Hyaluronidase Administration Guidelines
Introduction to Hyaluronidase Administration
- For hypodermoclysis, volumes up to 3000 mL have been safely delivered over 24 hours, according to the Clinical Nutrition guideline 1
- The American Society of Clinical Oncology recommends a common dilution of 1-6 mL of 150 USP units/mL hyaluronidase solution depending on the application, with a typical dosing ratio of 1 mL of hyaluronidase solution for 1 mL of extravasated drug, and administration should be through an existing IV line or directly into the affected area as soon as possible after extravasation is detected 2
Contraindications and Allergy Considerations
- Cross-reactivity exists between bee venom and hyaluronidase; therefore, the American Academy of Dermatology recommends that hyaluronidase should not be administered to patients with a history of bee sting allergy 3
- Allergic reactions, including urticaria or angioedema, occur in less than 0.1% of patients 2
Pediatric Use
- Pediatric patients, especially premature infants or neonates, require special care to avoid overhydration when hyaluronidase is used, with daily dosage not exceeding 25 mL/kg of body weight and administration rate not exceeding 2 mL per minute 2
- Monitoring of pediatric patients is crucial to avoid overhydration, especially in premature infants or neonates 2
Administration and Monitoring
- Administration of hyaluronidase should be done with caution, and monitoring should assess for improvement in capillary refill, skin color, and pain 2
- Documentation of each use of hyaluronidase is crucial, including patient information, date/time, drug concentration, and clinical response, as recommended by clinical guidelines 2
Dosing Considerations
- For patients receiving certain medications, such as salicylates, cortisone, ACTH, estrogens, or antihistamines, increased dosing of hyaluronidase may be required 2
- The administration rate and dosage of hyaluronidase may need to be adjusted based on individual patient needs and response to treatment 2
Incompatibilities
- Hyaluronidase is incompatible with furosemide, benzodiazepines, and phenytoin, although the exact recommendation is not provided with a citation