Isosulfan blue
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Turky Alkathery, M.D. [2]
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Overview
Isosulfan blue is a contrast agent that is FDA approved for the procedure of delineating the lymphatic vessels draining. Common adverse reactions include hypersensitivity reactions occur and include life threatening anaphylactic reactions with respiratory distress, shock, angioedema, urticaria, pruritus.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Indications
Lymphatic Vessel Delineation
- Isosulfan blue injection 1% upon subcutaneous administration, delineates lymphatic vessels draining the region of injection. It is an adjunct to lymphography in: primary and secondary lymphedema of the extremities; chyluria, chylous ascites or chylothorax; lymph node involvement by primary or secondary neoplasm; and lymph node response to therapeutic modalities.
Dosage
Subcutaneous administration
- Isosulfan blue injection 1% is to be administered subcutaneously, one-half (1/2) mL into three (3) interdigital spaces of each extremity per study. A maximum dose of 3 mL (30 mg) isosulfan blue is, therefore, injected.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
- There is limited information regarding Off-Label Guideline-Supported Use of Isosulfan blue in adult patients.
Non–Guideline-Supported Use
- There is limited information regarding Off-Label Non–Guideline-Supported Use of Isosulfan blue in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
- Safety and effectiveness of isosulfan blue injection 1% in children have not been established.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
- There is limited information regarding Off-Label Guideline-Supported Use of Isosulfan blue in pediatric patients.
Non–Guideline-Supported Use
- There is limited information regarding Off-Label Non–Guideline-Supported Use of Isosulfan blue in pediatric patients.
Contraindications
- Isosulfan blue injection 1% is contraindicated in those individuals with known hypersensitivity to triphenylmethane or related compounds.
Warnings
Hypersensitivity Reactions
- Life threatening anaphylactic reactions (respiratory distress, shock, angio-edema) have occurred after isosulfan blue injection 1% administration. Reactions are more likely to occur in patients with a history of bronchial asthma, allergies, drug reactions or previous reactions to triphenylmethane dyes. Monitor patients closely for at least 60 minutes after administration of isosulfan blue injection 1%. Trained personnel should be available to administer emergency care including resuscitation.
Precipitation of Isosulfan Blue Injection 1% by Lidocaine
- The admixture of isosulfan blue injection 1% (with local anesthetics (i.e. lidocaine)) in the same syringe results in an immediate precipitation of 4% to 9% drug complex. Use a separate syringe to administer a local anesthetic.
Interference with Oxygen Saturation and Methemoglobin Measurements
- Isosulfan blue injection 1% interferes with measurements of oxygen saturation in peripheral blood by pulse oximetry and can cause falsely low readings. The interference effect is maximal at 30 minutes and minimal generally by 4 hours after administration. Arterial blood gas analysis may be needed to verify decreased arterial partial pressure of oxygen.
- Isosulfan blue injection 1% may also cause falsely elevated readings of methemoglobin by arterial blood gas analyzer. Therefore, cooximetry may be needed to verify methemoglobin level.
Adverse Reactions
Clinical Trials Experience
- There is limited information regarding clinical trial experience.
Postmarketing Experience
- Hypersensitivity Reactions: Case series report an overall incidence of hypersensitivity reactions in approximately 2% of patients. Life threatening anaphylactic reactions have occurred. Manifestations include respiratory distress, shock, angioedema, urticaria, pruritus. A death has been reported following administration of a similar compound employed to estimate the depth of a severe burn. Reactions are more likely to occur in patients with a personal or family history of bronchial asthma, significant allergies, drug reactions or previous reactions to triphenylmethane dyes.
- Laboratory Tests: Isosulfan blue injection 1% interferes with measurements of oxygen saturation by pulse oximetry and of methemoglobin by gas analyzer.
- Skin: transient or long-term (tattooing) blue coloration.
Drug Interactions
- No drug interactions have been identified with isosulfan blue injection 1%.
Use in Specific Populations
Pregnancy
- Animal reproduction studies have not been conducted with isosulfan blue injection 1%. It is not known whether isosulfan blue injection 1% can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Isosulfan blue injection 1% should be given to a pregnant woman only if clearly needed.
Pregnancy Category (AUS):
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Isosulfan blue in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Isosulfan blue during labor and delivery.
Nursing Mothers
- It is not known whether this drug is excreted in human milk.
- Because many drugs are excreted in human milk, caution should be exercised when isosulfan blue injection 1% is administered to a nursing mother.
Pediatric Use
- Safety and effectiveness of isosulfan blue injection 1% in children have not been established.
Geriatic Use
There is no FDA guidance on the use of Isosulfan blue in geriatric settings.
Gender
There is no FDA guidance on the use of Isosulfan blue with respect to specific gender populations.
Race
There is no FDA guidance on the use of Isosulfan blue with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Isosulfan blue in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Isosulfan blue in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Isosulfan blue in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Isosulfan blue in patients who are immunocompromised.
Administration and Monitoring
Administration
- Subcutaneous.
Monitoring
- Monitor patients closely for at least 60 minutes after administration of isosulfan blue injection 1% for any anaphylactic reactions.
IV Compatibility
- There is limited information regarding IV Compatibility.
Overdosage
- Do not exceed indicated recommended dosage as overdosage levels have not been identified for isosulfan blue injection 1%.
Pharmacology
There is limited information regarding Isosulfan blue Pharmacology in the drug label.
Mechanism of Action
- There is limited information regarding mechanism of action.
Structure
- The chemical name of isosulfan blue injection 1% is N-4- 4-(diethylamino)phenyl (2,5-disulfophenyl) methylene-2,5-cyclohexadien-1-ylidene-N-ethylethanaminium hydroxide, inner salt, sodium salt. Its structural formula is:
Isosulfan blue injection 1% is a sterile aqueous solution for subcutaneous administration. Phosphate buffer in sterile, pyrogen free water is added in sufficient quantity to yield a final pH of 6.8 to 7.4. Each mL of solution contains 10 mg isosulfan blue, 6.6 mg sodium monohydrogen phosphate and 2.7 mg potassium dihydrogen phosphate. The solution contains no preservative. Isosulfan blue injection 1% is a contrast agent for the delineation of lymphatic vessels.
Pharmacodynamics
- Following subcutaneous administration, isosulfan blue injection 1% binds to serum proteins and is picked up by the lymphatic vessels. Thus, the lymphatic vessels are delineated by the blue dye.
Pharmacokinetics
- Up to 10% of the subcutaneously administered dose of isosulfan blue injection 1% is excreted unchanged in the urine in 24 hours in humans.
Nonclinical Toxicology
Carcinogenesis, Mutagenesis, Impairment of Fertility
- Long-term studies in animals have not been performed to evaluate the carcinogenic potential of isosulfan blue injection 1%. Reproduction studies in animals have not been conducted and, therefore, it is unknown if a problem concerning mutagenesis or impairment of fertility in either males or females exists.
Clinical Studies
- There is limited information regarding Clinical Studies.
How Supplied
Isosulfan blue injection 1% is supplied as a 5 mL single-use vial, 1% aqueous solution in a phosphate buffer prepared by appropriate manufacturing to be sterile and pyrogen-free.
Storage
Storage: Vials should be stored at 20° to 25°C (68° to 77°F). [See USP Con- trolled Room Temperature.] Avoid excessive heat.
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
- Inform patients that urine color may be blue for 24 hours following administration of isosulfan blue injection 1%.
Precautions with Alcohol
Alcohol-Isosulfan blue interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
- ISOSULFAN BLUE ®[1]
Look-Alike Drug Names
- There is limited information regarding Look-Alike Drug Names.
Drug Shortage Status
Price
References
The contents of this FDA label are provided by the National Library of Medicine.