Isosulfan Blue Dye (Lymphazurin) injection is used as an aid to lymphography to delineate the lymphatic vessels and nodes in patients with lymphedema or malignancy.

Isosulfan blue dye Uses:

• Lymphatic vessel delineation:

  • It is administered as an adjunct to lymphography to make the lymphatic vessels and nodes visible in patients with:
    • to evaluate the involvement of a lymph node by primary or secondary neoplasm; and
    • chyluria, chylous ascites, or chylothorax;
    • to assess the response to therapeutic modalities for visualization of the lymphatic system draining the region.
    • primary and secondary lymphedema of the extremities;

Isosulfan Blue Dye (Lymphazurin) Dose in Adults:

Isosulfan Blue Dye (Lymphazurin) Dose in the treatment of Lymphatic vessel delineation:

• SubQ:
  • Per trial, administer 0.5 mL subQ into three interdigital areas of each extremity; the maximum dosage is 3 mL, or 30 mg.

Use in Children:

Not indicated.

Pregnancy Risk Factor C

• It has not been used in animal reproduction studies.
• If clearly necessary, isosulfan blue injections should only be given during pregnancy.

Use during breastfeeding:

• It is unknown if the dye is found in breast milk.
• It is recommended that you use it with caution if you are breastfeeding.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Side Effects of Isosulfan Blue Dye (Lymphazurin):

• Dermatologic:

  • Pruritus

• Hypersensitivity:

  • Hypersensitivity reaction

• Local:

  • Local swelling

Contraindications to Isosulfan Blue Dye (Lymphazurin):

• There have been no known allergic reactions to triphenylmethane, isosulfane, or other components of the formulation.

Warnings and precautions

• Discoloration

  • After the drug has been administered, it may cause a blueish discoloration in your urine for up to 24 hours.
  • This may cause temporary or permanent discoloration at the injection site.

• Hypersensitivity reactions

  • After injection, hypersensitivity reactions can occur. Hypersensitivity reactions can be severe. 
  • Anaphylactic reactions that can cause life-threatening hypotension, shock, respiratory distress, or angioedema, have been reported.
  • After the injection, patients should be closely monitored for at least an hour.
  • Hypersensitivity reactions are more common in patients with bronchial asthma, history of drug reactions, allergies, and those who have had previous reactions to triphenylmethane dyes.
  • If the patient requires resuscitation, it is important to have emergency management equipment and appropriate treatment available.

Monitoring parameters:

• Monitor the patients for at least 24 hours after the administration of the drug for hypersensitivity reactions.
• The drug may interfere with pulse oximetry readings.
• It is recommended to monitor arterial blood gases if required for at least 30 - 240 minutes following the administration of the injection.

How to administer Isosulfan Blue Dye (Lymphazurin)?

• It is administered subQ.
• It should not be mixed with local anesthetics such as lidocaine as it may precipitate in the syringe.
• Monitor the patient for at least one hour after the drug administration for hypersensitivity reactions.

Mechanism of action of Isosulfan Blue Dye (Lymphazurin):

• Subcutaneous administration of the drug causes it to bind to serum proteins and then is transported by the lymphatic systems into the surrounding lymphatic systems. 
• These structures can be made more visible by the blue discoloration of lymphatic vessels or nodes.

Excretion

• Urine (upto 10% within 24 hours after administration of unchanged drug)

Isosulfan Blue Dye International Brand Names:

• Lymphazurin

Isosulfan blue dye Brand Names in Pakistan:

No Brands Available in Pakistan.