Hyaluronidase (1%) is a sterile, purified, lyophilized preparation of the enzyme hyaluronidase, derived from bovine testes. It is a spreading or diffusing agent that temporarily increases tissue permeability by hydrolyzing hyaluronic acid, a polysaccharide found in the intercellular ground substance of connective tissue. This action facilitates the absorption and dispersion of other injected drugs, increases the rate of absorption of parenteral fluids given by hypodermoclysis, and aids in the resorption of excess fluids and blood in tissues. In the Indian context, it is a critical adjunct in various ophthalmic, dermatological, and emergency procedures.
Adult: Highly variable based on indication. As an adjuvant: 15-150 IU (0.1-1 mL of 150 IU/mL solution) added to the injection solution or injected prior to the main drug. For hypodermoclysis: 150 IU added to 1 liter of clysis solution. For extravasation: 150-1500 IU injected subcutaneously in 5-6 sites around the extravasation area.
Note: For injection: Reconstitute the lyophilized powder with sterile normal saline or the diluent provided to achieve a 1% (150 IU/mL) solution. Use immediately. Administer via subcutaneous, intradermal, or subconjunctival routes. DO NOT ADMINISTER INTRAVENOUSLY. For hypodermoclysis, infuse into the subcutaneous tissue of the thigh, abdomen, or lateral chest wall.
Hyaluronidase is a hydrolytic enzyme that breaks down hyaluronic acid (HA) by cleaving the glucosaminidic bonds between C1 of the glucosamine moiety and C4 of glucuronic acid. HA is a key component of the extracellular matrix, providing viscosity and structural integrity. Its depolymerization reduces the viscosity of the interstitial barrier, decreasing tissue turgor and increasing permeability. This allows for enhanced diffusion of fluids, drugs, and contrast media through connective tissue.
Pregnancy: Category C: Animal reproduction studies have not been conducted. It is not known whether hyaluronidase can cause fetal harm when administered to a pregnant woman. Use only if the potential benefit justifies the potential risk to the fetus.
Driving: No effect expected. However, if used with sedatives or anesthetics, standard precautions apply.
| Local Anesthetics (Lidocaine, Bupivacaine) | Hyaluronidase increases the spread and absorption rate, potentially leading to faster onset but shorter duration of anesthesia. It may also increase systemic absorption and risk of toxicity. | Moderate |
| Salicylates (Aspirin), Cortisone, Estrogens, Antihistamines | These drugs may inhibit the spreading effect of hyaluronidase. | Moderate |
| Hyaluronic Acid Dermal Fillers (Restylane, Juvederm) | Hyaluronidase will rapidly degrade and dissolve hyaluronic acid fillers. This is a therapeutic interaction used for correction. | High |