indigo carmine

Action and Spectrum

Actions and Spectrum: 

• indigo carmine is a colorant that is a diagnostic agent in various medical procedures, particularly in urological and gastrointestinal examinations. Its mechanism of action is simple; it provides a distinct blue color to the area where it is introduced, allowing for better visualization and identification of specific anatomical structures or pathologies. 
• indigo carmine is injected into the urinary tract (bladder or ureters) for urological procedures. The kidneys rapidly excrete it, and appear in the urine as a blue color, helping urologists observe the urine flow and detect abnormalities in the urinary system. 
• In gastrointestinal procedures, indigo carmine is introduced into the digestive tract (usually via endoscopy) to improve visualization of the mucosal lining. It aids in identifying lesions, polyps, or other abnormalities. 
• indigo carmine is not an antimicrobial agent, so it does not have a direct spectrum of activity against bacteria, viruses, or fungi. 

Drug Interaction

Adverse Reaction

Frequency defined 

1-10% 

Constipation  

Vomiting 

Abdominal pain 

Nausea 

Dysuria  

Fever  

Post-marketing reports 

Bradycardia  

Asystole 

Cardiac arrhythmia 

Nonimmune anaphylaxis 

Anaphylaxis 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

• Allergy or Hypersensitivity: indigo carmine should not be used in patients with a known allergy or hypersensitivity to the dye or its components.  
• Renal Impairment: indigo carmine is excreted by the kidneys, and its use should be approached with caution in patients with impaired renal function.  
• Asthma or Respiratory Conditions: Some individuals with a history of asthma or other respiratory conditions may be at an increased risk of developing bronchospasm or other breathing difficulties when exposed to indigo carmine. 
• G6PD Deficiency: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder that can lead to hemolytic anemia when exposed to certain medications and substances. indigo carmine may not be recommended in patients with known G6PD deficiency. 

Pregnancy / Lactation

Pregnancy consideration: Insufficient data available 

Lactation: Excretion of the drug in human breast milk is unknown 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

indigo carmine works as a colorant, providing a distinct blue color to the area where it is introduced. This allows for better visualization and identification of specific anatomical structures or pathologies during medical procedures. 

indigo carmine is used in urology to assess urine flow and detect abnormalities in the urinary system. It is also utilized in gastroenterology to enhance the visualization of the gastrointestinal mucosal lining during endoscopy. 

Pharmacodynamics:  

The pharmacodynamics of indigo carmine involve its diagnostic effects, providing enhanced visualization and localization during urological and gastrointestinal procedures. 

Pharmacokinetics: 

Absorption 

indigo carmine is typically administered intravenously or intramuscularly. Upon administration, it quickly enters the bloodstream within 4 to 9 minutes, and its blue color makes it easy to track its movement within the body during specific diagnostic procedures. 

Distribution 

The drug’s distribution volume (Vd) is 10.7 liters (L). The drug is extensively distributed beyond the plasma, possibly indicating that it can penetrate tissues and enter various body compartments. Approximately 90% of the drug in circulation is bound to proteins in the blood.  

Metabolism 

indigo carmine is not significantly metabolized in the body. It is an inert dye and does not undergo any significant chemical changes or biotransformation. 

Elimination and Excretion 

The drug’s half-life after intravenous (IV) injection is 12 minutes. The drug is primarily eliminated through urine, with 16% of the administered dose excreted as the unchanged drug. 

Adminstartion

Administration: 

Intravenous administration 

• Use a 5-micron filter needle or straw to remove the contents of the ampule after giving it a minute of undiluted administration. 
• Has been injected into the ureter(s) during a pediatric patient’s cystoscopy treatment. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: indigo carmine 

Why do we use indigo carmine? 

indigo carmine (indigotindisulfonate sodium) has several medical uses, primarily as a diagnostic agent to improve visualization during various medical procedures. Here are the primary uses of indigo carmine: 

• Urological Procedures: indigo carmine is commonly used in urology to assess urine flow and detect abnormalities in the urinary system. It is injected into the urinary tract, usually in the bladder or ureters. The kidneys rapidly excrete the dye, appearing in the urine as a blue color.  
• Gastrointestinal Procedures: In gastroenterology, indigo carmine is used to improve the visualization of the mucosal lining during endoscopy. It is introduced into the gastrointestinal tract during endoscopic procedures, such as colonoscopy or esophagogastroduodenoscopy (EGD). 
• Lymphatic Mapping: indigo carmine has been used in some medical centres for lymphatic mapping in certain cancer surgeries, particularly for breast cancer. It helps surgeons identify the lymphatic drainage pathways and sentinel lymph nodes, the first to receive drainage from the primary tumor site.