Concomittant intraarticular injections-
Do not coadminister with other intraarticular  injectables.

Safety and efficacy has not been established

 Cardiovascular -    blood pressure 3%  

CNS -                    fatigue 1%   pareesthesia  1%

GI -                      nausea 1%

Musculoskeletal -    arthalgia  8%    arthosis  1%  back pain 5%   joint disorder 1%
                                  joint swelling 1%   pain in limb  1%   tendonitis 1%

Respiratory -    rhinitis  3%

Miscellaneous -    infection  1%

Hypersensitivity to the drug

Special Precaution
Avian allergies- use caution in patients allergic to avian proteins,  feathers, and egg products

Inflammed knee - safety and efficacy in severely inflammed knee joints have not been established

Inflammatory arthiritis- transcient increase in inflammation in infected knee following injections
with sodium hyaluronase have been reported in some patients with inflammatory arthiritis
( rheumatoid or gouty arthiritis )

Intraarticular administration- administer by intraarticular injection only.
Avoid intravascular , extra-articular , synovial tissue and capsule administeration.
Rare systemic adverse reactions reported

Safety and efficacy of intraarticular adminstration in locations other than the knee and for
conditions other than OA have not been established

Joint effusion- remove joint effusion before using hylanuronic acid derivatives.

Latex sensitivity - use caution in patients with a possible latex senstivity

Lymphatic  or venous statis- use synvisc with caution when evidence of lymphatic or
venous or statis exists in treatment leg 

Quarternary ammonium salts-  avoid concomittant use of disinfectants for skin preparation
containing quarternary ammonium salts , such as benzyl ammonium chloride ,precipitation
of drug may occur.

Treatment cycle-  the efficacy of a single treatment cycle of less than the recomended number
of injections has not been established. 3 injection are recommended. Safety and efficacy of
repeat cycles has not been established

Hypersensitivity reactions- anaphylactoid reactions have occured. All anaphylatic reactions
were classfied as mild to moderate

Pregnancy -  safety and efficacy have not been established in pregnant women. Give to
pregnant woman only if needed

Lactation- excercise caution when administering  to a breast feeding woman.

Children- safety and efficacy have not been established

Osteoarthiritis

Dosage-
Administer 2mL (2.5 ml ) by intramuscular injection in affected knee once weekly for the
recommended number of injections per treatment cycle.

If the treatment is bilateral use a separate 2ml vial/syringe for each knee

Do not prepare injection site with skin disinfectant containing quaternary ammonium salts,
precipation of drug can occur.

Do not give intra-articular injectables concomittantly

1. Inform patient that transcient pain and/or  swelling of the treated joint may occur after injection

2. Inform patients to avoid strenous or prolonged ( more than 1 hour )  weight bearing activities
   ( eg jogging, tennis,) within 48 hours following treatment

3. Advice patients that the safety and efficacy of repeated treatments cycles have not been
 studied

4. Avoid patients receiving synvisc that transceint effusion may occur. In some cases the
    effusion may be considerable and cause pronounced pain. Advice patients to consult
    with their health care providers if swelling is intensive.  

Pregnancy - 
Safety and efficacy have not been established in pregnant women. Give to
pregnant woman only if needed

Lactation-
Excercise caution when administering  to a breast feeding woman.

Children-
Safety and efficacy have not been established