Version May 2024
Cheek augmentation: SUBQ/Supraperiosteal: Adults >21 years of age:
Juvederm Voluma XC: Inject as required for cosmetic result; typical treatment regimen requires small boluses of 0.1 to 0.2 mL over a large area to volumize and contour the cheek; an additional treatment may be needed to achieve the desired level of correction; maximum: 20 mL/60 kg/year.
Restylane Contour: Maximum: 6 mL per treatment session; maximum recommended injected volume per subject and treatment (touch-up volume included): 12 mL.
Restylane Lyft: Maximum: 6 mL per treatment.
Chin augmentation: SUBQ/Supraperiosteal: Adults >21 years of age:
Juvederm Voluma XC: Inject as required for cosmetic result; typical treatment regimen requires small boluses of 0.1 to 0.2 mL over a large area to volumize and contour the chin; an additional treatment may be needed to achieve the desired level of correction; maximum: 20 mL/60 kg/year.
Restylane Defyne: Initial injection volume ~2.6 mL (depends on severity of chin retrusion); optimal correction (touch-up) volume ~1.4 mL; retreatment volume ~2.1 mL. Maximum volume for initial and retreatment: 4 mL (2 mL in chin and 2 mL in area inferior to lower lip); touch-ups: 2 mL.
Dermatoses: Topical: Spray emulsion (Penlen): Spray sufficient quantity to cover affected skin and allow to dry; may repeat up to 4 times daily or as needed.
Facial wrinkles/folds: Intradermal:
Note: Formulations differ in terms of recommended injection depth: Belotero Balance, Juvederm (all formulations except Voluma XC), Restylane, Restylane Defyne, Restylane-L, Restylane Refyne, Revanesse Versa, and Revanesse Versa+ are intended for mid to deep intradermal injection; Restylane Lyft is intended for injection into the deep dermis to superficial subcutis.
Belotero Balance and Belotero Balance Plus: Inject as required for cosmetic result; correct only to 100% of volume desired (average volume in clinical trials was ~1.5 mL/nasolabial fold); maximum: 6 mL/year.
Juvederm (all formulations except Voluma XC): Inject as required for cosmetic result; typical treatment regimen requires 1.6 to 1.7 mL/treatment site; typical volume for repeat treatment is 0.56 to 0.7 mL/treatment site; maximum: 20 mL/60 kg/year.
Restylane Lyft: Inject as required into deep dermis/superficial subcutis for cosmetic result; maximum: 6 mL per treatment.
Restylane, Restylane-L: Inject as required for cosmetic result; median total dose: 3 mL; maximum: 6 mL per treatment.
Restylane Defyne: Inject as required for cosmetic result; typical treatment is generally ~1.4 mL/treatment site; typical repeat treatment is ~0.7 mL/treatment site.
Restylane Refyne: Inject as required for cosmetic result; typical treatment is generally ~1.5 mL/treatment site; typical repeat treatment is ~1 mL/treatment site.
Revanesse Versa, Revanesse Versa+: Inject as required for cosmetic result; volume to inject is not described in the manufacturer’s labeling.
Hand augmentation: SUBQ: Adults >21 years of age: Restylane Lyft: Inject small boluses in the subcutaneous plane in the dorsum of the hand; maximum: 3 mL per hand per treatment session.
Infraorbital hollowing : SUBQ/Supraperiosteal: Adults >21 years of age:
Juvederm Volbella XC: Approximately 1 mL in the infraorbital hollows; correct to 100% of desired volume effect (do not overcorrect); repeat treatment is generally 0.4 mL in each infraorbital area; maximum: 20 mL/60 kg/year.
Lip augmentation: Submucosal:
Adults >21 years:
Juvederm Ultra XC: Approximately 2.2 mL to the lips and perioral area; correct to 100% of desired volume effect (do not overcorrect); repeat treatment is generally 1.5 mL; maximum: 20 mL/60 kg/year.
Juvederm Volbella XC: Approximately 2.6 mL to the lips and perioral area; correct to 100% of desired volume effect (do not overcorrect); repeat treatment is generally 1.6 mL; maximum: 20 mL/60 kg/year.
Restylane, Restylane-L, Restylane Silk: Maximum: 1.5 mL per lip (upper or lower) per treatment session.
Restylane Kysse: ≤1.5 mL per lip (upper or lower) per treatment session; optional treatment of perioral rhytids and philtral column may be performed; correct to 100% of desired volume effect (do not overcorrect). Maximum: 6 mL per treatment session (3 mL for lips, 3 mL for perioral area).
Adults ≥22 years of age:
Revanesse Lips: Maximum: 1.5 mL per lip (upper or lower) per treatment session.
Osteoarthritis of the knee: Intra-articular:
Durolane: Inject 60 mg (3 mL) once.
Euflexxa, sodium hyaluronate [Teva]: Inject 20 mg (2 mL) once weekly for 3 weeks (total of 3 injections).
Gel-One: Inject 30 mg (3 mL) once.
Gelsyn-3: Inject 16.8 mg (2 mL) once weekly for 3 weeks (total of 3 injections).
GenVisc 850, Supartz FX: Inject 25 mg (2.5 mL) once weekly for 5 weeks (total of 5 injections); some patients may benefit from a total of 3 injections.
Hyalgan: Inject 20 mg (2 mL) once weekly for 5 weeks (total of 5 injections); some patients may benefit with a total of 3 injections.
Hymovis: Inject 24 mg (3 mL) once weekly for 2 weeks (total of 2 injections).
Monovisc: Inject 88 mg (4 mL) once.
Orthovisc: Inject 30 mg (2 mL) once weekly for 3 to 4 weeks (total of 3 to 4 injections).
Synvisc: Inject 16 mg (2 mL) once weekly for 3 weeks (total of 3 injections).
Synvisc-One: Inject 48 mg (6 mL) once.
Triluron: Inject 20 mg (2 mL) once weekly for 3 weeks (total of 3 injections).
TriVisc: Inject 25 mg (2.5 mL) once weekly for 3 weeks (total of 3 injections).
Visco-3: Inject 25 mg (2.5 mL) once weekly for 3 weeks (total of 3 injections).
Perioral rhytids: Intradermal: Adults >21 years of age:
Restylane Kysse: Refer to lip augmentation dosing.
Restylane Silk: Maximum: 1 mL per correction per treatment session.
Juvederm Volbella XC: Refer to lip augmentation dosing.
Skin ulcers and wounds: Topical: Bionect cream, gel: Apply a thin layer to clean and disinfected wound or ulcer 2 to 3 times daily.
Surgical aid: Ophthalmic (Amvisc, Amvisc Plus, ClearVisc, Healon [all formulations], Provisc): Intraocular: Depends upon procedure (slowly introduce a sufficient quantity into eye).
Xerosis: Topical: Hylinate lotion: Apply liberally to affected area 2 to 3 times daily or as directed.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Type of reaction may vary by formulation and administration. Some reports may include concomitant lidocaine. Reported adverse reactions are for injectable products administered to adults.
>10%:
Dermatologic: Ecchymoses, skin discoloration at injection site, skin rash
Hematologic & oncologic: Bruise
Local: Bruising at injection site, erythema at injection site, hematoma at injection site, induration at injection site, injection site nodule, itching at injection site, local skin exfoliation (including injection site), muscle rigidity at injection site (including injection site movement impairment), pain at injection site (including burning sensation at injection site, discomfort at injection site), residual mass at injection site, swelling at injection site, tenderness at injection site
Nervous system: Headache
Neuromuscular & skeletal: Arthralgia, arthropathy (including arthritis, joint crepitation, joint lock, joint warmth), joint effusion, joint swelling, myopathy (facial asymmetry or deformity)
Ophthalmic: Increased intraocular pressure
1% to 10%:
Cardiovascular: Edema, hypertension, peripheral edema, presyncope
Dermatologic: Cheilosis, erythema of skin, fine wrinkling, hyperpigmentation, injection site blister formation, local acneiform eruptions, local dryness of skin (injection site), papule of skin (injection site), pruritus, rash at injection site (including eczema), skin tightness, xanthoderma
Gastrointestinal: Abdominal pain, diarrhea, dyspepsia, nausea, oral herpes simplex infection
Genitourinary: Urinary tract infection
Infection: Infection
Local: Bleeding at injection site, hypertrophy at injection site, injection site infection, injection site numbness
Nervous system: Dizziness, falling, hyperesthesia (injection site), hypoesthesia (including at injection site), pain, paresthesia, tingling sensation
Neuromuscular & skeletal: Back pain, bursitis, connective tissue disease, joint stiffness, limb pain, localized osteoarthritis (including aggravated), musculoskeletal pain (including discomfort), puffiness of cheeks
Ophthalmic: Blurred vision, retinal detachment
Respiratory: Bronchitis, cough, flu-like symptoms, nasopharyngitis, rhinitis, sinusitis, upper respiratory tract infection
Miscellaneous: Laceration (including injection site), wound
<1%:
Dermatologic: Hypopigmentation, pruritic rash, urticaria
Endocrine & metabolic: Increased serum glucose
Hematologic & oncologic: Leukocytosis, popliteal cyst
Hepatic: Increased serum alanine aminotransferase
Hypersensitivity: Hypersensitivity reaction
Infection: Herpes simplex infection (including reactivation)
Nervous system: Abnormal sensory symptoms, anxiety, depression, feeling of heaviness, myasthenia, nervousness, neuralgia, numbness of lips, tension headache
Neuromuscular & skeletal: Hemarthrosis, muscle spasm, myalgia, synovitis
Ophthalmic: Eyelid edema
Miscellaneous: Cyst, fever
Postmarketing:
Cardiovascular: Flushing, occlusive arterial disease, phlebitis (with varicosities), syncope, tachyarrhythmia
Dermatologic: Alopecia (localized), dermatitis, dermatophytosis, diaphoresis, facial swelling, localized vesiculation, pustules, red face, skin or other tissue necrosis, skin pain, telangiectasia, wound secretion (including injection site discharge), xeroderma
Gastrointestinal: Dysphagia, hemorrhoids, vomiting
Hematologic & oncologic: Granuloma, lymphadenopathy, thrombocytopenia
Hypersensitivity: Anaphylactic shock, anaphylaxis, angioedema, mouth edema, nonimmune anaphylaxis
Immunologic: Exacerbation of autoimmune disease
Infection: Abscess, herpes virus infection
Local: Application site reaction (implant migration), atrophy at injection site, injection site scarring, irritation at injection site, warm sensation at injection site
Nervous system: Chills, facial nerve paralysis, fatigue, insomnia, malaise
Neuromuscular & skeletal: Asthenia, muscle cramps, muscle twitching, tremor
Ophthalmic: Blepharoptosis, blindness, corneal decompensation, corneal edema, decreased visual acuity, dry eye syndrome, eye irritation, eye pain, increased lacrimation, intraocular inflammation, secondary glaucoma, swelling of eye, visual disturbance
Respiratory: Dyspnea
Miscellaneous: Fistula, foreign body reaction
Hypersensitivity to hyaluronate or any component of the formulation.
Intradermal/Submucosal: Additional contraindications include history of anaphylaxis or presence of multiple severe allergies (Belotero Balance, Belotero Balance Plus, Juvederm [all formulations], Restylane, Restylane Defyne, Restylane Kysse, Restylane Lyft, Restylane Refyne, Restylane Silk, Restylane-L, Revanesse Lips); bleeding disorders (Restylane, Restylane Lyft, Restylane Silk, Restylane-L); history of hypersensitivity to gram-positive bacterial proteins (Belotero Balance, Belotero Balance Plus, Juvederm [all formulations], Restylane, Restylane Defyne, Restylane Kysse, Restylane Lyft, Restylane Refyne, Restylane Silk, Restylane-L, Revanesse Lips, Revanesse Versa, Revanesse Versa+), or local anesthetics of the amide type, such as lidocaine (Belotero Balance Plus, Juvederm Ultra XC, Juvederm Ultra Plus XC, Juvederm Volbella XC, Juvederm Vollure XC, Restylane Defyne, Restylane Kysse, Restylane Lyft, Restylane Refyne, Restylane Silk, Restylane-L, Revanesse Lips, Revanesse Versa+); implantation/injection into sites other than the anatomical spaces recommended per labeling (Belotero Balance, Belotero Balance Plus, Restylane, Restylane Silk, Restylane-L, Revanesse Lips, Revanesse Versa, Revanesse Versa+).
Revanesse Lips, Revanesse Versa, Revanesse Versa+ (additional contraindications): Patients who develop hypertrophic scarring or keloid formation or have evidence of scars at intended treatment sites; in conjunction with a laser, intense pulsed light, chemical peeling, or dermabrasion treatments; topical wrinkle treatments within 4 weeks prior to treatment; acne or other inflammatory skin diseases; patients with unattainable expectations; patients with plans to undergo desensitization therapy; acute or chronic skin disease in or near injection sites or with any infection or unhealed wound of the face; patients taking anticoagulant/antiplatelet therapy; history of bleeding disorders, coagulation defects, or connective tissue disorders; pregnancy and breastfeeding (Revanesse Versa, Revanesse Versa+ only); adults <22 years of age (Revanesse Versa, Revanesse Versa+ only).
Intra-articular: Additional contraindications include knee joint infections or infections or skin diseases at the site of injection (Durolane, Euflexxa, Gel-One, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, Monovisc, OrthoVisc, sodium hyaluronate [Teva], Supartz FX, Synvisc, Synvisc-One, Triluron, TriVisc, Visco-3); hypersensitivity to gram-positive bacterial proteins (Hymovis, Monovisc, Orthovisc); systemic bleeding disorders (Monovisc).
Intraocular: There are no contraindications listed in the manufacturer's labeling (Amvisc, Amvisc Plus, ClearVisc, Healon [all formulations], Provisc).
SUBQ/Supraperiosteal: Additional contraindications include history of anaphylaxis or history or presence of multiple severe allergies (Juvederm Voluma XC, Restylane Contour, Restylane Defyne, Restylane Lyft); patients with a history of allergies to gram-positive bacterial proteins or lidocaine (Juvederm Voluma XC, Restylane Contour, Restylane Defyne, Restylane Lyft).
Dosage form specific issues:
• Injection (gel): Intradermal, submucosal, subcutaneous, supraperiosteal:
- All formulations: May be administered by intradermal (Belotero Balance, Belotero Balance Plus, Juvederm [all formulations except Voluma XC], Restylane, Restylane Defyne, Restylane Kysse, Restylane Lyft, Restylane Refyne, Restylane Silk, Revanesse Versa, Revanesse Versa+), submucosal (Restylane, Restylane Kysse, Restylane Silk, Revanesse Lips), or subcutaneous and/or supraperiosteal (Juvederm Volbella XC, Juvederm Voluma XC, Restylane Contour, Restylane Defyne, Restylane Lyft) injection. Treatment may result in bruising/bleeding; use caution in patients with bleeding disorders and patients receiving or recently exposed (≤3 weeks) to thrombolytics, anticoagulants, platelet inhibitors, or NSAIDs. Do not inject into site of active inflammation (skin eruptions such as cysts, pimples, rashes, or hives) or infection. Injection into a blood vessel may cause localized superficial necrosis or may cause occlusion and lead to embolism, ischemia, or infarction. Symptoms of vascular occlusion or embolization (eg, pain disproportionate to the procedure or remote from the injection site, immediate blanching extending beyond the injected area, dusky or reticular-appearing tissue) require intervention. Use of some products in patients susceptible to keloid formation, hypertrophic scarring, or pigmentation disorders has not been studied; use cautiously. Hyperpigmentation at the injection site has been reported with some formulations and may last for ≤6 weeks after treatment; keloid formation may also occur. Use caution in patients receiving immunosuppressive treatment. Use in patients with prior herpetic eruption may result in reactivation. Delayed inflammatory papules may result from injections, necessitating evaluation and treatment as soft tissue infection. If laser treatment, chemical peeling, or any other procedure based on an active dermal response is considered after treatment, there is a risk of acute inflammatory reaction at the injection site if performed following intradermal treatment and before the skin has healed completely. The safety of treatment with concomitant dermal therapies such as epilation, UV irradiation, or laser, mechanical, or chemical peeling procedures has not been evaluated. Patient must avoid exposure to UV rays (sun and UV lamp) or severe cold until swelling and redness is resolved.
- For facial administration, do not use in vascular-rich areas, such as glabella and nose; rare but serious adverse events associated with the intravascular injection of soft tissue fillers in the face have been reported and include temporary or permanent vision impairment, blindness, cerebral ischemia or cerebral hemorrhage leading to stroke, skin necrosis, and damage to underlying facial structures. Immediately stop the injection if a patient exhibits any of the following symptoms, including changes in vision, signs of a stroke, blanching of the skin, or unusual pain during or shortly after the procedure. Treatment site reactions usually improve in ≤7 days (chin augmentation, nasolabial folds), <18 days (lips), or <4 weeks (cheek augmentation). Strenuous exercise and ethanol consumption should be avoided for 24 hours following use. Supplemental "touch up" treatments may be required. Use of larger than recommended volumes per injection result in an increase in adverse events; if larger amounts are needed, follow-up treatment sessions are recommended.
- For dorsal hand administration, avoid injection into veins or tendons of the hand; may weaken tendons or cause tendons to rupture or cause embolization or thrombosis of veins. Use with caution in patients with disabilities, diseases, or injuries of the hand, including autoimmune diseases affecting the hand, hand implants, Dupuytren's contracture, history of hand tumor, vascular malformations, Raynaud disease and patients at risk for tendon rupture; use has not been studied. Injection of the dorsum of the hand may cause pain and swelling. Treatment site reactions (eg, redness, swelling, tenderness, pain) usually improve in ≤7 days. Increased risk for delayed onset adverse reactions may occur with strenuous use of hands or trauma to hands after injection into the hand. Reduced thumb flexion range lasting >3 months has been reported.
• Injection (gel, solution): Intra-articular: Not for use in infected joints; do not use disinfectants containing quaternary ammonium salts for skin preparation (may cause precipitation of hyaluronate). Remove synovial fluid or effusion, if present, prior to injection; do not use in cases of severe intra-articular effusion. Do not inject intravascularly, extra-articularly, or into synovium. Use with caution if venous or lymphatic stasis is present in the leg. Transient increases in reddening or inflammation, pain, or sensation of heat may occur after injection into the knee in patients with inflammatory arthritis. Avoid strenuous or prolonged weight bearing activities for 48 hours after injection. Some products are produced from avian sources; use with caution in patients with hypersensitivity to avian proteins, feathers, or egg products. Use Gel-One with caution in patients allergic to cinnamon. Use with caution in patients with preexisting chondrocalcinosis; may cause acute attack.
• Latex: Some products may contain natural latex rubber.
• Lidocaine: Some products contain lidocaine; methemoglobinemia has been reported with local anesthetics, including lidocaine. Risk may be increased in certain patients (eg, G6PD deficiency).
• Ophthalmic: Do not overfill the anterior chamber. Postoperative increases in intraocular pressure have occurred following use of sodium hyaluronate; remove from the anterior chamber at the end of surgery and monitor intraocular pressure closely. Mixing of quaternary ammonium salts (eg, benzalkonium chloride) with sodium hyaluronate results in the formation of a precipitate; do not irrigate the eye with any solution containing benzalkonium chloride during surgery.
• Topical: Bionect products (cream, gel): Do not use disinfectants containing quaternary ammonium salts for skin preparation (may cause precipitation of hyaluronate).
Other warnings/precautions:
• Appropriate administration: Dermal fillers, including hyaluronic acid derivatives, should be administered using a syringe with a needle or cannula. Needle-free devices for injection of dermal fillers are not FDA-approved and may cause serious injuries or permanent harm to the skin, lips, or eyes. FDA-approved dermal fillers should not be transferred into needle-free injection devices (FDA 2021).
• Appropriate patient selection: Juvederm Voluma XC: Safety for use in patients <35 years or >65 years of age (cheek augmentation) and <22 years or >80 years of age (chin augmentation) or with very thin skin in the mid-face region has not been established.
• Appropriate use: Chin augmentation: Treatment in the chin region may be obscured by skin laxity of the chin, neck, or jaw; has not been studied in patients with significant chin, neck, or jaw skin laxity. Effect on chin facial hair growth has not been studied.
• Appropriate use: Juvederm Voluma XC: Safety of cannula injection for cheek augmentation in patients with Fitzpatrick Skin Types V and VI has not been established.
• Appropriate use: Restylane Defyne, Restylane Refyne: Do not inject in a site that has been treated with a permanent implant.
• Experienced provider: Should be administered by an experienced health care provider who has appropriate training, experience, knowledge of anatomy at injection site, and knowledge of aseptic technique.
• MRI imaging: Spray emulsion (Penlen) contains silver nanoparticles that may heat during procedures; do not use prior to MRI.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, topical [sodium hyaluronate]:
Bionect: 0.2% (25 g, 100 g)
Emulsion, topical [sodium hyaluronate]
Penlen: 90 mL
Gel, topical [sodium hyaluronate]:
Bionect: 0.2% (100 g)
Therapevo: 2.5% (10 g [DSC], 75 g [DSC])
Injection, gel, intra-articular [hyaluronic acid]:
Durolane: 20 mg/mL (3 mL) [derived from or manufactured from bacterial source]
Injection, gel, intra-articular [cross-linked hyaluronan]:
Synvisc: 8 mg/mL (2 mL)
Injection, gel, intra-articular [cross-linked hyaluronate]:
Gel-One: 10 mg/mL (3 mL) [derived from or manufactured using an avian source]
Injection, gel, intradermal [cross-linked hyaluronan]:
Revanesse Versa: 22-28 mg/mL (1 mL, 1.2 mL)
Revanesse Versa+: 22-28 mg/mL and lidocaine 0.3% (1 mL, 1.2 mL)
Injection, gel, intradermal [hyaluronic acid]:
Belotero Balance: Hyaluronic acid 22.5 mg/mL (1 mL) [derived from or manufactured from bacterial source]
Belotero Balance Plus: Hyaluronic acid 22.5 mg/mL and lidocaine 0.3% (1 mL) [derived from or manufactured from bacterial source]
Juvederm Ultra Plus XC: Hyaluronic acid 24 mg/mL and lidocaine 0.3% (0.4 mL, 0.8 mL) [derived from or manufactured from bacterial source]
Juvederm Ultra XC: Hyaluronic acid 24 mg/mL and lidocaine 0.3% (0.4 mL, 0.8 mL) [derived from or manufactured from bacterial source]
Juvederm Volbella XC: Hyaluronic acid 15 mg/mL and lidocaine 0.3% (0.4 mL, 0.8 mL) [derived from or manufactured from bacterial source]
Juvederm Vollure XC: Hyaluronic acid 17.5 mg/mL and lidocaine 0.3% (0.4 mL, 0.8 mL) [derived from or manufactured from bacterial source]
Restylane: Hyaluronic acid 20 mg/mL [derived from or manufactured from bacterial source]
Restylane Contour: Hyaluronic acid 20 mg/mL and lidocaine 3 mg/mL [derived from or manufactured from bacterial source]
Restylane Defyne: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Restylane Kysse: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Restylane-L: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Restylane Lyft: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Restylate Refyne: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Restylane Silk: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Injection, gel, subcutaneous/supraperiosteal [cross-linked hyaluronic acid]:
Juvederm Voluma XC: Hyaluronic acid 20 mg/mL and lidocaine 0.3% [derived from or manufactured from bacterial source]
Injection, gel, submucosal [cross-linked hyaluronan]
Revanesse Lips: 22-28 mg/mL and lidocaine 0.3% (1 mL, 1.2 mL) [derived from or manufactured from bacterial source]
Injection, solution, intra-articular [hyaluronan]:
Hymovis: 24 mg/3 mL (3 mL) [derived from or manufactured from bacterial source]
Monovisc: 88 mg/4 mL (4 mL) [derived from or manufactured from bacterial source]
Orthovisc: 30 mg/2 mL (2 mL) [derived from or manufactured from bacterial source]
Generic: 20 mg/2 L (2 mL)
Injection, solution, intra-articular [hylan polymers A and B]:
Synvisc-One: 8 mg/mL (6 mL) [derived from or manufactured using an avian source]
Injection, solution, intra-articular [sodium hyaluronate]:
Euflexxa: 10 mg/mL (2 mL)
Gelsyn-3: 8.4 mg/mL (2 mL) [derived from or manufactured from bacterial source]
GenVisc 850: 25 mg/2.5 mL (2.5 mL) [derived from or manufactured from bacterial source]
Hyalgan: 10 mg/mL (2 mL) [derived from or manufactured using an avian source]
Supartz FX: 25 mg/2.5 mL (2.5 mL) [derived from or manufactured using an avian source]
Triluron: 20 mg/2 mL (2 mL) [derived from or manufactured using an avian source]
Trivisc: 10 mg/mL (3 mL) [derived from or manufactured from bacterial source]
Visco-3: 10 mg/mL (2.5 mL) [derived from or manufactured using an avian source]
Injection, solution, intraocular [sodium hyaluronate]:
Amvisc: 12 mg/mL (0.5 mL, 0.8 mL)
Amvisc Plus: 16 mg/mL (0.8 mL)
Clearvisc: 25 mg/mL (1 mL)
Healon5 Pro: 23 mg/mL (0.6 mL)
Healon Duet Pro: 10 mg/mL (0.55 mL) [Healon Pro] and 30 mg/mL (0.85 mL) [Healon Endocoat]
Healon Endocoat: 30 mg/mL (0.85 mL)
Healon GV Pro: 18 mg/mL (0.85 mL)
Healon Pro: 10 mg/mL (0.55 mL, 0.85 mL)
Provisc: 10 mg/mL (0.4 mL, 0.55 mL, 0.85 mL) [contains natural rubber/natural latex in packaging]
Stablevisc: 10 mg/mL (1 mL)
Totalvisc: 25 mg/mL [Clearvisc] (1 mL) and 10 mg/mL [Stablevisc] (1 mL)
Lotion, topical [sodium hyaluronate]:
Hylinate: 0.1% (340 mL)
No
Cream (Bionect External)
0.2% (per gram): $6.56
Foam (Bionect External)
0.2% (per gram): $8.75
Gel (Bionect External)
0.2% (per gram): $9.36
Gel (WoundGelHA External)
2.5% (per gram): $2.03
Prefilled Syringe (Durolane Intra-articular)
60 mg/3 mL (per mL): $430.00
Solution Prefilled Syringe (Amvisc Intraocular)
9.6 mg/0.8 mL (per 0.8 mL): $160.27
Solution Prefilled Syringe (Euflexxa Intra-articular)
20 mg/2 mL (per mL): $210.07
Solution Prefilled Syringe (Gelsyn-3 Intra-articular)
16.8 mg/2 mL (per mL): $225.00
Solution Prefilled Syringe (Hymovis Intra-articular)
24 mg/3 mL (per mL): $286.80
Solution Prefilled Syringe (Monovisc Intra-articular)
88 mg/4 mL (per mL): $450.00
Solution Prefilled Syringe (OrthoVisc Intra-articular)
30 mg/2 mL (per mL): $286.80
Solution Prefilled Syringe (Supartz FX Intra-articular)
25 mg/2.5 mL (per mL): $113.86
Solution Prefilled Syringe (SynoJoynt Intra-articular)
20 mg/2 mL (per mL): $279.40
Solution Prefilled Syringe (Synvisc Intra-articular)
16 mg/2 mL (per mL): $273.92
Solution Prefilled Syringe (Synvisc One Intra-articular)
48 mg/6 mL (per mL): $273.92
Solution Prefilled Syringe (TotalVisc Intraocular)
1 & 2.5% (per mL): $165.00
Solution Prefilled Syringe (Triluron Intra-articular)
20 mg/2 mL (per mL): $293.40
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Intra-articular: Inject directly into the knee joint; do not inject extra-articularly or into the synovial capsule or tissues. Do not use disinfectants containing quaternary ammonium salts for skin cleansing prior to injection. Remove synovial fluid or effusion, if present, prior to injection. If used for bilateral treatment, use a separate syringe for each knee. Refer to manufacturer's labeling for additional instructions on injection technique.
Intradermal/Submucosal/SUBQ/Supraperiosteal: Do not inject into a blood vessel. Topical or injectable anesthesia may be used during and after injection to manage pain. Following injection, slowly massage area so that it conforms to the contour of the surrounding tissue. May apply ice pack to injection site for a short period immediately after administration if treatment area swollen. Refer to manufacturer's labeling for additional instructions on injection technique. Prior to treatment, the patient should avoid taking aspirin, nonsteroidal anti-inflammatory medications, St. John's wort, or high doses of vitamin E supplements; these agents may increase bruising and bleeding at the injection site.
Belotero Balance and Belotero Balance Plus are intended for mid-to-deep intradermal injection.
Juvederm (all formulations except Voluma XC) is intended for mid-to-deep intradermal injection.
Juvederm Ultra XC is also intended for submucosal injection (lip augmentation).
Juvederm Volbella XC is also intended for SUBQ and/or supraperiosteal injection; if administering as cannula injection, safety has only been established with the TSK STERiGLIDE 27-gauge, 1.5-inch cannula.
Juvederm Voluma XC is intended for SUBQ and/or supraperiosteal injection; if administering as cannula injection, safety has only been established with the TSK STERiGLIDE 25-gauge, 1.5-inch cannula.
Restylane and Restylane-L are intended for mid-to-deep intradermal injection (facial wrinkles) or submucosal injection (lip augmentation).
Restylane Contour is intended for SUBQ and/or supraperiosteal injection; if administering as cannula injection, safety has only been established with the TSK STERiGLIDE 25- to 27-gauge, 1.5- to 2-inch cannulas.
Restylane Defyne is intended for mid-to-deep intradermal (facial wrinkles) or SUBQ and/or supraperiosteal (chin augmentation) injection.
Restylane Refyne is intended for mid-to-deep intradermal injection (facial wrinkles).
Restylane Kysse is intended for mid-dermis (perioral rhytids and philtral column) or submucosal injection (lip augmentation).
Restylane Lyft is intended for deep dermis to superficial subcutis (facial wrinkles), subcutaneous and/or supraperiosteal (cheek augmentation), or into the subcutaneous plane of the dorsal hand (rapid flow/injection should be avoided). When the injection is completed for treatment of dorsal hand, apply a lubricating agent (eg, ultrasound gel, petrolatum ointment) and ball hand into a fist; a deep hand massage should be performed to smooth out filler and push product into empty areas.
Restylane Silk is intended for mid to deep dermis (periorbital rhytids) or submucosal injection (lip augmentation).
Revanesse Lips is intended for submucosal injection (lip augmentation).
Revanesse Versa and Revanesse Versa+ are intended for mid-to-deep intradermal injection.
Ophthalmic: Allow to reach room temperature prior to use. Drug may become cloudy or form a slight precipitate after administration; clinical significance unknown, but cloudy or precipitated material should be removed by irrigation or aspiration. Refer to the manufacturer's labeling for additional procedure-specific instructions.
Topical:
Bionect products: Clean and disinfect wound prior to use (do not use quaternary ammonium salts due to potential for hyaluronic acid precipitation), and debride if necessary; apply a thin layer to wound or ulcer without extensive rubbing. After application, cover the area with a sterile gauze pad and if necessary, an elastic or compressive bandage.
Hylinate: Rub in thoroughly after application. Avoid contact with eyes, lips, and mucous membranes.
Penlen: Shake well prior to use. For external use only.
Intra-articular injection: Treatment of pain in osteoarthritis of the knee in patients who have failed nonpharmacologic treatment or simple analgesics (Durolane, Euflexxa, Gel-One, Gelsyn-3, GenVisc 850, Hyalgan, Hymovis, Monovisc, OrthoVisc, sodium hyaluronate [Teva], Supartz FX, Synvisc, Synvisc-One, Triluron, TriVisc, Visco-3) or nonsteroidal anti-inflammatory drugs (Gel-One).
Intradermal:
Belotero Balance, Belotero Balance Plus, Juvederm (all formulations except Volbella XC and Voluma XC), Restylane, Restylane Defyne, Restylane Lyft, Restylane-L, Restylane Refyne, Revanesse Versa, Revanesse Versa+: Correction of moderate to severe facial wrinkles or folds.
Juvederm Volbella XC, Restylane Kysse, and Restylane Silk: Correction of perioral rhytids in adults >21 years of age.
SUBQ: Restylane Lyft: Correction of volume deficit of the dorsal hand in adults >21 years of age.
SUBQ/supraperiosteal:
Juvederm Volbella XC: Improvement of infraorbital hollowing in adults >21 years of age.
Juvederm Voluma XC, Restylane Contour, Restylane Lyft: Correction of age-related volume deficit for cheek augmentation in the mid-face in adults >21 years; Juvederm Voluma XC, Restylane Defyne: Chin region augmentation in adults >21 years.
Ophthalmic: Surgical aid in cataract extraction (Amvisc, Amvisc Plus, ClearVisc, Provisc); intraocular lens implantation (Amvisc, Amvisc Plus, ClearVisc, Provisc); corneal transplant (Amvisc, Amvisc Plus); glaucoma filtration (Amvisc, Amvisc Plus); and retinal attachment surgery (Amvisc, Amvisc Plus); anterior segment surgery (Healon [all formulations]).
Submucosal: Lip augmentation in adults >21 years (Restylane, Restylane-L, Restylane Kysse, Restylane Silk, Juvederm Ultra XC, Juvederm Volbella XC) or in adults ≥22 years of age (Revanesse Lips).
Topical cream, gel: Management of skin ulcers and wounds (Bionect).
Topical lotion (Hylinate): Treatment of symptoms associated with xerosis.
Topical spray emulsion (Penlen): Manage and relieve burning and itching of dermatoses, including atopic and allergic contact dermatitis.
Hyalgan may be confused with Healon
Synvisc may be confused with Synagis
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
COVID-19 Vaccine (mRNA): May enhance the adverse/toxic effect of Dermal Fillers. Specifically, the risk for swelling at or near the site of dermal filler injection (usually face or lips) may be increased. Risk C: Monitor therapy
Adverse events were not observed in animal reproduction studies.
It is not known if hyaluronic acid derivatives are present in breast milk. The manufacturers recommend that caution be exercised when administering to a breastfeeding woman.
Intraocular pressure (ophthalmic formulations); signs and symptoms of excess local inflammation or infection (intradermal formulations)
Sodium hyaluronate is a biological polysaccharide which is distributed widely in the extracellular matrix of connective tissue in man (vitreous and aqueous humor of the eye, synovial fluid, skin, and umbilical cord). Sodium hyaluronate and its derivatives form a viscoelastic solution in water (at physiological pH and ionic strength) which makes it suitable for aqueous and vitreous humor in ophthalmic surgery, and functions as a tissue and/or joint lubricant which plays an important role in modulating the interactions between adjacent tissues. Intradermal injection may decrease the depth of facial wrinkles. Transcutaneous injection for lip augmentation may correct perioral rhytids. Subcutaneous and/or supraperiosteal injection for cheek or chin augmentation may correct age-related volume deficit. In the topical management of wounds and ulcers, sodium hyaluronate protects the skin against friction and abrasion.
Distribution: Intravitreous injection: Diffusion occurs slowly
Excretion: Ophthalmic: Via Canal of Schlemm
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