Sodium hyaluronate/Hylan G-F 20
Hylan G-F 20 (Synvisc) Sodium hyaluronate (Hyalgan)
Sodium hyaluronate/Hylan G-F 20
( SO-dee-um high-ah- LUR-ah-nayt) Hyalgan Synvisc (Rx)

Classification: Hyaluronic acid derivative

Action/Kinetics: Hyaluronic acid occurs naturally in body tissues and fluids. It is secreted by cells in synovial membranes and, in healthy synovial joints, maintains viscosity of synovial fluid and supports lubricating and shock-absorbing properties of the cartilage. In osteoarthritis, synovial fluid is decreased in viscosity and elasticity. Sodium hyaluronate and hylan G-F 20 replace diseased synovial fluid. Following intra-articular use, hylan G-F 20 permeates cartilage and slowly moves through joint tissues; it then passes through the lymph system into systemic circulation. Hyaluronic acid is metabolized by hyaluronidase in synovium.

Uses: Treatment of pain in osteoarthritis of knee in those who have not responded adequately to conservative non-drug therapy and to acetaminophen.

Contraindications: Hypersensivity to hyaluronan. Use in infections or skin diseases in area of injection site or with skin disinfectants containing quaternary ammonium salts (drug may precipitate). Concomitant use with other intra-articular injectables.

Special Concerns: Safety and efficacy on intra-articular use in areas other than knee or use for conditions other than osteoarthritis have not been determined. Use with caution in severely inflamed knee joints, when lymphatic or venous stasis exists in treatment leg, during lactation, and in those allergic to avian proteins, feathers and egg products. Safety and efficacy may be altered by dilutional effects. Safety and efficacy have not been determined during pregnancy or in children.

Side Effects: Sodium hyaluronate (Hyalgan): Injection site pain, skin reaction (ecchymosis, rash), pruritus, headache. Rarely, anaphylaxis.
Hylan G-F 20 (Synvisc): Knee pain, swelling, thorax and back rash, pruritus, calf cramps, hemorrhoid problems, ankle edema, muscle pain, tonsillitis with nausea, tachyarrhythmia, phlebitis with varicosities, low back sprain.

How Supplied: Sodium Hyaluronate (Hyalgan): Injection: 10 mg/mL; Hylan G-F 20 (Synvisc): Injection: 8 mg/mL

Dosage
?Intra-articular injection Osteoarthritis of knee.
Hyalgan
2 mL once weekly for total of 5 injections using 20 gauge needle.
Synvisc
2 mL once weekly for total of 3 injections using 18-20 gauge needle. For both drugs, inject local anesthetic (e.g., lidocaine) SC prior to administration. Pain relief may not be noted until after last injection.