AdultPediatricDosage Forms & Strengths intra-articular injection (prefilled syringe) 16mg/2mL (Synvisc) 30mg/2mL (Orthovisc) 48mg/6mL (Synvisc-One) 88mg/4mL (Monovisc) 24mg/3mL (Hymovis) 25mg/2.5mL (GenVisc 850) 25mg/2.5mL (Supartz FX) 25mg/2.5mL (Visco-3) Osteoarthritis of the Knee Indicated for treatment of pain in osteoarthritis of the knee Synvisc: Inject intra-articularly 16 mg (2 mL) to affected knee qWeek for 3 weeks Synvisc-One: Inject intra-articularly 48 mg (6 mL) to affected knee once as a single injection Orthovisc: Inject intr-articularly 30 mg (2 mL) to affected knee qWeek for 3 weeks Monovisc: Inject intra-articularly 88 mg (4 mL) to affected knee once as a single injection Supartz FX, GenVisc 850: Inject 25 mg (2.5 mL) once weekly for 5 weeks; 5 injections total; some patients may benefit from a total of 3 injections Hymovis: Inject 24 mg (3 mL) once weekly for 2 weeks (2 injections total) Visco-3: Inject 25 mg (2.5 mL) once weekly for 3 weeks (3 injections total) Emphysema (Orphan) Orphan designation for emphysema due to alpha1-antitrypsin deficiency Sponsor Gerard M. Turino, MD; Division of Pulmonary, Critical Care & Sleep Medicine; Mt. Sinai Roosevelt Hospital Center; New York, New York 10019 Safety and efficacy not established >10% Arthralgia (25%) Tenderness (61-92%) Swelling (81-91%) Firmness (88-89%) Bruising (52-87%) Pruritus (25-36%) Skin discoloration (33-78%) Firmness (86-89%) Lumps/bumps (56-83%) 1-10% Increased blood pressure (4%) Fatigue (1%) Nausea (<2%) Injection site pain (3%) Paresthesia (1%) Tendonitis (2%) Limb pain (1%) Tendonitis (2%) Joint effusion (2%) <1% Angioedema Arthritis Herpetic eruptions Thrombocytopenia Peripheral edema Vasovagal reaction Hives Gait disturbances Contraindications Hypersensitivity to hyaluronate preparations and components Knee joint infections or infections or skin diseases at the site of the injection Hypersensitivity to gram-positive bacterial proteins (Hymovis, Monovisc); systemic bleeding (Monovisc) Cautions Avoid strenuous activity or prolonged (>1 hr) weight-bearing activities (eg, running, tennis) within 48 hr following injection Pain relief may not be evident until after 3rd injection Disinfectants containing quaternary ammonium salts should not be used for skin preparation (may cause precipitation of hyaluronate) Not to be administered intravascularly, extra-articularly, or for injecting into the synovium Remove synovial fluid or effusion, if present before injection Not for use in cases of severe intra-articular effusion If venous or lymphatic stasis present in the leg, use with caution Patients with inflammatory arthritis may experience transient increases in reddening or inflammation, pain, sensation of heat after injection into the knee Some products produced from avian sources; use caution in patients with hypersensitivity to avian proteins, egg products, or feathers To be administered by experienced healthcare provider with appropriate experience, training, knowledge of anatomy at injection site, and aseptic technique Pregnancy Category: Not tested in pregnant women Lactation: Unknown whether distributed in breast milk, caution advisedPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action When injected intra-articularly, supplements joint cushioning to temporarily provide pain relief caused by osteoarthritis High molecular weight polysaccharide composed of repeating disaccharide units of sodium glucuronate and N-acetylglucosamine; derived from bacterial cells Intra-Articular Administration Concomitant use of disinfectants containing quaternary ammonium salts (eg, benzalkonium chloride) for skin preparation can precipitate in presence of hyaluronic acid Use strict aseptic injection technique Inject the full contents of single syringe intra-articularly into 1 knee only; if treatment is bilateral, a separate syringe should be used for each knee BRAND FORM. UNIT PRICE PILL IMAGE Synvisc intra-articular- 16 mg/2 mL solutionSynvisc-One intra-articular- 48 mg/6 mL solutionCopyright © 2010 First DataBank, Inc.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. OR Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. 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