What is the recommended dose of Fluorescein (FL) injection for fluorescein angiography?

Fluorescein Injection Dosing for Angiography

The standard dose for fluorescein angiography in adults is 500 mg, administered as either 5 mL of 10% solution or 2 mL of 25% solution via intravenous injection. 1

Adult Dosing

• Administer 500 mg of sodium fluorescein intravenously as the standard adult dose 1
• This can be given as:
  • 5 mL of 10% fluorescein solution (100 mg/mL), or 1, 2
  • 2 mL of 25% fluorescein solution (250 mg/mL) 1, 2

The 25% concentration in smaller volume (2-3 mL) has been demonstrated to provide superior image quality compared to the 10% solution in both subjective visualization and objective angiogram assessment, with no significant difference in adverse reaction rates 3. This makes the 25% solution preferable when available, as it delivers the same dose in a smaller injection volume.

Pediatric Dosing

• Calculate dose based on 7.7 mg/kg body weight (or 35 mg per 10 pounds of body weight) 1
• For infants with retinopathy of prematurity, administer 0.1 mL/kg of 10% solution as an intravenous bolus, followed by isotonic saline flush 4

Administration Technique

• Inject into the antecubital vein as the preferred site 2, 3
• Do not mix or dilute with other solutions or drugs 1
• Administer as a bolus injection followed by saline flush in pediatric cases 4
• Photography typically begins immediately after injection for standard angiography 2

Important Clinical Considerations

The FDA-approved formulations (AK-FLUOR) are available as single-dose vials and should not be confused with FDG (fluorodeoxyglucose) used in PET imaging, which has entirely different dosing calculations 1. The evidence provided regarding FDG dosing 5 is not applicable to fluorescein angiography.

While oral administration of 10 mL of 10% sodium fluorescein has been studied and shown 97.3% efficacy with minimal adverse effects (1.7% experiencing mild symptoms), this route is not FDA-approved and intravenous administration remains the standard of care 6.

Informed consent is required as fluorescein angiography carries potential risks including severe medical complications (approximately 1 in 200,000 patients) and rare anaphylactic reactions 7. Common mild reactions include transient nausea, skin discoloration, and urine discoloration 1, 8.