Management of amiodarone extravasation with intradermal hyaluronidase

Abstract

Administration of intradermal hyaluronidase after amiodarone extravasation was associated with decreased expansion of erythema and warmth as well as an improvement in patient-reported pain scores without any noted adverse effects.

A new approach to skin extravasation injury management during the neonatal period

“…Rowllet et al reported human hyaluronidase injection for extravasation of contrast media in a circle around the wound, which led to improvements during 4 h [ 22 ]. Fox et al illustrated wound enhancement after injection of hyaluronidase following amiodarone extravasation without any complications [ 23 ].…”

Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline

“…Hyaluronidase has been used for the treatment of hyperosmolar and pH‐related mechanisms of injury with success previously reported in managing TPN, calcium, radiographic contrast media, dextrose, potassium, mannitol, aminophylline, nafcillin, and phenytoin extravasations 4 . Amiodarone is the newest agent with reported success for the treatment of extravasation‐related pain with hyaluronidase 53 . Hyaluronidase can be administered at 15 units/mL (up to 150 units) in five divided doses (0.2 mL) injected subcutaneously around the site of extravasation or intravenously through the infiltrated catheter (Table 3).…”

Hyaluronidase for Skin Necrosis Induced by Amiodarone

“…He received intradermal hyaluronidase administration within 24 hours of developing severe pain from extravasation induced by amiodarone with no adverse outcomes and full recovery. 7 There are numerous properties of amiodarone that may have resulted in the skin necrosis seen in these cases. The acidic pH (3.5-4.5) of amiodarone can contribute to coagulative necrosis, cellular desiccation, eschar formation, and edema.…”

“…10 Extravasation of amiodarone can be treated nonpharmacologically with limb elevation and warm compresses, as these methods may promote vasodilation and enhance drug removal. [5][6][7] However, when extravasation leads to progressive erythema and skin necrosis or is refractory to these therapies, intradermal injection of hyaluronidase should be considered. Hyaluronidase mediates the degradation of hyaluronic acid in the extracellular matrix, allowing for increased permeability of injected fluids into tissues and diluting the concentration of toxins at the site of exposure.…”

“…4 Amiodarone-induced skin necrosis due to extravasation is a rare complication of this antiarrhythmic medication, with only 3 reported cases in the literature according to a PubMed search of articles indexed for MEDLINE using the search terms amiodarone and skin and (necrosis or ischemia or extravasation or reaction). [5][6][7] Although hyaluronidase is a known therapy for extravasation of fluids, including parenteral nutrition and chemotherapy, its use for the treatment of extravasation from amiodarone is not well documented. 6 We report a case of skin necrosis of the left dorsal forearm and the left dorsal and ventral hand following infusion of amiodarone through a peripheral IV line, which was treated with injections of hyaluronidase.…”