Hyaluronic Acid and Derivatives

Hyaluronic Acid and Derivatives are prescription medications used to treat the symptoms of knee pain in patients with joint inflammation (Orthovisc, Synvisc, Synvisc-One, MonoviscOrthovisc, Synvisc, Synvisc-One, MonoviscOrthovisc, Synvisc, Synvisc-One, Monovisc).

• Hyaluronic Acid and Derivatives are available under the following different brand names: Orthovisc, Synvisc, Synvisc-One, Monovisc, hyaluronan, Hylan G-F 20, Hymovis, GenVisc 850, Supartz FX, Visco-3

Adult dosage

 Intra-Articular Injection (Prefilled Syringe)

• 16mg/2mL (Synvisc)
• 30mg/2mL (Orthovisc)
• 48mg/6mL (Synvisc-One)
• 88mg/4mL (Monovisc)
• 24mg/3mL (Hymovis)
• 25mg/2.5mL (GenVisc 850)
• 25mg/2.5mL (Supartz FX)
• 25mg/2.5mL (Visco-3)

Osteoarthritis of the Knee

Adult dosage

• Synvisc: Inject intra-articularly 16 mg (2 mL) to the affected knee once a week for 3 weeks
• Synvisc-One: Inject intra-articularly 48 mg (6 mL) to the affected knee once as a single injection
• Orthovisc: Inject intr-articularly 30 mg (2 mL) to the affected knee once a week for 3 weeks
• Monovisc: Inject intra-articularly 88 mg (4 mL) to the affected knee once as a single injection
• Supartz FX, GenVisc 850: Inject 25 mg (2.5 mL) once weekly for 5 weeks; 5 injections total; some patients may benefit from a total of 3 injections
• Hymovis: Inject 24 mg (3 mL) once weekly for 2 weeks (2 injections total)
• Visco-3: Inject 25 mg (2.5 mL) once weekly for 3 weeks (3 injections total)

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Hyaluronic Acid and Derivatives include:

• injection site reactions (pain, swelling, redness, warmth, bruising, stiffness, or puffiness),
• muscle pain,
• trouble walking,
• fever,
• chills,
• nausea,
• prickly feeling in your skin,
• headache,
• dizziness, and
• itching or skin irritation around the knee

Serious side effects of Hyaluronic Acid and Derivatives include:

• severe headache,
• severe pain
• swelling around the knee
• fast or pounding heartbeat, or
• fever.

Rare side effects of Hyaluronic Acid and Derivatives include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Hyaluronic Acid and Derivatives have no noted serious interactions with any other drugs.
• Hyaluronic Acid and Derivatives have no noted severe interactions with any other drugs.
• Hyaluronic Acid and Derivatives have no noted moderate interactions with any other drugs.
• Hyaluronic Acid and Derivatives have no noted minor interactions with any other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications 

• Hypersensitivity to hyaluronate preparations and components
• Knee joint infections or infections or skin diseases at the site of the injection
• Hypersensitivity to gram-positive bacterial proteins (Hymovis, Monovisc); systemic bleeding (Monovisc)

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Hyaluronic Acid and Derivatives?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Hyaluronic Acid and Derivatives?”

Cautions

• Avoid strenuous activity or prolonged (more than an hour) weight-bearing activities (e.g, running, tennis) within 48 hours following injection
• Pain relief may not be evident until after 3rd injection
• Disinfectants containing quaternary ammonium salts should not be used for skin preparation (may cause precipitation of hyaluronate)
• Not to be administered intravascularly, extra-articularly, or for injecting into the synovium
• Remove synovial fluid or effusion, if present before injection
• Not for use in cases of severe intra-articular effusion
• If venous or lymphatic stasis is present in the leg, use with caution
• Patients with inflammatory arthritis may experience transient increases in reddening or inflammation, pain, and the sensation of heat after injection into the knee
• Some products are produced from avian sources; use caution in patients with hypersensitivity to avian proteins, egg products, or feathers
• To be administered by an experienced healthcare provider with appropriate experience, training, knowledge of anatomy at the injection site, and aseptic technique

Pregnancy & Lactation

• Not tested in pregnant women
• Lactation: 
  • Unknown whether distributed in breast milk, caution advised