Usage
- Sodium hyaluronate is used to treat pain caused by osteoarthritis of the knee, particularly in patients who haven’t responded well to other treatments like exercise, physical therapy, or simple pain relievers. It is also used as a surgical aid in ophthalmic procedures to protect the corneal endothelium during anterior segment and vitreous procedures (e.g., cataract extraction, intraocular lens implantation, corneal transplant, glaucoma filtration, and retinal attachment surgery). Additionally, it is used for the treatment of dry eye disease.
- Pharmacological classification: Viscosupplement, ophthalmic viscosurgical device, ophthalmic lubricant.
- Mechanism of action: Sodium hyaluronate acts as a lubricant and shock absorber in the joint. It is similar to a substance that occurs naturally in the synovial fluid of joints. It helps restore the viscoelastic properties of the synovial fluid and provides temporary pain relief, enabling greater joint mobility. It also helps maintain the shape of the eye during surgery and helps to retain moisture on the ocular surface for dry eye disease.
Alternate Names
How It Works
- Pharmacodynamics: Sodium hyaluronate integrates into the synovial fluid, increasing its viscosity and elasticity, improving joint lubrication, and reducing pain. In ophthalmic surgery, it maintains the shape of the eye, protects the corneal endothelium, and facilitates surgical maneuvers. For dry eye, it adheres to the ocular surface to help retain moisture and lubricate the eye, relieving the symptoms of dryness.
- Pharmacokinetics (for intra-articular injection): When injected into the knee joint, sodium hyaluronate is slowly absorbed into the surrounding tissues. It undergoes enzymatic degradation and is eventually eliminated primarily through hepatic pathways. A small portion might be excreted renally. Information about the pharmacokinetics of ophthalmic administration is limited. Topical administration of sodium hyaluronate for other conditions is not associated with significant systemic absorption.
Dosage
Standard Dosage
Adults:
- Osteoarthritis of the knee: 20 mg (2 mL) by intra-articular injection into the affected knee once weekly for 3-5 weeks, depending on the product used. Some products recommend a single injection of 60 mg (3 mL) as a one-time dose.
- Ophthalmic Viscosurgical Device: The dose and technique vary depending on the surgical procedure and the specific product used. A sufficient amount is slowly injected into the anterior chamber or the vitreous cavity.
- Dry eye disease: 1 drop of 0.1% - 0.3% sodium hyaluronate solution instilled into the affected eye 5-6 times per day or as needed, depending on the severity of symptoms.
- Topical application: 0.2% sodium hyaluronate is applied to the affected area 2 or 3 times daily.
Children:
The safety and effectiveness of sodium hyaluronate have not been established in children for intra-articular injection. For ophthalmic and topical use, the dosage must be determined by the physician.
Special Cases:
- Elderly Patients: Dose adjustments are generally not necessary, but caution should be used considering age-related physiological changes.
- Patients with Renal Impairment: No specific dose adjustment recommendations are available.
- Patients with Hepatic Dysfunction: No specific dose adjustment recommendations are available.
- Patients with Comorbid Conditions: Caution should be exercised in patients with bleeding disorders.
Clinical Use Cases
- Surgical Procedures (ophthalmic): Sodium hyaluronate is used during anterior segment and vitreous procedures to protect the corneal endothelium.
- Dry eye disease: Sodium hyaluronate is used to relieve symptoms such as burning, stinging, and foreign body sensation in patients with dry eye.
Dosage Adjustments:
Dosage modifications should be made based on individual patient response and tolerance. No specific adjustments based on renal/hepatic function or metabolic disorders are typically required for intra-articular injections.
Side Effects
Common Side Effects
- Intra-articular injection: Pain, swelling, and stiffness at the injection site, rash, itching, headache.
- Ophthalmic injection: Temporary blurred vision, transient increase in intraocular pressure.
- Ophthalmic drops: Temporary blurred vision, burning or stinging sensation.
- Topical application: Mild skin irritation.
Rare but Serious Side Effects
- Intra-articular injection: Infection, allergic reactions (hives, difficulty breathing, swelling of the face, lips, tongue, or throat).
- Ophthalmic injection: Severe inflammation, corneal edema, corneal decompensation.
Contraindications
- Hypersensitivity to sodium hyaluronate or any component of the formulation.
- Infection or skin disease at the injection site (for intra-articular injection).
Drug Interactions
- For intra-articular injections, concomitant use of disinfectants containing quaternary ammonium salts (e.g., benzalkonium chloride) for skin preparation may cause precipitation.
- No significant drug interactions have been reported for ophthalmic or topical use of sodium hyaluronate.
Pregnancy and Breastfeeding
- Pregnancy: Animal studies have not shown evidence of harm to the fetus. However, the safety of sodium hyaluronate has not been established in pregnant women. Use only if clearly needed and after careful consideration of the potential risks and benefits.
- Breastfeeding: It is unknown whether sodium hyaluronate passes into breast milk. Caution should be exercised if sodium hyaluronate is used during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Lubricant and shock absorber in the joint, protects corneal endothelium during ophthalmic surgery, retains moisture on the ocular surface for dry eye.
- Side Effects: Injection site reactions (pain, swelling, redness), temporary blurred vision, allergic reactions.
- Contraindications: Hypersensitivity, infection at injection site.
- Drug Interactions: Quaternary ammonium salts (for intra-articular injections).
- Pregnancy & Breastfeeding: Limited safety data, use with caution.
- Dosage: See detailed dosage section above.
- Monitoring Parameters: For intra-articular injection, monitor for injection site reactions and joint mobility. For ophthalmic procedures, monitor for intraocular pressure and corneal clarity. For dry eye, assess symptom improvement.
Popular Combinations
Sodium hyaluronate is often used alone. No commonly used drug combinations are indicated.
Precautions
- General Precautions: Use caution in patients with bleeding disorders. Use strict aseptic injection technique for intra-articular injections. Discard any unused portion of the single-use vial or syringe.
- Specific Populations:
- Pregnant Women: Use with caution only if clearly needed.
- Breastfeeding Mothers: Use with caution.
- Children & Elderly: Limited safety and efficacy data in children. Use caution in elderly patients considering age-related changes.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Sodium Hyaluronate for osteoarthritis of the knee?
A: The recommended dosage varies depending on the specific product. Common regimens include 20 mg once weekly for 3-5 weeks or a single 60 mg injection.
Q2: How is sodium hyaluronate administered?
A: For osteoarthritis of the knee, it is administered via intra-articular injection. For ophthalmic use, it is injected into the anterior chamber or vitreous cavity. For dry eye disease, it is administered as eye drops.
Q3: What are the common side effects of sodium hyaluronate injection for the knee?
A: Common side effects include pain, swelling, and redness at the injection site.
Q4: Can sodium hyaluronate be used in patients with other joint problems?
A: Sodium hyaluronate injection is specifically indicated for osteoarthritis of the knee. It has not been adequately studied in other joints.
Q5: What are the contraindications to sodium hyaluronate injections?
A: Contraindications include hypersensitivity to sodium hyaluronate, active infection or skin disease at the planned injection site.
Q6: Are there any drug interactions with sodium hyaluronate?
A: Skin disinfectants containing quaternary ammonium salts may cause precipitation when used concomitantly with intra-articular sodium hyaluronate injections.
Q7: Is sodium hyaluronate safe to use during pregnancy or breastfeeding?
A: Safety has not been established in pregnancy or breastfeeding. Its use should be considered only if the potential benefit justifies the potential risk to the fetus or infant.
Q8: How long does the pain relief from sodium hyaluronate injections last?
A: The duration of pain relief varies, but it typically lasts for several months. Some patients may require repeat injections after 6 months or longer.
Q9: What is the role of sodium hyaluronate in ophthalmic surgery?
A: It acts as a viscoelastic device to maintain the shape of the eye, protect the corneal endothelium, and facilitate surgical maneuvers.
Q10: How often should I use sodium hyaluronate eye drops for dry eye?
A: The frequency of use depends on the severity of your dry eye symptoms and the specific product used. Follow your doctor’s instructions or the instructions on the product label. Usually, 1 drop 5-6 times a day, or as needed.
