sodium hyaluronate

Action and Spectrum

Actions and spectrum: 

sodium hyaluronate is a naturally occurring substance in the body, particularly in connective tissues and joint fluid. It is widely used in medical and cosmetic applications due to its unique properties. sodium hyaluronate acts as a viscoelastic agent and lubricant, providing hydration and lubrication to various tissues.

In ophthalmology, it is an ocular lubricant to relieve dry eye symptoms and improve ocular surface health. It forms a protective layer on the cornea, reducing friction and improving tear film stability. sodium hyaluronate has a broad spectrum of action, promoting tissue healing, reducing inflammation, and enhancing the overall health and comfort of the ocular surface. 

Drug Interaction

Adverse Reaction

Frequency defined 

1-10% 

Fatigue (1%) 

Nausea (<2%) 

Tendonitis (6%) 

Paresthesia (1%) 

Increased bp (4%) 

Injection site pain (3%) 

Infection (1%) 

Limb pain (2%)  

>10% 

Intradermal Injection 

• Swelling (91-03%) 
• Lumps/bumps (56-83%) 
• Pruritus (25-36%) 
• Erythema (75-93%) 
• Tenderness (61-92%) 
• Discoloration (33-78%)

Frequency not defined 

Intraocular administration 

• Keratitis 
• Conjunctival hemorrhage 
• Increased IOP 
• Cystoid macular edema

Intra-articular injection 

• Headache 
• Anaphylactoid reaction 
• Arthralgia 
• Injection site pain

Black Box Warning

Black Box Warning: 

sodium hyaluronate does not have a black box warning. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: sodium hyaluronate should not be used in individuals with a known hypersensitivity or allergic reaction to hyaluronic acid. 
• Eye Infections: sodium hyaluronate should not be used in the presence of active eye infections, as it may exacerbate the condition or interfere with the effectiveness of other prescribed medications. 
• Ocular Trauma: In cases of recent or severe ocular trauma, the use of sodium hyaluronate may be contraindicated. It is important to ensure the eye is stable and the trauma has been adequately managed before considering its use. 
• Eye Surgery: sodium hyaluronate should be used with caution following recent eye surgery. It is important to follow the specific postoperative instructions provided by the ophthalmologist or surgeon.

Caution: 

• Use under Medical Supervision: sodium hyaluronate eye drops or formulations should be used under the supervision and guidance of a healthcare professional, typically an ophthalmologist. 
• Temporary Blurred Vision: sodium hyaluronate eye drops may cause temporary blurred vision immediately after application.  
• Contact Lens Use: If there are contact lenses, it is recommended to remove them before applying sodium hyaluronate eye drops.  
• Allergic Reactions: Although rare, some individuals may develop an allergic reaction to sodium hyaluronate. If there are symptoms such as itching, redness, swelling, or difficulty breathing, discontinue use and seek immediate medical attention. 
• Interactions with Other Eye Medications: sodium hyaluronate eye drops may interact with other eye medications.

Comorbidities: 

• Dry Eye Syndrome: sodium hyaluronate is commonly used to alleviate the dry eye syndrome symptoms. 
• Conjunctivitis: sodium hyaluronate may be used in conjunction with other treatments for conjunctivitis, an inflammation of the conjunctiva. 
• Corneal Abrasions or Ulcers: sodium hyaluronate can aid in the healing process of corneal abrasions or ulcers, which are injuries to the cornea. 
• Contact Lens-Related Irritations: Individuals who wear contact lenses may experience eye dryness or irritation, and sodium hyaluronate can help alleviate these symptoms. 

Pregnancy / Lactation

Pregnancy consideration: N/A 

Lactation: N/A  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

• Hydration and Lubrication: sodium hyaluronate has a high water-binding capacity, allowing it to retain moisture and provide hydration to the ocular surface. It forms a protective layer that lubricates the cornea and conjunctiva, reducing friction and discomfort. 
• Viscosity and Elasticity: sodium hyaluronate exhibits viscoelastic properties, providing a cushioning effect and enhancing tear film stability. It helps maintain the tear film integrity and improves the spreading of tears across the ocular surface. 
• Healing and Tissue Repair: sodium hyaluronate has been shown to promote tissue repair and wound healing. It can aid in the regeneration of epithelial cells in the cornea and promote the healing of ocular surface injuries, such as corneal abrasions or ulcers. 
• Anti-inflammatory Effects: sodium hyaluronate has mild anti-inflammatory properties. It can help decrease inflammation and provide relief to inflamed or irritated ocular tissues.

Pharmacodynamics: 

• Hydration and Moisturization: sodium hyaluronate can bind & retain water molecules, resulting in increased hydration of the ocular surface. This helps to alleviate dryness and improve tear film stability. 
• Lubrication and Viscosity: sodium hyaluronate forms a lubricating layer on the ocular surface, reducing friction and providing a smooth surface for eyelid movement. It also exhibits viscoelastic properties, contributing to tear film stability and promoting comfortable blinking. 
• Protection and Barrier Function: sodium hyaluronate creates a protective barrier on the cornea and conjunctiva, shielding them from environmental irritants and maintaining the integrity of the ocular surface. 
• Wound Healing and Tissue Repair: sodium hyaluronate can accelerate the healing process of corneal epithelial wounds, such as abrasions or erosions. It helps to promote cell migration, proliferation, and differentiation, facilitating the regeneration of damaged tissue.

Pharmacokinetics: 

Absorption 

sodium hyaluronate applied topically to the ocular surface is not significantly absorbed systemically. It remains mainly localized to the site of application, providing its therapeutic effects directly to the ocular tissues. 

Distribution 

After application, sodium hyaluronate distributes and spreads over the ocular surface, forming a protective and lubricating layer. It remains within the tear film and does not extensively penetrate deeper ocular tissues or reach systemic circulation. 

Metabolism 

sodium hyaluronate is a naturally occurring polysaccharide that undergoes minimal to no metabolism within the body. It is primarily metabolized by enzymatic degradation by hyaluronidase enzymes present in the tissues. However, the metabolism of sodium hyaluronate is limited in the ocular environment. 

Elimination and excretion 

sodium hyaluronate applied topically to the eyes is not excreted through renal or hepatic pathways. Instead, it is typically eliminated from the ocular surface through natural tear drainage, blinking, and tear turnover. 

Adminstartion

Administration: 

• Preparation: Ensure hands are clean and dry before handling the sodium hyaluronate product. If using single-dose vials, open the vial by twisting off the cap. If using a multi-dose container, follow the instructions for priming and dispensing the solution. 
• Positioning: Tilt the head back slightly and look up. Gently pull the lower eyelid to create a small pocket. 
• Application: Squeeze the prescribed number of drops or small amount of gel into the lower conjunctival sac.  
• Closure: Close the eye gently and keep it closed for a short period, typically around one to two minutes, to allow the solution or gel to spread and distribute over the ocular surface. 
• Excess Removal: If any excess solution or gel is present, carefully blot it away with a clean tissue without rubbing the eye. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: sodium hyaluronate 

Pronounced: (soh-dee-uhm hahy-uh-loo-ruh-neyt)  

Why do we use sodium hyaluronate? 

• Ophthalmology: sodium hyaluronate is used as an ocular lubricant to relieve symptoms of dry eye syndrome, including eye dryness, irritation, and discomfort. It helps to moisturize and hydrate the ocular surface, improving tear film stability. 
• Orthopedics: In orthopedic medicine, sodium hyaluronate is used as a viscosupplement in the treatment of osteoarthritis. It is injected into the affected joint to provide lubrication and cushioning, reducing pain, and improving joint mobility. 
• Dermal Fillers: sodium hyaluronate is commonly used in cosmetic procedures as dermal fillers. It is injected into skin to restore volume, reduce the fine lines and wrinkles, and increase the facial contours. 
• Wound Healing: sodium hyaluronate can be applied topically or used as a wound dressing to promote wound healing and tissue repair. It creates a moist environment, facilitates cell migration and proliferation, and supports the healing process. 
• Skincare Products: sodium hyaluronate is a popular ingredient in skincare products like moisturizers, serums, and masks. It helps to hydrate the skin, improve elasticity, and reduce the appearance of wrinkles and dryness.