Iopromide is a non-ionic, water-soluble contrast agent used in various radiological procedures to enhance visibility in the body's internal structures during imaging.

Iopromide (Ultravist) is a non-ionic low-osmolar contrast agent used in angiographic and other procedures requiring contrast enhancement.

Iopromide (Ultravist) Uses:

Intra-arterial:

• Used to improve imaging in aortography, coronary angiography, cerebral and peripheral angiography, visceral angiography, and left ventriculography.

Intravenous:

• Used to improve imaging in contrast-enhanced computed tomography of the head and body (intrathoracic, intraabdominal, and retroperitoneal areas) for the assessment of neoplastic and nonneoplastic lesions.

Iohexol is another similar contrast agent.

Iopromide (Ultravist) dose in adults:

Key point:

• You shouldn't use more than 86 grams of iodine for the test.
• To decide the right amount, consider the patient's age, weight, the size and speed of blood flow in the vessel being looked at.
• Also, think about how clear the image needs to be, what body part is being examined, any health issues, and the equipment and method being used.

Aortography and visceral angiography:

Aortography and Visceral Angiography:

• Intra-arterial (370 mg iodine/mL): Amount and speed of injection depend on the blood flow and characteristics of the vessels being studied. Maximum dose: 225 mL.

Cerebral Arteriography:

• Intra-arterial (300 mg iodine/mL): Maximum dose: 150 mL.

Carotid Artery Visualization:

• 3 to 12 mL.

Vertebral Artery Visualization:

• 4 to 12 mL.

Aortic Arch Injection:

• 20 to 50 mL.

Coronary Arteriography and Left Ventriculography:

• Intra-arterial (370 mg iodine/mL): Maximum dose: 225 mL.
• Left coronary: 3 to 14 mL.
• Right coronary: 3 to 14 mL.
• Left ventricle: 30 to 60 mL.

Peripheral Arteriography:

• Intra-arterial (300 mg iodine/mL): Maximum dose: 250 mL.
• Subclavian or femoral artery: 5 to 40 mL.
• Aortic bifurcation for distal runoff: 25 to 50 mL.

Contrast-Enhanced CT: IV:

• 300 mg iodine/mL:
  • Head: 50 to 200 mL; maximum dose: 200 mL.
  • Body (Single phase):
    • Bolus injection: 50 to 200 mL; maximum dose: 200 mL.
    • Rapid infusion: 100 to 200 mL; maximum dose: 200 mL.
  • Body (Multiple phase):
    • 50 to 200 mL; use power injector for simultaneous administration of contrast and saline. Maximum dose: 200 mL.
• 370 mg iodine/mL:
  • Head: 41 to 162 mL; maximum dose: 162 mL.
  • Body (Single phase):
    • Bolus injection: 41 to 162 mL; maximum dose: 162 mL.
    • Rapid infusion: 81 to 162 mL; maximum dose: 162 mL.
  • Body (Multiple phase):
    • 41 to 162 mL; use power injector for simultaneous administration of contrast and saline. Maximum dose: 162 mL.

Excretory urography:

• For a kidney imaging test (Excretory Urography) using an IV injection, use a solution that has 300 mg of iodine per mL.
• The usual dose is 1 mL for every kilogram of the patient's weight.
• However, make sure not to use more than 100 mL for the whole test, especially if the patient has normal kidney function.

Iopromide (Ultravist) dose in Children:

Heart chambers and related arteries:

Children older than 2 years and Adolescents:

• For children over 2 years old and adolescents, when using an intra-arterial injection with a solution containing 370 mg of iodine per mL, the recommended dose is 1 to 2 mL for every kilogram of their body weight.
• However, the total amount injected should not exceed 4 times their body weight.

Iopromide (Ultravist) use in contrast-enhanced CT or excretory urography:

Children >2 years and Adolescents:

• For kids older than 2 years and teenagers getting a contrast-enhanced CT or kidney imaging test, the dose is 1 to 2 mL of a solution (with 300 mg of iodine in each mL) for every kilogram they weigh.
• But, don't use more than 3 mL for every kilogram of their weight in the entire procedure.

Pregnancy Risk Category: B2

• Iopromide can pass from a pregnant woman to her baby, and traces of it were found in a baby's stomach and pee when it was born.
• There's no evidence of it causing thyroid problems in newborns.
• Still, because there are concerns that iodide might harm the fetus, it's best not to use iopromide during pregnancy unless the information from the test is crucial for the care of the mother or baby.

Iopromide use during breastfeeding:

• The special dye used for imaging might end up in a nursing mother's breast milk, but the amount is usually very low and not easily absorbed by a baby's stomach.
• This means most breastfeeding can continue without problems after using this dye.
• Some moms might notice a change in the milk's taste, though it's not harmful.
• If a mom prefers, she can stop breastfeeding temporarily after the test.
• She can pump and store milk before the test, then bottle-feed stored milk for about 12 to 24 hours after the test.
• The choice to breastfeed should consider the possible baby exposure, the benefits of breastfeeding, and the mom's treatment needs.

Iopromide (Ultravist) Dose in Kidney Disease:

• The maker of the medicine doesn't give specific changes in dosage for patients with kidney problems or combined kidney and liver disease.
• It's advised to be careful and use the smallest effective dose in these situations.

 

Iopromide (Ultravist) Dose in Liver disease:

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

 

Side Effects of Iopromide (Ultravist):

• Cardiovascular:
  • Chest Pain
  • Bradycardia
  • Vasodilation
  • Facial Edema
  • Flushing
  • Hypertension
  • Complete Atrioventricular Block
  • Coronary Thrombosis
  • Peripheral Edema
  • Peripheral Vascular Disease
  • Ventricular Premature Contractions
  • Syncope
  • Vascular Disease
• Gastrointestinal:
  • Sore Throat
  • Stomach Discomfort
  • Dysgeusia
  • Abdominal Distress
  • Abdominal Pain
  • Constipation
  • Diarrhea
  • Upper Abdominal Pain
  • Xerostomia
  • Nausea
  • Vomiting
  • Dyspepsia
  • Gastrointestinal Pain
  • Salivation
  • Tenesmus
• Central Nervous System:
  • Anxiety
  • Ataxia
  • Chest Discomfort
  • Chills
  • Headache
  • Agitation
  • Confusion
  • Seizure
  • Speech Disturbance
  • Dizziness
  • Drowsiness
  • Malaise
  • Myasthenia
  • Neuropathy
  • Feeling Hot
  • Hypertonia
  • Hypoesthesia
  • Paresthesia
• Dermatologic:
  • Urticaria
  • Pruritus
  • Skin Rash
  • Erythema
  • Hyperhidrosis
• Genitourinary:
  • Urinary Retention
  • Urinary Urgency
  • Dysuria
• Local:
  • Injection Site Reaction
    • Hemorrhage
    • Pain
    • Skin Rash
    • Warm Feeling
    • Edema
    • Erythema
    • Hematoma
• Respiratory:
  • Increased Cough
  • Pulmonary Hypertension
  • Respiratory Tract Disease
  • Dyspnea
  • Hypoxia
  • Pharyngeal Edema
  • Apnea
  • Asthma
  • Pharyngitis
  • Pleural Effusion
• Endocrine & Metabolic:
  • Increased Lactate Dehydrogenase
  • Polydipsia
• Neuromuscular & Skeletal:
  • Weakness
  • Limb Pain
  • Musculoskeletal Pain
  • Neck Pain
  • Tremor
  • Back Pain
  • Arthralgia
• Hematologic & Oncologic:
  • Leukocytosis
  • Increased Hemoglobin
• Ophthalmic:
  • Visual Field Defect
  • Visual Disturbance
• Renal:
  • Renal Pain
  • Increased Blood Urea Nitrogen
• Miscellaneous:
  • Fever

Side effects of Iopromide (Ultravist) (Frequency unknown):

• Central Nervous System:
• • Cerebral Edema
• Gastrointestinal:
  • Mucous Membrane Disease
• Hypersensitivity:
  • Fixed Drug Eruption
• Endocrine & Metabolic:
  • Diabetes Insipidus
• Cardiovascular:
  • Cerebrovascular Accident
  • Ischemic Heart Disease
  • Cardiac Arrhythmia
• Respiratory:
  • Epistaxis
  • Respiratory Insufficiency
  • Aspiration
  • Cyanosis
• Neuromuscular & Skeletal:
  • Joint Effusion
  • Muscle Cramps
• Ophthalmic:
  • Conjunctivitis
• Renal:
  • Acute Renal Failure

Contraindications to Iopromide (Ultravist):

Don't use it for:

• Injection into the spinal canal (intrathecal use).
• In kids who have been dehydrated on purpose (like by not drinking for a long time or taking a laxative) before getting the iopromide shot.

In Canada (but not in the U.S.):

• Don't use if allergic to iopromide or anything else in it.
• Don't use for people with an overly active thyroid.
• Don't use in tests involving certain areas of the brain and spine (myelography, cerebral ventriculography, and cisternography).

Warnings and precautions

Contrast media reactions

• Some people have had severe and even life-threatening reactions to contrast dyes.
• Be extra careful if someone:
  • Had a bad reaction to contrast dye or iodine before.
  • Has allergies, like asthma, hay fever, or food allergies.
• Always watch the patient closely during the test and for about 30 to 60 minutes after. Sometimes, bad reactions can happen a bit later.

Acute kidney injury caused by contrast:

• Using contrast dyes in the bloodstream can sometimes damage the kidneys. In severe cases, this can lead to kidney failure.
• People at higher risk include those who:
  • Already have kidney problems.
  • Are older.
  • Have major blood vessel diseases.
  • Have heart failure.
  • Are dehydrated.
  • Have diabetes.
  • Take medicines that are tough on the kidneys or use water pills (diuretics).
  • Have conditions like multiple myeloma.
  • Get large amounts or frequent doses of contrast dye.
• To lower the risk, make sure patients drink enough fluids before and after the test.

Dermatological effects

• Some people have had serious skin reactions after using this medicine. These can happen as quickly as 1 hour or as long as several weeks after getting the medicine. Some of these reactions are:
  • Stevens-Johnson syndrome (SJS)
  • Toxic epidermal necrolysis (TEN)
  • Acute generalized exanthematous pustulosis (AGEP)
  • Drug reaction with symptoms like high eosinophils (a type of white blood cell) and body-wide symptoms (DRESS).
• If someone has had this medicine before, the reactions might be worse and happen faster the next time.
• Don't use this medicine in people who had a severe skin reaction to a similar medicine called iothalamate.

Extravasation:

• The contrast dye might cause irritation or damage if it leaks out of the blood vessel (this is called "extravasation"). Some types of dyes or larger amounts can increase this risk.
• Before and during giving the dye, make sure the needle or tube is correctly placed in the blood vessel. Keep an eye on where the dye is being given.
• Try to prevent the dye from leaking into the surrounding tissue.
• If it does leak, it can cause tissue death or increase pressure in that area, especially in people with major blood vessel problems.

Events that are thromboembolic:

• Blood clots have happened during procedures using both types of contrast dyes (ionic and nonionic).
• Blood can clot if it stays in syringes with the dye for too long.
• So, it's super important to be very careful when giving the dye into the bloodstream.

Cardiovascular disease

• Be careful when using this dye in people with heart problems or heart failure.
• The dye can change the balance of fluids in the blood, which might affect heart function, especially if a lot of dye is used or if it's used multiple times.
• People with heart problems should be watched for several hours after the test to check for any delayed changes in their heart function.
• Dehydrating patients on purpose before the test can be risky, especially for those with heart failure or major blood vessel issues. Make sure these patients get enough fluids and avoid limiting their fluid intake.

Diabetes:

• Be extra careful when using this dye in people with diabetes. They might have changes in their kidney blood flow, which can increase the chance of kidney damage.
• Dehydrating patients on purpose before the test can be risky, especially for those with diabetes. Make sure they drink enough and don't limit their fluids.

Hepatic impairment

• Be extra careful when using this dye in people with liver problems.
• It's even more critical if they also have kidney issues or if they're getting both oral and IV contrast dyes around the same time.

Homocystinuria

• Don't use angiography (a test that uses dye to see blood vessels) for people with homocystinuria.
• They might have a higher risk of blood clots and blockages.

Hyperthyroidism:

• Be extra careful when using this dye in people with thyroid issues.
• A very severe and dangerous thyroid reaction, called "thyroid storm," can happen, especially if they've had an overactive thyroid or a certain kind of thyroid lump before.

Hypothyroidism:

• Some adults and kids, including babies, showed signs of low thyroid function after using the dye.
• This condition was rare.
• Some of these patients needed treatment for an underactive thyroid.

Multiple myeloma

• Be extra careful when using this dye in people with multiple myeloma.
• They might have a higher risk of kidney problems, especially if they are dehydrated.

Pheochromocytoma:

• If someone has pheochromocytoma (or it's suspected they might have it), be very careful when using this dye.
• Use as little dye as possible and keep a close eye on their blood pressure during the test.
• Be ready with treatments in case their blood pressure goes dangerously high.

Renal impairment

• Be careful when using this dye in people with kidney problems.
• The dye might make their kidney function worse or increase a blood marker called serum creatinine.
• This risk is higher for older people, those with diabetes, major blood vessel issues, or who are dehydrated.
• For people with kidney problems, use the smallest amount of dye that will work.

Sickle cell disease:

• Be careful when using this dye in people with sickle cell disease.
• The dye might trigger their blood cells to change shape (sickle).

Iopromide (Ultravist) : Drug Interaction

Risk Factor C (Monitor therapy)
Aldesleukin	Iodinated contrast agents may be more likely to cause allergic or hypersensitive reactions.
Risk Factor D (Consider therapy modification)
MetFORMIN	The harmful or toxic effects of metFORMIN may be increased by iodinated contrast agents. Lactic acidosis associated with metformin can be brought on by renal impairment that may be brought on by iodinated contrast agents. Management: The guidance on management differs. For more information, consult the medication interaction monograph in its entirety.

Monitoring parameters:

General Monitoring:

• Kidney function
• Blood pressure
• Make sure the patient is well-hydrated
• Watch the injection site during IV to make sure the liquid doesn’t leak out (extravasation)
• Check for allergic reactions for at least 30 to 60 minutes

For Coronary Arteriography:

• Heart activity (ECG)
• Vital signs (like heart rate, blood pressure)
• Look out for signs of an allergic reaction
• Monitor kidney function

How to administer Iopromide (Ultravist)?

Usage:

• Only for injection directly into veins (IV) or arteries (intra-arterial).
• The liquid should be near body temperature.
• Don't mix with other medicines or nutritional injections.
• Can be given alongside saline using special equipment (power injector).
• Make sure patients drink enough fluids before and after getting the medicine.
• Inject at a rate that matches the flow in the blood vessel.
• Wait a bit between large injections.

Caution:

• This medicine might damage skin or tissue if it leaks. Always make sure the needle or tube is correctly placed.

If There's a Leak (Extravasation):

• Stop the infusion at once and remove the needle.
• Lift the part of the body where the leak happened.
• Don't try to suck out the leaked medicine.
• There's mixed advice on using a medicine called hyaluronidase. Some experts don't recommend it for treating leaks, while others do.

If Using Hyaluronidase:

• Inject in the skin or just under it, at the leak site.
• Use a thin needle and give in 5 separate spots around the leak area. There are different methods and amounts used, so follow expert guidance.

Mechanism of action of Iopromide (Ultravist):

• Iopromide makes blood vessels show up clearly on X-rays, letting doctors see inside the body.

How Iopromide Moves in the Body:

• Volume it spreads through: 16 liters.
• Sticks to proteins in the body: Just 1%.
• How long it stays in the body:
  • First part: 2 hours.
  • Last part: 6.2 hours.

When It Shows Up Strongest:

• When injected quickly into the bloodstream:
  • Fast boost in contrast: 15 to 120 seconds.
• When injected into a vein:
  • Kidneys light up: 5 to 15 minutes.

How the Body Gets Rid of It:

• Mostly goes out in the pee: 97% unchanged.

International Brands of Iopromide:

• Ultravist
• Ultravist 240
• Ultravist 300
• Ultravist 370
• Clarograf
• Prosure
• Ultravist

Iopromide Brand Names in Pakistan:

Update soon.