Gliolan (Aminolevulinic Acid Hydrochloride)

Gliolan is indicated for fluorescence‑guided surgical procedures that enhance the surgeon’s ability to distinguish malignant tissue from normal brain or bladder tissue, thereby supporting more complete tumor removal.

• Fluorescence‑guided resection of malignant glioma in adult patients, allowing real‑time visualization of tumor margins during craniotomy.
• Photodynamic diagnosis of bladder cancer performed during cystoscopy, where the agent highlights suspicious lesions under blue light.
• Intra‑operative identification of tumor margins in neurosurgical procedures, helping to differentiate infiltrative tumor from surrounding healthy brain tissue.
• Adjunctive use for detecting residual tumor tissue after primary resection, reducing the likelihood of leaving microscopic disease behind.
• Support for surgical planning in cases where conventional imaging is insufficient, providing additional visual cues to guide operative decisions.

The safety profile of Gliolan includes a range of observed adverse reactions, which are categorized by frequency and clinical significance.

Common

• Transient headache or pressure sensation during illumination.
• Nausea or mild vomiting shortly after oral administration.
• Temporary photosensitivity of the skin at the injection site.
• Mild visual disturbances such as glare under blue light.
• Mild dizziness or light‑headedness occurring within the first few hours after dosing.
• Transient increase in blood pressure observed during the illumination phase of surgery.

Serious

• Severe allergic reaction, including rash, itching, swelling, or anaphylaxis.
• Persistent or worsening neurological deficits after surgery.
• Significant hepatic enzyme elevation indicating possible liver involvement.

When using Gliolan, healthcare professionals should observe specific precautions to minimize risks and ensure optimal diagnostic performance.

• Verify patient eligibility, including absence of known hypersensitivity to aminolevulinic acid derivatives.
• Conduct a thorough medical history to identify liver disease, porphyria, or photosensitivity disorders.
• Ensure the patient avoids strong ambient light exposure for 24 hours after administration to reduce skin photosensitivity.
• Perform baseline laboratory tests, especially liver function tests, before initiating therapy.
• Use appropriate protective eyewear for operating staff during blue‑light illumination.
• Document the timing of oral dose relative to surgical start to achieve optimal fluorescence.

Gliolan may interact with other agents that affect photosensitivity, hepatic metabolism, or porphyrin pathways; awareness of these interactions helps prevent adverse outcomes.

Avoid

• Concomitant use of strong photosensitizing drugs such as tetracyclines, sulfonamides, or psoralen compounds.
• Administration of other porphyrin‑based agents that could compete for metabolic pathways.
• Avoid exposure to intense sunlight or UV lamps within 24 hours after dosing.

Use with caution

• Hepatotoxic medications (e.g., high‑dose acetaminophen, certain antifungals) that may exacerbate liver enzyme changes.
• Anticoagulants, as surgical bleeding risk may be influenced by intra‑operative lighting.
• Drugs that alter blood pressure, requiring monitoring during illumination.
• Patients on medications that affect renal function should be monitored, as altered clearance may modify fluorescence intensity.