fluorescein sodium: clinical use

Prescribing considerations

• Check for previous fluorescein reactions, allergy or asthma history, cardiopulmonary disease, renal impairment and concomitant medicines, particularly beta blockers.
• Injection requires an appropriately experienced clinician and immediately available resuscitation facilities.
• Assess benefit and risk carefully in cardiovascular disease, diabetes, renal risk or multiple concomitant therapies.
• The selected injection is not licensed for patients under 18; the selected eye drops are indicated for children, adults and older people.
• Skin testing does not reliably predict intolerance and may itself be hazardous.

Contraindications and cautions

• Hypersensitivity to fluorescein sodium or an injection excipient.
• The injection must not be given intra-arterially or intrathecally.
• The selected eye drops must not be used with soft contact lenses.

Monitoring

• Observe closely throughout angiography and for at least 30 minutes afterwards for hypersensitivity or cardiopulmonary reactions.
• Maintain intravenous access briefly after injection so a severe reaction can be treated promptly.
• Check injection-site patency and watch for extravasation.
• Assess renal risk where clinically relevant.
• Account for temporary interference with selected laboratory tests and possible radiographic misinterpretation soon after injection.

Clinical pharmacology

Fluorescein sodium is a fluorochrome diagnostic stain. Systemic fluorescein distributes into extracellular spaces, is rapidly glucuronidated and is mainly cleared renally. Topical fluorescein largely remains in the tear film over an intact cornea but enters disrupted tissue, producing visible staining.

Formulation and product differences

• The injection is a clear red-orange, single-use intravenous preparation for ocular-fundus angiography.
• The eye drops are sterile, single-use units for eye-surface staining, Goldmann tonometry and fitting hard contact lenses.
• Systemic exposure and severe-reaction precautions are substantially greater with injection, although very rare anaphylaxis has also followed topical use.

Eye drops

Route: Ophthalmic

Strengths: 1% w/v, 2%

Injection

Route: Parenteral

Strengths: 100 mg/mL