[optimal] Re: fluorescein pricing
- From: "Darrin Landry" <darrin@xxxxxxxxxxxxxxxx>
- To: <optimal@xxxxxxxxxxxxx>
- Date: Fri, 11 Jul 2014 07:58:51 -0700
I ordered 20 boxes (240 vials) of 25% from Justice on June 20. Received it at
the beginning of this week.
Darrin A. Landry, CRA, OCT-C
Ophthalmic Consultant
Bryson Taylor Inc.
www.brysontaylorpublishing.com
----------------------------------------
From: "Peterson John C" <JPeterson@xxxxxxxxxxxx>
Sent: Friday, July 11, 2014 10:56 AM
To: "optimal@xxxxxxxxxxxxx" <optimal@xxxxxxxxxxxxx>
Subject: [optimal] Re: fluorescein pricing
10 % Fluorescite is all we've been able to get since the shortage hit. We're
keeping it under lock and key, and we've raised the threshold of medical
necessity for authorizing FAs for the time being.
This dye is noticeably less fluorescent than what we're used to, which means
we're pumping up the contrast and gain.
We've discussed dividing doses, but decided against it for reasons of
sanitation.
Other than that we're just waiting for good news from our pharmacy.
Hope this helps,
John
********
John C. Peterson, MBA-ITM
Senior Ophthalmic Photographer
UW Health Eye Clinic
2880 University Ave., Rm. 246
Madison, WI 53705
(608) 263-7163
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Lee, Katherine K.
Sent: Friday, July 11, 2014 8:23 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] fluorescein pricing
Here at our hospital university setting we have to order all drugs through the
hospital pharmacy.
Our contact there just updated me that the $70.00 12 pack of 10% dye we
purchased in October 2013 from Akorn is now $171.43. And even better, it's not
available.
Alcon, however has a product called Fluorescite 10% that we can purchase for
$396.31 a twelve pack.
How are you, my fellow Optimalers handling this market manipulation?
Katherine K Lee COT
Storm Eye Institute
843-792-2764
fax 792-8865
pager 17576
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From: optimal-bounce@xxxxxxxxxxxxx [optimal-bounce@xxxxxxxxxxxxx] on behalf of
Paula Morris [paula.morris@xxxxxxxxxxxx]
Sent: Wednesday, July 09, 2014 11:40 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #90
Yeah - Duke Elder ( who pooh poohed Harold Ridley's idea of intraocular lenses)
said that fluorescein is a vegetable based dye.. And that concept is STILL
hanging around despite the fact that the chemical composition and step by step
synthesis of the dye proves that idea wrong.
The bottom line is that you do what your employers/physicians say you should
do. They write the checks, they dictate the medical practices of the group.
You can lead a horse to water....
Good luck, Chris. Perhaps there is another compelling reason why they are
insistent on not doing same day ICGs on Metformin patients. Anecdotally, we
have never had a problem doing ICGs on our uveitis patients who are diabetic
and on Metformin. To be honest, we have never had a problem with an ICG
patient in all the years we have been doing them - and we have a large uveitis
practice. I have had TWO cardiac arrests with fluorescein sodium, however.
But my husband the biostatistician says "you never say never" when it comes to
human tissue. Reactions can happen that have nothing to do with tone element
of the procedure, but that element can be blamed.
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Sandor Ferenczy
Sent: Wednesday, July 09, 2014 8:46 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #90
how many residents do you hear still telling patients that sodium fluorescein
is a vegetable dye??
as another aside, anecdotally, i am hearing of very few (perhaps zero) cases of
IVFA reaction during EUA. this caused me to research the occurrence of
vasovagal responses in general, local & non-anesthetized patients.
it is amazing what happens when you disconnect the brain from the body
(chemically speaking). i don't discount nausea, emesis & syncope, but it puts
it in a different light when you realize it stops occurring under general
anesthesia.
On Wed, Jul 9, 2014 at 10:33 AM, Carlton, Chris [VA] <Chris.Carlton@xxxxxx>
wrote:
Unfortunately it is more than just the AAO. Do a search for ICG
contraindication and this comes up from the ATPO. Many Ophthalmic photography
clinics have the same info. Our RN contacted our pharmacy and the Pharmacist
reiterated the same old tune. It is in their info as well. I had read the JOP
article and will give a copy to the Department head. I doubt it will be a
priority as we do 3 - 4 ICG per week on average. I wonder how much out of date
or incorrect information is still out there forever repeated because it is
written. Is not the earth still flat?
Properties of ICG
The dye is contraindicated in patients with iodine and shellfish allergies.
Furthermore, patients with a
history of liver disease and those undergoing hemodialysis for chronic renal
failure may be
at an increased risk of experiencing adverse side effects. Like sodium
fluorescein, ICG has
not been proven to be teratogenic, though many ophthalmologists elect not to
perform the
study on pregnant females.
----------------------------------------
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Paula Morris
Sent: Tuesday, July 08, 2014 10:13 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #90
So sorry, it would appear that the AAO site is out of date, not based on the
most recent literature.
Chris Larsen, a Master's in Pharmacy candidate and I wrote a letter to the
editor in the JOP about Metformin and ICG: Morris, P, Larsen, C: Is
Indocyanine Green Choroidal Angiography Safe for Diabetic Patients Taking
Metformin? Journal of Ophthalmic Photography, vol. 20, #2, Oct. 1998
The answer for safety was YES - Mr. Larsen's pharmacological research showed
that the Metformin manufacturer was covering ALL bases in stating there was
about IODINE allergy. And as stated, ICG has a sodium iodide ION, not the
whole molecule of Iodine. This letter was published in 1998, but I am unaware
of more recent literature that has a differing opinion. The findings were
verified by the University of Utah College of Pharmacy and the University of
Utah Health Sciences Center Poison Control group - whose sole task is to advise
on possible inadvertent poisonings from house plant ingestion, etc, and drug
interactions.
Perhaps you could ask a pharmacist that works closely with your practice to
review the AAO statement and given an opinion to your physicians. Hard to
imagine an pharmacist's studied opinion would be ignored. Not worrying about
Metformin would certainly ease your way for patients needing ICG and not having
to stop drug and wait.
Good luck, Chris,
Paula
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Carlton, Chris [VA]
Sent: Tuesday, July 08, 2014 8:37 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #90
From the AAO website
ICG appears to have a lower rate of side effects than does fluorescein dye.
Unlike with fluorescein dye, nausea and vomiting are rare. Mild adverse events
are seen in less than 1% of patients. Allergic reactions are no more common
with ICG than with fluorescein, but the dye should be used with caution in
individuals with a history of allergy to iodides and shellfish because ICG
contains 5% iodide. Angiographic facilities should develop an emergency plan
and establish a protocol to minimize risks and manage complications associated
with either fluorescein or ICG administration. Contraindications to ICG may
include liver disease or the use of the drug metformin (Glucophage) to control
type 2 diabetes.
This is the problem I can not overcome. It is all over many medical sites and
in many cases the word caution is dropped for an outright contraindication. It
is an outright ban with so called iodine allergies in my work place. All our
Metformin patients get delayed by GFR testing before ICG. I work in a large
hospital where risk management says we have to follow protocol because it is
written and the hospital pencil pushers and RN's will not investigate any
further.
The patients that had a reaction to ICG in the study literature that had
shellfish allergies were likely Atopic as described by the ACR manual on
contrast media 2013. This means they will be at 2-3 times increased risk of a
reaction but that is same as other allergies. Radiology no longer uses
shellfish allergies as a contraindication to their iodized contrast media.
I found this interesting from Pulsion medical the European supplier of ICG. The
scientist gives his opinion however both iodine and iodide are listed as a
contraindication in the rest of the info. Not use ICG-PULSION: allergic to
indocyanine green, sodium iodide or iodine.
http://www.pulsion.com/fileadmin/pulsion_share/Products_Flyer/ICG/IodideFlyer_EN_MPIIC00305_R00_030809_low.pdf
Chris Carlton
Ophthalmic Photographer
VGH/UBC Eye Care Center
________________________________________
From: optimal-bounce@xxxxxxxxxxxxx [optimal-bounce@xxxxxxxxxxxxx] On Behalf Of
Paula Morris [paula.morris@xxxxxxxxxxxx]
Sent: July 7, 2014 8:07 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #90
One of the articles by Dr. Yanuzzi mentions Iodine allergies, but as has been
pointed out, there is NO complete iodine molecule in the empirical formula of
ICG. The sodium iodide ion is added to make it soluble. An article by
Hope-Ross M, Yanuzzi L, and Gragoudas E et al, "Adverse reactions due to
indocyanine green", in Ophthalmology, 1994;101:530-531, suggests that most
people who have an allergy to iodine tolerate ICG just fine, while some
reactions to ICG are pseudoallergic, with a non-immunologic release of
histamine.
And we know that Metformin use is not contraindicated for ICG. That was a
misconception early on as well.
As with anything, covering all the bases is important - and you can never say
never, so exercising care in consenting your patients is important.
p
-----Original Message-----
From: optimal-bounce@xxxxxxxxxxxxx [mailto:optimal-bounce@xxxxxxxxxxxxx] On
Behalf Of Steffens, Timothy
Sent: Monday, July 07, 2014 8:03 AM
To: optimal@xxxxxxxxxxxxx
Subject: [optimal] Re: optimal Digest V5 #90
BTW, there is no iodine in ICG. It's iodide. In the 90s Bill Nyberg and I did
some research and found out that there was as much iodine in ICG as there is in
Summer Squash.
http://en.wikipedia.org/wiki/Iodide
http://en.wikipedia.org/wiki/Iodine
Thanks,
Tim
On 7/7/14 9:41 AM, "Cavicchi, Robert" <Robert.Cavicchi@xxxxxxxxxxxxxxxxxx>
wrote:
>Chris,
>
>This would make an interesting topic as an abstract for the OPS
>Scientific Session at the 2014 OPS Annual Program. Hope you are
>planning to attend and willing to submit.
>
>Link abstract submission here:
>
>http://www.opsweb.org/default.asp?page=SciSesApSub
>
>bob
>
>From: <Carlton>, "Chris [VA]"
><Chris.Carlton@xxxxxx<mailto:Chris.Carlton@xxxxxx>>
>Reply-To: Optimal <optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>>
>Date: Friday, July 4, 2014 10:37 AM
>To: Optimal <optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>>
>Subject: [optimal] Re: optimal Digest V5 #90
>
>The shellfish iodine nexus has been recognized as a myth. Check pub med
>there are lots of studies that support this with none opposed. It is
>not practice in radiology to withhold contrast media with iodine in
>patients with shellfish allergies. The immunology/ allergy
>organizations are in agreement a shellfish allergy does not mean you are
>allergic to iodine.
>The patient is allergic to proteins in shellfish. Many foods you eat
>daily contain iodine such as eggs and table salt. Many scientists now
>believe iodine allergies are impossible. Patients are allergic to a
>particular substance that just happens to contain some iodine or are
>Atopic. The Ophthalmology studies that started this in the first place
>where done years ago when it was widely accepted belief. However it
>appears there was never any evidence to support this.
>
>Chris Carlton
>VGH/BC Eye Care Center
>
>________________________________
>From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
>[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of stu weedn
>Sent: Thursday, July 03, 2014 1:28 PM
>To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
>Subject: [optimal] Re: optimal Digest V5 #90
>
>
>Hi Denice,
>I am supplying ICG through Apollo Ophthalmic just shipped the last box
>and I am taking back orders,( if this posts on optimal no sales message
>is intended, strictly informational, and establishing my industry
>position) I have no association with HUB.
>
> Do you mean contraindications, if so, still only thing is shell fish
>allergy and that is sometimes overruled by necessity, ICG does contain
>a very small amount of iodide. Also no contraindications with
>metformin, ICG is excreted hepaticlly metformin is contraindicated for
>patients with compromised hepatic systems but there is no interaction between
>the two.
>Metformin in rare cases may cause lactic acidosis and has a host of
>other cautions.
>
>I am happy to provide any information directly for those who would like
>to contact me privately.
>
>Happy Holiday,
>Stuart
>Stuart
>
>Can you update me on the most RECENT advancements in ICG; specifically,
>predispositions for use. Last peer reviewed reference I found was 2001
>
>Denice Barsness, CRA, COMT, ROUB, CDOS, FOPS Ophthalmic Diagnostic
>Center CPMC Department of Ophthalmology
>2100 Webster Street Suite 212
>San FranciscoCA 94115
>(415) 600-3937<tel:%28415%29%20600-3937> FAX (415)
>600-6563<tel:%28415%29%20600-6563>
>
>From:optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
>[mailto:optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxx
>g>]
> On Behalf Of stu weedn
>Sent: Thursday, July 03, 2014 11:42 AM
>To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
>Subject: [optimal] Re: optimal Digest V5 #90
>
>
>There is a good bit of ICG used in neurosurgery, cardiovascular
>surgery, lump analysis, prostate surgery, tumor boundary delineation in
>several specialties and although ophthalmic use has declined by
>pathology there are many more Heidelberg systems in place which use ICG
>than at any time in the past. Expect ongoing shortages, maintaining 4-6
>week inventories is your best bet.
>Stuart Weedn
>On Jul 3, 2014 6:12 AM, "wmshprd"
><wmshprd@xxxxxxx<mailto:wmshprd@xxxxxxx>> wrote:
>Increased demand? Hard to imagine in ophthalmology. .cardiology
>maybe..I was under the impression that fewer ICG's were being done.
>
>
>William Shepard
>860-748-8979<tel:860-748-8979> c
>860-549-2020<tel:860-549-2020> o
>wmshprd@xxxxxxx<mailto:wmshprd@xxxxxxx>
>Eye Disease Consultants
>Suite 522
>85 Seymour St
>Hartford Ct. 06106
>
>
>-------- Original message --------
>From: FreeLists Mailing List Manager
>Date:07/03/2014 1:13 AM (GMT-05:00)
>To: optimal digest users
>Subject: optimal Digest V5 #90
>
>optimal Digest Wed, 02 Jul 2014 Volume: 05 Issue: 090
>
>In This Issue:
> [optimal] Re: ICG
> [optimal] Zeiss Uber Sale
>
>----------------------------------------------------------------------
>
>From: "Carlton, Chris [VA]"
><Chris.Carlton@xxxxxx<mailto:Chris.Carlton@xxxxxx>>
>Date: Wed, 2 Jul 2014 07:18:08 -0700
>Subject: [optimal] Re: ICG
>
>Indocyanine Green
>[12 June 2014]
>Products Affected - Description
>IC Green, Akorn
>25 mg kit (NDC 17478-0701-02<tel:17478-0701-02>)
>
>Indocyanine Green, Hub Pharmaceuticals
>25 mg vial (NDC 25431-0424-02)
>
>Reason for the Shortage
>
> * Akorn states the reason for the shortage is increased demand.
> * Hub Pharmaceuticals cannot provide a reason for the shortage.
>
>Available Products
>
>No presentations are available.
>
>Estimated Resupply Dates
>
> * Akorn has IC Green on back order and the company estimates a release
>date in late-June 2014.
> * Hub Pharmaceuticals has indocyanine green on back order. Product may
>be available at wholesalers. Check your wholesaler for availability.
>
>Found this on a pharmacy website that refers to drug shortages.
>________________________________
>From: optimal-bounce@xxxxxxxxxxxxx<mailto:optimal-bounce@xxxxxxxxxxxxx>
>[mailto:optimal-bounce@xxxxxxxxxxxxx] On Behalf Of Adeline Stone
>Sent: Monday, June 30, 2014 2:33 PM
>To: optimal@xxxxxxxxxxxxx<mailto:optimal@xxxxxxxxxxxxx>
>Subject: [optimal] ICG
>
>Hello-
>
>Has anyone heard that Akorn is no longer making ICG? We typically don't
>order much at a time and now we are considering a little more since
>this sounds to be "back ordered" per Akorn. But we are hearing that
>Akorn will not be making it any longer.
>
>Thanks!
>
>
>
>[cid:image001.gif@01CF95C5.C6298720<mailto:image001.gif@01CF95C5.C62987
>20>
>]
>
>Adeline Stone, COT CRA
>Diagnostic Services Supervisor
>Spokane Eye Clinic, PS
>427 S. Bernard
>Spokane, WA 99204
>Clinic 509-456-0107 Ext 1508<tel:509-456-0107%20Ext%201508>
>Cell 509-385-2629<tel:509-385-2629>
>Fax 509-456-0316<tel:509-456-0316>
>astone@xxxxxxxxxxxxxx<mailto:astone@xxxxxxxxxxxxxx><mailto:astone@spoka
>nee
>ye.com<mailto:astone@xxxxxxxxxxxxxx>>
>
>
>
>
>
>
>
>
>
>
>
>
>------------------------------
>
>Date: Wed, 2 Jul 2014 15:22:52 -0700 (GMT-07:00)
>From: serar <serarphoto@xxxxxxxxxxxxx<mailto:serarphoto@xxxxxxxxxxxxx>>
>Subject: [optimal] Zeiss Uber Sale
>
>Hi..
>
>Zeiss uber sale !!! For sale 6 Zeiss FF-3 fundus cameras. $750 each
>plus shipping. Yaa,it's twu it's twu ! All in good condition with no
>camera back. Will deliver with in reason.
>Thanks,
>Ben Serar
>626-862-7642<tel:626-862-7642>
>
>------------------------------
>
>End of optimal Digest V5 #90
>****************************
>
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