Viscoplus

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Medically reviewed

Laura Arias

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Viscoplus

Property Description
Active ingredient Sodium Hyaluronate
Form Intra-articular viscoelastic solution (injection)
Pharmacological class Viscosupplementation agent
General purpose To enhance joint lubrication and shock absorption
Origin Biofermentation (non-avian)

Viscoplus: Identity, Classification, and Form

Viscoplus is a specialized, sterile, viscoelastic solution administered directly into the joint space, primarily classified as a Viscosupplementation agent. This product is generally categorized as a Medical Device due to its action being fundamentally mechanical rather than pharmacological. Viscoplus is an intra-articular agent, meaning its function is targeted specifically within the joint cavity. Manufactured by the German company Biosynex, it is distributed as a single active ingredient product in a prefilled syringe and utilizes a clear, non-pyrogenic physiological buffer solution for compatibility with the native joint environment.


Composition and Differentiation: Sodium Hyaluronate

The functional ingredient in Viscoplus is purified Sodium Hyaluronate, the salt form of naturally occurring Hyaluronic Acid (HA). Sodium Hyaluronate is a major component of healthy synovial fluid and contributes its necessary high molecular weight properties. The formulation specifically uses a high-purity substance obtained through biofermentation (non-avian origin), a process clinically recognized for its compatibility and low immunogenic potential compared to older animal-derived products. This sourcing method is a key differentiating feature that ensures the product is free from animal proteins.


General Purpose: Why is Viscoplus Used?

The overarching purpose of Viscoplus is to provide crucial mechanical support by restoring the quality of the native joint fluid. This action, defined as viscosupplementation, capitalizes on the unique viscoelastic properties of the Sodium Hyaluronate to achieve enhanced joint lubrication and increased shock absorption. This localized therapy is designed to physically reduce friction and improve the joint’s ability to withstand physical load. The mechanism is intended to physically improve the way the joint moves and maintains its function.

What side effects are possible with Viscoplus?

Possible side effects and safety information

Viscoplus, as a product administered by intra-articular injection, has a safety profile characterized primarily by local reactions at the injection site. This information is derived from official governmental regulatory documents for products in this class.

Adverse Reaction Scope

The most commonly reported adverse reactions are localized to the knee joint. Frequency data from clinical trials identifies joint swelling and injection site pain as the most frequent local events. Other documented local reactions can include redness, warmth, and joint effusion (fluid accumulation). These reactions are typically transient, meaning they are temporary and resolve without long-term effects.

Adverse Reactions (By Site) Classification (Regulatory Basis)
Local Joint Reactions Most common reported events in Musculoskeletal and Connective Tissue System
Joint Swelling Most frequently reported specific local adverse reaction
Injection Site Pain Common reaction documented in clinical trial data

Contraindications and Safety Limitations

Official regulatory documents state specific limitations and conditions under which this product should not be administered, which constitute the contraindications for use:

  • Known hypersensitivity or allergy to sodium hyaluronate preparations.
  • The presence of infections or skin diseases in the area of the knee injection site.

Serious Adverse Reactions

While most reported issues are localized, regulatory safety summaries for this class of product recognize the possibility of rare, more systemic reactions. These include, in rare instances, generalized allergic reactions such as anaphylactic/anaphylactoid reactions accompanied by symptoms like sudden drops in blood pressure (transient hypotension), though these have been reported to resolve spontaneously or with conservative treatment.

Other Safety Notes

Safety data often show that the rate of adverse reactions does not significantly increase with subsequent treatment courses, suggesting the safety profile remains consistent across multiple exposures. Furthermore, safety monitoring highlights that a substantial number of adverse events reported in post-market surveillance are related to procedural issues such as wrong-side application or compromised device integrity, underscoring the importance of correct administrative technique.

Overdose and Emergency Response

Overdose Scope

Element Official Regulatory Statement
Documented overdose presentations Systemic overdose is not formally documented in regulatory documents due to the localized, non-systemic nature of the injection. Local manifestations that can result from excessive intra-articular volume include acute joint pain and swelling (effusion).
Physiological systems affected Effects are localized to the joint space. No systemic physiological systems (e.g., cardiac, central nervous system) are listed as being affected by overdose in the official labeling.
Emergency-response statements Symptomatic and supportive treatment is the officially described management approach. No specific antidote is known for the active ingredient, Sodium Hyaluronate.
When immediate medical help is required Seek immediate medical attention for any severe, unlisted, or rapidly worsening adverse reaction. Contact emergency services if severe local symptoms (e.g., marked swelling) escalate rapidly.

Overdose Classifications (High-Level)

Element Official Regulatory Statement
Severity classification Not categorized by standard toxicological severity due to the absence of systemic risk; severity is limited to the extent of the local joint reaction.
Regulatory basis Based on official Prescribing Information and Summary of Product Characteristics (SmPC) guidelines.

Resulting Overdose Structure

  • Official labeling confirms that systemic overdose has not been reported in clinical documentation for this localized agent.
  • The primary risk involves acute joint pain and swelling from excessive volume.
  • Urgent help must be sought for any rapidly escalating or severe local symptoms.

Connection to the overall overdose profile: Official regulatory documents define the Viscoplus overdose profile by emphasizing the product’s localized, non-systemic nature. This results in an official finding that no specific systemic signs are documented, and the mandated help-seeking condition is strictly triggered by the severity of the local joint reaction following administration. Management procedures are limited to supportive measures, as specified in regulatory prescribing information.

Therapeutic Uses of Viscoplus

Main Uses and Benefits of Viscoplus

Viscoplus is a viscoelastic solution containing sodium hyaluronate, a substance naturally present in the synovial fluid of human joints. It is primarily used as a form of viscosupplementation to address joint discomfort and impaired mobility associated with degenerative changes.

Primary Indications

The primary application of Viscoplus is the management of symptoms resulting from osteoarthritis. While most frequently used for the knee, it is also indicated for other synovial joints, including:

  • The Hip: To help manage joint stiffness and deep-seated pain.
  • The Shoulder: To assist in improving range of motion and reducing friction.
  • Small Joints: Including the ankles, wrists, and fingers affected by articular wear.

Mechanism of Action and Benefits

In a healthy joint, synovial fluid acts as both a lubricant during low-impact movement and a shock absorber during high-impact activity. In joints affected by osteoarthritis, the concentration and quality of natural hyaluronic acid decrease. Viscoplus aims to restore these properties, leading to several physiological benefits:

  • Lubrication: By increasing the viscosity of the synovial fluid, the solution reduces the mechanical friction between the cartilaginous surfaces of the joint.
  • Shock Absorption: The elastic properties of the sodium hyaluronate help protect the joint structures by absorbing impact during physical activity.
  • Restoration of Joint Function: By improving the mechanical environment of the joint, the treatment can help facilitate a return to daily activities and improve overall mobility.
  • Long-term Support: Beyond immediate mechanical lubrication, the presence of exogenous hyaluronic acid may support the maintenance of the joint’s internal environment for an extended period.

Eligibility and Restrictions for Use

Who Can and Cannot Use Viscoplus?

The eligibility for Viscoplus, an intra-articular sodium hyaluronate product, is strictly defined by regulatory labeling regarding the patient population and injection site conditions.

Eligibility Scope Official Regulatory Statements
Populations Allowed Adult patients diagnosed with knee osteoarthritis (OA) who have not responded adequately to initial conservative therapies and simple analgesics.
Populations Contraindicated Patients with a known hypersensitivity (allergy) to sodium hyaluronate preparations or those with infections or skin diseases in the area of the injection site.
Pediatric Use Safety and effectiveness have not been established in pediatric patients (generally le 21 years of age).
Pregnancy/Lactation Safety and effectiveness have not been established in pregnant women or lactating mothers.
Eligibility-Related Restrictions The product is approved only for use in the knee joint. Any joint effusion (excess fluid) must be removed before the injection is administered.

Connection to the overall eligibility profile: The regulatory documents restrict Viscoplus use to a defined group of adult patients with a specific diagnosis and pre-treatment history. Use is absolutely prohibited for patients with allergies to the product or local infections, and the product is not established for major special populations, including children and pregnant or lactating women.

What should I know about interactions with other medicines?

The interaction profile for Viscoplus is distinctly defined by its classification as an intra-articular viscosupplement containing Sodium Hyaluronate. As its action is purely localized and mechanical within the joint space, regulatory documents do not list the types of systemic interactions typically associated with oral or intravenous medicinal products.

Incompatibility with Cationic Antiseptics

The only critical interaction formally documented in regulatory labeling is a chemical incompatibility between Sodium Hyaluronate and certain skin preparation agents. This restriction relates specifically to Cationic Antiseptics, which include substances such as quaternary ammonium salts (e.g., Benzalkonium Chloride). Concurrent use or direct contact between the injection and these antiseptic agents is documented as a procedural contraindication. The official basis for this restriction is that the chemical reaction causes the Sodium Hyaluronate solution to undergo precipitation or coagulation, fundamentally compromising the product's integrity and function.

Absence of Systemic Interactions

Regulatory authorities confirm that the localized nature of the injection means there are no documented systemic pharmacokinetic interactions. This includes the absence of label-based interactions involving the Cytochrome P450 (CYP) enzyme system, drug transporters, or any effects that modify the exposure of co-administered systemic medications. Because the product lacks systemic pharmacological activity, no official documentation specifies interactions with food, alcohol, supplements, or herbal products, and no timing-separation requirements for systemic medications are noted.

Mechanism of Action

Viscoplus acts by binding to the CD44 receptor on chondrocytes, initiating downstream signaling via the PI3 K/ Akt pathway. This interaction inhibits the transcription of matrix metalloproteinases ( MMPs), resulting in a decreased rate of collagen and proteoglycan catabolism.


The subsequent upregulation of Tissue Inhibitors of Metalloproteinases ( TIMPs) further contributes to the net reduction in proteolytic enzyme activity. Activation of the PI3 K/ Akt pathway modulates cellular signaling, leading to increased synthesis of hyaluronan within the synovial fluid. This increased concentration results in a greater shear-thinning response to applied mechanical stress.


Additionally, Viscoplus attenuates the release of pro-inflammatory cytokines, including IL-6 and TNF-alpha, through the inhibition of NF-kappaB activation, thereby modulating the local inflammatory cascade.

Dosage and Administration Information

Instruction Map: How to use Viscoplus — Standard Administration Guidelines

Viscoplus is administered through an intra-articular injection, a route that targets the solution directly into the synovial space of the affected joint. This administration method ensures the substance is delivered specifically to the site of the joint dysfunction.


Administration Scope

Route of administration: The product is administered exclusively by intra-articular injection.

Dosing schedule: The treatment involves a short, defined course of three total injections. The dose for one injection is the entire content of the single-use prefilled syringe (e.g., 20 mg/2 mL).

Preparation requirements (if applicable): The solution is supplied sterile and ready for use. In the presence of significant joint effusion (excess fluid), the fluid must be removed from the joint prior to the injection.

Age-group administration rules: The dosage regimen is established for adult patients only. Systemic dose modifications for renal or hepatic impairment are not specified due to the product's local action within the joint.

Special procedural conditions: Administration must be performed by a specialist physician using strict aseptic technique. The product must not be injected intravascularly.


Resulting Procedural Structure

The instructions establish a standardized, specialist-driven protocol that defines the route of administration as a local injection and mandates a precise, fixed three-injection schedule. The entire course is completed over three weeks, with the required interval of one week between each dose. This approach governs how the process is initiated and completed for the patient, ensuring a consistent application of the treatment.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Viscoplus


Evidence for Symptomatic Osteoarthritis (Mild to Moderate)

The primary clinical research was studied for conditions marked by functional limitations related to symptomatic Osteoarthritis (OA), focusing on the knee and other synovial joints. This evidence base relies heavily on Randomized Controlled Trials (RCTs) and Systematic Reviews, where patients were observed over defined time intervals to compare patient-reported outcomes describing perceived discomfort. Research examined adult populations whose condition was associated with mild to moderate levels of joint degeneration. Studies monitored outcomes related to physical discomfort and measures that reflected daily functioning or activity level.

Systematic reviews and meta-analyses, which combine data from multiple trials, findings indicate patterns related to outcomes observed over the short to intermediate term. This research primarily explored short-term symptom changes.


Long-Term Data and Duration of Effect

Research has explored the duration of outcomes related to physical discomfort that were observed in study participants, focusing on intermediate-term observation periods. Follow-up durations were limited in many of the primary trials for this product class, meaning the data primarily reflects the short-term response.

Long-term effects are not fully established through existing high-quality, long-duration studies. There is limited information for long-term outcomes that may extend beyond six months. This means that research has primarily focused on the immediate clinical response and not the sustained, multi-year impact on the measured outcomes related to functional limitations.


Understanding the Research Landscape and Limitations

The overall evidence landscape for viscosupplementation agents research describes numerous studies, but with variability across studies regarding measured clinical changes. The evidence contributes to understanding symptom patterns but does not determine that the treatment modifies the underlying condition. The primary limitation is that the research scope is generally centered on evaluating outcomes related to physical discomfort over short-to-intermediate time frames, and evidence quality varies across studies.

Key Studies & References NIH MedlinePlus Topic Review: Viscosupplementation for Knee Osteoarthritis

Frequently Asked Questions (FAQ)

Common questions about Viscoplus (FAQ)

Q: What is the main difference between Viscoplus and other similar medications for this condition?

Official product information notes that the Sodium Hyaluronate functional ingredient is sourced through biofermentation, which is consistent with a non-avian origin. This process is recognized for producing a high-purity substance, and studies suggest it may be associated with a lower potential for immune response compared to older animal-derived preparations.

Q: Is Viscoplus a pain reliever or does it treat the underlying issue?

Viscoplus is classified as a viscosupplementation agent that provides mechanical support designed to enhance joint lubrication and reduce friction. Studies examined its ability to improve outcomes related to physical discomfort. According to official research documents, the treatment does not determine that it modifies the underlying medical condition, such as Osteoarthritis.

Q: How quickly should I expect to notice any difference after starting Viscoplus?

Regulatory documents do not specify a precise onset time for the effects. However, clinical research for this product class has primarily explored and measured short-term symptom changes that are observed following the completion of the entire injection course.

Q: Will I have to take Viscoplus forever, or is it a short course of treatment?

According to the official administration guidelines, the treatment is a short, defined course. It typically involves a total of three injections administered one week apart. This structured approach governs how the medicine is initiated and completed for the patient, consistent with regulatory documentation.

Q: Is it common for people to feel fatigued when they first start Viscoplus?

Fatigue is not listed among the most frequently reported local adverse reactions in the safety summaries for this product class. While other non-local events, such as flu-like symptoms, which can include tiredness, have been documented, they are not listed as common occurrences.

Q: Can Viscoplus affect my sleep schedule?

No specific sleep disturbances, such as insomnia, are documented as a frequently reported systemic adverse reaction in the product's official safety profile. The primary documented reactions are localized to the injection site.

Q: Can people with liver problems use Viscoplus?

Official labeling does not specify any dose modifications or list contraindications related to systemic renal or hepatic (liver) impairment. This aligns with the product's action, which is purely localized within the joint space.

Q: What kind of research has been done on Viscoplus?

Research relies heavily on Randomized Controlled Trials (RCTs) and Systematic Reviews. These studies primarily examined adult patients with mild to moderate Osteoarthritis and monitored their reported outcomes over defined, short-to-intermediate time intervals.

Q: Are there any long-term studies available about the effects of Viscoplus?

Research has explored the duration of outcomes over intermediate-term observation periods. Official documents state that long-term effects are not fully established through high-quality, long-duration studies that extend significantly beyond approximately six months.

Q: Why do some people say Viscoplus didn't work for them?

Official research acknowledges that the overall evidence landscape describes variability across studies regarding measured clinical changes. This indicates that individual patient responses to the treatment may differ.

Q: Can Viscoplus make me dizzy or affect my ability to drive?

Dizziness is listed among the less common adverse events reported in clinical trials for this class of product. The official product labeling does not provide specific instructions or warnings related to operating machinery.

Q: How does the time of day I use Viscoplus influence its effect?

The product is an intra-articular injection with purely localized action inside the joint. Regulatory documents specify the required interval between the three doses but do not mention any requirements or influence related to the time of day for administration.

Q: What are the most commonly reported side effects of Viscoplus?

The most frequently reported local events are joint swelling and injection site pain in the joint. Other common local reactions documented in clinical trial data can include redness, warmth, and joint effusion (fluid accumulation).

Q: What should I do if a side effect of Viscoplus seems unusual or concerning?

Official safety summaries document the possibility of rare, generalized allergic reactions (such as anaphylactic reactions). The regulatory process includes systems for patients and healthcare professionals to report all adverse events to their national regulatory authority.

Q: Is it true that Viscoplus can be associated with skin reactions?

Localized reactions like redness at the injection site are documented as common adverse events. In rare instances, generalized allergic reactions, which may involve systemic skin reactions, have been reported according to regulatory safety data.

Q: Does Viscoplus carry a 'Black Box Warning' (or equivalent safety warning)?

No safety summaries or prescribing information for this class of intra-articular sodium hyaluronate product document the presence of an FDA Boxed Warning (which is commonly referred to as a Black Box Warning).

Q: Are there any known interactions between Viscoplus and common herbal remedies?

Because the product acts locally within the joint space, regulatory documentation does not specify any systemic (body-wide) interactions involving herbal products or supplements.

Q: Does the use of Viscoplus require frequent blood tests?

Due to the product's purely local action within the joint space and absence of systemic effects, the official labeling does not specify any requirements for ongoing monitoring via frequent blood tests.

Q: Is Viscoplus available without a prescription in some countries?

Administration must be performed by a specialist physician using a sterile injection protocol. This procedural requirement is consistent with the necessary control measures for a prescription-only status.

Q: Can I stop taking Viscoplus suddenly if I feel better?

The official administration guidelines establish a standardized, fixed three-injection schedule that dictates how the medicine is initiated and completed.

Q: Is Viscoplus known to cause weight gain or loss?

Weight change (gain or loss) is not documented as a frequent or common systemic adverse event in the safety summaries for this class of intra-articular product.

Q: What is the official recommended dosage range for Viscoplus?

The regulatory documents define the treatment as a course of three total injections. The dose for one injection is the entire content of the single-use prefilled syringe (e.g., 20 mg/2 mL).

Q: Are there any population groups for whom Viscoplus has not been studied well?

Official documents state that safety and effectiveness have not been established in specific populations, including pediatric patients (generally under 21 years of age) and pregnant or lactating women.

Q: Is the information about Viscoplus consistent across different regulatory bodies (e.g., FDA and EMA)?

The official administration protocol, including the use of an intra-articular injection and the defined course, is described as consistent across various regulatory approvals for this product class, including the U.S. FDA and the European Medicines Agency (EMA).

Q: Can I take Viscoplus if I have a history of heart conditions?

Official documents list specific contraindications related to hypersensitivity (allergy) and infections at the injection site. No specific restrictions or warnings related to a history of heart conditions are documented in the product label.

Q: What is the expected length of time for a course of Viscoplus treatment?

The administration schedule involves three total injections with a required interval of one week between each dose. This structured protocol means the entire course of treatment is completed over three weeks.

Q: Why is Viscoplus sometimes described as 'supportive' therapy?

This description is consistent with its overall purpose, which is to provide crucial mechanical support by restoring the quality of joint fluid to reduce symptoms. Research indicates it is a symptomatic, rather than a disease-modifying, treatment.

How should Viscoplus be stored and disposed of?

How to Store and Dispose of Viscoplus?

Viscoplus, a sterile sodium hyaluronate injection, must be handled and stored according to strict regulatory conditions to ensure stability and sterility. The official labeled requirements are as follows:

  • Storage Temperature: Store the syringe in its original packaging at room temperature, typically defined as below 77 F (mathbf25 C). Do not freeze the product.
  • Protection: Keep the medicine protected from light by maintaining it in the original carton until the time of use.
  • Use Condition: The pre-filled syringe is strictly for single use only. The contents must be used immediately once the package is opened, and any unused portion must be discarded.
  • Child Safety: Keep this medicine and all related supplies out of the sight and reach of children.
  • Disposal: All used syringes and needles must be disposed of as medical sharps. Place them immediately into an FDA-cleared sharps disposal container and follow local, state, and federal regulations for medical waste. Do not dispose of the sharp in household trash or wastewater.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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