Version May 2024
Not for intrathecal use. Solution for instillation is also not for intravascular administration.
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.
Intravascular imaging: Conray:
Arterial digital subtraction angiography: Usual dose: Carotid or vertebral arteries: 3 to 8 mL; aortic arch: 15 to 25 mL; subclavian and brachial arteries: 5 to 15 mL; major branches of the aorta: 5 to 20 mL; lumbar aorta (bifurcation): 10 to 25 mL.
Arthrography: Usual dose: 5 to 15 mL (knee, hip), 5 to 10 mL (shoulder, ankle), 1 to 4 mL (other).
Carotid and vertebral angiography: Usual dose: 6 to 10 mL; repeat as indicated.
Contrast enhancement of body CT:
Vascular opacification: 25 to 50 mL by bolus injection; repeat as necessary.
Prolonged arterial or venous phase enhancement and enhancement of specific lesions: 150 mL rapid infusion; 100 to 150 mL infusion may be employed to define the area of interest followed by bolus injections of 20 to 50 mL to clarify selected scans.
Contrast enhancement of brain CT: Usual dose: 2 mL/kg (maximum: 150 mL).
Cranial computerized angiotomography: Usual dose: May be given by bolus injection (0.5 to 1 mL/kg at an injection rate of 2 mL/second; repeat dose as needed [maximum total dose per procedure: 200 mL]) OR by bolus injection followed by IV infusion (50 mL bolus injection followed by a rapid infusion of 150 mL OR 100 mL bolus injection followed by a rapid infusion of 100 mL).
Direct cholangiography:
Operative/postoperative: Usual dose: 10 to 25 mL.
Percutaneous transhepatic cholangiography: Usual dose: 20 to 40 mL; may repeat for exposures in different planes.
Endoscopic retrograde cholangiopancreatography: Usual dose: 10 to 100 mL (common bile duct); 2 to 10 mL (pancreatic duct); administer under fluoroscopic control.
Excretory urography: Usual dose: 30 to 60 mL.
Intravenous digital subtraction angiography: Usual dose: 20 to 40 mL; repeat as needed.
Peripheral arteriography: Usual dose: 20 to 40 mL.
Retrograde brachial cerebral angiography: Usual dose: 35 to 50 mL into the right brachial artery.
Venography: Usual dose: 20 to 40 mL.
Urographic imaging: Cysto-Conray II:
Retrograde cystography and cystourethrography: Usual dose: 200 to 400 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.
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.
Intravascular imaging:
Arthrography, cerebral angiography, cranial computerized angiotomography, peripheral arteriography/venography: Conray: Children and Adolescents: Refer to adult dosing; reduce dosage in approximate proportion to age and body weight.
Lower extremity venography: Conray 43: Children and Adolescents: Refer to adult dosing; reduce dosage in approximate proportion to age and body weight.
Contrast enhancement of brain CT:
Conray 30:
Children and Adolescents <12 years and <45 kg: Usual dose: 4 mL/kg
Children and Adolescents ≥12 years and ≥45 kg: Refer to adult dosing.
Conray 43: Children and Adolescents: Refer to adult dosing.
Conray: Children and Adolescents: Usual dose: 2 mL/kg (maximum: 150 mL)
Contrast enhancement of body CT: Conray 43: Children and Adolescents: Refer to adult dosing; reduce dosage in approximate proportion to age and body weight.
Excretory urography: Conray:
Infants, Children, and Adolescents <14 years: Usual dose: 0.5 mL/kg (up to 30 mL)
Adolescents ≥14 years: Refer to adult dosing.
Urography:
Conray 30: Children ≥12 years and Adolescents: Refer to adult dosing.
Conray 43: Children and Adolescents: Refer to adult dosing.
Urographic imaging:
Retrograde cystography and cystourethrography: Conray 43 and Cysto-Conray II: Children and Adolescents: Usual dose: 30 to 300 mL
Retrograde pyelography: Conray 43: Children and Adolescents: Refer to adult dosing; reduce dosage in approximate proportion to body weight.
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.
The following adverse drug reactions are derived from product labeling unless otherwise specified and may vary with dose and/or route of administration. Reactions listed are based on reports for other agents in this same pharmacologic class and may not be specifically reported for iothalamate meglumine.
Postmarketing:
Cardiovascular: Acute myocardial infarction, bradycardia, cardiac arrhythmia, cardiac fibrillation, cardiac insufficiency, chest tightness, decreased blood pressure, facial flushing, flushing, hypotensive shock, peripheral edema, syncope, tachycardia, thrombophlebitis, thrombosis, vasodilation, venospasm
Dermatologic: Acute generalized exanthematous pustulosis, diaphoresis, erythema of skin, gangrene of skin and/or subcutaneous tissues, maculopapular rash, pruritus, skin discoloration, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
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: Cholangitis, nausea, pancreatitis (including pancreatic irritation), severe abdominal pain, vomiting, xerostomia
Genitourinary: Bladder mucosa irritation, ureter irritation
Hematologic & oncologic: Abnormal erythropoiesis (red blood cell crenation), disseminated intravascular coagulation, erythrocyte agglutination, interference in clot formation
Hypersensitivity: Anaphylaxis, angioedema, drug reaction with eosinophilia and systemic symptoms, facial edema, hypersensitivity reaction
Infection: Septicemia
Local: Bleeding at injection site, localized burning, localized warm feeling, venous thrombosis at injection site
Nervous system: Amnesia, aphasia, cerebrovascular accident, chills, choking sensation, coma, dizziness, headache, paralysis, paresis, seizure, tremor
Neuromuscular & skeletal: Arthralgia, brachial plexus injury, laryngospasm, muscle spasm
Ophthalmic: Conjunctival abnormalities, visual field loss
Renal: Acute kidney injury, renal disease, renal failure syndrome
Respiratory: Apnea, bronchospasm, cough, cyanosis, dyspnea, exacerbation of asthma, nasal congestion, pulmonary edema, sneezing, wheezing
Miscellaneous: Fever
Conray: Hypersensitivity to iothalamate meglumine or any component of the formulation; myelography; active infection in or near joint when performing arthrography; percutaneous transhepatic cholangiography in patients with coagulation defects and prolonged prothrombin times; endoscopic retrograde cholangiopancreatography during an acute attack of pancreatitis or during severe clinically evident cholangitis and in patients in whom endoscopy is prohibited.
Canadian labeling: Additional contraindications (not in the US labeling): Anuria or severe oliguria; injection into cysts or sinuses that may communicate with the subarachnoid space; enhancement of CT brain images in patients with suspected cranial subarachnoid hemorrhage.
Cysto-Conray ll: Intrathecal administration; intravascular administration.
Concerns related to adverse effects:
• Contrast media 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. 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 patient at risk for allergic reaction (strong allergy history, prior contrast media reaction, or positive pretest) to reduce the incidence and severity of reactions. Begin corticosteroids early prior to contrast media and continue for 24 hours after administration. Administer antihistamines within 30 minutes before contrast agent. Monitor closely for 30 to 60 minutes after administration of the contrast media and discontinue immediately if a serious reaction occurs. For minor reactions the infusion may be slowed or interrupted until the reaction subsides. A higher incidence of adverse reactions was reported in patients also receiving general anesthesia.
• 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 iothalamate.
• Extravasation: Vesicant (higher osmolar contrast media and higher volumes are associated with a higher risk); ensure proper needle/catheter/line placement prior to and during administration. Monitor infusion site. Avoid infiltration. Ioxaglate meglumine is hypertonic. Burning pain, hematomas, bruising, thrombophlebitis, and tissue necrosis have been reported with extravasation.
• Neurotoxicity: Serious neurologic sequelae, including paralysis (permanent) may occur following cerebral arteriography, selective spinal arteriography, and arteriography of vessels supplying the spinal cord. Do not inject contrast media after administration of vasopressors; may potentiate neurologic effects.
• Renal failure: Acute renal failure has been reported in patients with hepatic impairment administered an oral cholecystographic agent followed by an intravascular iodinated radiocontrast agent, in diabetic patients with diabetic nephropathy, susceptible nondiabetic patients (eg, elderly patients with preexisting renal disease), and patients with occult renal disease (particularly patients with diabetes and/or hypertension); avoid fluid restriction and maintain normal hydration in these patients. Preparatory dehydration may contribute to acute renal failure in infants, young children and elderly patients, patients with preexisting renal impairment, multiple myeloma, advanced vascular disease, and diabetes.
• Thromboembolic events: 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: Preparatory dehydration may contribute to acute renal failure in patients with advanced vascular disease; avoid fluid restriction and maintain normal hydration in these patients.
• Cerebral lesions: Seizures have occurred in patients with cerebral lesions (primary or metastatic) following administration of contrast agent for CT brain images.
• Diabetes: Preparatory dehydration may contribute to acute renal failure in patients with diabetes; avoid fluid restriction and maintain normal hydration in these patients.
• Endotoxemia: Contrast media studies should be undertaken with caution in patients with endotoxemia.
• Hepatic impairment: Use with caution in patients combined renal and hepatic disease; excretion may be impaired.
• Homocystinuria: Avoid angiography in patients with homocystinuria; may be at risk for thrombosis and embolism.
• Hyperthermia: Contrast media studies should be undertaken with caution in patients with elevated body temperatures.
• Hyperthyroidism: Thyroid storm following intravascular administration of iodinated contrast media have occurred in patients with hyperthyroidism or with an autonomously functioning thyroid nodule.
• Multiple myeloma: Use with caution in patients with multiple myeloma; use of intravascular contrast agents may lead to irreversible progressive anuria, renal impairment, and death. Dehydration may be a causative factor; partial dehydration in preparation for procedures may precipitate myeloma protein in renal tubules and is not recommended in myeloma patients.
• 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 to manage hypertensive crisis should be readily available.
• Renal impairment: Use with caution in patients with advanced renal disease. Excretion may be impaired; use only if clearly needed. Patients with combined renal and hepatic disease, severe hypertension or heart failure, and recent renal transplant are at increased risk for impaired excretion. Preparatory dehydration may contribute to acute renal failure in patients with preexisting renal impairment.
• Sickle cell disease: Use with caution in homozygous sickle cell patients; administration may result in disease exacerbation. Fluid restriction is not recommended.
• Subarachnoid hemorrhage: In patients with subarachnoid hemorrhage, contrast administration may be associated with deterioration in clinical status (including seizure and fatality); administer with extreme caution.
• Urinary tract infection: Use solution for instillation with caution in patients with acute UTI.
Special populations:
• Older adult: Preparatory dehydration may contribute to acute renal failure in elderly patients; avoid fluid restriction and maintain normal hydration in elderly patients with renal impairment.
• 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, heart failure, serum creatinine >1.5 mg/dL, or pediatric patients <12 months of age. Preparatory dehydration may contribute to acute renal failure in infants and young children. 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: Serious adverse reactions (including death, seizure, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, rhabdomyolysis, hyperthermia, and brain edema) have been reported due to inadvertent intrathecal administration of iodinated contrast agents not indicated for intrathecal use. In contrast-enhanced computerized tomography (CECT), contrast may obscure some lesions previously seen on unenhanced CT scans.
• 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.
Solution, Injection:
Conray: 60% (30 mL, 50 mL, 150 mL)
Solution, Urethral:
Cysto-Conray II: 17.2% (250 mL) [contains edetate (edta) calcium disodium]
No
Solution (Conray Injection)
60% (per mL): $0.37
Solution (Cysto-Conray II Urethral)
17.2% (per mL): $0.14
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Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection:
Conray 60: 60% (30 mL, 50 mL, 100 mL, 150 mL) [contains edetate (edta) calcium disodium]
Solution, Urethral:
Cysto-Conray II: 17.2% (250 mL, 500 mL) [contains edetate (edta) calcium disodium]
Solution for injection: Not for intrathecal use. Administration recommendations vary by indication; refer to prescribing information for detailed administration information.
Contrast media should be at or close to body temperature when injected. Patient should omit the meal that precedes the examination. Appropriate premedication (eg, barbiturate, tranquilizer, or an analgesic) may be administered prior to the examination. Patients with a strong allergic history may receive an antihistamine within 30 minutes of administration of the contrast agent and corticosteroids prior to and for 24 hours after the contrast agent.
Vesicant (higher osmolar contrast media and 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 (ACR 2023). 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 (ACR 2023); other sources suggest its utility in extravasation management for inoperable cases with compartment syndrome (Stefanos 2023).
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 (Stefanos 2023).
Solution for instillation: Not for intrathecal or intravascular use. Administer into the urinary bladder by gravity flow using an appropriate venoclysis set or by syringe. Avoid excessive pressure. Unless contraindicated, a laxative should be administered the night before the examination. Consider premedication with an antihistamine and/or a corticosteroid prior to administration of the contrast agent in patients with a strong allergic history.
Parenteral: For IV and intra-arterial use only; not for intrathecal use. Administer at or close to body temperature. Patient should omit the meal that precedes the examination. Unless contraindicated, a laxative should be administered the night before the examination. Slow or stop the injection if a minor reaction occurs during administration; discontinue if a major reaction occurs. Appropriate premedication (eg, barbiturate, tranquilizer, or an analgesic) may be administered prior to the examination. Patients with a strong allergic history may receive an antihistamine within 30 minutes of administration of the contrast agent and corticosteroids prior to and for 24 hours after the contrast agent. Administration recommendations vary by product and indication; refer to prescribing information for detailed administration information.
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 (ACR 2018). 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 (ACR 2018); other sources suggest its utility in extravasation management (Belin 2002; Reynolds 2014) (see Management of Drug Extravasations for more details).
Solution for instillation: Not for intrathecal or intravascular use. Administer into the urinary bladder by gravity flow using an appropriate venoclysis set or by syringe. Avoid excessive pressure. Unless contraindicated, a laxative should be administered the night before the examination. Consider premedication with an antihistamine and/or a corticosteroid prior to administration of the contrast agent in patients with a strong allergic history.
Imaging:
Conray: Excretory urography, cerebral angiography, peripheral arteriography, venography, arthrography, direct cholangiography, endoscopic retrograde cholangiopancreatography, contrast enhancement of CT brain images, cranial computerized angiotomography, IV digital subtraction angiography and arterial digital subtraction angiography; enhancement of CT scans performed for detection and evaluation of lesions in the liver, pancreas, kidneys, abdominal aorta, mediastinum, abdominal cavity and retroperitoneal space.
Cysto-Conray II: Retrograde cystography and cystourethrography.
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.
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
Iodinated contrast media agents may cross the placenta.
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).
Iothalamate salts are present in breast milk.
Because of the low expected excretion 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).
Renal function, BP, hydration; monitor for extravasation during IV administration; monitor for hypersensitivity reactions for ≥30 to 60 minutes.
Pediatric patients 0 to 3 years of age: Individualize thyroid function monitoring based on underlying risk factors, especially in term and preterm neonates.
Direct cholangiography: Monitor patient for ≥24 hours to ensure prompt detection of bile leakage and hemorrhage.
Endoscopic retrograde cholangiopancreatography: Monitor patient for 24 hours.
Peripheral arteriography/venography: Monitor blood pressure for 10 minutes following injection.
Radiopaque contrast agent; opacifies vessels in the path of the flow of the contrast medium, permitting radiographic visualization of the internal structures of the body.
Distribution: Rapid (following intravascular administration)
Half-life elimination: 90 minutes
Excretion: Urine (primarily and as unchanged drug); feces (minor)
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