Indocyanine Green

Drug overview for INDOCYANINE GREEN (indocyanine green):

Generic name: INDOCYANINE GREEN
Drug class:
Therapeutic class: Diagnostic Agents

Indocyanine green is a tricarbocyanine dye used for measurement of cardiac Indocyanine green, a tricarbocyanine dye is used to test hepatic function and measure hepatic blood flow. output.

Indocyanine green is used as a test of hepatic function and for measurement Indocyanine green is used in the measurement of cardiac output by the indicator-dilution method. It is the dye most frequently used in the of hepatic blood flow. The dye is of little value in determining the exact measurement of cardiac output because it has several advantages over other nature of liver disease, but it is useful as a supplement to clinical dyes: its maximum spectral absorbance occurs at a wavelength where reduced impression and other indices of hepatic function in determining the functional status of the liver.

hemoglobin and oxyhemoglobin transmit light equally, it is relatively nontoxic, it can be analyzed in relatively low concentrations, and its analysis is not affected by hemolysis. The concentration of the dye in the In the measurement of hepatic function, indocyanine green appears to be blood may be measured using a conventional cuvette densitometer or with an generally about as accurate as sulfobromophthalein sodium (BSP). In ear densitometer.

recommended doses, BSP may be more sensitive to minor alterations in hepatic function; however, BSP is no longer commercially available in the Indocyanine green has also been used to measure plasma volume and regional US for use as a hepatic diagnostic agent. One study has shown that blood flow and to assess hemodynamics in various organs including the indocyanine green in doses of 5 mg/kg is equally effective in detecting kidneys, eyes, and lungs. minor hepatic dysfunction.

Indocyanine green has several advantages over other dyes: its maximum spectral absorbance occurs at a wavelength where For information on the use of indocyanine green in hepatic function reduced hemoglobin and oxyhemoglobin transmit light equally, it is determination and measurement of hepatic blood flow, see Indocyanine Green relatively nontoxic, it can be analyzed in relatively low concentrations, (Hepatic) 36:44. and its analysis is not affected by hemolysis. In addition, it has the advantages over BSP of not undergoing metabolism, enterohepatic circulation, or extrahepatic excretion, and having a plasma disappearance rate curve which is more nearly exponential.

Indocyanine green has also been used to measure plasma volume and regional blood flow and to assess hemodynamics in various organs including the kidneys, eyes, and lungs. For information on the use of indocyanine green in cardiac output determinations, see Indocyanine Green (Cardiac) 36:18.

DRUG IMAGES

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The following indications for INDOCYANINE GREEN (indocyanine green) have been approved by the FDA:

Indications:
Diagnostic imaging
Ophthalmic angiography

Professional Synonyms:
Diagnostic imaging exam
Diagnostic imaging procedure
Diagnostic radiography
Diagnostic radiology

The following dosing information is available for INDOCYANINE GREEN (indocyanine green):

Dosing
Administration
Dosing Information
Generic

In the determination of cardiac output, the usual dose of indocyanine green In the determination of hepatic function, the usual dose of indocyanine green is 0.5 mg/kg, although doses as low as 0.1 mg/kg and as high as 5 is 5 mg for adults, 2.5

mg for children, and 1.25 mg for infants, diluted, if necessary, with sterile water for injection or 0.9% sodium chloride mg/kg have been used.

It has been reported that doses of 5 mg/kg allow detection of mild hepatic dysfunction not otherwise detectable with injection to make a final volume of 1 mL. These doses are repeated indocyanine green. periodically to obtain several dilution curves.

The manufacturer recommends

that the total dose of indocyanine green not exceed 2 mg/kg.

The patient should be studied in a fasting, basal state. If the photometric Indocyanine green solution is injected as rapidly as possible into the method is used, a 6-mL sample of blood is obtained from a vein in the arm for use as a blank, and the dye is injected through the same needle as right atrium, right ventricle, or pulmonary artery through a cardiac catheter. The residual dye should be flushed from the catheter with saline rapidly as possible without allowing the dye to escape.

Disappearance of the dye from the plasma may be measured using a dichromatic ear to prevent hemolysis. The measurement of indocyanine green should begin densitometer, or blood samples may be obtained from a vein of the opposite immediately after administration of the dye using either a dichromatic ear arm at 5-minute intervals for 15 minutes to determine the percentage densitometer or continuous arterial blood withdrawal and a cuvette densitometer. Cardiac output is calculated using the data derived from the disappearance rate (PDR) of the dye.

An additional sample should be initial peak of the blood level-time curve. Specialized references should obtained 20 minutes after injection to determine the percentage retention be consulted for specific procedures and to determine the most appropriate of the dye. PDRs range from 18-24 in healthy adult males and 24-30 in healthy infants.

Specialized references should be consulted for specific method of calculation and the interpretation of the results of cardiac output studies. procedures, methods of calculating PDR, and interpretation of results of

hepatic function studies.

Indocyanine green has been administered IV in the determination of hepatic blood flow. Blood from a peripheral artery and a hepatic vein is sampled, and the hepatic blood flow is calculated using the Fick principle. For specific dosage, procedures, and methods of calculating hepatic blood flow specialized references should be consulted.

No enhanced Administration information available for this drug.

No dosing information available.

No generic dosing information available.

The following drug interaction information is available for INDOCYANINE GREEN (indocyanine green):

Contraindicated
Severe
Moderate

There are 0 contraindications.

There are 2 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Radioactive Iodide/Agents that Affect Iodide SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1) CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1) PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less. PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(2) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(3) DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1)	ADREVIEW, JEANATOPE, MEGATOPE, SODIUM IODIDE I-123, VOLUMEX
Sodium Iodide I 131/Agents that Affect Iodide SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1,2) CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1,2) PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less. PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1,2) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(3) The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(4) DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g: amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1,2)	HICON, SODIUM IODIDE I-131

Drug Interaction

Drug Names

Radioactive Iodide/Agents that Affect Iodide

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1)

CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1)

PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less.

PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(2)

The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(3)

DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g:

amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1)

ADREVIEW, JEANATOPE, MEGATOPE, SODIUM IODIDE I-123, VOLUMEX

Sodium Iodide I 131/Agents that Affect Iodide

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Many compounds can affect iodide protein binding and alter iodide pharmacokinetics and pharmacodynamics.(1,2)

CLINICAL EFFECTS: Compounds that affect iodide pharmacokinetics and pharmacodynamics may impact the effectiveness of radioactive iodide.(1,2)

PREDISPOSING FACTORS: Compounds that affect iodide pharmacokinetics and pharmacodynamics are expected to have the most impact during therapy using radioactive iodide. Diagnostic procedures would be expected to be impacted less.

PATIENT MANAGEMENT: Discuss the use of agents that affect iodide pharmacokinetics and pharmacodynamics with the patient's oncologist.(1,2) Because indocyanine green contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of indocyanine green.(3)

The manufacturer of iopamidol states administration may interfere with thyroid uptake of radioactive iodine and decrease therapeutic and diagnostic efficacy. Avoid thyroid therapy or testing for up to 6 weeks post administration of iopamidol.(4)

DISCUSSION: Many agents interact with radioactive iodine. The average duration of effect is: anticoagulants - 1 week antihistamines - 1 week anti-thyroid drugs, e.g: carbimazole, methimazole, propylthiouracil - 3-5 days corticosteroids - 1 week iodide-containing medications, e.g:

amiodarone - 1-6 months expectorants - 2 weeks Lugol solution - 3 weeks saturated solution of potassium iodine - 3 weeks vitamins - 10-14 days iodide-containing X-ray contrast agents - up to 1 year lithium - 4 weeks phenylbutazone - 1-2 weeks sulfonamides - 1 week thyroid hormones (natural or synthetic), e.g.: thyroxine - 4 weeks tri-iodothyronine - 2 weeks tolbutamide - 1 week topical iodide - 1-9 months (1,2)

HICON, SODIUM IODIDE I-131

There are 0 moderate interactions.

Moderate List
No disease contraindications

The following adverse reaction information is available for INDOCYANINE GREEN (indocyanine green):

Overview
Severe
Less Severe

Adverse reaction overview.

No enhanced Common Adverse Effects information available for this drug.

There are 1 severe adverse reactions.

More Frequent	Less Frequent
None.	None.

Rare/Very Rare
Anaphylaxis

There are 5 less severe adverse reactions.

More Frequent	Less Frequent
None.	Headache disorder Hyperhidrosis Pruritus of skin

Rare/Very Rare
Hyperbilirubinemia Urticaria

The following precautions are available for INDOCYANINE GREEN (indocyanine green):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

Safe use of indocyanine green during pregnancy has not been established.

No enhanced Lactation information available for this drug.

No enhanced Geriatric Use information available for this drug.