Isosulfan Blue (Subcutaneous)

Isosulfan Blue is a contrast agent and an adjunct to a medical imaging procedure known as lymphography.


Isosulfan Blue is a type of blue dye that is used during a lymphography, a medical imaging process which checks for abnormalities in the lymphatic system.

Several conditions can be detected when the blue dye helps medical imaging specialist decipher the lymph nodes from the blood vessels due to the contrast it creates. Some examples of lymphatic system medical issues that can be detected with the help of Isosulfan Blue injections include:

Isosulfan Blue is generally injected underneath the skin at the site of the reported problem. The contrast effect it provides is confined to the lymphatic system, helping physicians make a more accurate diagnosis. In the event a tumor is present, for example, the imaging device portrays this with a blue stain.

This sentinel lymph node mapping agent is heavily utilized in the medical industry. In fact, it's reliability and efficiency has made it the standard of choice for a lymphography for more than three decades. However, safety has only been established for adult patients. This drug is not generally prescribed for children.

Isosulfan Blue is a prescription only drug which is generally administered in a hospital or clinical setting via subcutaneous injection. It is available under the U.S. trade name Lymphazurin.

Conditions Treated?


Type Of Medicine?

Contrast agent

Side Effects

Most if not all drugs carry some risk of side effects. Isosulfan Blue is no different.

The most common unwanted reaction of Isosulfan Blue is a change in urine color. Patients may see blue-colored urine for up to 24 hours, after which it returns to normal. If you have concerns about this side effect, consult your healthcare provider.

Serious and rare side effects

In rare instances, Isosulfan Blue may also cause a serious allergic reaction known as Anaphylaxis shock.


Isosulfan Blue is supplied in a 5 ml single-use vial.

The dose amount for Isosulfan Blue during a lymphography exam is generally:

0.5 ml under the skin.

The standard protocol is to inject this dose amount in at least 3 separate areas, based on patient symptoms and an initial assessment by a medical provider. The maximum daily dose is 3 ml of the solution.

Please note that this dose amount applies to adult patients. Currently, medical specialists do not recommend prescribing Isosulfan Blue to pediatric patients.

Standard protocols for medical professionals

For the safety of other staffers and patients, follow these tips:

  • Monitoring after subcutaneous injection' due to the possibility of a postponed reaction to this medicine coupled with the possibility of anaphylaxis shock, patients should be carefully monitored for up to one hour after administering the dose,
  • Do not mix with other medicines ' do no place Isosulfan Blue in the same syringe containing other medicines, including anesthetics. If another subcutaneous dose is needed, a new syringe should be used.
  • Prepare emergency responses' in the event of an allergic reaction, be sure to have emergency medicines and equipment on hand to treat patients fast, including epinephrine shots for example.
  • Aseptic processes prepare the solution for subcutaneous injection in a sterile and germ-free environment. Read the insert label included with each vial for best practices regarding mixing.
  • Follow safety protocols ' to reduce the risk of transmission of infections and protect patients and staff, always adhere to the safety standards mandated by your healthcare facility. This includes wearing gloves during administration; using new syringes for each dose and disposing of any used needles and gloves in a biohazard container.


Very few negative interactions have been established for Isosulfan Blue.

In general, this dye should not be mixed with other solutions, particularly anesthetics in the same syringe ' due to the risk of precipitation.


Tell your doctor if you are using or plan to use any over the counter medicines, including NSAIDs, herbal supplement, and vitamins before the lymphography. In some cases, these medicines interfere with the medical imaging readings or may cause an adverse reaction when used concomitantly with contrast agents like Isosulfan Blue.

Underlying medical conditions

Some conditions may worsen with the use of Isosulfan Blue or predispose patients to more side effects. Tell your doctor if you have a history of any of the following conditions as negative interactions can occur:

Asthma'There is an established link between serious adverse reactions to Isosulfan Blue and asthmatic patients. This medicine should

Triphenylmethane hypersensitivity'serious allergic reactions can result in people who have a known hypersensitivity to the compound Triphenylmethane.


The manufacturers of Isosulfan Blue list the following precautions to promote patient safety:

Upcoming medical tests

If you have lab tests, medical imaging procedures, or other diagnostic evaluations scheduled, inform your doctor of your recent use of Isosulfan Blue. It is well known that Isosulfan Blue can influence the results of medical tests, subsequently resulting in false readings.

Urine color changes

Do not be alarmed if your urine color is blue after receiving an injection with Isosulfan Blue. This urinary color change can last for up to 24 hours.


In some cases, patients who receive Isosulfan Blue may experience a severe reaction to the drug called Anaphylaxis. This is a serious allergy that requires immediate medical intervention. Some of the telltale signs of anaphylaxis include:

  • Skin that feels cold and sticky
  • Feeling lightheaded, dizzy, or faint
  • Rashes that develop suddenly on the skin
  • Difficulty breathing or swallowing
  • Swelling

Since Isosulfan Blue is exclusively administered in a hospital setting, trained medical staff will be on duty to watch for the signs of anaphylaxis shock and have the proper measures in place to treat patients exhibiting the signs of this condition.

However, patients should also be aware of this possibility when using Isosulfan Blue and call for help if anaphylaxis shock is suspected.

As an extra precaution, you should also tell your doctor if you have a history of allergies to any dyes, foods, medicines, or animal products. This helps medical specialists determine if contrast agents like Isosulfan Blue are safe to prescribe.

In particular, you should tell your doctor or if you know of any hypersensitivities to triphenylmethane ' a key ingredient of Isosulfan Blue.

Oxygen saturation

Medical workers should note that this contrast agent can cause incorrect or extremely low-level oxygen readings. This is often cause for alarm; however, oxygen saturation levels can be confirmed by utilizing an Arterial blood gas (ABS) analysis. The depressed readings are temporary and generally last between 30 minutes to 4 hours.

Pregnancy and breastfeeding

There is limited data on how Isosulfan Blue injections affect developing fetuses or newborns and infants. A risk vs. benefit assessment should be collaborated between patients and doctors to determine if the procedure should be postponed or commenced. As an extra precaution, breastfeeding mothers can typically follow the pump and dump rule until the medicine has been fully excreted from the system. Ask your medical provider for more information.


To store Isosulfan Blue, keep in the original vials and place in a controlled room temperature of 20 to 25 degrees C (68 to 77 degrees F). Do not keep in heat, light, or areas with high moisture.


Isosulfan Blue is a type of contrast agent used during lymphatic system diagnostic tests such as a lymphography for example. It features a blue dye which when injected under the skin, creates a highlight between the lymph nodes and vessels. This reaction helps physicians to pinpoint serious health conditions associated with the lymphatic system, including cancers, Chyluria, Lymphedema, and more. Physicians benefit from better visibility and providing patients with a more accurate diagnosis.

Isosulfan Blue is dispensed by prescription only and it is sold under the brand name Lymphazurin. It is typically given in a hospital or clinical setting where a lymphography is performed.

The side effects of Isosulfan Blue are limited when compared to other medications. The most commonly reported adverse reactions are that it may cause the urine color to be blue for up to 24 hours. Additionally, anaphylaxis shock has been reported especially in patients with a history of allergies or asthma. As a result, patients should disclose their full medical history before taking this prescription.

Some of the main warning signs of Anaphylaxis shock are hives, welts, rashes on the skin, difficulty breathing, and puffiness in the facial area. In the event of anaphylaxis shock, the hospital usually has protocols in place to treat patients quickly.

Isosulfan Blue may moreover cause false readings in other medical tests, so be sure to disclose the recent use of this drug if you have any upcoming diagnostics scheduled.

In summary, Isosulfan Blue injections are proven to be reliable, effective, and safe for most adult patients, having been used in medical diagnostics for more than 30 years.