Hexvix (Hexaminolevulinate)

Hexvix is employed as a diagnostic aid during cystoscopic procedures to identify urothelial lesions.

• Detection of non‑muscle invasive bladder cancer (NMIBC) during blue‑light cystoscopy.
• Guidance for complete transurethral resection of bladder tumor (TURBT) by highlighting malignant tissue.
• Assessment of tumor margins after initial resection to reduce residual disease.
• Adjunctive evaluation in patients with a history of bladder cancer undergoing surveillance cystoscopy.
• Optional use in clinical studies investigating fluorescence‑guided bladder imaging.
• Facilitation of targeted biopsies by providing visual contrast between normal and malignant urothelium.

• Hexvix contains hexaminolevulinate, a prodrug that preferentially accumulates in malignant urothelial cells. Inside these cells, enzymatic conversion yields protoporphyrin IX, a photosensitizer that emits red fluorescence when excited by blue light (380–450 nm). The fluorescence highlights cancerous tissue during cystoscopy, allowing clinicians to differentiate tumor from normal bladder lining. This selective accumulation relies on the higher metabolic activity of neoplastic cells compared with healthy urothelium.

Adverse reactions reported after intravesical administration of Hexvix are generally mild, but rare serious events have been described.

Common

• Transient bladder irritation, including burning or stinging sensations.
• Mild hematuria or pink urine discoloration.
• Temporary urinary urgency or frequency.
• Low‑grade fever or chills lasting less than 24 hours.
• Mild abdominal discomfort or cramping.
• Transient increase in urinary leukocytes detected on dipstick testing.

Serious

• Acute allergic reaction with rash, pruritus, or angioedema.
• Severe bladder spasm or painful urinary retention.
• Persistent hematuria requiring medical evaluation.
• Anaphylaxis, although extremely rare.
• Delayed urinary obstruction due to severe edema of the bladder wall.
• Renal impairment secondary to obstructive uropathy, though extremely uncommon.

Before using Hexvix, clinicians should evaluate patient history and bladder condition to minimize potential risks.

• Confirm absence of active urinary tract infection prior to instillation.
• Ensure the bladder is adequately emptied and inspected for lesions that could impede distribution.
• Avoid use in patients with known hypersensitivity to hexaminolevulinate or related porphyrins.
• Defer administration in pregnant or nursing women, as safety data are lacking.
• Review concomitant medications that may increase photosensitivity, such as tetracyclines or sulfonamides.
• Monitor for immediate urinary discomfort or allergic signs during and after the procedure.
• Document any adverse events in the patient’s medical record.

Hexvix may interact with other agents that affect photosensitivity or bladder physiology.

Avoid

• Concurrent use of systemic photosensitizing drugs (e.g., porfimer sodium, aminolevulinic acid) that could amplify fluorescence reactions.
• Administration immediately after intravesical chemotherapy agents such as mitomycin C, which may increase bladder irritation.
• Avoid use of topical photosensitizers on the skin that could cause systemic photosensitivity during the procedure.

Use with caution

• Oral tetracyclines or fluoroquinolones, which can enhance photosensitivity and should be discontinued before the procedure if possible.
• Anticoagulants, because hematuria may be more pronounced during cystoscopy.
• Non‑steroidal anti‑inflammatory drugs (NSAIDs), which may affect bladder mucosal healing post‑procedure.
• Consider adjusting dosage of diuretics, as increased urine output may dilute the intravesical solution and affect fluorescence intensity.