SPY AGENT GREEN KIT

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SPY AGENT GREEN KIT (SPY AGENT GREEN KIT).

How it works

SPY AGENT GREEN KIT contains indocyanine green (ICG), a tricarbocyanine dye that binds to plasma proteins, primarily albumin, and remains intravascular. It is used for fluorescence imaging to visualize blood vessels, lymphatic structures, and tissues during surgery. ICG fluoresces near-infrared light (NIR) upon excitation, allowing real-time visualization of perfusion and drainage patterns.

What the body does with it

Metabolism	ICG is rapidly taken up by the liver and excreted unchanged into bile via the hepatobiliary system without significant metabolism. It is not metabolized by hepatic microsomal enzymes.
Excretion	Primarily renal excretion of the intact indocyanine green (ICG) molecule; >90% of the administered dose is cleared unchanged into bile and eliminated in feces, with negligible renal excretion (<5%).
Half-life	Terminal elimination half-life is approximately 2.5-3.0 minutes in patients with normal hepatic function; clinically, the rapid clearance allows for repeated assessments of hepatic function and cardiac output.
Protein binding	Highly bound to plasma proteins, primarily albumin and alpha-1-lipoproteins; approximately 95-98% bound.
Volume of Distribution	Initial volume of distribution is approximately 20-30 mL/kg, reflecting confinement to the vascular space; Vd is small (0.02-0.03 L/kg), consistent with limited extravascular distribution.
Bioavailability	Only administered intravenously; bioavailability is 100% by the IV route.
Onset of Action	Intravenous administration: Immediate onset of fluorescence (within seconds) due to rapid mixing in the blood pool.
Duration of Action	Duration of detectable fluorescence is approximately 10-15 minutes following IV injection; clinically limited by rapid hepatic clearance, enabling repeated measurements within 30 minutes.

Classification & Brands

Dosing & administration

Indocyanine Green 0.25-0.5 mg/kg intravenous bolus as a single dose for cardiac output determination or hepatic function assessment. Repeat dosing after 30-60 minutes if needed.

Dosage form	POWDER
Renal impairment	No dose adjustment required for renal impairment as ICG is primarily excreted by the liver into bile. GFR does not affect pharmacokinetics.
Liver impairment	In Child-Pugh Class A and B: standard dose. In Child-Pugh Class C: reduce dose to 0.125-0.25 mg/kg due to reduced clearance and risk of prolonged retention. Monitor for adverse effects.
Pediatric use	Neonates: 0.5 mg/kg IV bolus. Infants and children: 0.25-0.5 mg/kg IV bolus. Maximum single dose: 25 mg. Use with caution in neonates due to limited data.
Geriatric use	No specific dose adjustment required; consider reduced hepatic blood flow in elderly and use lower end of dosing range (0.25 mg/kg). Monitor closely for adverse effects.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SPY AGENT GREEN KIT (SPY AGENT GREEN KIT).

Breastfeeding	Contraindicated during breastfeeding. Indocyanine green is excreted into breast milk but M/P ratio not established. May cause severe adverse reactions in nursing infants.
Teratogenic Risk	FDA Pregnancy Category D. First trimester: High risk of neural tube defects, cardiovascular malformations, and cleft palate. Second and third trimesters: Increased risk of intrauterine growth restriction, oligohydramnios, and fetal renal dysplasia.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to indocyanine green or iodine","Patients with known iodine allergy or anaphylaxis to iodinated contrast media","Pregnancy (category C) - use only if potential benefit justifies risk","Lactation - discontinue nursing or drug due to potential excretion in breast milk"]

Clinical Precautions

Precautions

["Contains iodine; may cause allergic reactions in patients with iodine sensitivity","Anaphylactic reactions have been reported, especially in patients with a history of allergy to iodinated compounds","Use with caution in patients with hyperthyroidism, thyroid nodules, or thyroid autoimmune disease due to iodine content","Extravasation may cause tissue irritation or necrosis; ensure proper intravenous administration","Do not administer intra-arterially; may cause severe adverse reactions","Hepatic dysfunction may alter ICG clearance; dose adjustment may be necessary"]

Clinical Tips & Counseling

Drug interactions

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SPY AGENT GREEN KIT

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SPY AGENT GREEN KIT (SPY AGENT GREEN KIT).

How it works

What the body does with it

Metabolism	ICG is rapidly taken up by the liver and excreted unchanged into bile via the hepatobiliary system without significant metabolism. It is not metabolized by hepatic microsomal enzymes.
Excretion	Primarily renal excretion of the intact indocyanine green (ICG) molecule; >90% of the administered dose is cleared unchanged into bile and eliminated in feces, with negligible renal excretion (<5%).
Half-life	Terminal elimination half-life is approximately 2.5-3.0 minutes in patients with normal hepatic function; clinically, the rapid clearance allows for repeated assessments of hepatic function and cardiac output.
Protein binding	Highly bound to plasma proteins, primarily albumin and alpha-1-lipoproteins; approximately 95-98% bound.
Volume of Distribution	Initial volume of distribution is approximately 20-30 mL/kg, reflecting confinement to the vascular space; Vd is small (0.02-0.03 L/kg), consistent with limited extravascular distribution.
Bioavailability	Only administered intravenously; bioavailability is 100% by the IV route.
Onset of Action	Intravenous administration: Immediate onset of fluorescence (within seconds) due to rapid mixing in the blood pool.
Duration of Action	Duration of detectable fluorescence is approximately 10-15 minutes following IV injection; clinically limited by rapid hepatic clearance, enabling repeated measurements within 30 minutes.

Classification & Brands

Dosing & administration

Indocyanine Green 0.25-0.5 mg/kg intravenous bolus as a single dose for cardiac output determination or hepatic function assessment. Repeat dosing after 30-60 minutes if needed.

Dosage form	POWDER
Renal impairment	No dose adjustment required for renal impairment as ICG is primarily excreted by the liver into bile. GFR does not affect pharmacokinetics.
Liver impairment	In Child-Pugh Class A and B: standard dose. In Child-Pugh Class C: reduce dose to 0.125-0.25 mg/kg due to reduced clearance and risk of prolonged retention. Monitor for adverse effects.
Pediatric use	Neonates: 0.5 mg/kg IV bolus. Infants and children: 0.25-0.5 mg/kg IV bolus. Maximum single dose: 25 mg. Use with caution in neonates due to limited data.
Geriatric use	No specific dose adjustment required; consider reduced hepatic blood flow in elderly and use lower end of dosing range (0.25 mg/kg). Monitor closely for adverse effects.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SPY AGENT GREEN KIT (SPY AGENT GREEN KIT).

Breastfeeding	Contraindicated during breastfeeding. Indocyanine green is excreted into breast milk but M/P ratio not established. May cause severe adverse reactions in nursing infants.
Teratogenic Risk	FDA Pregnancy Category D. First trimester: High risk of neural tube defects, cardiovascular malformations, and cleft palate. Second and third trimesters: Increased risk of intrauterine growth restriction, oligohydramnios, and fetal renal dysplasia.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

None

Side Effect Profile

Serious Effects

Absolute Contraindications

Clinical Precautions

Precautions

Clinical Tips & Counseling

Drug interactions

Loading safety data…