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What is Isosulfan Blue
Isosulfan blue is a triphenylmethane-based dye used to directly visualize lymphatic vessels and nodes.
It is commonly used either alone or in combination with technetium 99m sulfur colloid to localize sentinal nodes in various types of cancer such as breast and melanoma, most commonly, with cervical, colorectal, cutaneous, thoracic, and uterine cancers gaining popularity.
The advantage of sentinel lymph node mapping is the avoidance of unnecessary lymph node dissection in patients with node-negative disease; lymph node dissection is associated with long-term risks such as lymphedema and sensory disturbances.
Isosulfan blue is also used to identify lymphatic vessel leaks or lymphatic grafting in patients with lymphedema.
Hypersensitivity reactions, including anaphylaxis, have been reported with the use of isosulfan blue.
The general population is frequently exposed to triphenylmethane dyes as they are commonly found in textiles, paper, paints, inks, cosmetics, and leather. As such, sensitization to triphenylmethane dyes can occur, although a positive skin test may not always be evident.
In 2001, a shortage of isosulfan blue caused clinicians to use other dyes for sentinal lymph node diagnosis; several reports indicate that methylene blue is just as effective but cheaper and without the risk of anaphylaxis and hypersensitivity.
Regardless, isosulfan blue is still a commonly used dye for sentinal lymph node localization.
Indications
- lymphedema
- lymphography
- sentinel lymph node mapping
For use as an adjunct to lymphography for direct visualization of the lymphatic system draining the region of injection
for patients with primary or secondary lymphedema of the extremities, chyluria, chylous ascites, or chylothorax; and to evaluate the lymph node response to therapeutic modalities
Side Effects
- anaphylactoid reactions
- angioedema
- erythema
- hypotension
- hypoxia
- injection site reaction
- pruritus
- rash
- sinus tachycardia
- skin discoloration
- urine discoloration
- urticaria
- wheezing
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- asthma
- atopy
- breast-feeding
- children
- pregnancy
Interactions
- Acebutolol
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Tramadol
- Acyclovir
- Aldesleukin, IL-2
- Alogliptin; Metformin
- Aminoglycosides
- Amiodarone
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amoxapine
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamine; Dextroamphetamine Salts
- Amphotericin B
- Angiotensin-converting enzyme inhibitors
- Aprotinin
- Aripiprazole
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Atenolol
- Atenolol; Chlorthalidone
- Bendroflumethiazide; Nadolol
- Benzphetamine
- Beta-blockers
- Betaxolol
- Bictegravir; Emtricitabine; Tenofovir Alafenamide
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Brexpiprazole
- Brimonidine; Timolol
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Bumetanide
- Bupropion
- Bupropion; Naltrexone
- Caffeine
- Caffeine; Ergotamine
- Canagliflozin; Metformin
- Capreomycin
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Phenylephrine
- Carteolol
- Carvedilol
- Chlophedianol; Guaifenesin; Phenylephrine
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Phenylephrine
- Cisplatin
- Clomipramine
- Clozapine
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Colistimethate, Colistin, Polymyxin E
- Cyclobenzaprine
- Cyclosporine
- Dapagliflozin; Metformin
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Deferasirox
- Desipramine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Diethylpropion
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Dopamine
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Dorzolamide; Timolol
- Doxepin
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir alafenamide
- Emtricitabine; Tenofovir disoproxil fumarate
- Entecavir
- Ephedrine
- Ertugliflozin; Metformin
- Esmolol
- Ethacrynic Acid
- Ethanol
- Fluoxetine; Olanzapine
- Furosemide
- Glipizide; Metformin
- Glyburide; Metformin
- Green Tea
- Guaifenesin; Phenylephrine
- Haloperidol
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone; Phenylephrine
- Ibandronate
- Iloperidone
- Imipramine
- Labetalol
- Lamivudine; Tenofovir Disoproxil Fumarate
- Levobetaxolol
- Levobunolol
- Linagliptin; Metformin
- Lisdexamfetamine
- Loop diuretics
- Loxapine
- Lurasidone
- Maprotiline
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methamphetamine
- Methylphenidate
- Metoprolol
- Midodrine
- Molindone
- Monoamine oxidase inhibitors
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Nonsteroidal antiinflammatory drugs
- Norepinephrine
- Nortriptyline
- Olanzapine
- Oxaliplatin
- Pamidronate
- Pemoline
- Penbutolol
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenothiazines
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Pimozide
- Pindolol
- Polymyxins
- Propranolol
- Protriptyline
- Quetiapine
- Risperidone
- Sodium Iodide
- Sodium Oxybate
- Sotalol
- Telbivudine
- Tenofovir Alafenamide
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Thiothixene
- Thyroid hormones
- Timolol
- Torsemide
- Tramadol
- Tricyclic antidepressants
- Trimipramine
- Valacyclovir
- Ziprasidone
- Zoledronic Acid
