Diatrizoate meglumine (Cystografin) is a radiocontrast agent that is used for bladder instillation during the retrograde cystourethrography procedure.

Diatrizoate meglumine Uses:

• Retrograde cystourethrography:
  • It is used as a diagnostic agent for retrograde cystourethrography

Diatrizoate meglumine (Cystografin) Dose in Adults:

Note: A low residue diet the day before the procedure and a laxative the night before are recommended. A scout film is recommended before the contrast administration.

Diatrizoate meglumine (Cystografin) Dose in Retrograde cystourethrography:

• Bladder instillation: 25 to 300 mL.
• The dose depends on the patient’s age and the degree of bladder irritability
• More than 300 mL may be used if bladder capacity allows.
• Results are best when the bladder is filled to its capacity with the contrast agent.

Use in Children:

Refer to adults dosing.   

Diatrizoate meglumine (Cystografin) Pregnancy Category: C

• Like most iodinated contrast agent, the drug can pass through the placental barrier.
• It should not be used in pregnancy unless absolutely necessary.

Use during breastfeeding:

• After diatrizoate injection, you can detect iodine in breast milk.
• You can continue breastfeeding after the instillation of the drug, as it is not absorbed into the infant's gastrointestinal tract.
• It can alter the flavor of milk. Some lactating mothers may stop breastfeeding temporarily and discard the milk 24 to 48 hours after it is given. Breastmilk can be stored prior to the procedure and may be administered via a bottle during the 48-hour period.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.   

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.   

Side effects of Diatrizoate meglumine (Cystografin):

• Endocrine & metabolic:
  • Altered thyroid hormone levels (transient thyroid hormone suppression)
  • Hypothyroidism
• Hypersensitivity:
  • If intravasation of the drug occurs, severe allergic reactions such as anaphylactoid reactions may develop.
  • Also, facial edema, glottis edema, seizures, shock-like reactions have been reported.

Contraindications to Diatrizoate meglumine (Cystografin):

Allergy reactions to diatrizoate, diatrizoic acids salts, or any component

Warnings and precautions

• Allergy reactions:
  • Some patients may experience severe allergic reactions. Hypersensitivity reactions are more common in those with bronchial asthma or who have had a history of reaction to contrast agents or bronchial asthma.
  • Patients with a history if allergic reactions to iodine should exercise extreme caution (although it is not strictly contraindicated).
• Hypothyroidism:
  • Hypothyroidism can occur in both children and adults. It may be temporary or require treatment.
• Urinary infection
  • Patients suffering from active infections of the urinary tract should not use it.

Diatrizoate meglumine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

Monitor for the clinical features of allergic reactions.   

How to administer Diatrizoate meglumine?

• It is indicated only for bladder instillation. Intravenous use should be avoided.
• It is instilled into the bladder after sterile catheterization using a sterile bladder administration set.
• The bladder is filled to its capacity, however, avoid excessive pressure, trauma, and rapid bladder distension.
• Spontaneous voiding, bladder distension, and discomfort are indicative of a full bladder.

Mechanism of action of Diatrizoate meglumine:

It is a radiopaque contrast agent that is used for imaging.   

International Brand Names of Diatrizoate meglumine:

• Cystografin
• Cystografin-Dilute
• Angiografin
• Angiografina
• Angiografine

Diatrizoate meglumine Brand Names in Pakistan: