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Indocyanine green: Drug information

Indocyanine green: Drug information
For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • IC Green [DSC]
Brand Names: Canada
  • Spy Agent Green;
  • Spy Agent Green AIM/Pinpoint;
  • Spy Agent Green Lymphat Pinpoi;
  • Spy Agent Green Spy Elite;
  • Spy Agent Green Spy Phi
Pharmacologic Category
  • Diagnostic Agent
Dosing: Adult

US labeling:

Cardiac output determination

Cardiac output determination: IV: 5 mg injected rapidly via a cardiac catheter; maximum total dose: 2 mg/kg.

Note: An average of 5 dilution curves are needed in a diagnostic cardiac catheterization; doses are usually injected in 1 mL volume. Flush dye from catheter with NS to prevent hemolysis.

Hepatic function studies

Hepatic function studies: IV: 0.5 mg/kg; patient should be in a fasting basal state

Ophthalmic angiography

Ophthalmic angiography: IV: Up to 40 mg (depending on the imaging equipment and technique used); immediately follow with a 5 mL bolus of NS.

Canadian labeling:

Blood flow and tissue perfusion imaging

Blood flow and tissue perfusion imaging: IV: 1.25 mg to 5 mg for a single image sequence or 3.75 mg to 10 mg for visualization of extremities through the skin; an additional 2 to 3 doses may be administered at the discretion of the imaging health care provider. Maximum total dose: <2 mg/kg. Immediately follow with a 10 mL bolus of NS.

Extrahepatic biliary anatomy imaging

Extrahepatic biliary anatomy imaging: IV: 2.5 mg; an additional 2 to 3 doses may be administered at the discretion of the imaging health care provider. Maximum total dose: <2 mg/kg.

Lymph node and lymphatic vessels imaging

Lymph node and lymphatic vessels imaging: Interstitial: 5 mg (divided as 4 injections of 1.25 mg/mL) into cervix.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric
Cardiac output determination

Cardiac output determination: IV: Note: An average of 5 dilution curves are needed in a diagnostic cardiac catheterization; doses are usually injected in 1 mL volume. Flush dye from catheter with NS to prevent hemolysis.

Infants: 1.25 mg injected rapidly via a cardiac catheter; maximum total dose: 2 mg/kg.

Children and Adolescents: 2.5 mg injected rapidly via a cardiac catheter; maximum total dose: 2 mg/kg.

Hepatic function studies

Hepatic function studies: Infants, Children, and Adolescents: Refer to adult dosing.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified.

Postmarketing:

Cardiovascular: Hemodynamic deterioration (decreased blood pressure and increased heart rate) (Zhai 2017)

Dermatologic: Urticaria (Higuchi 2019)

Hypersensitivity: Anaphylactic shock (Higuchi 2019), anaphylaxis (Higuchi 2019), type 1 hypersensitivity reaction (Meira 2020)

Contraindications

Hypersensitivity to iodides.

Canadian labeling: Additional contraindications (not in the US labeling): Hypersensitivity to indocyanine green, iodinated imaging contrast agents, or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylaxis: Anaphylaxis has been reported, including deaths during cardiac catheterization procedures

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Intravenous:

IC Green: 25 mg (1 ea [DSC])

Generic: 25 mg (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (reconstituted) (Indocyanine Green Intravenous)

25 mg (per each): $169.79

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Injection:

Spy Agent Green: 25 mg (1 ea)

Spy Agent Green AIM/Pinpoint: 25 mg (1 ea)

Spy Agent Green Lymphat Pinpoi: 25 mg (1 ea)

Spy Agent Green Spy Elite: 25 mg (1 ea)

Spy Agent Green Spy Phi: 25 mg (1 ea)

Solution Reconstituted, Intravenous:

Generic: 25 mg (1 ea)

Administration: Adult

US labeling:

IV:

Cardiac output determination: In the performance of dye dilution curves, administer as a single bolus as rapidly as possible via a cardiac catheter into selected sites in the vascular system. Inject the dose of dye in 1 mL volume; an average of 5 dilution curves are recommended in the procedure. Attach a recording instrument (oximeter or densitometer) to a needle or catheter for sampling of the dye-blood mixture from a systemic arterial sampling site. Use sterile water for injection to rinse the syringe; use isotonic saline to flush the residual dye from the cardiac catheter into circulation to avoid hemolysis; saline should be used in all other parts of the catheterization procedure. See manufacturer's labeling for specific information regarding calibration of dye curves.

Hepatic function studies: Inject into the lumen of an arm vein as rapidly as possible, without allowing the dye to escape outside the vein. If the photometric method is used, prior to injecting indocyanine green, withdraw 6 mL venous blood from the patients arm for serum blank and standard curve construction, and through the same needle, inject the correct amount of dye. Ear oximetry has also been used; see manufacturer's labeling for additional information.

Ophthalmic angiography studies: Administer as a bolus injection into the antecubital vein; immediately follow with a 5 mL bolus of normal saline.

Canadian labeling:

IV:

Blood flow and tissue perfusion imaging: Administer as a bolus injection via a central or peripheral IV line using a three-way stopcock; immediately follow with a 10 mL bolus of NS. A visible fluorescence response in blood vessels may be seen within 5 to 15 seconds after administration.

Extrahepatic biliary anatomy imaging: Administer IV ~45 minutes prior to surgery; a visible fluorescence response in blood vessels may be seen ~45 minutes after administration.

Interstitial: Lymph node and lymphatic vessels imaging: Administer into the cervix at the 3 and 9 o'clock positions with a superficial (1 to 3 mm) and deep (1 to 3 cm) injection at each position for a total of 4 injections while patient is under anesthesia. A visible fluorescence response in lymph nodes and lymphatic vessels may be seen within 1 minute after administration.

Administration: Pediatric

IV:

Cardiac output determination: In the performance of dye dilution curves, administer as a single bolus as rapidly as possible via a cardiac catheter into selected sites in the vascular system. Inject the dose of dye in 1 mL volume; an average of 5 dilution curves are recommended in the procedure. Attach a recording instrument (oximeter or densitometer) to a needle or catheter for sampling of the dye-blood mixture from a systemic arterial sampling site. Use SWFI to rinse the syringe; use NS to flush the residual dye from the cardiac catheter into circulation to avoid hemolysis; NS should be used in all other parts of the catheterization procedure. See manufacturer's labeling for specific information regarding calibration of dye curves.

Hepatic function studies: Inject into the lumen of an arm vein as rapidly as possible, without allowing the dye to escape outside the vein. If the photometric method is used, prior to injecting indocyanine green, withdraw 6 mL venous blood from the patient's arm for serum blank and standard curve construction, and through the same needle, inject the correct amount of dye. Ear oximetry has also been used; see manufacturer's labeling for additional information.

Use: Labeled Indications

US labeling:

Cardiac/hepatic function diagnostics: For determining cardiac output, hepatic function, and liver blood flow.

Ophthalmic angiography: For ophthalmic angiography.

Canadian labeling:

Diagnostic imaging:

IV administration: Fluorescence imaging of blood flow and tissue and organ perfusion during gastrointestinal, organ transplant, plastic micro and reconstructive, and vascular surgeries (includes minimally invasive surgical procedures); imaging of biliary ducts and intraoperative cholangiography when used in combination with Advanced Imaging Modality (AIM) or PINPOINT Fluorescence Imaging Systems; intraoperative fluorescence angiography with SPY Elite, SPY-PHI, Advanced Imaging Modality (AIM) and PINPOINT Fluorescence Imaging Systems.

Interstitial administration: Fluorescence imaging of lymph nodes and delineation of lymphatic vessels in the cervix and uterus during lymphatic mapping in patients with solid tumor undergoing an intraoperative procedure; used with Advanced Imaging Modality and PINPOINT Fluorescence Imaging Systems during lymphatic mapping.

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Pregnancy Considerations

Reproduction studies have not been done.

Breastfeeding Considerations

It is not known if indocyanine green is excreted in breast milk. The manufacturer recommends that caution be exercised when administering indocyanine green to nursing women.

Reference Range

Normal percentage disappearance rate is 18% to 24% per minute

Mechanism of Action

Indocyanine dye is a tricarbocyanine dye that permits recording of the indicator-dilution curves for both diagnostic and research purposes independently of fluctuations in oxygen saturation.

Pharmacokinetics (Adult Data Unless Noted)

Protein binding: 95% to albumin

Half-life elimination: 2.5 to 3 minutes

Excretion: Bile

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AT) Austria: Icg pulsion;
  • (DE) Germany: Cardio green | Verdye;
  • (EE) Estonia: Aurogreen | Infracyanine;
  • (FR) France: Infracyanine;
  • (GB) United Kingdom: Cardio green | Verdye;
  • (GR) Greece: Icg pulsion;
  • (JP) Japan: Diagnogreen | Ophthagreen;
  • (KR) Korea, Republic of: Diagnogreen | Dongindang indocyanine green | Ic green;
  • (LT) Lithuania: Verdye;
  • (NL) Netherlands: Verdye;
  • (NO) Norway: Igc pulsion | Verdye orifarm;
  • (PR) Puerto Rico: Cardio green | Ic green;
  • (RU) Russian Federation: Indocyanine zelenyi pulsion | Verdye;
  • (SE) Sweden: Indocyaningroen pulsion | Verdye;
  • (TH) Thailand: Diagnogreen;
  • (TW) Taiwan: Diagnogreen
  1. Higuchi K, Nanashima A, Hiyoshi M, et al. Resected intrahepatic cholangiocarcinoma with anaphylactic shock from a preoperative liver function test before hepatectomy. Case Rep Gastroenterol. 2019;13(1):140-143. doi:10.1159/000499181 [PubMed 31097929]
  2. IC-Green (indocyanine green) [prescribing information]. Lake Forest, IL: Akorn; March 2022.
  3. Meira J, Marques ML, Falcão-Reis F, Rebelo Gomes E, Carneiro Â. Immediate reactions to fluorescein and indocyanine green in retinal angiography: review of literature and proposal for patient's evaluation. Clin Ophthalmol. 2020;14:171-178. doi:10.2147/OPTH.S234858 [PubMed 32021082]
  4. Spy Agent Green (indocyanine green) [product monograph]. Burnaby, British Columbia, Canada: Novadaq Technologies ULC; June 2022.
  5. Zhai Q, Wang Y, Tian A. Severe hemodynamic instability after indocyanine green injection during off-pump coronary artery bypass grafting: a case report. Medicine (Baltimore). 2017;96(46):e8766. doi:10.1097/MD.0000000000008766 [PubMed 29145331]
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