Orthovisc (Hyaluronic Acid) Syringe Injection

Antirheumatic, Orthopedics, Miscellaneous

OrthoVisc/Provisc/Synvisc Work

Hyaluronic acid is a naturally occurring glycosaminoglycan polysaccharide and is the chief component of the extracellular matrix.  Hyaluronic acid and its derivatives are highly anionic and attract water which results in volume expansion and structural support of soft tissues essentially functioning as a tissue and joint lubricant improving the modulating interaction between adjacent tissues.  When hyaluronic acid is used as an intra-articular injection increases the relative viscosity of synovial fluid in cartilage.  When administered as an intra-articular injection, the hyaluronic acid is cleared within several hours with half-lives ranging from 17 hours to 1.5 days.  The half-life is longer for purified and synthesized hyaluronic acid preparations with larger molecular weight.  Despite such as short half-life, the clinical benefit of hyaluronic acid in providing significant symptomatic pain can be long-lasting following an intra-articular hyaluronic acid injection.  More recently, studies have shown promising results in the treatment of tendinopathies which have been attributed to their anti-inflammatory activity, enhanced cell proliferation, collagen deposition besides the lubricating action on the sliding surface of the tendon.

Intra-articular use if officially indicated for the treatment of pain in osteoarthritis.  Various other indications for other formulations.

Do not use in patients with a known hypersensitivity to hyaluronic acid or any components of its formulation

Do not use in a pre-existing infection of the skin region of the intended injection site

Do not use in patients with a systemic bleeding disorder

Should only be administered by a medical professional trained in accepted injection techniques 

When administering by intra-articular injection, always refer to the manufacturer’s labelling for additional instructions on injection technique.

Injectable: According to the prescribed directions of a licensed medical doctor.

The following dosing recommendations are according to knee osteoarthritis:

Durolane: Inject 60 mg (3 mL) once.

Euflexxa: Inject 20 mg (2 mL) once weekly for 3 weeks (total of 3 injections).

Gel-One: Inject 30 mg (3 mL) once.

Gelsyn-3: Inject 16.8 mg (2 mL) once weekly for 3 weeks (total of 3 injections).

GenVisc 805, Supartz, Supartz FX: Inject 25 mg (2.5 mL) once weekly for 5 weeks (total of 5 injections); some patients may benefit from a total of 3 injections.

Hyalgan: Inject 20 mg (2 mL) once weekly for 5 weeks (total of 5 injections); some patients may benefit with a total of 3 injections.

Hymovis: Inject 24 mg (3 mL) once weekly for 2 weeks (total of 2 injections).

Monovisc: Inject 88 mg (4 mL) once.

Orthovisc: Inject 30 mg (2 mL) once weekly for 3 to 4 weeks (total of 3 to 4 injections).

Synvisc: Inject 16 mg (2 mL) once weekly for 3 weeks (total of 3 injections).

Synvisc-One: Inject 48 mg (6 mL) once.

Triluron: Inject 20 mg (2 mL) once weekly for 3 weeks (total of 3 injections).

TriVisc: Inject 25 mg (2.5 mL) once weekly for 3 weeks (total of 3 injections).

Visco-3: Inject 25 mg (2.5 mL) once weekly for 3 weeks (total of 3 injections).

Hyaluronate Derivative Injection: Should be injected only into a joint and never extra-articular or into the synovial capsule or tissues.  Do not use disinfectants containing ammonium salts for cleaning the injection site prior to administration.  Should only be administered by a trained medical doctor.   

Hyaluronate Derivative Should be Stored: Store this medication at 36°F to 77°F (2°C to 25°C) and away from heat, moisture, and light. Keep all medicine out of the reach of children. Throw away any unused medicine after the beyond use date. Do not flush unused medications or pour down a sink or drain.

The type of local reaction may vary from product to product and site to site:

>10%:

Central Nervous System: Headache (≤18%)

Dermatologic: Skin discoloration at injection site (4% to 78%), ecchymoses (≤14%), skin rash (≤14%)

Hematologic and Oncologic: Bruise (≤28%; more common in older patients)

Local: Swelling at injection site (3% to 98%), tenderness at injection site (17% to 95%), bruising at injection site (3% to 93%), erythema at injection site (≤93%), induration at injection site (6% to 92%), pain at injection site (≤92%), residual mass at injection site (3% to 90%), itching at injection site (7% to 47%), muscle rigidity at injection site (25%), hematoma at injection site (8% to 18%)

Neuromuscular and Skeletal: Arthralgia (1% to 25%), joint swelling (knee; ≤14%), joint effusion (≤11%)

Miscellaneous: Swelling (18% to 28%)