Fluorescein is a fluorescent, water-soluble, dibasic xanthine dye used topically or systemically as a diagnostic aid. The molecule produces an intense green fluorescent color which is used to visualize the anterior surface of the eye following topical application and to examine the retinal and choroidal circulation following systemic use, with fluorescein angiography (FA). Multi-dose dropper bottles of fluorescein ophthalmic solution have become contaminated with Pseudomonas and Proteus: thus, fluorescein impregnated ophthalmic strips are preferred by many practitioners. FA may be useful in the diagnosis and disease progression monitoring of macular degeneration, diabetic retinopathy, and other retinal, and to a lesser degree, choroidal vascular diseases. FA is not a substitute for a full ophthalmologic examination and, although rare, carries risk of significant anaphylactoid reactions. An intradermally administered test dose of fluorescein may identify patients with drug-induced hypersensitivity; however, not all sensitive individuals will react to this test. Use fluorescein injection only when the procedure is essential. Although not FDA approved for other indications, specialist have used this dye to test tissue perfusion following the placement of a skin flap and to visualize an intracranial tumor during neurosurgery. This drug was originally approved by the FDA in 1976.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Injectable Administration
Intravenous Administration
-Administer by intravenous injection. An intradermal skin test may be performed prior to intravenous administration.
-Inspect product for particulate matter and discoloration before administration.
-Do not mix or dilute with other solutions or drugs. Flush intravenous cannulas with 0.9% Sodium Chloride Injection before and after other medications are injected to avoid physical incompatibility reactions (personal communication, Akorn Inc., November 10, 2006).
-Ophthalmologist monitoring of patient during procedure and for 30 minutes after completion is strongly recommended.
-Leave venous assess open for 5 minutes following injection for emergency measures if needed.
-Emergency resuscitation resources must be available during procedure.
Skin test:
-If a potential allergy to fluorescein is suspected, an intradermal skin test may be performed prior to intravenous administration.
-Inject 5 mg intradermally, and evaluate 30 to 60 minutes after administration.
-Of note, a negative skin test is not proof that a patient is not allergic to fluorescein.
IV push:
-Follow administration guidelines to avoid extravasation.
-Connect fluorescein syringe to transparent tubing with a 23 gauge butterfly needle.
-Insert needle and draw the patient's blood to the hub of the syringe; visualize small air bubble in the tubing.
-Slowly inject the blood back into the vein while watching the skin; if a skin bulge is seen over the needle tip, stop the injection before fluorescein is injected.
-When certain extravasation has not occurred, turn off room lights, and inject dose rapidly (1 mL/second) into antecubital vein.
-Luminescence usually becomes visible in the retina and choroidal vessels in 7 to 14 seconds.
Ophthalmic Administration
Ophthalmic strip:
-Remove contact lenses prior to procedure; flush the eye(s) with sterile, 0.9% Sodium Chloride Irrigation, and wait at least 1 hour before replacing lenses.
-Anesthetize eye(s).
-Apply in 1 of 2 manners; either, retract upper lid and touch tip of the strip to the bulbar conjunctiva on the temporal side until an adequate amount of stain is available OR moisten strip with Sterile Water for Irrigation and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly until appropriate staining is achieved and blink several times after strip removal.
As fluorescein is a dye, temporary staining of skin and body fluids is an expected effect. Following systemic use, all skin tissue, including mucous membranes and sclera, and all bodily fluids are effected. The yellow skin discoloration fades in 6 to 12 hours. Urine discoloration, seen as a fluorescence, may persist for 24 to 36 hours. Following topical use of fluorescein, local staining is expected. Soft contact lens discoloration may be permanent following topical or systemic fluorescein exposure. Remove soft contact lenses prior to fluorescein use. If fluorescein is used topically, rinse the eye thoroughly after use with a sterile normal saline solution and wait at least one hour prior to replacing the soft contact. If fluorescein is used systemically, delaying the reintroduction of soft contact lenses until lacrimal discoloration resolves is prudent.
Following the intravenous administration of fluorescein, fever and sneezing have been reported. Such effects are considered mild and resolve without medical treatment or sequelae.
Adverse reactions to fluorescein are usually mild and self-limiting. Transient nausea and vomiting are reported to occur in 4 to 20% of patients treated with fluorescein injection. Nausea and/or vomiting and gastrointestinal distress occur commonly within the first few minutes following injection, and these reactions usually subside within 10 minutes. Only a 0.7% incidence of nausea severe enough to interrupt the procedure was reported among 11,898 cases of fluorescein angiography. Still nausea and vomiting can be problematic, causing patient discomfort and interfering with imaging. Various prophylactic methods have been studied. Warming fluorescein injection to 37 degrees C prior to administration did not significantly alter the incidence of nausea or the overall incidence of adverse events in a trial involving 547 angiograms. On the other hand, IV diphenhydramine, oral granisetron, and IV metoclopramide have been shown to decrease the incidence of nausea and vomiting to a statistically significant degree in patients premedicated with one of the agents. Other reported gastrointestinal adverse effects include gastrointestinal distress and dysgeusia, manifested as a metallic taste. Consider premedication in patients with a history of significant gastrointestinal intolerance to fluorescein injection.
Photosensitivity is not widely reported in the literature; however, 6 of 14 healthy volunteers, with no previous history of photoeruption, experienced increased sun sensitivity following oral administration of 4 ml of 25% fluorescein. Phototoxic reactions were noted in 2 persons. The application of sunscreen did not appear to protect sensitive individuals from reacting as the UV blockade of sunscreen does not include 487 nm blue light. Advise patients to avoid UV exposure following systemic fluorescein use whenever possible.
An injection site reaction, including pain and edema, has been reported in 0.1% of patients following fluorescein injection. Thrombophlebitis at the injection site, tissue necrosis, and nerve palsy have also been reported. Care must be taken to avoid extravasation as the high pH (8-9.8) can result in severe local tissue damage including musculoskeletal pain lasting several hours, sloughing of the skin, superficial phlebitis, subcutaneous granuloma, toxic neuritis along the median curve in the antecubital area, intense pain at the site, and a dull aching pain in the injected arm. Administer with caution; if extravasation does occur, discontinue injection and treat as appropriate.
Intravenous administration of fluorescein has resulted in drug-induced syncope (1 in 337 cases). Mild vaso-vagal reactions to the injection may account for patient dizziness (0.3%) and headache (incidence undisclosed), though these adverse reactions are usually mild and self-limiting.
Urticaria has been reported with fluorescein use. Following intravenous administration systemic urticaria has been reported (in approximately 1 in every 82 cases), and following topical administration there have been rare reports of local periorbital urticaria. Flushing and a tingling sensation of the lips have also been reported with intravenous administration, though these were mild and resolved without medical treatment or sequelae.
A delayed allergic response to fluorescein injection was described in a published case report. Approximately 2 hours after dose administration the patient presented to an emergency department with complaints of back pain, chills, fever, malaise, and petechial rash (unspecified) on his lower arms and trunk. Of note is that his only previous fluorescein injection also resulted in symptoms, though not as severe. Obtain a complete medical history including past adverse and hypersensitivity reactions prior to fluorescein use and document all cases of adverse events following a fluorescein exposure. Use this medication only when determined to be essential, if at all, in patients with a history of fluorescein intolerance. Follow safety measure for all patients undergoing fluorescein therapy.
Severe adverse reactions have rarely occurred following fluorescein injection administration. Anaphylactoid reactions may be responsible for some of both the cardiovascular and the respiratory events reported. One in 3,800 cases of systemic fluorescein use have been approximated to result in bronchospasm, laryngeal edema, and/or anaphylaxis. Cardiac reactions, including basilar artery ischemia, cardiogenic shock, cardiac arrest, and hypotension, have been estimated to occur in 1 in 5,300 cases. One death was reported among the approximately 222,000 cases reviewed in a 1984 survey. A 1998 to 2004 single center survey of 11,898 cases of intravenous fluorescein use in retinal angiography reported no cases of severe drug-induced events. Obtain a complete medical history including past adverse and hypersensitivity reactions prior to fluorescein use and document all cases of adverse events following a fluorescein exposure. Use this medication only when determined to be essential, if at all, in patients with a history of fluorescein intolerance. Premedication with glucocorticosteroids and/or antihistamines may be used to prophylaxis for adverse events; however, this may not prevent serious events. Follow safety measure for all patients undergoing fluorescein therapy.
There have been rare reports of tonic-clonic seizures (1 in 13,900 cases) following fluorescein injection. Obtain a complete medical history including past adverse and hypersensitivity reactions prior to use and document all cases of adverse events following a fluorescein exposure. Use this medication only when determined to be essential, if at all, in patients with a history of fluorescein intolerance. Follow safety measure for all patients undergoing fluorescein therapy.
Fluorescein injection is approved for intravenous administration only; avoid intraarterial administration, intramuscular administration, and intrathecal administration. Avoid extravasation during injection as the high pH (8 to 9.8) of fluorescein injectable solution can result in severe local tissue damage. Complications associated with fluorescein extravasation include severe arm pain (lasting several hours), sloughing of skin, superficial phlebitis, subcutaneous granuloma, and toxic neuritis along the median curve in the antecubital area. If significant extravasation occurs, discontinue fluorescein injection, and implement conservative measures to address damaged tissue and pain.
Fluorescein is contraindicated in patients with known hypersensitivity to fluorescein or its excipients. Use with caution in patients with a history of asthma, eczema, hay fever, or allergy manifested as food- or drug-induced urticaria as these patient populations may be at a higher risk of hypersensitivity to other agents including fluorescein. If a potential allergy is suspected, an intradermal skin test may be peformed prior to intravenous administration. Of note, a negative skin test is not proof that the patient will not develop a hypersensitivity reaction to fluorescein. Although premedication with an H1-antihistamine and/or a corticosteroid may not prevent serious reactions, administration may be considered. Rare cases of death due to anaphylaxis have been reported during procedures involving fluorescein injection; follow appropriate measures for all patients. These measures include ophthalmologist monitoring of patients who receive fluorescein injection throughout the procedure and for 30 minutes after its completion, keeping venous assess open for at least 5 minutes following injection to facilitate emergency treatment, and having necessary emergency resuscitation resources available (e.g. emergency tray, oxygen). In addition to hypersensitivity reactions, recipients of fluorescein have experienced serious intolerance reactions. These reactions are unpredictable, but do occur more frequently in patients who have previously experienced an adverse reaction to fluorescein (symptoms other than nausea and vomiting) or in patients with a history of allergic rhinitis, asthma, eczema, or drug-induced urticaria. Conduct a thorough medical history on each patient prior to administering fluorescein to evaluate for any prior history of allergy.
Do not use fluorescein ophthalmic strips or ophthalmic solution while the patient is wearing soft contact lenses as staining may occur. Following ophthalmic application flush the eye(s) with sterile normal saline solution and wait at least one hour before replacing contact lenses.
As anaphylactoid reactions may be particularly damaging to vulnerable patient populations, use fluorescein injection with caution, if at all, in patients with renal impairment, unstable cardiac disease, or recent history of myocardial infarction or stroke. Further, consider dosage adjustments if renally-eliminated fluorescein injection is used in patients with significant renal impairment. A fluorescein injection manufacturer recommends reducing the standard dose by one-half in patients receiving dialysis.
Use fluorescein during pregnancy only if clearly needed. There are insufficient data with the use of fluorescein in pregnant women to inform a drug-associated risk. It is not know whether fluorescein can cause fetal harm when administered to a pregnant woman. An accidental exposure has been documented in a case report. A 45-year-old woman was exposed via fluorescein angiography at pregnancy week 9. No adverse side effects to the mother or child were observed. Adequate animal reproduction studies have not been conducted with fluorescein.
Use fluorescin with caution in a breast-feeding woman. Fluorescein has been shown to be transferred into human milk for up to 4 days after IV administration.
For radiographic examination (i.e., diagnostic angiography or angioscopy) of the retina and iris vasculature:
Intravenous and Intradermal dosage:
Adults: 500 mg IV. A lower dose of 200 mg IV may be appropriate in cases where highly sensitive imaging system is used. If a potential fluorescein allergy is suspected, an intradermal test dose may be performed before intravenous administration. Inject 5 mg intradermally, and evaluate 30 to 60 minutes later. A negative skin test is not proof that the patient will not experience a hypersensitivity reaction.
Children: 7.7 mg/kg (Max: 500 mg) IV. If a potential fluorescein allergy is suspected, an intradermal test dose may be performed before intravenous administration. Inject 5 mg intradermally, and evaluate 30 to 60 minutes later. A negative skin test is not proof that the patient will not experience a hypersensitivity reaction.
For staining the anterior segment of the eye for eye trauma diagnosis:
Topical dosage (ophthalmic strips):
Adults: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
Children*: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
For staining the anterior segment of the eye for contact lens fitting:
Ophthalmic dosage (ophthalmic strips):
Adults: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
Children*: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
For staining the anterior segment of the eye for post-ophthalmic surgery wound closure assessment following anterior chamber reformation:
Topical dosage (ophthalmic strips):
Adults: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
Children*: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
For staining the anterior segment of the eye for lacrimal drainage diagnosis:
Topical dosage (ophthalmic strips):
Adults: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
Children*: Use 1 strip per eye; either touch tip of strip to the bulbar conjunctiva of the anesthetized eye until an adequate amount of stain is available or moisten strip with sterile water and place at the fonix in the lower cul-de-sac close to the punctum, then have patient close eyes tightly and blink several times after strip removal.
Maximum Dosage Limits:
-Adults
Maximum dosage limits are not available.
-Elderly
Maximum dosage limits are not available.
-Adolescents
Maximum dosage limits are not available.
-Children
Maximum dosage limits are not available.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that dosage adjustments are not needed.
Patients with Renal Impairment Dosing
Fluorescein is metabolized and eliminated renally. Systemic dosage may be modified depending on clinical response and degree of renal impairment, but no standardized recommendations are available.
Continuous hemodialysis
In dialyzed patients, 250 mg (100 mg/mL) IV injection is recommended.
*non-FDA-approved indication
Acebutolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Amlodipine; Benazepril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Angiotensin-converting enzyme inhibitors: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Atenolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Atenolol; Chlorthalidone: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Benazepril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Benazepril; Hydrochlorothiazide, HCTZ: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Benzalkonium Chloride: (Moderate) The use of fluorescein with benzalkonium chloride aqueous solutions may be incompatible.
Benzalkonium Chloride; Benzocaine: (Moderate) The use of fluorescein with benzalkonium chloride aqueous solutions may be incompatible.
Beta-blockers: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Betaxolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Bisoprolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Brimonidine; Timolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Captopril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Carteolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Carvedilol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Dorzolamide; Timolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Enalapril, Enalaprilat: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Esmolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Fosinopril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Fosinopril; Hydrochlorothiazide, HCTZ: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Hydrochlorothiazide, HCTZ; Moexipril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Labetalol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Levobunolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Lisinopril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Metoprolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Metoprolol; Hydrochlorothiazide, HCTZ: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Moexipril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Nadolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Nebivolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Nebivolol; Valsartan: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Perindopril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Perindopril; Amlodipine: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Pindolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Propranolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Quinapril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Quinapril; Hydrochlorothiazide, HCTZ: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Ramipril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Sotalol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Timolol: (Moderate) Patients on beta-blockers are at an increased risk of adverse reaction when administered fluorescein injection. It is thought that beta-blockers may worsen anaphylaxis severity by exacerbating bronchospasm or by increasing the release of anaphylaxis mediators; alternately, beta-blocker therapy may make the patient more pharmacodynamically resistance to epinephrine rescue treatment.
Trandolapril: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Trandolapril; Verapamil: (Moderate) Patients on angiotensin-converting enzyme inhibitors are at an increased risk of adverse reactions when administered fluorescein injection. If fluorescein injection is deemed necessary in a patient on ACE inhibitor therapy, monitor as appropriate during and after the procedure.
Fluorescein is a fluorescent dye that is used as a diagnostic aid. The unbound fraction of the drug responds to electromagnetic radiation and light between the wavelengths of 465-490 nm and emits light at wavelengths of 520-530 nm. Thus, the fluorescein hydrocarbon is excited by blue light and emits yellowish-green light. Fluorescein is used both systemically to highlight the vascular circulation of the eye and topically to visualize the anterior surface of the eye. After intravenous injection, fluorescein circulates through the vasculature. A blue flash from a fundus camera onto the retina elicits the hallmark yellowish-green fluorescence of the dye. The fluorescence demarcates the retinal and/or choroidal vasculature under observation, distinguishing it from adjacent areas and structures. Images captured by the fundus camera are used to diagnosis abnormalities in and to monitor disease progression of the ocular vascular system. Following topical application of fluorescein on the eye, a cobalt blue lamp or slit lamp device is used to visualize the anterior ocular surface for defects and for contact lens fittings.
Fluorescein is administered intravenously in the antecubital vein and topically to the ocular surface. The drug undergoes rapid metabolism to fluorescein monoglucuronide with a hepatic clearance estimated at 1.5 mL/min/kg. Elimination of fluorescein and its metabolites occurs mainly through renal excretion with a renal clearance rate estimated at 1.75 mL/min/kg. The urine remains slightly fluorescent for 24-36 hours post dose.
-Route-Specific Pharmacokinetics
Intravenous Route
Following IV administration, fluorescein is approximately 80% protein bound within human plasma and has a very rapid distribution within the vascular system; fluorescein may be seen in the central artery of the eye within 7-14 seconds of dosing. Soon after, fluorescein distributes into interstitial space with a total estimated volume of distribution of 0.5 L/kg. In a pharmacokinetic study of 7 healthy adults, approximately 80% of a 14 mg/kg dose was metabolized within 1 hour of IV administration. The manufacturer reports that systemic clearance was essentially complete by 48-72 hours after IV administration of 500 mg fluorescein.