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Hyaluronidase is an enzymatic adjunct that enhances the dispersion and absorption of injectable therapies by temporarily depolymerizing hyaluronic acid within the extracellular matrix. Clinical applications include subcutaneous fluid administration, optimization of drug delivery, management of extravasation, and reversal of hyaluronic acid–based dermal fillers. Emerging evidence also highlights a role in improving intratumoral drug penetration and facilitating subcutaneous administration of biologic therapies. This activity reviews the mechanism of action, FDA-approved and off-label indications, dosing strategies, and administration techniques of hyaluronidase. Emphasis is placed on safety considerations, including adverse effects, contraindications, and risk mitigation strategies, as well as evidence-based clinical decision-making and interprofessional collaboration. Participation in this activity is expected to enhance clinician knowledge of appropriate hyaluronidase use, support informed therapeutic decision-making, and promote improved patient safety across diverse clinical settings. Objectives: Identify patient-specific factors that influence safe and effective use of hyaluronidase, including comorbidities and risk for thrombosis or hypersensitivity. Implement monitoring and risk mitigation strategies to prevent and manage complications associated with hyaluronidase therapy. Differentiate between compatible and incompatible medications when coadministering hyaluronidase. Communicate patient-specific risks, indications, and monitoring parameters among interprofessional team members to support safe and effective hyaluronidase therapy. Access free multiple choice questions on this topic.

Toxicity due to hyaluronidase is rare. When the enzyme is injected intravenously, it is rapidly degraded, and its enzymatic activity ceases. Tissue inflammation may result from local hyaluronidase toxicity.[21] The most serious complications of hyaluronidase therapy are thrombosis and hypersensitivity reactions. The medication should be discontinued immediately if either of these occurs.

Prescribing clinicians should recognize the benefits of hyaluronidase use in appropriate clinical settings. Clinicians should collaborate with pharmacists to determine the appropriate dose and method of administration. Hyaluronidase should be administered by qualified healthcare professionals, and patients should be monitored for serious complications. Patients should be adequately hydrated before administration of the dose and monitored for signs of thrombosis, anaphylaxis, and injection-site reactions. In the inpatient setting, nursing staff should monitor vital signs and assess for acute changes. When using hyaluronidase for labeled indications, healthcare providers should know that intravenous administration is ineffective. This enzyme rapidly degrades in the bloodstream, thereby losing its beneficial effects. The individual administering the subcutaneous injection (typically a nursing staff member) should examine the injection site to ensure it is free of infection. Administration of hyaluronidase in inflamed or infected tissues may facilitate the spread of infection. Effective communication among patients and healthcare providers is essential within an interprofessional care team. Nurses should monitor for changes in patient health status and notify the attending clinician. Nursing staff are typically responsible for medication administration. Patients should also receive education on drug delivery methods and potential adverse reactions if self-administration at home is anticipated. Adjunctive use of hyaluronidase with injectable medications improves treatment efficacy. Pharmacists should consult with the prescribing clinician regarding potential dose adjustments and perform dose verification and medication reconciliation. Improved systemic absorption may allow lower doses and less frequent administration of concomitant medications, thereby improving patient adherence and satisfaction.[1] An interprofessional approach involving clinicians, nursing staff, and pharmacists is essential to optimize hyaluronidase use and achieve optimal outcomes.