Drug Monograph
Full clinical overview, indications, dosage references & safety notes.
Available forms3 forms · 8 strengths documentedShow all ↓
Sodium hyaluronate 10 mg/mLSodium hyaluronate 11 mg/mLHyalovet® and Hyvisc® for intra-articular useLegend® for IV or intra-articular useNexHA® for IV use
0.1%0.15%0.2%0.4%An‑HyPro®, ClinaDry®, Hyabak®, Hylo‑Forte®, Hylo‑Tear® and Vismed Multi®
0.4% cross-linked0.75% cross-linkedHyasent‑S® (Remend® Corneal Lubricant and Corneal Repair Gel)
Overview
Hyaluronate is a naturally occurring, high-viscosity mucopolysaccharide used as an adjunctive treatment for synovitis not associated with severe degenerative joint disease. It may also be beneficial in the treatment of secondary synovitis when full-thickness cartilage loss is present.
Mechanism of Action (MOA): Hyaluronate is a normal constituent of connective tissue and is present in high concentrations in synovial fluid and articular cartilage. Within joints, it provides cushioning and lubrication, reduces protein and cellular influx into the joint, and exerts direct anti-inflammatory effects by scavenging free radicals and suppressing prostaglandin production.
Indications
Hyaluronate is used as an adjunctive treatment for synovitis in dogs.
- Synovitis: Adjunctive treatment of synovitis not associated with damaged articular cartilage.
- Osteoarthritis: Intra-articular hyaluronic acid is used in dogs with osteoarthritis.
- Tear film disorders: Used as a tear replacement and in the management of quantitative (keratoconjunctivitis sicca) and qualitative tear film disorders.
- Corneal ulcers: Hyaluronate-containing eye preparations may accelerate the healing of corneal ulcers, although the evidence is variable.
Dosage
Dogs
The following dosage has been reported for adjunctive treatment of synovitis.
| Indication | Route | Dose | Frequency | Notes |
|---|---|---|---|---|
| Adjunctive treatment of synovitis not associated with damaged articular cartilage | IA | 5 – 15mg/joint (not mg/kg) | Once weekly for 3–5 weeks | Extra-label. Use a high molecular weight product labelled for intra-articular use. |
| Osteoarthritis (extra-label) | IA | 15–30 mg/joint | Once weekly for 3 treatments | May be combined with an intra-articular corticosteroid. |
| Tear replacement / tear film disorders | Topical (eye) | 1 drop per eye | Every 4–6 hours (hourly if required) | In dogs with keratoconjunctivitis sicca, a hyaluronic acid eye drop used twice daily had greater ameliorative effects on ocular surface health and discomfort than a carbomer gel. |
Cats
The following topical ophthalmic dosage has been reported.
| Indication | Route | Dose | Frequency | Notes |
|---|---|---|---|---|
| Tear replacement / tear film disorders | Topical (eye) | 1 drop per eye | Every 4–6 hours (hourly if required) | In feline conjunctivitis a hyaluronate-based artificial tear has been used every 8 hours, and in feline keratoconjunctivitis sicca it is used short term. |
Warnings & Precautions
Hyaluronate should be used only after an appropriate diagnosis has been established and administered according to the product label.
- Diagnosis: Hyaluronate should not be used as a substitute for an adequate diagnosis. Radiographic examination should be performed to rule out severe fractures.
- Route of administration: Administer hyaluronate only by the routes specified on the product label.
- Intra-articular injection: Do not perform intra-articular injections through skin that has recently been fired or blistered, or through skin with excessive scurf or counterirritants.
- Breeding, pregnancy, and lactation: Safe use has not been established. Use only when the maternal benefits outweigh the potential risks to the offspring.
Drug Interactions
No clinically significant drug interactions have been reported.
- Known interactions: None were noted.
Side Effects & Overdose
Side Effects
Adverse effects vary depending on the route of administration and are generally transient.
- Intravenous administration: Occasional depression, lethargy, and fever.
- Intra-articular administration: Transient lameness, joint effusion, joint or injection-site swelling, joint pain, and synovial sepsis.
- Resolution: Adverse effects generally resolve within 24–48 hours, although some animals may require up to 96 hours. No treatment is recommended for these effects.
- Combination therapy: The incidence of joint flares may be higher when hyaluronate is used with other drugs.
- Systemic effects: No systemic adverse effects have been reported.
Overdose
Acute toxicology studies in horses have demonstrated no systemic toxicity associated with hyaluronate overdose.
Key Notes
Practical clinical points for the use of hyaluronate in dogs.
- Product selection: Different hyaluronate products have different dosage recommendations; always verify the product label before administration.
- Molecular weight: No controlled studies have directly compared high- and low-molecular-weight products for treating joint disease; product selection is largely based on clinician preference.
- Administration: Hyaluronate injections should only be administered by a veterinarian.
