Version May 2024
Isovue-200, Isovue-250, Isovue-300, and Isovue-370 are not for intrathecal use.
Note: General dosing guidelines are presented. Doses should be individualized and the lowest dose needed to obtain adequate visualization should be used. Patients should be well hydrated prior to and after administration. Refer to product information for detailed dosing and administration information.
Intravascular imaging:
Angiography:
Cerebral arteriography: Isovue-300: 8 to 12 mL by carotid puncture or transfemoral catheterization, with total multiple doses ranging to 90 mL
Coronary arteriography and ventriculography: Isovue-370: 2 to 10 mL for selective coronary artery injection; 25 to 50 mL for ventriculography or nonselective opacification of multiple coronary arteries following injection at the aortic root. Total dose for combined procedures has not exceeded 200 mL. EKG monitoring is essential during procedure.
Peripheral arteriography: Isovue-300:
Femoral artery or subclavian artery: 5 to 40 mL up to a total of 250 mL
Aorta for a distal runoff: 25 to 50 mL up to a total of 250 mL
Peripheral venography (phlebography):
Isovue-200: 25 to 150 mL per lower extremity. Combined total dose for multiple injections has not exceeded 350 mL.
Isovue-300: 15 to 100 mL per lower extremity. Combined total dose for multiple injections should not exceed 230 mL
Selective visceral arteriography and aortography: Isovue-370: Up to 50 mL may be required for injection into the larger vessels, such as the aorta or celiac artery; doses up to 10 mL may be required for injection into the renal arteries. Combined total dose for multiple injections has not exceeded 225 mL.
Computed tomography:
CECT of the head: IV: Imaging may be performed immediately after completion of administration.
Isovue-250:130 to 240 mL; maximum: 240 mL
Isovue-300: 100 to 200 mL; maximum: 200 mL
CECT of the body: IV by rapid infusion or bolus injection:
Isovue-250: 130 to 240 mL; maximum: 240 mL
Isovue-300: 100 to 200 mL; maximum: 200 mL
Equivalent doses of Isovue-370 based on organically bound iodine content may also be used.
Urography, excretory: Administer by rapid IV injection
Isovue-250: 50 to 100 mL
Isovue-300: 50 mL
Isovue-370: 40 mL
Intrathecal imaging:
Computed tomographic cisternography: Isovue-M 200: 4 to 6 mL via lumbar injection
Myelography:
Lumbar or thoracic myelogram: Isovue-M 200: 10 to 15 mL
Cervical myelogram (via lumbar injection):
Isovue-M 200: 10 to 15 mL
Isovue-M 300: 10 mL
Cervical myelogram (via lateral cervical injection): Isovue-M 200: 10 mL
Total columnar myelography: Isovue-M 300: 10 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, anuria, and in the 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.
Refer to adult dosing.
Note: General dosing guidelines are presented. Doses should be individualized and the lowest dose needed to obtain adequate visualization should be used. Patients should be well hydrated prior to and after administration. Refer to product information for detailed dosing and administration information.
Intravascular imaging:
Angiocardiography: Isovue-370: Note: May be performed by injection into a large peripheral vein or direct catheterization of the heart:
<2 years: Single injection: 10 to 15 mL; cumulative injection: 40 mL
2 to 4 years: Single injection: 15 to 30 mL; cumulative injection: 50 mL
5 to 9 years: Single injection: 15 to 30 mL; cumulative injection: 100 mL
10 to 18 years: Single injection: 20 to 50 mL; cumulative injection: 125 mL
Computed tomography: IV:
CECT of the head and body:
Isovue-250: 1.2 to 3.6 mL/kg; maximum: 120 mL
Isovue-300: 1 to 3 mL/kg; maximum: 100 mL
Urography, excretory: IV:
Isovue-250: 1.2 to 3.6 mL/kg; should not be necessary to exceed a total dose of 120 mL
Isovue-300: 1 to 3 mL/kg; should not be necessary to exceed a total dose of 100 mL
Intrathecal imaging:
Myelography: Lumbar or thoracic myelogram: Isovue-M 200:
2 to 7 years: 7 to 9 mL
8 to 12 years: 8 to 11 mL
13 to 18 years: 10 to 12 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, anuria, and in the 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.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Nervous system: Headache (≤16%)
1% to 10%:
Cardiovascular: Angina pectoris (≤3%), bigeminy (≤1%), bradycardia (≤1%), chest pain (≤1%), circulatory shock (≤1%), cold extremity (≤1%), depression of ST segment on ECG (≤1%), extrasystoles (≤1%), flushing (≤2%), hypertension (≤1%), hypotension (≤1%), ischemic heart disease (≤1%), syncope (≤1%), tachycardia (≤1%), thrombophlebitis (≤1%), tingling of the arms (≤1%), transient ischemic attacks (≤1%), vasodepressor syncope (≤1%), ventricular fibrillation (≤1%)
Dermatologic: Diaphoresis (≤1%), pruritus (≤1%), skin rash (≤1%), urticaria (≤1%)
Endocrine & metabolic: Hot flash (≤3%)
Gastrointestinal: Anorexia (≤1%), diarrhea (≤1%), dysgeusia (≤1%), heartburn (≤1%), nausea (1% to 7%), vomiting (≤4%)
Genitourinary: Urinary retention (≤1%)
Local: Localized irritation (≤1%; cervicobrachial, lumbosacral, meningeal, radicular), pain at injection site (≤1%, including erythema at injection site, swelling at injection site)
Nervous system: Ataxia (≤1%), burning sensation (1%), chills (≤1%), confusion (≤1%), dizziness (≤1%), facial grimace (≤1%), fatigue (≤1%), hallucination (≤1%), involuntary body movements (≤1%; including involuntary movements of limbs [legs]), irritability (≤1%), localized warm feeling (1%), malaise (≤1%), myasthenia (≤1%; including ocular muscle weakness), numbness (≤1%), pain (3%), paresthesia (≤1%), sciatica (≤1%), stress (≤1%)
Neuromuscular & skeletal: Asthenia (≤1%), back pain (2%), back spasm (≤1%), lower extremity pain (1%), lower limb cramp (≤1%), musculoskeletal pain (≤1%), neck pain (1%; including neck stiffness)
Ophthalmic: Visual disturbance (≤1%)
Respiratory: Dyspnea (≤1%), nasal congestion (≤1%), pharyngeal edema (≤1%), pulmonary edema (≤1%)
Miscellaneous: Fever (≤1%)
Frequency not defined: Cardiovascular: ECG changes (including prolonged QT interval on ECG, increased R-R wave, T-wave amplitude), increased left ventricular end-diastolic pressure, systolic hypotension
Postmarketing:
Cardiovascular: Arterial spasm, atrioventricular block, cardiac arrhythmia, cardiac decompensation, chest tightness, facial edema, vasodilation
Dermatologic: Pallor
Endocrine & metabolic: Hypothyroidism (premature infants, infants, and children ≤3 years with underlying medical conditions may be more vulnerable; FDA Safety Alert March 30, 2022)
Gastrointestinal: Abdominal cramps, retching (severe)
Genitourinary: Hematuria
Hypersensitivity: Hypersensitivity reaction, nonimmune anaphylaxis
Nervous system: Absent reflexes, agitation, amnesia (temporary), anxiety, apprehension, aseptic meningitis, asterixis, bacterial meningitis, choking sensation (severe), coma, depersonalization, depression, disorientation, dysphasia, genitourinary pain, Guillain-Barre syndrome, hyperesthesia, hyperreflexia, hypertonia, myoclonus, paralysis, peripheral neuropathy (including peripheral sensory neuropathy, peripheral motor neuropathy, nerve root disorder, myelitis, sixth nerve palsy, cauda equina syndrome), restlessness, seizure, speech disturbance (including echolalia), spinal myoclonus, stupor, transient organic psychosis, trigeminal neuralgia
Neuromuscular & skeletal: Fasciculations, muscle cramps, muscle hypotonia, muscle spasm, muscle spasticity, tremor
Ophthalmic: Conjunctivitis, cortical blindness, eye pruritus, lacrimation, periorbital edema
Otic: Auditory disturbance (including echoacousia), hearing loss, tinnitus
Respiratory: Apnea, asthma, increased cough, laryngeal edema, rhinitis, sneezing
Intravenous: There are no contraindications listed in the manufacturers labeling.
Intrathecal: Concurrent intrathecal corticosteroid administration; immediate repeat myelography in the event of technical failure (potential for overdose); significant local or systemic infection where bacteremia is likely (myelography only).
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in the US labeling): Hypersensitivity to iopamidol or any component of the formulation; significant renal and/or hepatic impairment; direct intracisternal administration or gravitational displacement of a concentrated bolus of iopamidol into the intracranial subarachnoid spaces.
Concerns related to adverse effects:
• Contrast-induced hypersensitivity reactions: Adverse reactions (including delayed reactions) to iodine-containing contrast media have occurred. Most cases are minor; however, serious and life-threatening reactions may occur without warning and often resemble allergic-type reactions. 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 severe cutaneous adverse reactions. Patients with a history of bronchial asthma, allergy (including food allergy), family history of allergy, or prior allergy or hypersensitivity to contrast agents are at a higher risk for allergic reaction. Obtain allergy and hypersensitivity history prior to administration. Pretesting for allergic reaction may not reliably predict potential for reaction. Premedication with antihistamines and corticosteroids should be considered in patients at risk for allergic reaction (strong allergy history, prior contrast media reaction, or positive pretest) to reduce the incidence and severity of reactions. Monitor closely for 30 to 60 minutes after administration of the contrast media. A higher incidence of adverse reactions was reported in patients also receiving general anesthesia.
• Contrast-associated acute kidney injury: Acute kidney injury, including renal failure, may occur following administration of iodinated contrast media. Risk factors include patients with preexisting renal disease, advanced age, advanced vascular disease, heart failure, dehydration, diabetes, concomitant use of nephrotoxic agents or diuretics, multiple myeloma, or large doses or multiple doses of iodinated contrast media. Adequately hydrate patients prior to and following administration to minimize the risk.
• Extravasation: May be a vesicant; ensure proper needle/catheter/line placement prior to and during administration. Monitor infusion site. Avoid infiltration. Extravasation may result in tissue necrosis and/or inflammation, particularly in patients with severe arterial or venous disease.
• Seizures: Avoid in patients with history of epilepsy unless medically justified; focal and generalized motor seizures have been reported after intrathecal use; antiseizure therapy should be continued. Premedication with barbiturates or phenytoin should be considered in patients with a history of seizure activity not currently on antiseizure therapy. CNS-acting agents, primarily those which lower seizure threshold (eg, phenothiazines, MAO inhibitors, tricyclic antidepressants, CNS stimulants), may be withheld 48 hours pre- and 24 hours post-intrathecal contrast administration, based on consideration of the potential risks and benefits.
• Thromboembolism: Serious, rarely fatal, thromboembolic events causing MI and stroke have been reported during angiographic procedures with both ionic and nonionic contrast media. Ionic iodinated contrast media may inhibit blood coagulation (more than nonionic contrast media). Use meticulous intravascular administration techniques during angiographic procedures. 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.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease, especially when combined with renal impairment; severe, life-threatening, and fatal cardiovascular reactions have occurred. Observe patients with heart failure for several hours following the procedure to detect delayed hemodynamic disturbances, which may be associated with a transitory increase in the circulating osmotic load. Perform selective coronary angiography only if the anticipated benefit outweighs potential risks.
• Diabetes: Use with caution in patients with diabetes; these patients may have altered renal blood flow, increasing the risk of nephrotoxicity. Preparatory dehydration may contribute to acute renal failure in patients with diabetes; avoid fluid restriction and maintain normal hydration in these patients.
• Hepatic impairment: Use with caution in patients with combined renal and hepatic impairment.
• Homocystinuria: Avoid angiography in patients with homocystinuria; may be at risk for thrombosis and embolism.
• Hyperthyroidism: Thyroid storm following intravascular administration of iodinated contrast media has occurred in patients with hyperthyroidism or with an autonomously functioning thyroid nodule.
• Myasthenia gravis: Use may worsen myasthenia gravis (MG); use with caution and monitor for worsening MG (AAN [Narayanaswami 2021]).
• Pheochromocytoma: Use with extreme caution in patients with pheochromocytoma (known or suspected). Minimize the amount of contrast agent used (for intravascular administration) and monitor blood pressure closely throughout procedure. Therapy for treatment of hypertensive crisis should be readily available.
• Renal impairment: Use with caution in patients with severe renal impairment, combined renal and hepatic impairment, or anuria, especially if large doses or repeat doses are needed. Preparatory dehydration may contribute to acute renal failure in patients with preexisting renal impairment. Acute renal failure has been reported in patients with preexisting renal impairment.
• Sickle cell disease: Use with caution in sickle cell disease; may promote sickling in patients homozygous for sickle cell disease.
Special populations:
• Older adult: Use with caution in elderly patients. Preparatory dehydration may contribute to acute renal failure in elderly patients.
• Pediatrics: Pediatric patients at higher risk of experiencing any adverse events during contrast medium administration may include those having asthma, sensitivity to medication or allergens, cyanotic heart disease, heart failure, serum creatinine >1.5 mg/dL, or those <12 months. 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: Isovue-200, Isovue-250, Isovue-300, and Isovue-370 are not for intrathecal use. Serious adverse reactions (eg, acute renal failure, arachnoiditis, cardiac arrest, cerebral hemorrhage, coma, seizures, brain edema, hyperthermia, paralysis, rhabdomyolysis, death) have been reported due to inadvertent intrathecal administration of iodinated contrast agents not indicated for intrathecal use.
• Appropriate use: Intrathecal administration (Isovue-M 200 and Isovue-M 300 only): Direct intracisternal or ventricular administration for standard radiography (without computerized tomographic enhancement) is not recommended. Avoid inadvertent intracranial administration of large dose or concentrated bolus of contrast medium; avoid rapid dispersion of medium, which could lead to inadvertent rise in intracranial levels (as may occur with active patient movement). If such intracranial entry of the medium occurs, prophylactic antiseizure treatment with diazepam or barbiturates orally for 24 to 48 hours should be considered. Use intrathecal administration with caution in patients with multiple sclerosis, increased intracranial pressure or suspicion of intracranial tumor, abscess, hematoma, chronic alcoholism, and the elderly. If frankly bloody cerebrospinal fluid is observed, the anticipated benefit versus the potential risks should be considered prior to myelography.
• Appropriate use: Intravascular administration: In angiographic procedures, during catheter manipulations and contrast medium injection, a possibility of dislodging plaques or damaging (or perforating) vessel walls exists. Ensure proper catheter placement with test injections. In contrast-enhanced computerized tomography (CECT), contrast may obscure some lesions previously seen on unenhanced CT scans.
• Appropriate use: Coronary arteriography: Use with caution in patients with chronic pulmonary emphysema.
• Appropriate use: Venography: Use with caution in patients with suspected thrombosis, phlebitis, severe ischemic disease, local infection, or a totally obstructed venous system. Fluoroscopy is recommended, especially in patients with severe arterial or venous disease.
• Trained personnel: Clinicians using radiopaque contrast agents should be well trained in diagnosis and management of emergencies that may arise from the use of these agents. Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use during and for 30 to 60 minutes after administration (delayed reactions have occurred).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection:
Isovue-M 200: 41% (10 mL, 20 mL [DSC]) [contains edetate (edta) calcium disodium]
Isovue-M 300: 61% (15 mL)
Generic: 41% (10 mL, 20 mL); 61% (15 mL)
Solution, Intravenous:
Isovue-200: 41% (50 mL [DSC], 200 mL) [contains edetate (edta) calcium disodium]
Isovue-250: 51% (50 mL [DSC], 100 mL, 150 mL [DSC], 200 mL [DSC]) [contains edetate (edta) calcium disodium]
Isovue-300: 61% (30 mL, 50 mL, 75 mL [DSC], 100 mL, 150 mL, 200 mL, 500 mL) [contains edetate (edta) calcium disodium]
Isovue-370: 76% (50 mL, 75 mL, 100 mL, 125 mL, 150 mL, 200 mL, 500 mL) [contains edetate (edta) calcium disodium]
Yes
Solution (Iopamidol Injection)
41% (per mL): $6.20
61% (per mL): $5.50
Solution (Isovue-200 Intravenous)
41% (per mL): $0.38
Solution (Isovue-250 Intravenous)
51% (per mL): $0.48
Solution (Isovue-300 Intravenous)
61% (per mL): $0.55
Solution (Isovue-370 Intravenous)
76% (per mL): $0.58
Solution (Isovue-M 200 Injection)
41% (per mL): $7.75
Solution (Isovue-M 300 Injection)
61% (per mL): $6.87
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.
Solution, Injection:
Isovue 370: 370 mg/mL (50 mL, 100 mL, 150 mL, 200 mL) [contains edetate (edta) calcium disodium]
Isovue 200: 41% (20 mL, 50 mL, 100 mL, 200 mL) [contains edetate (edta) calcium disodium]
Solution, Intravenous:
Isovue 300: 61% (15 mL, 50 mL, 100 mL, 150 mL)
Isovue Multipack-300: 61% (500 mL)
Isovue Multipack-370: 76% (500 mL)
Precautions should be taken to ensure products intended for IV administration are not administered intrathecally. Patients should be well hydrated prior to and following procedure. Premedication with antihistamines or corticosteroids may be considered in some patients to minimize the potential for allergic reactions. Solutions 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 guidewire manipulation.
May be a vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.
Intrathecal: Administer slowly over 1 to 2 minutes to avoid excessive mixing with CSF through a lumbar needle under fluoroscopic control. If repeat examination is needed, an interval of at least 48 hours should be allowed; whenever possible 5 to 7 days is recommended.
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).
Parenteral: Patients should be well hydrated prior to and following procedure. Premedication with antihistamines or corticosteroids may be considered in some patients to minimize the potential for allergic reactions. Solutions should be at body temperature prior to administration.
IV: Precautions should be taken to ensure products intended for IV administration are not administered intrathecally.
Angiocardiography: Isovue 370: Administer by IV injection into a large peripheral vein or by direct catheterization of the heart
Urography, excretory: Isovue 250, Isovue 300: Administer by rapid IV injection
Computed tomography (head and body): Isovue 250, Isovue 300: Administer by rapid IV infusion or bolus injection
Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. 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 (Ref) (see Management of Drug Extravasations for more details).
Intrathecal: Isovue M 200: Precautions should be taken to ensure products intended for IV administration are not administered intrathecally. Administer slowly over 1 to 2 minutes to avoid excessive mixing with CSF through a lumbar needle under fluoroscopic control. If repeat examination is needed, an interval of at least 48 hours should be allowed; whenever possible 5 to 7 days is recommended.
Angiography: Isovue: Diagnostic agent for angiography throughout the cardiovascular system, including cerebral and peripheral arteriography, coronary arteriography and ventriculography, pediatric angiocardiography, selective visceral arteriography and aortography, peripheral venography (phlebography).
Computed tomography:
Isovue: Diagnostic agent for adult and pediatric contrast enhancement of computed tomographic (CECT) head and body imaging.
Isovue-M: Diagnostic agent for CECT cisternography and ventriculography in adults.
Myelography: Isovue-M: Diagnostic agent for myelography (lumbar, thoracic, cervical, total columnar) in adults; diagnostic agent for myelography (lumbar, thoracic) in children >2 years.
Urography: Isovue: Diagnostic agent for adult and pediatric excretory urography.
The Institute for Safe Medication Practices (ISMP) includes this medication (intrathecal administration) among its list of drugs that have a heightened risk of causing significant patient harm when used in error.
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Agents With Seizure Threshold Lowering Potential: May enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. 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 enhance the potential for allergic or hypersensitivity reactions to Iodinated Contrast Agents. Risk C: Monitor therapy
Loop Diuretics: May enhance the nephrotoxic effect of Iodinated Contrast Agents. Risk C: Monitor therapy
MetFORMIN: Iodinated Contrast Agents may enhance the adverse/toxic effect 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
Sodium Iodide I131: Iodinated Contrast Agents may diminish the therapeutic effect 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 combination
Iopamidol crosses the placenta and can be detected in the newborn gut at birth (Fitzpatrick 2011; Huang 2014).
Thyroid dysfunction in the neonate has not been reported (Atwell 2011). However, 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 723 2017; ACR 2018).
Iodinated contrast media may be present in breast milk (ACOG 723 2017; ACR 2018).
Because of the low expected excretion of iodinated contrast agents into breast milk and the low absorption from an infant's GI tract, breastfeeding may be continued without interruption after use (ACOG 723 2017; ACR 2018). Theoretically, the taste of milk could be altered if it contains contrast media. Women who prefer to temporarily withhold breastfeeding may express and discard milk from both breasts during a period of 12 to 24 hours after the administration of contrast media. They can pump and store milk prior to the procedure then bottle feed using the stored milk during this time (ACR 2018). The manufacturer recommends that caution be exercised when administering iopamidol to breastfeeding women.
Some products may contain sodium.
ECG (during coronary arteriography and ventriculography procedures); hydration; signs/symptoms of hypersensitivity during and for at least 30 to 60 minutes following procedure; renal function; monitor infusion site for extravasation during IV administration.
Pediatric patients 0 to 3 years of age: Individualize thyroid function monitoring based on underlying risk factors, especially in term and preterm neonates.
Opacification of vessels and anatomical structures in the path of flow of the contrast media which allows for radiographic visualization.
Metabolism: None
Half-life, elimination: ~2 hours; prolonged in renal impairment
Excretion: Urine (80% to 90% unchanged)
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