Synvisc cross-reaction?

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

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  1. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    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.
     
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  3. jj337

    jj337 5+ Year Member

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    Had one yesterday allergic to Synvisc and gets one of the synthetic versions without problem... I don't know if n=1 helps...:scared:
     
  4. Jcm800

    Jcm800 7+ Year Member

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    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
     
  5. ParaVert

    ParaVert Interventional Pain 10+ Year Member

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    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.
     
  6. Apollyon

    Apollyon Screw the GST Lifetime Donor 10+ Year Member

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    I thought it was allergy to birds - not limited to chickens.
     
  7. Gauss

    Gauss Damnit Jim! 10+ Year Member

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    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
     
  8. TX PAIN DOC

    TX PAIN DOC SDN Lifetime Donor Lifetime Donor 5+ Year Member

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    :thumbup: I would agree with the above. I would obtain previous medical record documenting the reaction and physical findings prior to treatment.
     
  9. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    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)?
     
  10. Jcm800

    Jcm800 7+ Year Member

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    im with you...not a lot of reward for 2 years of lingering risk...
     
  11. bedrock

    bedrock Member 10+ Year Member

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    Sounds like that patient is ready for a joint replacement.

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

    specepic 7+ Year Member

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    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.
     
  13. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    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.
     
  14. Doctodd

    Doctodd 10+ Year Member

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    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.
     
  15. hyperalgesia

    hyperalgesia member Lifetime Donor 7+ Year Member

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    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
     
  16. Ligament

    Ligament Interventional Pain Management Lifetime Donor SDN Advisor 10+ Year Member

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    Do any of you use Orthovisc?
     
  17. SSdoc33

    SSdoc33 7+ Year Member

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    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
     
  18. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    Since posting this last year I've been using Euflexxa for those with Synvisc reactions. No problems at all.
     
  19. ampaphb

    ampaphb Interventional Spine 7+ Year Member

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    I personally had the "pseudosepsis" reaction to Synvisc when my knee was injected. Switched practice to Supartz the following day.
     
  20. nvrsumr

    nvrsumr Member 10+ Year Member

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    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.
     
  21. hyperalgesia

    hyperalgesia member Lifetime Donor 7+ Year Member

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    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.
     
  22. Ducttape

    Ducttape SDN Lifetime Donor Lifetime Donor 5+ Year Member

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    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.
     
  23. mjakec

    mjakec Junior Member 10+ Year Member

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  24. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    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.
     
  25. hyperalgesia

    hyperalgesia member Lifetime Donor 7+ Year Member

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    Have you guys tried "Gel-One" by Zimmer? Supposed to be purified so less chance of avian reaction. Interesting they also claim the "joint residence time" in animal studies is 91 days, compared to 28 days for Synvisc-One...
     
  26. Mister Mxyzptlk

    Mister Mxyzptlk 10+ Year Member

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    Interesting to hear about "joint residence time". For some reason I was under the impression that it was gone a lot faster than that.
     

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