About the ads

Synvisc cross-reaction?

Discussion in 'Pain Medicine' started by Mister Mxyzptlk, Feb 15, 2012.

  1. SDN is a nonprofit organization. Services are made possible through the generous support of SDN members and sponsors. Thank you.
  1. Mister Mxyzptlk

    Mister Mxyzptlk

    Joined:
    May 16, 2006
    Messages:
    3,520
    Location:
    Yewston, TX
    Status:
    Attending Physician
    SDN 7+ Year Member

    SDN Members don't see this ad. (About Ads)
    I was referred a patient who had an allergic reaction to Synvisc, asking me to use one of the synthetic preparations. In reviewing the prescribing materials they all say to avoid use if there has been a previous reaction to hyaluronate derivatives.

    Any experience with this? I don't think the products are that much different, mostly a matter of molecular size.
  2. jj337

    jj337

    Joined:
    Jul 26, 2010
    Messages:
    150
    Status:
    Attending Physician
    SDN 2+ Year Member
    Had one yesterday allergic to Synvisc and gets one of the synthetic versions without problem... I don't know if n=1 helps...:scared:
  3. Jcm800

    Jcm800

    Joined:
    Jul 13, 2008
    Messages:
    4,021
    Status:
    Attending Physician
    SDN 5+ Year Member
    Isnt Euflexxa the only "completely" synthetic... but i think this only applies if you are allergic to chicken...

    I think if you have a problem, its gonna be hard to defend...i would avoid. but im a scaredy cat
  4. ParaVert

    ParaVert Interventional Pain

    Joined:
    Apr 23, 2006
    Messages:
    304
    Location:
    southern small town
    Status:
    Attending Physician
    SDN 7+ Year Member
    Not a crazy idea to send to immunologist for skin testing. Tiny skin wheal of Synvisc may help rule out the unlikely notion of her actually being allergic.

    Patients are clueless about what allergies are. Can't tell you how many people think they are allergic to local anesthetic because their heart raced when they got a shot at the dentist.
  5. Apollyon

    Apollyon Screw the GST Lifetime Donor

    Joined:
    Nov 24, 2002
    Messages:
    16,358
    Location:
    SCREW IT!
    Physician SDN 10+ Year Member
    I thought it was allergy to birds - not limited to chickens.
  6. Gauss

    Gauss Damnit Jim!

    Joined:
    Mar 3, 2002
    Messages:
    749
    Status:
    Attending Physician
    SDN 10+ Year Member
    extra-articular injection of any hyaluronate may generate hyper-inflammatory soft tissue reaction. Synvisc is a known culprit even intra-articular: "only the non-hyaluronan portion of the Synvisc product created an immunological response"
    http://www.jbjs.org/article.aspx?Volume=89&page=148

    euflexxa + some corticosteroid if you wanna be safe
  7. TX PAIN DOC

    TX PAIN DOC SDN Lifetime Donor Lifetime Donor

    Joined:
    Mar 29, 2009
    Messages:
    62
    Location:
    DFW
    Status:
    Attending Physician
    SDN 5+ Year Member
    :thumbup: I would agree with the above. I would obtain previous medical record documenting the reaction and physical findings prior to treatment.
  8. Mister Mxyzptlk

    Mister Mxyzptlk

    Joined:
    May 16, 2006
    Messages:
    3,520
    Location:
    Yewston, TX
    Status:
    Attending Physician
    SDN 7+ Year Member
    I just decided to not do it. Every package insert for every alternative has an allergy warning. What is the risk/benefit ratio here (for me I mean)?
  9. Jcm800

    Jcm800

    Joined:
    Jul 13, 2008
    Messages:
    4,021
    Status:
    Attending Physician
    SDN 5+ Year Member
    im with you...not a lot of reward for 2 years of lingering risk...
  10. bedrock

    bedrock Member

    Joined:
    Oct 23, 2005
    Messages:
    2,347
    Status:
    Attending Physician
    SDN 7+ Year Member
    Sounds like that patient is ready for a joint replacement.

    And they can thank the legal community for that one.........
  11. specepic

    specepic

    Joined:
    Feb 2, 2008
    Messages:
    1,223
    Location:
    New England
    Status:
    Attending Physician
    SDN 5+ Year Member
    I am in an ortho group so we use a lot of visco. We stopped using synvisc b/c of the 1/50 risk of sterile synovitis. So did the pt have a general allergic reaction or focal redness/pain at the joint? Also, our answer for pts with a synvisc issue, whatever the cause, is euflexxa. I would have no concerns injecting this pt with Euflexxa. If one was really worried you could pre-treat just like you would for 'contrast alergy' pts but that seems over the top.
  12. Mister Mxyzptlk

    Mister Mxyzptlk

    Joined:
    May 16, 2006
    Messages:
    3,520
    Location:
    Yewston, TX
    Status:
    Attending Physician
    SDN 7+ Year Member
    I don't know if the synovitis is a true reaction or if perhaps they get a synovial injection. What has decreased the incidence for me is I inject 3 ccs of lidocaine as I advance the needle to push the synovium out of the way.

    I just got a note from the referring doc asking me to please please please try it, so Euflexxa it is.
  13. Doctodd

    Doctodd

    Joined:
    Jul 4, 2005
    Messages:
    2,002
    Location:
    Miami, FL
    SDN 7+ Year Member
    the very rare reaction with Synvisc isnt worth using it ...... ever. The other reps make sure we know this.....Hyalgan or Supartz or Euflexxa, but the Orthos usually get these patients.
  14. hyperalgesia

    hyperalgesia member

    Joined:
    Jan 9, 2010
    Messages:
    1,804
    Status:
    Attending Physician
    SDN 2+ Year Member
    Henry Schein charges almost $1400 for Synvisc ONE. I saw on the company website how to bill for this in (units). But can anyone give me an idea how/if this is reimbursed by Medicare? It's a pretty hefty investment... TIA
  15. Ligament

    Ligament Interventional Pain Management SDN Advisor

    Joined:
    Jan 8, 2002
    Messages:
    3,133
    Location:
    Seattle
    Status:
    Attending Physician
    SDN 10+ Year Member
    Do any of you use Orthovisc?
  16. SSdoc33

    SSdoc33

    Joined:
    Apr 23, 2007
    Messages:
    3,094
    Status:
    Attending Physician
    SDN 7+ Year Member
    yeah, i do.

    i think they are all pretty much interchangeable, except for synvisc and synvisc 1, which have more problems with the aseptic reaction
  17. Mister Mxyzptlk

    Mister Mxyzptlk

    Joined:
    May 16, 2006
    Messages:
    3,520
    Location:
    Yewston, TX
    Status:
    Attending Physician
    SDN 7+ Year Member
    Since posting this last year I've been using Euflexxa for those with Synvisc reactions. No problems at all.
  18. ampaphb

    ampaphb

    Joined:
    May 13, 2007
    Messages:
    2,474
    Location:
    New Orleans, LA
    Status:
    Attending Physician
    SDN 7+ Year Member
    I personally had the "pseudosepsis" reaction to Synvisc when my knee was injected. Switched practice to Supartz the following day.
  19. nvrsumr

    nvrsumr Member

    Joined:
    Apr 25, 2002
    Messages:
    960
    Location:
    CO
    Status:
    Attending Physician
    SDN 10+ Year Member
    I had been having my patients get their synvisc thru their pharmacy benefit program but this has been less and less succesful recently.

    For patients with straight medicare but no supplement if I order synvisc- J7325 will they owe me the 20% or will medicare cover the whole J code?

    Any billing secrets so I dont get caught holding the bag on a $500 med?

    Thanks in advance as always.
  20. hyperalgesia

    hyperalgesia member

    Joined:
    Jan 9, 2010
    Messages:
    1,804
    Status:
    Attending Physician
    SDN 2+ Year Member
    I'm thinking about asking a patient to pick up his prescribed Synvisc at Walmart Pharmacy and bring it to his appt. Anyone else do this? It's about $1k worth of med.
  21. Ducttape

    Ducttape Lifetime Donor

    Joined:
    Oct 7, 2011
    Messages:
    2,844
    Status:
    Attending Physician
    SDN 2+ Year Member
    Didn't do for sunvisc per se but did this for qutenza a few times. One patient elected to cancel at last minute cause of expense. Sticker shock was great in all cases.
  22. mjakec

    mjakec Junior Member

    Joined:
    Jul 6, 2005
    Messages:
    42
    Location:
    WA
    Status:
    Resident [Any Field]
    SDN 7+ Year Member
  23. Mister Mxyzptlk

    Mister Mxyzptlk

    Joined:
    May 16, 2006
    Messages:
    3,520
    Location:
    Yewston, TX
    Status:
    Attending Physician
    SDN 7+ Year Member
    Last year two of my patients were admitted because they went to the ER for a Synvisc reaction and were diagnosed with septic joints (even though it was only 24 hrs). One almost had her knee I&D'd. Fortunately they called an ortho consult (not me of course) who pointed out that WBC was normal and when the knee was tapped there was clear yellow fluid.

    There have also been several who didn't go to the ER that I treated with IA steroids. I have used synthetic on them w/o any trouble.

    Now I use synthetic stuff. It's a PITA to have to do 3 shots instead of one but there have been too many ADR's to justify Synvisc now unless they have had it before w/o problems and want it for the repeat.

Share This Page


About the ads