Fluorescein
Injection · Intravenous
Uses
1. INDICATIONS & USAGE AK-FLUOR® 10% (100 mg/mL) and 25% (250 mg/mL) is indicated in diagnostic fluorescein angiography or angioscopy of the retina and iris vasculature.
Dosage and administration
2. DOSAGE & ADMINISTRATION 2.1 Dosing Adult Dose The recommended dosage of AK-FLUOR® 10% (100 mg/mL) and of 25% (250 mg/mL) is 500 mg via intravenous administration. Pediatric Dose For children, the dose is 7.7 mg/kg (actual body weight) up to a maximum of 500 mg, via intravenous infusion calculated on the basis of 35 mg for each 10 lbs. (4.54 kg) of body weight. 2.2 Preparation for Administration Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not mix or dilute with other solutions or drugs. 2.3 Administration Inject the dose (over 5-10 seconds is normally recommended) into the antecubital vein, after taking precautions to avoid extravasation. A syringe, filled with AK-FLUOR®, may be attached to transparent tubing and a 23 gauge butterfly needle for injection. Insert the needle and draw the patient's blood to the hub of the syringe so that a small air bubble separates the patient's blood in the tubing from the fluorescein. With the room lights on, slowly inject the blood back into the vein while watching the skin over the needle tip. If the needle has extravasated, the patient's blood will be seen to bulge the skin and the injection should be stopped before any fluorescein is injected. When assured that extravasation has not occurred, the room light may be turned off and the fluorescein injection completed. Luminescence usually appears in the retina and choroidal vessels in 7 to 14 seconds and can be observed by standard viewing equipment. Reduction in dose from 500 mg to 200 mg of AK-FLUOR® 10% may be appropriate in cases when a highly sensitive imaging system e.g., scanning laser ophthalmoscope is used.
Dosage forms and strengths
3. DOSAGE FORMS & STRENGTHS AK-FLUOR® (fluorescein injection, USP) 10%, 100 mg/mL in a 5 mL single-dose vial. AK-FLUOR® (fluorescein injection, USP) 25%, 250 mg/mL in a 2 mL single-dose vial.
Contraindications
4. CONTRAINDICATIONS 4.1 Hypersensitivity AK-FLUOR® is contraindicated in patients with known hypersensitivity to fluorescein sodium or any other ingredients in this product. Rare cases of death due to anaphylaxis have been reported [see WARNINGS AND PRECAUTIONS (5.1) and ADVERSE REACTIONS (6.2) ].
Warnings and precautions
5. WARNINGS AND PRECAUTIONS 5.1 Respiratory Reactions Caution should be exercised in patients with a history of allergy or bronchial asthma. An emergency tray should always be available. If a potential allergy is suspected, an intradermal skin test may be performed prior to intravenous administration, i.e., 0.05 mL injected intradermally to be evaluated 30 to 60 minutes following injection. Given the sensitivity and specificity of skin testing, a negative skin test is not proof that a patient is not allergic to fluorescein. 5.2 Severe local tissue damage Extravasation during injection can result in severe local tissue damage due to high pH of fluorescein solution. The following complications resulting from extravasation of fluorescein have been noted to occur: Sloughing of the skin, superficial phlebitis, subcutaneous granuloma, and toxic neuritis along the median nerve in the antecubital area. Complications resulting from extravasation can cause severe pain in the arm for up to several hours. When extravasation occurs, the injection should be discontinued and conservative measures to treat damaged tissue and to relieve pain should be implemented. [see ADMINISTRATION (2.3) and ADVERSE REACTIONS (6.6) ].
Side effects
6. ADVERSE REACTIONS WARNINGS AND PRECAUTIONS (5.1) 6.1 Skin and urine discoloration The most common reaction is discoloration of the skin and urine. Skin will attain a temporary yellowish discoloration. Urine attains a bright yellow color. Discoloration of the skin usually fades in 6 to 12 hours and usually fades in urine in 24 to 36 hours. 6.2 Gastrointestinal Reaction The next most common adverse reaction is nausea. Vomiting, and gastrointestinal distress have also occurred. A strong taste may develop after injection. 6.3 Hypersensitivity Reactions Symptoms and signs of hypersensitivity have occurred. Generalized hives and itching, bronchospasm and anaphylaxis have been reported. [see CONTRAINDICATIONS (4.1) and WARNINGS AND PRECAUTIONS (5.1) ] 6.4 Cardiopulmonary Reactions Syncope and hypotension may occur. Cardiac arrest, basilar artery ischemia, severe shock and death may occur rarely. [see ] 6.5 Neurologic Reactions Headache may occur. Convulsions may rarely occur following injection. 6.6 Thrombophlebitis Thrombophlebitis at the injection site has been reported. Extravasation of the solution at the injection site causes intense pain at the site and a dull aching pain in the injected arm. [see ADMINISTRATION (2.3) and WARNINGS AND PRECAUTIONS (5.2) ].
Use in specific populations
8. USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Category C. Adequate animal reproduction studies have not been conducted with fluorescein sodium. It is also not known whether fluorescein sodium can cause fetal harm when administered to a pregnant woman. Fluorescein sodium should be given to a pregnant woman only if clearly needed. 8.3 Nursing Mothers Fluorescein sodium has been demonstrated to be excreted in human milk. Caution should be exercised when fluorescein sodium is administered to a nursing woman. 8.4 Pediatric Use Pediatric patients have been included in clinical studies. No overall differences in safety or effectiveness have been observed between pediatric and adult patients. 8.5 Geriatric Use No overall differences in safety or effectiveness have been observed between elderly and other adult patients.
Description
11. DESCRIPTION AK-FLUOR® (fluorescein injection, USP) is a sterile solution for use intravenously as a diagnostic aid. It is a dark reddish orange solution with a pH of 8.3 to 9.8 and an osmolality of 572 to 858 mOsm/kg for the 10% and 1800 to 2200 mOsm/kg for the 25%. Its chemical name is spiro[isobenzofuran-1 (3H),9'-[9H]xanthene]-3-one,3'6'-dihydroxy, disodium salt. The active ingredient is represented by the chemical structure: MW = 376.27 AK-FLUOR® 10% contains: Active: fluorescein sodium (equivalent to fluorescein 10 % w/v, 100 mg/mL) Inactives: Sodium Hydroxide and/or Hydrochloric Acid may be used to adjust pH (8.3 to 9.8), and Water for Injection. AK-FLUOR® 25% contains: Active: fluorescein sodium (equivalent to fluorescein 25% w/v, 250 mg/mL) Inactives: Sodium Hydroxide and/or Hydrochloric Acid may be used to adjust pH (8.3 to 9.8), and Water for Injection. STRUCTURE
How supplied
16. HOW SUPPLIED is supplied in the following dosage forms. NDC 51662-1533-2 AK-FLUOR® 10% FLUORESCEIN INJECTION, USP 100mg/mL 5mL VIAL NDC 51662-1533-3 AK-FLUOR® 10% FLUORESCEIN INJECTION, USP 100mg/mL 5mL VIAL (BOX OF 12) HF Acquisition Co LLC, DBA HealthFirst Mukilteo, WA 98275 Also supplied in the following manufacture supplied dosage forms: AK-FLUOR® (fluorescein injection, USP) 10% is supplied in a single-dose 5 mL glass vial with a gray bromobutyl serum siliconized stopper and orange flip-off cap. It contains a sterile dark reddish orange solution of fluorescein sodium. (NDC 17478-253-10) 5 mL, single dose vials in a package of 12. AK-FLUOR® (fluorescein injection, USP) 25% is supplied in a single-dose 2 mL glass vial with a gray bromobutyl serum siliconized stopper and orange flip-off cap. It contains a sterile dark reddish orange solution of fluorescein sodium. (NDC 17478-250-20) 2 mL, single dose vials in a package of 12. AK-FLUOR® should be stored at 20° to 25°C (68° to 77°F). Do not freeze.
Label text from the FDA structured product label by HF Acquisition Co LLC, DBA HealthFirst (revised Aug 8, 2021). Long sections are shortened; the complete label is on DailyMed.
Active ingredients
- Fluorescein Sodium in 6 products
- Fluorescein in 2 products
Fluorescein NDC products (8)
| NDC | Strength & form | Labeler | Type |
|---|---|---|---|
| 54288-179 | Fluorescein Sodium 500 mg/5mL Injection, Solution | BPI Labs LLC | ANDA |
| 14789-122 | Fluorescein 500 mg/mL Injection | Nexus Pharmaceuticals LLC | ANDA |
| 14789-123 | Fluorescein 250 mg/mL Injection | Nexus Pharmaceuticals LLC | ANDA |
| 70771-1969 | Fluorescein Sodium 100 mg/mL Injection | Zydus Lifesciences Limited | ANDA |
| 70771-1970 | Fluorescein Sodium 250 mg/mL Injection | Zydus Lifesciences Limited | ANDA |
| 70710-2045 | Fluorescein Sodium 100 mg/mL Injection | Zydus Pharmaceuticals USA Inc. | ANDA |
| 70710-2046 | Fluorescein Sodium 250 mg/mL Injection | Zydus Pharmaceuticals USA Inc. | ANDA |
| 51662-1533 | Fluorescein Sodium 100 mg/mL Injection | HF Acquisition Co LLC, DBA HealthFirst | NDA |
Frequently asked questions
What is Fluorescein used for?
1. INDICATIONS & USAGE AK-FLUOR® 10% (100 mg/mL) and 25% (250 mg/mL) is indicated in diagnostic fluorescein angiography or angioscopy of the retina and iris vasculature.
What are the side effects of Fluorescein?
6. ADVERSE REACTIONS WARNINGS AND PRECAUTIONS (5.1) 6.1 Skin and urine discoloration The most common reaction is discoloration of the skin and urine. Skin will attain a temporary yellowish discoloration. Urine attains a bright yellow color. Discoloration of the skin usually fades in 6 to 12 hours and usually fades in urine in 24 to 36 hours. 6.2 Gastrointestinal Reaction The next most common… See the full label for the complete list.
Who makes Fluorescein?
Fluorescein is listed by 5 labelers in the FDA NDC directory, including BPI Labs LLC, Nexus Pharmaceuticals LLC, Zydus Lifesciences Limited, Zydus Pharmaceuticals USA Inc..