Dosing & Uses
Dosing Form & Strengths
ophthalmic strips
- 0.6mg
- 1mg
solution, injection
- 10%
- 25%
Eye Examination
Diagnostic staining
- Ophthalmic strips are indicated for staining the anterior segment of the eye during eye examinations
- Moisten by applying 1-2 gtt sterile isotonic irrigation solution, sterile water, or other ophthalmic solution
- Application: While patient looks down, stroke applicator tip across bulbar conjunctiva for fornix; then have patient blink several time
- Alternative application methods include having patient close lid tightly over strip until desired amount of staining occurs for exam
Ophthalmic angiography
- If allergy reaction a possibility, use an intradermal test dose of 0.05 mL; evaluate 30-60 min following intradermal injection; a negative test dose does not exclude potential for allergic reaction; immediate treatment for anaphylaxis, including epinephrine 1:1000 should be available during the procedure
-
Intravenous
- May administer using a 23 gauge needle attached to small syringe; take steps to ensure needle has not extravasated prior to turning off room light
- Administer 500 mg as single dose IV into antecubital vein; in cases where a highly sensitive imaging system used (eg, scanning laser ophthalmoscope), may administer a dose of 200 mg; inject dose into antecubital vein over 5-10 sec; luminescence appears 7-30 sec following injection; maintain venous access following procedure in event treatment is needed for anaphylaxis
-
Oral (off-label)
- Administer 1 g of injection solution orally; clarity of photographs reportedly poorer than photographs obtained following IV administration
Dosing Form & Strengths
ophthalmic strips
- 0.6mg
- 1mg
solution, injection
- 10%
- 25%
Eye Examination
Diagnostic staining
- Ophthalmic strips are indicated for staining the anterior segment of the eye during eye examinations
- Moisten by applying 1-2 gtt sterile isotonic irrigation solution, sterile water, or other ophthalmic solution
- Application: While patient looks down, stroke applicator tip across bulbar conjunctiva for fornix; then have patient blink several time
- Alternative application methods include having patient close lid tightly over strip until desired amount of staining occurs for exam
Ophthalmic angiography
- If allergy reaction a possibility, use an intradermal test dose of 0.05 mL; evaluate 30-60 min following intradermal injection; a negative test dose does not exclude potential for allergic reaction; immediate treatment for anaphylaxis, including epinephrine 1:1000 should be available during the procedure
- May administer using a 23 gauge needle attached to small syringe; take steps to ensure needle has not extravasated prior to turning off room light
- Administer 3.5 mg/lb (7.7 mg/kg) as single dose IV into antecubital vein over 5-10 sec; not to exceed 500 mg; luminescence appears 7-30 sec following injection; maintain venous access following procedure in event treatment is needed for anaphylaxis
Adverse Effects
Frequency Not Defined
Seizure
Dizziness
Headache
Cardiac arrest (rare)
Shock
Hypotension
Syncope
Basilar artery ischemia (rare)
Pruritus GI distress
Skin discoloration (yellow)
Hives
Taste disturbance
Vomiting
Urine discoloration
Dermatitis
Extravasation
Thrombophlebitis
Bronchospasm
Postmarketing reports
Pulmonary edema (acute)
Respiratory arrest
Sickle cell crisis
Localized nerve palsy
Hemolytic anemia
Warnings
Contraindications
Hypersensitivity to components or mercury-containing compounds; history of hypersensitivity to fluorescein sodium
Cautions
Severe local tissue damage, including phlebitis, skin sloughing, toxic neuritis, may occur from extravasation; use caution; discontinue immediately if extravasation occurs
Use caution in patients with history of hypersensitivity, allergies, or asthma
Skin may turn yellow within few minutes of administration and fade in 6-12 hr; urine may appear bright yellow for 24-36 hr
Not for intrathecal or arterial administration
Nausea and/or vomiting and gastrointestinal distress may occur commonly within few minutes following injection; may subside within 10 min
Remove contact lenses before use to avoid staining; after exam, flush eye with saline eye drops and wait at least 1 hr before reinserting contact lenses
Pregnancy & Lactation
Pregnancy Category: C
Lactation: Excreted into breast milk; American Academy of Pediatrics classifies fluorescein as compatible with breast-feeding
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Indicator dye and diagnostic aid; emits fluorescence when exposed to blue wavelength
Distribution
Vd: 0.5 L/kg
Elimination
Excretion: Urine
Metabolism
Rabidly metabolized to fluorescein monoglucuronide (80%) within 1 hr following IV administration
