IC-GREEN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for IC-GREEN (IC-GREEN).
Indocyanine green (ICG) binds to plasma proteins, primarily albumin, and remains confined to the intravascular compartment. It is eliminated exclusively by the liver into bile without enterohepatic circulation or renal excretion, allowing its use as a marker for hepatic function and blood flow. Its fluorescence under near-infrared light enables visualization of vasculature and tissues.
| Metabolism | ICG is not metabolized; it is taken up by hepatocytes and excreted unchanged into bile via the liver. |
| Excretion | Primarily hepatic excretion into bile (≥80% unchanged), with minimal renal elimination (<5% unchanged). Fecal elimination accounts for >95% of total clearance. |
| Half-life | Terminal elimination half-life: 2.5–4.0 minutes (biphasic decay with early rapid phase). Clinical context: Extremely short half-life limits systemic accumulation; used for real-time vascular imaging. |
| Protein binding | 98% bound; primarily to albumin and alpha-1-lipoproteins. |
| Volume of Distribution | Vd: 0.2–0.3 L/kg (low, indicating confinement to plasma and interstitial space; does not cross intact blood-brain barrier). |
| Bioavailability | Intravenous: 100% (only route of administration). Not absorbed orally; no other routes used. |
| Onset of Action | Intravenous: Immediate (seconds) upon injection; visible fluorescence appears within 1–2 circulation times (~10–20 seconds). |
| Duration of Action | Intravenous: 5–10 minutes for angiographic imaging; hepatic clearance limits duration. Clinical note: Repeated dosing may be needed for prolonged procedures. |
2.5 mg/kg IV bolus, maximum 5 mg/kg; administered as a single dose for cardiac output determination or hepatic function assessment; may repeat after 30 minutes if needed.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required; IC-Green is not renally excreted; clearance is primarily hepatic. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated due to significantly reduced clearance. |
| Pediatric use | 2.5 mg/kg IV bolus, maximum 5 mg/kg; weight-based dosing with total dose not to exceed 5 mg/kg; use patient's actual body weight. |
| Geriatric use | Use with caution due to potential decreased hepatic function; start at lower end of dosing range (2.5 mg/kg); monitor for adverse reactions. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for IC-GREEN (IC-GREEN).
| Breastfeeding | It is unknown if IC-Green is excreted in human breast milk. The molecular weight (775 Da) suggests possible excretion. M/P ratio not available. Due to short half-life (2.5-3 min initial phase, 15 min secondary) and low doses used, risk to nursing infant is likely low. Caution: consider pumping and discarding milk for 24 hours after administration. |
| Teratogenic Risk | Indocyanine green (IC-Green) is FDA Pregnancy Category C. No adequate human studies exist. In animal studies, no teratogenic effects were observed at doses up to 5 mg/kg IV in rats and rabbits. However, because IC-Green is a diagnostic agent with transient exposure, risk is considered low. First trimester: theoretical risk, avoid unless essential. Second/third trimester: may be used when clearly indicated; no known fetal harm from standard doses. |
■ FDA Black Box Warning
Contains sodium iodide. Use with caution in patients with a history of allergy to iodides.
| Serious Effects |
Known hypersensitivity to indocyanine green or iodides. Uncontrolled hyperthyroidism. Thyroid adenoma.
| Precautions | Hypersensitivity reactions, including anaphylaxis, may occur. Iodide sensitivity should be assessed. Use caution in patients with hepatic impairment. Interference with coagulation tests (e.g., PT, PTT) due to the dye's absorbance. Avoid extravasation as it may cause tissue necrosis. |
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| Fetal Monitoring | Monitor for hypersensitivity reactions (urticaria, tachycardia, dyspnea) during infusion. In pregnancy, standard fetal monitoring (heart rate) during procedure if indicated. No specific maternal-fetal monitoring required beyond usual clinical observation. |
| Fertility Effects | No data on human fertility effects. Animal studies have not shown impaired fertility at therapeutic doses. As a diagnostic agent, single use is unlikely to impact fertility. |