Zyogreen - Sagent Pharmaceuticals

ZYOGREEN is indicated for fluorescence imaging of vessels (micro- and macro-vasculature), blood flow and tissue perfusion before, during and after vascular, gastrointestinal, organ transplant, plastic, micro- and reconstructive surgeries, including general minimally invasive surgical procedures in adults and pediatric patients.

ZYOGREEN is indicated for fluorescence imaging of extrahepatic biliary ducts in adults and pediatric patients from birth to less than 1 year of age and 6 years of age and older.

ZYOGREEN is indicated for fluorescence imaging of lymph nodes and delineation of lymphatic vessels during lymphatic mapping in adults with cervical and uterine cancer for which this procedure is a component of intraoperative management.

ZYOGREEN is indicated for use in ophthalmic angiography in adults and pediatric patients.

• ZYOGREEN is a ready-to-use solution, provided in ampules at a concentration of 2.5 mg per mL.
• Use immediately after opening ampule.
• Withdraw the contents of the ampule through a 5 micrometer or smaller straw/filter needle to ensure that the withdrawn solution contains no particulates.
• Visually inspect the withdrawn solution for particulate matter and discoloration prior to administration.
• Each ampule of ZYOGREEN is for a single dose. Discard any unused portion.

Dosing

• Administer the recommended initial dose of ZYOGREEN as a single intravenous injection. The recommended initial dose is based on patient age as shown in Table 1.
• Additional doses may be administered to obtain imaging sequences during the procedure.
• The maximum total dose for any patient, including all initial and additional doses combined, must not exceed 2 mg/kg.

Administration

• Prior to the imaging procedure, draw the desired dose of ZYOGREEN into a syringe.
• For adults, prepare 10 mL of 0.9% Sodium Chloride Injection in a separate syringe for flushing.
• For pediatric patients, adjust the amount and type of flush for the individual patient to avoid volume and sodium overload.
• Administer via a central or peripheral venous line using a three-way stopcock.
• Inject ZYOGREEN as a tight bolus.
• Immediately switch the access on the stopcock and inject the prepared flush.

Imaging Instructions

• Use ZYOGREEN with an FDA-authorized imaging device that is intended to be used with indocyanine green for fluorescence imaging of vessels, blood flow and tissue perfusion.
• A fluorescence response should be visible in blood vessels within 5 seconds to 15 seconds after injection.

Dosing and Administration

• Administer the recommended dose of ZYOGREEN as a single intravenous injection. The initial dose and timing of administration are based on patient age as shown in Table 2.
• Additional doses may be administered to obtain imaging sequences during the procedure.
• The maximum total dose for any patient, including all initial and additional doses combined, must not exceed 2 mg/kg.

Imaging Instructions

• Use ZYOGREEN with an FDA-authorized imaging device that is intended to be used with indocyanine green for fluorescence imaging of extrahepatic biliary ducts.
• For patients 6 years of age and older, fluorescence is visible in the biliary tree within 45 minutes after injection.
• For patients less than 1 year of age, fluorescence is visible in the biliary tree between 12 hours and 24 hours after injection.

Dosing and Administration

• The recommended dose of ZYOGREEN for lymphatic mapping of cervical and uterine cancer in adults is 5 mg.
• Administer this dose interstitially as four separate 1.25 mg injections into the cervix, with each injection consisting of a 0.5 mL volume of the 2.5 mg/mL solution. The injections should be given at the 3 o'clock and the 9 o'clock positions of the cervix. At each of these two positions, one superficial injection (1 mm to 3 mm depth) and one deep injection (1 cm to 3 cm depth) are required to complete the dosing.

Imaging Instructions

• Use ZYOGREEN with an FDA-authorized imaging device that is intended to be used with indocyanine green for fluorescence imaging of lymph nodes and delineation of lymphatic vessels during lymphatic mapping of cervical and uterine cancer.
• Fluorescent lymphatic vessels and lymph nodes should begin to be visible within 1 minute after injection.

• Administer doses up to 40 mg of ZYOGREEN intravenously for ophthalmic angiography in adult and pediatric patients. The specific dose should be determined based on the imaging equipment and technique being used.
• The total dose must not exceed 2 mg/kg.
• For adults, administer a 5 mL bolus of 0.9% Sodium Chloride Injection immediately following the injection.
• For pediatric patients, adjust the amount and type of flush solution for the individual patient to avoid volume and sodium overload.
• The antecubital vein can be used for ZYOGREEN administration.

Hypersensitivity reactions including anaphylaxis, urticaria, and deaths due to anaphylaxis have been reported following intravenous administration of indocyanine green, the active ingredient in ZYOGREEN [see Adverse Reactions (6)].

ZYOGREEN is contraindicated in patients with a history of hypersensitivity to indocyanine green [see Contraindications (4)]. Always have cardiopulmonary resuscitation personnel and equipment readily available and monitor all patients for hypersensitivity reactions.

Because ZYOGREEN contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration [see Drug Interactions (7)].

Interference with Thyroid Radioactive Iodine Uptake Studies

Because ZYOGREEN contains sodium iodide, the iodine-binding capacity of thyroid tissue may be reduced for at least one week following administration. Do not perform radioactive iodine uptake studies for at least one week following administration of ZYOGREEN.

Of the total number of subjects in clinical studies of indocyanine green for visualization of vessels, blood flow and tissue perfusion, 7% were 65 and over, while 1% were 75 and over. Of the total number of subjects in clinical studies of indocyanine green for visualization of lymph nodes and lymphatic vessels during lymphatic mapping of cervical and uterine cancer, 9% were 65 and over, while 2% were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between elderly and younger patients.

Clinical studies of indocyanine green for visualization of extrahepatic biliary ducts did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

When bound to proteins in plasma or in lymph fluid, indocyanine green absorbs light in the near-infrared region with peak absorption at 805 nm and emits fluorescence (light) at a slightly longer wavelength, with peak emission at 830 nm. Fluorescence imaging devices provide external energy as near infrared light for indocyanine green to absorb, resulting in excitation of the indocyanine green, and the emitted light (fluorescence) is transferred from the field of view to an image on a monitor. These optical properties of indocyanine green are utilized in fluorescence imaging of the micro- and macro- vasculature, blood flow and tissue perfusion, the extrahepatic biliary ducts, and for lymphatic mapping of lymph nodes and lymphatic vessels.

There is no pharmacodynamic data.

No studies have been performed to evaluate the potential for carcinogenicity, mutagenicity, or impairment of fertility by indocyanine green.

The effectiveness of ZYOGREEN for fluorescence imaging of lymph nodes and delineation of lymphatic vessels during lymphatic mapping in adults with cervical and uterine cancer has been established based on a study of another formulation of indocyanine green. Below is a description of the FILM Study (NCT 02209532).

The study was a randomized, prospective, multi-center, open-label study in patients with early stage uterine or cervical cancer and no known regional nodal or metastatic disease by standard clinical evaluation. Indocyanine green and a blue dye comparator were injected into the cervix of patients at the beginning of the operative procedure.

A total of 176 patients were randomized to receive either indocyanine green followed by blue dye or blue dye followed by indocyanine green. A total of four 1 mL injections of a 1.25 mg/mL solution of indocyanine green for a total dose of 5 mg were administered interstitially into the cervix at the 3 o'clock and 9 o'clock positions with a superficial (1 mm to 3 mm) and a deep (1 cm to 3 cm) injection at each position.

Lymphatic mapping was performed intraoperatively using a fluorescence imaging device and standard light, followed by excision of tissues identified by indocyanine green, blue dye, or the surgeon's visual and palpation examination. The resected tissues were evaluated by histopathology to confirm presence of lymph nodes. The efficacy of indocyanine green in the detection of lymphatic vessels and lymph nodes during lymphatic mapping procedures was determined by the number of histology-confirmed lymph nodes detected by indocyanine green and/or the blue dye comparator.

The mean age of the 176 patients was 63 years (range: 31 to 88 years); distribution by race and ethnicity was 79% White, 4% Black or African American, 3% Asian, 13% Hispanic/Latino and 1% other.

Table 3 shows the distribution of resected, confirmed lymph nodes detected by indocyanine green or blue dye in the modified intent-to-treat population (mlTT). Among the confirmed lymph nodes identified, 93% were identified using indocyanine green, and 43% were identified using blue dye, a difference of 50% [95% confidence interval 39% to 60%].

Table 4 shows the number of patients with at least one resected, confirmed lymph node and the number of patients with at least one bilateral lymph node pair detected by indocyanine green or blue dye. With indocyanine green, approximately 97% of patients had at least one resected, confirmed lymph node detected and 73% had at least one bilateral lymph node pair detected, compared with 68% and 28%, respectively, with blue dye (p-values for each analysis <0.0001).

How Supplied

ZYOGREEN (Indocyanine Green Injection), is a deep emerald-green ready-to-use solution in amber glass ampules supplied as follows:

Storage and Handling

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [See USP Controlled Room Temperature].

Store in original carton to protect from light.
Do not refrigerate or freeze.
Use immediately after opening ampule. Discard unused portion.

Sterile, Nonpyrogenic, Preservative-free.
Not made with natural rubber latex.

Hypersensitivity Reactions

Advise patients to seek medical attention for reactions following injection of ZYOGREEN such as difficulty breathing, swollen tongue or throat, skin reactions including hives, itching and flushed or pale skin, low blood pressure, a weak and rapid pulse and other symptoms or signs of an anaphylactic reaction [see Warnings and Precautions (5.1)].

sagent^®

Mfd. for SAGENT Pharmaceuticals
Schaumburg, IL 60173 (USA)
Made in France
©2026 Sagent Pharmaceuticals

June 2026