Hyaluronidase

Uses

Hyaluronidase has been used to enhance the absorption of fluids given by subcutaneous injection [ , ] or intramuscular injection [ ], and to improve the diffusion of local anesthetics [ , ]. Drugs whose subcutaneous administration has been facilitated in this way include morphine [ ], ceftriaxone [ ], insulin [ , , ], and immunoglobulins [ , ]. Improved diffusion of botulinum toxin in the treatment of axillary hyperhidrosis has also been described [ ]. It has been used to enhance the dispersion of fluids or drugs that have accidentally extravasated into the tissues after intravenous injection [ ] or the dispersion of hematomas [ ]. It has also been used to reverse the effects of hyaluronic acid after its use as a cosmetic filler [ ].

Other uses have included limiting the size of myocardial infarction [ ], enhancing the actions of anticancer drugs [ ] by increasing drug penetration into the tumor [ , ], inducing cervical ripening and labor [ ], preventing perineal trauma during spontaneous delivery [ ] (although it was ineffective in a randomized, placebo-controlled, double-blind study in 160 primiparous women [ ]), reducing the painful effects of post-laminectomy scar tissue [ ], and injection into the central nervous system to relieve the effects of arachnoid granulations [ ].

Observational studies

In a retrospective survey of the use of recombinant human hyaluronidase (rHuPH20) for facilitation of subcutaneous hydration and drug infusion in 32 patients, 26 received it to enhance hypodermoclysis at flow rates up to 500 ml/hour; in six cases it was also used to enhance subcutaneous infusion of nine medications [ ]. Induration at the infusion site occurred in one patient receiving hydration and there was a higher than expected serum lidocaine concentration in another.