Ialuset Uses

• Ialuset indications
• Uses of Ialuset in details
• Ialuset description
• Ialuset dosage
• Ialuset interactions
• Ialuset side effects
• Ialuset contraindications

What is Ialuset?

Ialuset injection is used to treat knee pain caused by osteoarthritis (OA) in patients who have already been treated with pain relievers (e.g., acetaminophen) and other treatments that did not work well.

Ialuset is similar to a substance that occurs naturally in the joints. It works by acting like a lubricant and shock absorber in the joints and helps the joints to work properly.

Ialuset is to be administered only by or under the immediate supervision of your doctor.

Ialuset indications

* Sores in the mouth, when applied to the skin as a gel.

* Eye surgery and corneal transplant, when injected by an eye surgeon.

Osteoarthritis, when injected into the joint by a healthcare provider. Despite being approved by the FDA for treatment of osteoarthritis by injection, results vary. Some people report a moderate improvement in joint stiffness and pain decrease with Ialuset treatment, but this is not always the case. Whether Ialuset might delay or lessen progressive joint damage with long-term use is unknown. Adjunctive therapy in: * Healing skin wounds and burns.

* Detached retina and other eye injuries.

* Preventing the effects of aging.

How should I use Ialuset?

Use Ialuset as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• An extra patient leaflet is available with Ialuset. Talk to your pharmacist if you have questions about this information.
• Ialuset is given as an injection into the knee joint at your doctor's office, hospital, or clinic.
• Ialuset is usually given as a series of injections 1 week apart for a total of 3 to 5 injections depending upon the particular product you are using. You may not experience relief until you have received several injections.
• Do not use Ialuset if it contains particles, is cloudy or discolored, or if the vial or syringe is cracked or damaged.
• Do not use disinfectants containing ammonium salts to prepare the skin for injection because side effects may occur.
• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
• If you miss a dose of Ialuset, contact your doctor to establish a new dosing schedule.

Ask your health care provider any questions you may have about how to use Ialuset.

Uses of Ialuset in details

Ialuset is used to treat knee pain caused by osteoarthritis (a disorder of joints that causes stiffness, pain and loss of movement due to breakdown of lubricating fluid between joints) when treatment with common painkillers or other physical therapy (exercise, physiotherapy etc.) does not provide adequate relief. It is also used for treatment of mouth sores, prevention of skin aging and during cataract surgery.

Ialuset description

Each bottle contains 100 mL soln plus 1 applicator for nasal use and 1 applicator for the use in the ear, sealed in a bag.

Inside the metal bottle, the soln remains isolated and not in contact with the propellant because it is contained within a bag made of nontoxic material. The propellant used is air and it is pressurized within the entire space surrounding the bag inside the metal bottle. The inhalation of Ialuset occurs via valve positioned above the bag.

With the system: The air is used like a gas propellant, so Ialuset does not damage the ozone layer. It is necessary to use preservatives so the possibility of allergic reaction is reduced. The bottle can be used in any direction so Ialuset is practical and easy to use.

Ialuset dosage

No information provided.

How supplied

Ialuset® is supplied as a sterile, non-pyrogenic solution in 2 mL vials or 2 mL pre-filled syringes.

Detailed Device Description

Each vial or syringe contains:

Ialuset 20.0 mg

Sodium chloride 17.0 mg

Monobasic sodium phosphate • 2H0 1.2 mg

Water for injection q.s.* to 2.0 mL

*q.s. = up to

Directions For Use

Ialuset® is administered by intra-articular injection. A treatment cycle consists of five injections given at weekly intervals. Some patients may experience benefit with three injections given at weekly intervals. This has been noted in studies reported in the literature in which patients treated with three injections were followed for 60 days.

Precaution: Do not use Ialuset® if the package is opened or damaged. Store in the original packaging (protected from light) below 77° F (25° C). DO NOT FREEZE.

Precaution: Strict aseptic administration technique must be followed.

Warning: Do not concomitantly use disinfectants containing quaternary ammonium salts for skin preparation because Ialuset can precipitate in their presence.

Inject subcutaneous lidocaine or similar local anesthetic prior to injection of Ialuset®.

Precaution: Remove joint effusion, if present, before injection of Ialuset®.

Do not use the same syringe for removing joint effusion and for injecting Ialuset®.

Take care to remove the tip cap of the syringe and needle aseptically.

Inject Ialuset® into the joint through a 20-gauge needle.

Precaution: The vial/syringe is intended for single use. The contents of the vial must be used immediately once the container has been opened. Discard any unused Ialuset®. Inject the full 2 mL in one knee only. If treatment is bilateral, a separate vial should be used for each knee.

REFERENCES

1. M. Carrabba et a l., 1991 Ialuset sodium salt (Ialuset®) in the treatment of patients with osteoarthritis of the knee: a controlled trial versus Orgotein, Final Report, April 1991. Data on file.

2. M. Carrabba et a l., 1995. Effectiveness and safety of 1, 3 and 5 injections of 20 mg/2 ml Ialuset® in comparison with a placebo and with arthrocentesis only, in the treatment of knee osteoarthritis. European Journal of Rheumatology and Inflammation 15:25-31.

3. M. Dougados et al., 1993. High molecular weight Ialuset (hyalectin) in osteoarthritis of the knee: a one-year placebo-controlled trial. Osteoarthritis and Cartilage 1:97-103.

4. R. Kotz and G. Kolarz, 1997 published as R. Kotz and G. Kolarz, 1999. Intra-articular Ialuset: duration of effect and results of repeated treatment cycles. The American Journal of Orthopedics, 28:5-7.

5. G. Leardini et a l., 1987. Intra-articular Ialuset (Ialuset®) in gonarthrosis. Clinical Trials Journal 24(4):341-350.

6. J.J. Scali, 1995. Intra-articular Ialuset in the treatment of osteoarthritis of the knee: a longterm study 15(1 ):57-62.

MANUFACTURED BY: Fidia Farmaceutici S.p. A., Via Ponte della Fabbrica 3/A - 35031 Abano Terme, Padua (PD), Italy. MANUFACTURED FOR: Fidia Pharma USA Inc., Parsippany, NJ 07054. Revised May 2014

Ialuset interactions

See also:
What other drugs will affect Ialuset?

To date, there are no reports of incompatibilities (interactions) of Ialuset with other solutions for intra-articular administration. The patient may benefit from the concurrent use of oral analgesic and anti-inflammatory agents during the first days of treatment.

Incompatibiliies: There is a known incompatibility between Ialuset and quaternary ammonium salts eg, benzalkonium chloride which can be used as skin disinfectants. Ialuset must therefore never come into contact with such products, nor with medical or surgical equipment treated with these types of products, since Ialuset can precipitate in their presence.

Ialuset side effects

See also:
What are the possible side effects of Ialuset?

Ialuset® was investigated in a pivotal clinical investigation conducted in the United States in which there were three arms (164 subjects treated with Ialuset®; 168 with placebo; and 163 with naproxen) (refer to Table 1). Common adverse events reported for the Ialuset®-treated subjects were gastrointestinal complaints, injection site pain, knee swelling/effusion, local skin reactions (rash, ecchymosis), pruritus, and headache. Swelling and effusion, local skin reactions (ecchymosis and rash), and headache occurred at equal frequency in the Ialuset®- and placebo-treated groups. Ialuset® treated subjects had 48/164 (29%) incidents of gastrointestinal complaints that were not statistically different from the placebo-treated group. A statistically significant difference in the occurrence of pain at the injection site was noted in the Ialuset®-treated subjects: 38/164 (23%) in comparison to 22/168 (13%) in the placebo-treated subjects (p = 0.022). There were 6/164 (4%) premature discontinuations in Ialuset®-treated subjects due to injection site pain in comparison to 1/168 ( < 1%) in the placebo-treated subjects. These differences were not statistically significant. Two (2/164, 1.2%) Ialuset®-treated subjects and 3/168 (1.8%) placebo-treated subjects were reported to have positive bacterial cultures of effusion aspirated from the treated knee. The two Ialuset®-treated subjects and two of the placebo-treated subjects did not exhibit evidence of infection clinically or subsequently and were not treated with antibiotics. One of the placebo-treated subjects was hospitalized and received presumptive treatment for septic arthritis.

Ialuset® has been in clinical use in Europe since 1987. Analysis of the adverse events that have been reported with the use of Ialuset® in Europe reveals that most of the events are related to local symptoms such as pain, swelling/effusion, and warmth or redness at the injection site. Usually such symptoms disappear within a few days by resting the affected joint and applying ice locally. Only sporadically have these events been more severe and longer lasting. Very rare cases of intra-articular infection have been reported. Strict aseptic technique must be followed in administering Ialuset®. Systemic allergic reactions rarely have been recorded. Isolated cases of an anaphylactic or anaphylactic-like reaction have been reported in post-marketing experience and they all resolved. Allergic-type signs and symptoms such as rash, pruritus, and urticaria also are very rare. A few cases of fever were reported. In some instances, they were associated with local reactions, in other cases, no association other than temporal was found with the use of the product.

Adverse experience data from the literature contain no evidence of increased risk relating to retreatment with Ialuset®. The frequency and severity of adverse events occurring during repeat treatment cycles did not increase over that reported for a single treatment cycle. (Carrabba et al., 1995; Carrabba et al., 1991; Kotz and Kolarz, 1999; Scali, 1995).

Ialuset contraindications

See also:
What is the most important information I should know about Ialuset?

• Ialuset gel is contraindicated for use in breast augmentation, or for implantation into bone, tendon, ligament, or muscle,
• Ialuset gel is contraindicated for patients with a history of known hypersensitivity to avian proteins.
• Ialuset gel must not be injected into blood vessels. Introduction of Ialuset gel into the vasculature may occlude the vessels and could cause infarction or embolization.

Active ingredient matches for Ialuset:

Hyaluronic Acid in France.

Sodium hyaluronate in France.

References

1. PubChem. "HYALURONIC ACID". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
2. DrugBank. "HYALURONIC ACID". http://www.drugbank.ca/drugs/DB08818 (accessed September 17, 2018).
3. MeSH. "Adjuvants, Immunologic". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology