Indocyanine Green

(BAN, USAN, rINN)
Indocyanine Green Chemical formula

💊 Chemical information

Verde de indocianina. Sodium 2-{7-[1,1-dimethyl-3-(4-sulphobutyl)benz[e]indolin-2-ylidene]hepta-1,3,5-trienyl}-1,1-dimethyl-1H-benz[e]indolio-3-(butyl-4-sulphonate).
Chemical formula: C43H47N2NaO6S2 = 775.0.
CAS — 3599-32-4.

Pharmacopoeias.

In Chin. and US.

USP 31

(Indocyanine Green). An olive-brown, dark green, bluegreen, dark blue, or black powder. Is odourless or has a slight odour. It contains not more than 5.0% of sodium iodide, calculated on the dried basis. Soluble in water and in methyl alcohol; practically insoluble in most other organic solvents. Its solutions are deep emerald-green in colour. pH of a 0.5% solution in water is about 6. Its aqueous solutions are stable for about 8 hours. Store at a temperature of 25°, excursions permitted between 15° and 30°.

💊 Adverse Effects and Precautions

Indocyanine green is reported to be well tolerated. Anaphylaxis and urticaria have been reported. Solutions contain a small amount of sodium iodide and should be used with caution in pa tients hypersensitive to iodine. Clearance of indocyanine green may be altered by drugs that interfere with liver function.
1. Jackson TL. Indocyanine green accused. Br J Ophthalmol 2005; 89: 395–6
2. Cheng SN, et al. Ocular toxicity of intravitreal indocyanine green. J Ocul Pharmacol Ther 2005; 21: 85–93.

Hypersensitivity.

A report of anaphylactoid reactions to indocyanine green in 3 patients.1 The authors commented that of 20 reactions that had been reported 9 involved anaphylactoid shock (with 2 subsequent deaths) and 11 involved hypotension or bronchospasm; they suggested that such reactions were dose-dependent and had a non-immune mechanism.
1. Speich R, et al. Anaphylactoid reactions after indocyanine-green administration. Ann Intern Med 1988; 109: 345–6.

💊 Pharmacokinetics

After intravenous injection indocyanine green is rapidly bound to plasma protein. It is taken up by the liver and is rapidly excreted unchanged into the bile.

💊 Uses and Administration

Indocyanine green is an indicator dye used for assessing cardiac output and liver function, and for examining the choroidal vasculature in ophthalmic angiography. It is also used to assess blood flow and haemodynamics in various organs including the liver. The usual dose for cardiac assessment is 5 mg injected rapidly via a cardiac catheter. A suggested dose for children is 2.5 mg, and for infants 1.25 mg. Several doses need to be given to obtain a number of dilution curves. However, the total dose should not exceed 2 mg/kg. The usual dose of indocyanine green for testing liver function is 500 micrograms/kg given intravenously.

Diagnostic use.

Indocyanine green has been used to assess blood flow to various organs and in other haemodynamic studies. However, some methods of determination of indocyanine green clearance as a measure of liver blood flow have been questioned on the grounds that extraction of the dye by the liver is not complete as is often assumed.1 Interindividual variability in indocyanine clearance may introduce further error.2 There have been reports of the use of indocyanine green to assess cerebral blood flow in children during cardiopulmonary bypass3and to measure plasma volume in neonates.4 In ophthalmology, indocyanine green angiography is used to visualise the choroidal circulation,5,6 and as a stain during surgical repair of macular holes.7,8
1. Skak C, Keiding S. Methodological problems in the use of indocyanine green to estimate hepatic blood flow and ICG clearance in man. Liver 1987; 7: 155–62
2. Bauer LA, et al. Variability of indocyanine green pharmacokinetics in healthy adults. Clin Pharm 1989; 8: 54–5
3. Roberts I, et al. Estimation of cerebral blood flow with near infrared spectroscopy and indocyanine green. Lancet 1993; 342: 1425
4. Anthony MY, et al. Measurement of plasma volume in neonates. Arch Dis Child 1992; 67: 36–40
5. Owens SL. Indocyanine green angiography. Br J Ophthalmol 1996; 80: 263–6
6. Dzurinko VL, et al. Intravenous and indocyanine green angiography. Optometry 2004; 75: 743–55
7. Rodrigues EB, et al. Intravitreal staining of the internal limiting membrane using indocyanine green in the treatment of macular holes. Ophthalmologica 2005; 219: 251–62
8. Lee KL, et al. A comparison of outcomes after indocyanine green and trypan blue assisted internal limiting membrane peeling during macular hole surgery. Br J Ophthalmol 2005; 89: 420–4.

💊 Preparations

USP 31: Indocyanine Green for Injection.

Proprietary Preparations

Fr.: Infracyanine; Ger.: ICG-Pulsion; Gr.: ICG-Pulsion; Israel: IC Green; ICG-Pulsion; Neth.: ICG-Pulsion; USA: Cardio-Green†; IC Green.
Published May 08, 2019.