 1
• Do not assume all clinical applications require the same dose—chemotherapy extravasation requires substantially higher total doses (150-900 U) compared to anesthetic adjunct use (7.2 IU) 2

budget:budget_used 10753 9500 1253 0.0418