Version July 2025
Use only the iohexol concentrations and presentations recommended for intrathecal procedure. Intrathecal administration of iohexol of a wrong iodine concentration, even if inadvertent, may cause death, convulsions/seizures, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, rhabdomyolysis, hyperthermia, and brain edema.
Note: Concentration, volume, and rate may depend on the equipment, condition of injected vessel, size/condition of patient, and imaging technique used. Refer to prescribing information for detailed dosing and administration information.
Intrathecal imaging:
Myelography (lumbar, thoracic, cervical, and total columnar): Intrathecal: Iohexol 180 mgI/mL (Omnipaque 180):
0 to <3 months: 2 to 4 mL (0.36 to 0.72 gI).
3 months to <3 years: 4 to 8 mL (0.72 to 1.44 gI).
3 to <7 years: 5 to 10 mL (0.9 to 1.8 gI).
7 to <13 years: 5 to 12 mL (0.9 to 2.16 gI).
13 to 18 years: 6 to 15 mL (1.08 to 2.7 gI).
For a single myelographic procedure: Do not exceed a concentration of 180 mgI/mL or total dose of iodine 2,700 mg. If a repeat procedure is required, wait at least 48 hours (5 to 7 days is preferred).
Intravascular imaging: Note: Method of administration variable determined by imaging technique.
Ventriculography: Infants, Children, and Adolescents:
Iohexol 300 mgI/mL (Omnipaque 300): Injection: 1.75 mL/kg; range: 1.5 to 2 mL/kg; if multiple injections are used, then maximum total dose: 5 mL/kg not to exceed a total volume of 291 mL.
Iohexol 350 mgI/mL (Omnipaque 350): Injection: 1.25 mL/kg; range: 1 to 1.5 mL/kg; if multiple injections are used, then maximum total dose: 5 mL/kg not to exceed a total volume of 250 mL.
Pulmonary angiography: Infants, Children, and Adolescents: Iohexol 350 mgI/mL (Omnipaque 350): Injection: 1 mL/kg.
Combined angiocardiographic procedures: Infants, Children, and Adolescents: Maximum total dose for all procedures:
Iohexol 300 mgI/mL (Omnipaque 300): Total volume of doses: 6 mL/kg not to exceed a volume of 291 mL.
Iohexol 350 mgI/mL (Omnipaque 350): Total volume of doses: 5 mL/kg not to exceed a volume of 250 mL.
Aortography (aortic root, aortic arch, ascending and descending aorta): Infants, Children, and Adolescents: Iohexol 350 mgI/mL (Omnipaque 350): Injection: Usual dose: 1 mL/kg; maximum total dose: 5 mL/kg not to exceed a total volume of 250 mL.
Contrast enhanced CT head imaging: Infants, Children, and Adolescents: Iohexol 240 mgI/mL (Omnipaque 240) or iohexol 300 mgI/mL (Omnipaque 300): Injection: 1 to 2 mL/kg; maximum dose, product dependent: Omnipaque 240: 28 gI/dose or Omnipaque 300: 35 gI/dose.
Excretory urography: Infants, Children, and Adolescents: Iohexol 300 mgI/mL (Omnipaque 300): Injection: Usual dose: 1 to 1.5 mL/kg; range: 0.5 to 3 mL/kg; maximum total dose: 3 mL/kg total.
Oral/body cavity imaging:
Pass-through gastrointestinal examination: Note: When administered rectally, larger volumes may be used.
<3 months: Iohexol 180 mgI/mL (Omnipaque 180), undiluted: Oral, Rectal: 5 to 30 mL.
3 months to 3 years: Iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300), undiluted: Oral, Rectal: Up to 60 mL.
4 to 10 years: Iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300), undiluted: Oral, Rectal: Up to 80 mL.
>10 years and Adolescents: Iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300), undiluted: Oral, Rectal: Up to 100 mL.
Contrast enhanced abdomen CT:
Omnipaque: Infants, Children, and Adolescents:
Diluted Iohexol 9 to 21 mgI/mL (Omnipaque): Oral: 180 to 750 mL; use smaller volumes for higher concentrations; may administer all at once or over 30 to 45 minutes; maximum total iodine dose is age dependent: <3 years: 5 gI total; 3 to 18 years: 10 gI total.
Diluted Iohexol 240 or 300 mgI/mL (Omnipaque 240 or 300): IV: 2 mL/kg; range: 1 to 2 mL/kg; maximum total IV dose: 3 mL/kg total; use in combination with oral diluted iohexol and administer ~30 to 60 minutes after oral diluted iohexol dose.
Voiding cystourethrography (VCU): Infants, Children, and Adolescents: Iohexol diluted to 50 to 100 mgI/mL (Omnipaque): Intraurethral: Use a volume sufficient to fill the bladder; dependent on patient age and size; usual volume ranges from 50 to 300 mL at a concentration of 100 mgI/mL or 50 to 600 mL at a concentration of 50 mgI/mL.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling. Use caution in severe impairment and in setting of combined renal and hepatic disease.
There are no dosage adjustments provided in the manufacturer's labeling. Use caution in patients with combined hepatic and renal disease.
(For additional information see "Iohexol: Drug information")
Dosage guidance:
Clinical considerations: Specific dosage forms, concentrations, and presentations of iohexol are recommended for each type of imaging procedure. Concentration, volume, and rate may depend on the equipment, condition of injected vessel, size/condition of patient, and imaging technique used. Hydrate patients before and after administration. Refer to prescribing information for detailed dosing and administration information.
Dosage form information: Product labeling designates concentration (eg, iohexol 350 = Iohexol 350 mgI/mL); gI = grams of iodine; mgI = mg of iodine.
Body cavity imaging:
Endoscopic retrograde pancreatography, cholangiopancreatography: Intraductal: Iohexol 240: 10 to 50 mL.
Herniography:
Intraperitoneal: Iohexol 240 or Iohexol 300: 15 to 20 mL.
Hysterosalpingography:
Intrauterine: Iohexol 240: 50 mL.
Intra-arterial imaging:
Cardiac ventriculography: Intra-arterial: Iohexol 350: 40 mL (range 30 to 60 mL) as a single dose; with multiple injections, do not exceed a total volume of 250 mL. May be combined with selective coronary arteriography.
Selective coronary arteriography: Intra-arterial: Iohexol 350: 5 mL (range 3 to 14 mL) per injection; with multiple injections, do not exceed a total volume of 250 mL.
Aortic root and arch studies: Intra-arterial: Iohexol 350: 50 mL (range: 20 to 75 mL); with multiple injections, do not exceed a total volume of 250 mL.
Aortography and selective visceral arteriography: Intra-arterial: Iohexol 300 or 350 (initial dose is listed below based on injection site; may repeat up to a maximum total of 290 mL [iohexol 300] or 250 mL [iohexol 350]).
Abdominal aorta and its branches (celiac, hepatic, mesenteric, and splenic arteries): Intra-arterial: 30 to 60 mL.
Aorta: 50 to 80 mL.
Renal arteries: 5 to 15 mL.
Cerebral arteriography: Intra-arterial: Iohexol 300 (initial dose is listed below based on injection site; may repeat up to a maximum total of 290 mL):
Common carotid artery: 6 to 12 mL.
Internal carotid artery: 8 to 10 mL.
External carotid artery: 6 to 9 mL.
Vertebral artery: 6 to 10 mL.
Digital subtraction angiography (initial dose is listed below based on injection site; may repeat up to a maximum total of 250 mL): Intra-arterial:
Iohexol 140:
Aorta: 20 to 45 mL (rate: 8 to 20 mL/second).
Carotid: 5 to 10 mL (rate: 3 to 6 mL/second).
Femoral: 9 to 20 mL (rate: 3 to 6 mL/second).
Vertebral: 4 to 10 mL (rate: 2 to 8 mL/second).
Renal: 6 to 12 mL (rate: 3 to 6 mL/second).
Other aorta branches (subclavian, axillary, innominate and iliac): 8 to 25 mL (rate: 3 to 10 mL/second).
Peripheral arteriography (initial dose is listed below based on injection site; may repeat up to a maximum total of 290 mL [iohexol 300] or 250 mL [iohexol 350]): Intra-arterial:
Aortofemoral runoffs:
Iohexol 300: 30 to 90 mL.
Iohexol 350: 20 to 70 mL.
Selective arteriograms:
Iohexol 300: 10 to 60 mL.
Iohexol 350: 10 to 30 mL.
Intra-articular imaging: Note: Lower volumes recommended for double-contrast examinations; higher volumes recommended for single-contrast examinations.
Arthrography: Intra-articular:
Knee joint:
Iohexol 240: 5 to 15 mL.
Iohexol 300: 5 to 15 mL.
Iohexol 350: 5 to 10 mL.
Shoulder joint: Iohexol 300: 10 mL.
Temporomandibular joint: Iohexol 300: 0.5 to 1 mL.
Intrathecal imaging: Note: Verify product prior to administration; some products are contraindicated for intrathecal administration. For sequential or repeat examinations, allow at least 48 hours before repeat administration; if possible, 5 to 7 days between examinations is recommended.
CT cisternography: Intrathecal:
Lumbar (lumbar injection):
Iohexol 180: 10 to 17 mL.
Iohexol 240: 7 to 12.5 mL.
Myelography: Intrathecal:
Lumbar (lumbar injection):
Iohexol 180: 10 to 17 mL.
Iohexol 240: 7 to 12.5 mL.
Thoracic (lumbar or cervical injection):
Iohexol 240: 6 to 12.5 mL.
Iohexol 300: 6 to 10 mL.
Cervical:
Lumbar injection:
Iohexol 240: 6 to 12.5 mL.
Iohexol 300: 6 to 10 mL.
Cervical (c1-2) injection:
Iohexol 180: 7 to 10 mL.
Iohexol 240: 6 to 12.5 mL.
Iohexol 300: 4 to 10 mL.
Total columnar (lumbar injection):
Iohexol 240: 6 to 12.5 mL.
Iohexol 300: 6 to 10 mL.
IV imaging:
Contrast enhanced CT: IV:
Head imaging by injection:
Iohexol 300: 70 to 150 mL.
Iohexol 350: 80 mL.
Head imaging by infusion: Iohexol 240: 120 to 250 mL.
Body imaging by injection:
Iohexol 300: 50 to 200 mL.
Iohexol 350: 60 to 100 mL.
Digital subtraction angiography (abdominal, head, neck, peripheral, and renal vessels): IV: Iohexol 350: 30 to 50 mL (rate: 7.5 to 30 mL/second) using a pressure injector; may repeat up to a maximum of 250 mL.
Excretory urography: IV: Iohexol 300 or 350: 0.6 to 1.2 mL/kg; maximum dose: 102 mL.
Peripheral venography (phlebography): IV:
Iohexol 240: 20 to 150 mL per leg.
Iohexol 300: 40 to 100 mL per leg.
Oral imaging with or without IV imaging:
Contrast enhanced abdominal and pelvis CT:
Oral: Iohexol injection diluted to 6 to 12 mgI/mL or iohexol 9 or 12 mgI/mL oral solution: 500 to 1,000 mL (use smaller volumes for higher concentrations); may administer all at once or over a period of up to 45 minutes; give in conjunction with IV iohexol.
IV: Iohexol 300: 100 to 150 mL (administered up to 40 minutes after consumption of oral iohexol); give in conjunction with dilute oral iohexol.
Gastrointestinal tract examination: Oral: Iohexol 350 (undiluted): 50 to 100 mL.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling. Use with caution in patients with preexisting kidney impairment; may increase risk of acute kidney injury.
Dialysis: Iohexol is removed by dialysis.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Cardiac arrhythmia (intravascular: 2% to 16%; including atrial premature contractions, ventricular premature contractions)
Gastrointestinal: Diarrhea (body cavity injection, intravascular: ≤3%; oral/rectal: 36% to 42%), nausea (body cavity injection, intrathecal, intravascular: ≤6%; oral/rectal: 5% to 15%), vomiting (body cavity injection, intravascular: ≤2%; intrathecal: 3% to 6%; oral/rectal: 9% to 11%)
Local: Local pain (intra-articular: 26%), local swelling (intra-articular: 22%)
Nervous system: Headache (body cavity injection, intravascular, oral: ≤6%; intrathecal: 9% to 18%), localized warm feeling (body cavity injection: ≤13%; intra-articular: 7%; intrathecal, intravascular: <1%), pain (body cavity injection: 7% to 49%; intrathecal: 8% [including back pain, neck pain, stiffness, neuralgia]; intravascular: ≤5%)
Neuromuscular & skeletal: Lower limb cramp (intravascular: 21%)
Ophthalmic: Vision disturbance (intravascular: ≤15%, including photomas)
1% to 10%:
Cardiovascular: Angina pectoris (intravascular: ≤8%), bradycardia (intravascular: ≤1%), chest pain (intravascular: ≤1%), hypertension (body cavity injection, intrathecal, intravascular: ≤1%), hypotension (intrathecal, intravascular, oral/rectal: ≤3%), syncope (body cavity injection, intrathecal, intravascular: ≤1%), tachycardia (intravascular: ≤1%)
Dermatologic: Urticaria (intrathecal, intravascular, oral/rectal: ≤2%)
Gastrointestinal: Abdominal distress (pressure: body cavity injection: ≤1%), abdominal pain (oral/rectal: 2% to 7%), dysgeusia (intravascular: ≤1%), flatulence (body cavity injection: ≤10%; oral: 2%)
Local: Hematoma at injection site (body cavity injection: ≤1%)
Nervous system: Burning sensation (body cavity injection: ≤1%), cerebral infarction (intravascular: ≤2%), dizziness (body cavity injection, intrathecal, intravascular: ≤2%), drowsiness (body cavity injection, intrathecal: ≤3%), malaise (body cavity injection: ≤3%), myasthenia (body cavity injection: ≤1%), transient ischemic attacks (intravascular: ≤2%), tremor (body cavity injection: ≤1%)
Ophthalmic: Blurred vision (intravascular: ≤2%)
Miscellaneous: Fever (body cavity injection, intrathecal, intravascular, oral/rectal: ≤5%)
<1% (any procedure):
Cardiovascular: Asystole, heart block, heart failure, vasodepressor syncope, ventricular tachycardia
Dermatologic: Diaphoresis, pruritus, skin rash
Endocrine & metabolic: Hypoglycemia
Gastrointestinal: Abdominal cramps, anorexia, dyspepsia, stomach pain, xerostomia
Genitourinary: Difficulty in micturition
Hematologic & oncologic: Anemia, purpuric disease
Infection: Abscess
Nervous system: Anxiety, feeling of heaviness, hemiparesis, hypertonia, motor dysfunction, neurologic abnormality, paresthesia, seizure, shivering, speech disturbance, vertigo, visual hallucination
Neuromuscular & skeletal: Neck stiffness
Ophthalmic: Nystagmus disorder, photophobia
Otic: Tinnitus
Respiratory: Apnea, cough, dyspnea, laryngitis, respiratory congestion, rhinitis
Postmarketing (any procedure):
Cardiovascular: Acute myocardial infarction, flushing, palpitations, peripheral vasodilation, shock, thrombophlebitis, vasospasm (including coronary artery vasospasm)
Dermatologic: Acute generalized exanthematous pustulosis, bullous dermatitis, erythema of skin, exfoliative dermatitis, fixed drug eruption, hyperhidrosis, pallor, pleomorphic rash, skin blister, skin discoloration, Stevens-Johnson syndrome, toxic epidermal necrolysis
Endocrine & metabolic: Hyperthyroidism, hypothyroidism (premature infants, infants, and children ≤3 years with underlying medical conditions may be more vulnerable; FDA Safety Alert March 30, 2022)
Gastrointestinal: Dysphagia, enlargement of the salivary glands, pancreatitis (including aggravation)
Genitourinary: Anuria, oliguria, proteinuria, toxic nephrosis
Hematologic & oncologic: Neutropenia
Hypersensitivity: Drug reaction with eosinophilia and systemic symptoms, hypersensitivity reaction (including anaphylactic shock, anaphylaxis, angioedema, nonimmune anaphylaxis)
Local: Injection-site reactions, localized edema
Nervous system: Agitation, aseptic meningitis, asthenia, chills, coma, confusion, disorientation, encephalopathy (transient contrast-induced toxic encephalopathy), hypoesthesia, impaired consciousness, loss of consciousness, meningism, restlessness, status epilepticus
Neuromuscular & skeletal: Arthritis, laryngospasm, muscle spasm, muscle spasticity
Ophthalmic: Conjunctival hyperemia, eye irritation, eye pruritus, eyelid edema, lacrimation, ocular hyperemia, periorbital edema, visual impairment (including cortical blindness)
Renal: Acute kidney injury, increased serum creatinine
Respiratory: Bronchospasm, cyanosis, exacerbation of asthma, laryngeal edema, pharyngeal edema, pleuritic chest pain, pulmonary edema, respiratory distress, respiratory failure, sneezing, status asthmaticus, throat irritation, tightness in chest or throat, wheezing
Hysterosalpingography: Pregnancy (known or suspected); menstruation or when menstruation is imminent; within 6 months after pregnancy termination; within 30 days after conization or curettage; when signs of infection are present in any portion of the genital tract including external genitalia; reproductive tract neoplasia (known or suspected).
Canadian labeling: Additional contraindications (not in the US labeling): Clinically significant impairment of both hepatic and renal function.
Concerns related to adverse effects:
• Cardiovascular events: Life-threatening or fatal cardiovascular reactions (eg, hypotension, shock, cardiac arrest) have occurred with parenteral iohexol administration; fatal events, while rare, typically occurred during or 5 to 10 minutes after administration. Cardiovascular disease is the predominant aggravating factor. Cardiac decompensation, serious arrhythmias, myocardial ischemia, or MI may occur during coronary arteriography and ventriculography. Use the lowest necessary dose in patients with heart failure; emergency resuscitation equipment and trained personnel should be available during administration. Monitor all patients for severe cardiovascular reactions.
• Dermatological effects: Severe cutaneous adverse reactions (including Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TEN], acute generalized exanthematous pustulosis [AGEP], drug reaction with eosinophilia and systemic symptoms [DRESS]) have occurred 1 hour to several weeks after administration; reaction severity may increase and time to onset may decrease with repeat administration. Avoid use in patients with a history of a severe cutaneous adverse reaction to iohexol.
• Extravasation: May be a vesicant (higher osmolar contrast and/or higher volumes are associated with a higher risk); ensure proper needle/catheter/line placement prior to and during administration. Monitor infusion site. Avoid infiltration. Iohexol 140, 180, 240, 300, and 350 have osmolalities of 1.1 to 3 times that of plasma. Extravasation may result in tissue necrosis and/or compartment syndrome, particularly in patients with severe arterial or venous disease.
• Hypersensitivity: Iohexol may cause life-threatening or fatal hypersensitivity reactions, including anaphylaxis. Manifestations have included respiratory arrest, laryngospasm, bronchospasm, angioedema, and shock. Most severe reactions develop shortly after the start of the injection (within 1 to 3 minutes), although reactions may be delayed. The risk for hypersensitivity is increased in patients with a prior history of reaction to contrast agents, known allergic disorders (eg, bronchial asthma, medication, food allergies), and/or other hypersensitivities. Premedication with antihistamines or corticosteroids does not prevent serious life-threatening reactions, although it may reduce the incidence and severity of reactions. Obtain allergy and hypersensitivity history prior to administration. Emergency resuscitation equipment and trained personnel should be available prior to iohexol administration.
• Nephrotoxicity: Acute kidney injury, including renal failure, may occur after parenteral iohexol administration. Risk factors for nephrotoxicity include preexisting renal impairment, dehydration, diabetes mellitus, congestive heart failure, advanced vascular disease, older age, concomitant use of nephrotoxic or diuretic medications, multiple myeloma (or paraproteinaceous diseases), and repeated and/or large iodinated contrast agent doses. Use the lowest necessary dose in patients with renal impairment. Adequately hydrate patients prior to and following parenteral iohexol administration. Avoid laxatives, diuretics, or preparatory dehydration prior to iohexol administration.
• Thromboembolic events: Serious, rarely fatal, thromboembolic events causing MI and stroke have been reported with iodinated contrast agents during angiocardiography procedures as increased thrombosis and complement system activation occurs. Use meticulous intravascular administration techniques during angiographic procedures and minimize the length of the procedure to minimize the risk. Clotting has been reported when in vitro blood remains in contact with syringes containing nonionic contrast media; use of plastic syringes in place of glass syringes has been reported to decrease, but not eliminate, the likelihood of in vitro clotting. Due to the risk of thrombosis/embolism, avoid angiocardiography in patients with homocystinuria.
Disease-related concerns:
• Hyperthyroidism: Thyroid storm following intra-arterial or IV administration of iodinated contrast media have occurred in patients with hyperthyroidism or with an autonomously functioning thyroid nodule; evaluate risk.
• Myasthenia gravis: Use may worsen myasthenia gravis (MG); use with caution and monitor for worsening MG (AAN [Narayanaswami 2021]).
• Pheochromocytoma: Hypertensive crisis has occurred after the use of iodinated contrast agents in patient with pheochromocytoma. Use with extreme caution in patients with pheochromocytoma (known or suspected). Minimize the amount of contrast agent used (for intra-arterial or IV administration) and monitor blood pressure closely throughout procedure. Therapy to manage hypertensive crisis should be readily available.
• Seizures: Use with caution in patients with history of epilepsy. Antiseizure therapy should be maintained. Prophylactic antiseizure therapy should be considered in patients with a seizure history but not currently on antiseizure therapy, and in those with evidence of inadvertent intracranial entry of a concentrated or large bolus of contrast media. Discontinue medications that may lower the seizure threshold (eg, phenothiazine derivatives, including those used for their antihistaminic properties, tricyclic antidepressants, monoamine oxidase inhibitors, CNS stimulants, analeptics, antipsychotic agents) at least 48 hours prior to and 24 hours following the procedure. Major motor seizures with nonionic myelographic media are generally associated with one or more of the following situations (avoid situation): Deviations from recommended procedures or in myelographic management; use in patients with history of epilepsy; overdosage; intracranial entry of bolus or premature diffusion of a high medium concentration; medication with neuroleptic drugs or phenothiazine agents for antinausea; failure to maintain head elevation during and following the procedure; and excessive and active patient movement/straining.
• Sickle cell disease: Use with caution in sickle cell disease; iodinated contrast agents may promote sickling in patients homozygous for sickle cell disease. Hydrate patients prior to and following iohexol administration; use iohexol only if the imaging information needed cannot be obtained with alternative imaging measures.
Special populations:
• Older adult: Select doses cautiously, usually starting at the low end of the dosing range, due to a higher frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy in older adult patients.
• Pediatric: Pediatric patients at higher risk of experiencing any adverse events during contrast medium administration may include those having asthma, sensitivity to medication or allergens, heart failure, serum creatinine >1.5 mg/dL, or pediatric patients <12 months of age. Thyroid dysfunction, including transient thyroid suppression or hypothyroidism, has been reported in pediatric patients 0 to 3 years of age following single exposure and multiple exposures to iodinated contrast media; risk increases with younger age, very low birth weight, prematurity, underlying medical conditions affecting thyroid function, neonatal or pediatric intensive care admission, and congenital cardiac conditions (may be greatest risk due to requiring higher doses during invasive cardiac procedures).
Other warnings/precautions:
• Appropriate use: Intrathecal administration: Only iohexol 180, 240, and 300 (not bulk) are indicated for intrathecal administration. If repeat procedure is required, a sufficient time in between should be used to allow for clearance (≥48 hours; 5 to 7 days is recommended).
• Appropriate use: Oral administration (Iohexol 9 and 12): Do not administer oral contrast solutions parenterally; serious adverse reactions such as sepsis and hemolysis may occur. Nausea, vomiting, and diarrhea commonly occur with oral administration.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Combination:
Omnipaque: Iodine 300 mg/mL (125 mL [DSC]); Iodine 350 mg/mL (125 mL [DSC]) [contains edetate (edta) calcium disodium]
Solution, Injection:
Omnipaque: Iodine 180 mg/mL (10 mL, 20 mL [DSC]); Iodine 240 mg/mL (50 mL [DSC]); Iodine 300 mg/mL (10 mL, 30 mL, 50 mL, 75 mL [DSC], 100 mL, 125 mL [DSC], 150 mL, 200 mL [DSC], 500 mL) [contains edetate (edta) calcium disodium]
Solution, Injection [preservative free]:
Omnipaque: Iodine 240 mg/mL (10 mL, 20 mL, 50 mL, 100 mL, 150 mL [DSC], 200 mL [DSC]) [pyrogen free; contains edetate (edta) calcium disodium]
Solution, Intravenous:
Omnipaque: Iodine 140 mg/mL (50 mL)
Omnipaque: Iodine 350 mg/mL (50 mL, 75 mL, 100 mL, 125 mL [DSC], 150 mL, 200 mL, 500 mL) [contains edetate (edta) calcium disodium]
Solution, Oral [preservative free]:
Omnipaque: Iodine 9 mg/mL (500 mL); Iodine 12 mg/mL (500 mL) [contains edetate (edta) calcium disodium]
No
Solution (Omnipaque Injection)
180 mg/mL (per mL): $4.81
240 mg/mL (per mL): $2.76
300 mg/mL (per mL): $1.67
Solution (Omnipaque Intravenous)
140 mg/mL (per mL): $0.80
350 mg/mL (per mL): $1.21
Solution (Omnipaque Oral)
9 mg/mL (per mL): $0.02
12 mg/mL (per mL): $0.03
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection:
Omnipaque: 350 mg/mL (50 mL, 100 mL, 150 mL, 200 mL, 500 mL)
Omnipaque 240: Iodine 240 mg/mL (15 mL, 20 mL, 50 mL, 100 mL, 200 mL)
Omnipaque 300: Iodine 300 mg/mL (10 mL, 20 mL, 50 mL, 100 mL, 150 mL)
Omnipaque: Iodine 180 mg/mL ([DSC]) [contains edetate (edta) calcium disodium]
Note: Osmolality: Omnipaque 140: 322 mOsm/kg water; Omnipaque 180: 408 mOsm/kg water; Omnipaque 240: 520 mOsm/kg water; Omnipaque 300: 672 mOsm/kg water; Omnipaque 350: 844 mOsm/kg water.
Intrathecal: Draw into syringe immediately prior to administration. Intrathecal doses should be administered slowly over 1 to 2 minutes (to avoid excessive mixing with CSF) through a lumbar or cervical needle under fluoroscopic control. Note: Use caution in product selection. For pediatric administration, only use iohexol 180 mgI/mL (Omnipaque 180); for adults, only use iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300). Iohexol 140 and 350 are not for intrathecal use.
Prior to procedure, consider discontinuation of neuroleptic medications (including phenothiazines) at least 48 hours prior to procedure. May maintain a normal diet up to 2 hours before the procedure. Ensure hydration fluids up to the procedure (hydrate well prior to and following administration).
During the procedure, when positioning keep the patient's head elevated above the highest level of the spine; do not lower the head of the table more than 15° in moving contrast medium cranially; consider a lateral position (administration and medium movement) in patients with excessive lordosis; to maintain as a bolus, move medium very slowly to distal area; avoid intracranial entry of a bolus; avoid early and high cephalad medium dispersion; avoid abrupt or active patient movement.
After the procedure, raise head of stretcher to at least 30° prior to transferring patient on to it; move patient slowly, maintaining a head-up position; before moving patient to a bed, raise head to 30° to 45°; advise patient to remain still in bed, in a sitting or semi-sitting position, at least for the first few hours; observe closely for at least 12 hours after myelogram; encourage oral fluids/diet as tolerated; if nausea and vomiting occur, do not use phenothiazines for management of nausea/vomiting; utilize prompt fluid replacement in the event of nausea/vomiting to prevent dehydration.
Intravascular: Patient should be well hydrated prior to and following administration.
Draw into syringe immediately prior to administration. Intravascular doses should be at body temperature prior to administration. In angiography, use meticulous intravascular administration technique to minimize thrombotic events including use of plastic syringes, frequent catheter flushing, and close attention to catheter and guide wire manipulation. When large individual volumes are administered (ie, for ventriculography or aortography), wait several minutes between each injection to allow possible hemodynamic disturbances to subside.
Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; initiate hyaluronidase antidote; elevate extremity.
Oral: Patient should be well-hydrated prior to and following administration.
Omnipaque: Pediatric patients: Large volumes of dilute oral solution may be administered all at once or over 30 to 45 minutes (if not tolerated all at once).
For body cavity (intraductal, intraperitoneal, or intrauterine), intra-arterial, intra-articular, IV, intrathecal, oral use. Hydrate well prior to and following administration.
Injection: Iohexol 300 and 350 mg iodine/mL in 500 mL bottles may be used as an imaging bulk package; use only with an automated contrast injection system, contrast management system, or approved contrast media transfer set. May be administered simultaneously with saline. Iohexol 300 and 350 mg iodine/mL in 500 mL bottles may also be used as pharmacy bulk package; use to dispense aliquots with a dispensing set (not for direct infusion). Iohexol 300 and 350 (in 150 mL bottles) may also be used with a contrast management system approved for use with iohexol 300 and 350 (in 150 mL bottles); also refer to device instructions. When using contrast media management system, use for one procedure, do not remove bottle from work area once punctured.
Intra-arterial, IV: Doses should be at body temperature or room temperature prior to administration. Do not mix with other medications; do not administer in the same line containing other medications or parenteral nutrition.
May be a vesicant (higher osmolar contrast and/or higher volumes are associated with a higher risk). Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect; remove needle/cannula; elevate extremity. Aspiration of extravasated contrast media is not recommended (Ref). Information conflicts regarding the use of hyaluronidase; the American College of Radiology (ACR) Manual on Contrast Media does not recommend hyaluronidase in the management of contrast media extravasation (Ref); other sources suggest its utility in extravasation management for inoperable cases with compartment syndrome (Ref).
If using hyaluronidase: Intradermal or SUBQ: Dose varies based on the size of infiltration; inject a total of 5 to 250 units (~100 mL contrast reabsorbed per 15 units of hyaluronidase) around the site of extravasation (Ref).
Intrathecal: Administer intrathecal doses slowly over 1 to 2 minutes (to avoid excessive mixing with CSF) through a lumbar or cervical needle under fluoroscopic control. Note: Use caution in product selection. Use iohexol 180, 240, or 300 only. Iohexol 140 and 350 are not for intrathecal use.
Consider discontinuing medications that may lower the seizure threshold (eg, phenothiazine derivatives, including those used for their antihistaminic properties, tricyclic antidepressants, monoamine oxidase inhibitors, CNS stimulants, analeptics, antipsychotic agents) at least 48 hours prior and 24 hours following the procedure.
Oral: Large volumes of dilute oral solution may be administered all at once or over up to 45 minutes (if difficult to consume the entire volume).
Solution for injection: Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Protect from light. Do not freeze (discard product if inadvertently frozen). May be stored in a contrast media warmer that does not exceed at 37°C (98.6°F) for up to 1 month. Once imaging bulk package or pharmacy bulk package is punctured, use within 8 hours of initial puncture; discard unused portion. Once 150 mL bottles are punctured, use within 4 hours of initial puncture; discard unused portion.
Oral solution (Iohexol 9 and 12): Store at 0°C to 30°C (32°F to 86°F). Protect from light. Do not freeze (discard product if inadvertently frozen).
Intrathecal:
Omnipaque 180: Myelography (lumbar, thoracic, cervical, and total columnar) and contrast enhancement for computerized tomography (CT) (FDA approved in all ages).
Omnipaque 240, 300: Myelography (lumbar, thoracic, cervical, and total columnar) and contrast enhancement for computerized tomography (FDA approved in adults).
Intravascular:
Omnipaque 350: Angiocardiography and aortography (FDA approved in pediatric patients [age not specified] and adults); contrast enhancement for CT head and body imaging, intravenous digital subtraction angiography of head, neck, abdominal, renal and peripheral vessels, peripheral arteriography, and excretory urography (FDA approved in adults).
Omnipaque 300: Ventriculography (FDA approved in pediatric patients [age not specified] and adults); contrast enhancement for CT head imaging (FDA approved in pediatric patients [age not specified] and adults); excretory urography (FDA approved in pediatric patients [age not specified] and adults); aortography, CT body imaging, cerebral arteriography, and phlebography (FDA approved in adults).
Omnipaque 240: Contrast enhancement for CT head imaging (FDA approved in pediatric patients [age not specified] and adults); peripheral venography (phlebography) (FDA approved in adults).
Omnipaque 140: Intra-arterial digital subtraction angiography of head, neck, abdominal, renal, and peripheral vessels (FDA approved in adults).
Oral/body cavity:
Omnipaque 350: Arthrography; oral pass-through gastrointestinal tract examination (FDA approved in adults).
Omnipaque 300: Examination of the GI tract (FDA approved in pediatric patients ≥3 months of age); arthrography, hysterosalpingography (FDA approved in adults).
Omnipaque 240: Examination of the GI tract (FDA approved in pediatric patients ≥3 months of age), arthrography, endoscopic retrograde pancreatography and cholangiopancreatography, herniography, and hysterosalpingography (FDA approved in adults).
Omnipaque 180: Examination of the GI tract (FDA approved in pediatric patients [age not specified] and adults).
Omnipaque (diluted): Voiding cystourethrography (FDA approved pediatric patients [age not specified]); contrast enhanced abdominal CT with intravenous iohexol (Omnipaque 240: FDA approved in infants, children, and adolescents; Omnipaque 300: FDA approved in infants, children, adolescents, and adults).
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (epidural and intrathecal medications; contraindicated in pregnancy [hysterosalpingography use]) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care and Community/Ambulatory Care Settings).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Agents With Seizure Threshold Lowering Potential: May increase adverse/toxic effects of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Aldesleukin: May increase hypersensitivity effects of Iodinated Contrast Agents. Risk C: Monitor
Loop Diuretics: May increase nephrotoxic effects of Iodinated Contrast Agents. Risk C: Monitor
MetFORMIN: Iodinated Contrast Agents may increase adverse/toxic effects of MetFORMIN. Renal dysfunction that may be caused by iodinated contrast agents may lead to metformin-associated lactic acidosis. Management: Management advice varies. Refer to the full drug interaction monograph content for details. Risk D: Consider Therapy Modification
Methoxyflurane: Iodinated Contrast Agents may increase nephrotoxic effects of Methoxyflurane. Risk X: Avoid
Sodium Iodide I131: Iodinated Contrast Agents may decrease therapeutic effects of Sodium Iodide I131. Management: Discontinue iodinated contrast agents before sodium iodide I-131 administration, and avoid concurrent use. Stop water soluble agents 2 months before, and stop lipophilic agents 6 months before, sodium iodide I-131 administration. Risk X: Avoid
Sodium Perchlorate: May decrease therapeutic effects of Iodinated Contrast Agents. Risk C: Monitor
Use of iohexol body cavity 240 and 300 is contraindicated for hysterosalpingography during menstruation or when menstruation is imminent, and with reproductive tract neoplasia.
Routine pregnancy testing is not required prior to iodinated contrast media use; however, screening may be required based on the procedure (ACR 2021).
Iohexol crosses the placenta (Moon 2000).
Due to theoretical concerns that exposure to free iodide may adversely affect the fetus, use should be avoided unless absolutely required to obtain diagnostic information that will influence the care of the mother or fetus during pregnancy (ACOG 2017; ACR 2021).
Use of iohexol body cavity 240 and 300 is contraindicated for hysterosalpingography during pregnancy and within 6 months after pregnancy termination.
Monitor for signs/symptoms of hypersensitivity and severe cardiovascular reactions; monitor for extravasation during administration; blood pressure; hydration status; renal function. Continuously monitor vital signs when administering large doses of iohexol 350. In patients <3 years of age, monitor thyroid function within 3 weeks following exposure.
Opacification of vessels and anatomical structures in the path of flow of the contrast media which allows for radiographic visualization
Duration:
CNS: ~30 minutes following intrathecal administration, 60 minutes following intravenous administration.
Serum: 15 to 120 seconds.
Absorption: Oral: Poorly absorbed.
Distribution: Vd: IV: 165 mL/kg (range: 108 to 219 mL/kg); Intrathecal: 559 mL/kg (range: 350 to 849 mL/kg).
Metabolism: Not significantly metabolized.
Protein binding: Minimal.
Excretion: Urine (Intra-arterial, intrathecal, IV: ~90%, as unchanged drug; Oral: <1%).
