Iothalamate meglumine is an iodine-containing radiocontrast agent used in medical imaging, particularly in radiographic studies involving the kidney. It is used because its properties allow it to be visible under X-ray.

Iothalamate meglumine (Cornay) is an organic iodine compound that blocks x-rays as they cross the tissues. Tissues not containing the dye are therefore visualized.

Iothalamate meglumine Uses:

• Imaging:
  • Conray:
    • direct cholangiography
    • peripheral arteriography
    • arterial digital subtraction angiography
    • venography
    • arthrography
    • Excretory urography
    • cerebral angiography
    • endoscopic retrograde cholangiopancreatography
    • cranial computerized angio-tomography
    • improvements made to CT scans used for the identification and assessment of lesions in the liver, pancreas, kidneys, abdominal aorta, mediastinum, abdominal cavity, and retroperitoneal space
    • IV digital subtraction angiography
  • Conray 30:
    • Urography using IV infusion, cerebral computed tomography (CT) with contrast enhancement, and arterial digital subtraction angiography.
  • Conray 43:
    • Venography of the lower extremities
    • CT brain pictures with IV urography contrast enhancement
    • Arterial digital subtraction angiography enhancement of CT images is utilised for the detection and evaluation of lesions in the liver, pancreas, kidneys, abdominal aorta mediastinum, abdominal cavity, and retroperitoneal region retrograde cystography, cystourethrography, and retrograde pyelography.
  • Cysto-Conray II:
    • Retrograde cystography and cystourethrography.

Iothalamate meglumine dose in adults:

Note:

• The amount, size, and speed of giving iothalamate meglumine might change based on the machine used, the health of the blood vessel it's put into, the patient's size and health, and the type of picture taken.

Iothalamate meglumine dose in Intravascular imaging:

Arterial pictures (Arterial digital subtraction angiography):

• Conray 30 & 43: For different arteries, the dose can range from 3 mL to 30 mL. The most anyone should get is 250 mL for Conray 30 and 200 mL for Conray 43.

Joint pictures (Arthrography):

• Conray: For bigger joints like the knee or hip, 5 to 15 mL. For smaller joints, 1 to 10 mL.

Neck artery pictures (Carotid and vertebral angiography):

• Conray: Usually, 6 to 10 mL. Can give more if needed.

Body CT scan with contrast:

• Different amounts depending on the version of Conray, but it can range from 25 mL to 250 mL.

Brain CT scan with contrast:

• Amounts depend on the patient's weight and the Conray type. For example, smaller people might get 4 mL/kg.

Brain blood vessel pictures (Cranial computerized angiotomography):

• Conray: This can be given fast or slowly, but total should not exceed 200 mL.

Liver duct pictures:

• Conray: 10 to 40 mL, depending on the procedure.

Digestive system duct pictures (Endoscopic retrograde cholangiopancreatography):

• Conray: 2 to 100 mL, depending on the exact location.

Kidney pictures (Excretory urography):

• Conray: 30 to 60 mL.

Vein and artery pictures:

• Conray: 20 to 50 mL, depending on the procedure.

Bladder and urinary pictures:

• Conray 30, 43, & Cysto-Conray II: Ranges from 5 mL to 400 mL, depending on the test.

Iothalamate meglumine dose in children:

Note:

• Concentration, volume, and rate may depend on the equipment, condition of the injected vessel, size/condition of the patient, and imaging technique used.

Iothalamate meglumine for Intravascular imaging:

For different imaging types (like looking at joints, the brain's blood vessels, and veins/arteries):

• Conray: Kids and teens should use the adult dose but adjust it based on their age and weight.

For looking at veins in the legs (Lower extremity venography):

• Conray 43: Kids and teens should use the adult dose but adjust it based on their age and weight.

For brain CT scans with contrast:

• Conray 30:
  • Kids under 12 and weighing less than 45 kg: Usually, 4 mL for every kg they weigh.
  • Teens 12 and older and weighing more than 45 kg: Use the adult dose.
• Conray 43: Kids and teens should use the adult dose.
• Conray: Kids and teens usually get 2 mL for every kg they weigh, but not more than 150 mL total.

For body CT scans with contrast:

• Conray 43: Kids and teens should use the adult dose but adjust it based on their age and weight.

For pictures of the kidneys (Excretory urography):

• Conray:
  • Infants, kids, and teens under 14: Usually, 0.5 mL for every kg they weigh, but not more than 30 mL total.
  • Teens 14 and older: Use the adult dose.

For urinary pictures (Urography):

• Conray 30: Teens 12 and older should use the adult dose.
• Conray 43: Kids and teens should use the adult dose.

Iothalamate meglumine in Urographic imaging:

For imaging of the bladder and urethra (Retrograde cystography and cystourethrography):

• Conray 43 & Cysto-Conray II:
  • Kids and teens: They typically get between 30 to 300 mL.

For imaging of the kidney pelvis (Retrograde pyelography):

• Conray 43:
  • Kids and teens: They should use the adult dose but adjust it based on their weight.

Pregnancy Risk Category: C

• Iodinated contrast agents can reach the baby in the womb.
• There's a worry that this could harm the baby because of the iodide in these agents.
• So, doctors recommend not using them during pregnancy unless it's really necessary to get important information that can help in taking care of the mother or baby.

Use of Iothalamate meglumine during breastfeeding

• Iothalamate salts can end up in breast milk.
• But, since only a small amount is expected to pass into the milk and babies don't really absorb much of it from their stomachs, it's usually okay for mothers to keep breastfeeding after using these salts.
• However, the taste of the milk might change a bit because of the contrast media.
• If a mom is concerned, she can choose not to breastfeed for 12 to 24 hours after getting the contrast and throw away the milk she pumps during this time.
• If she wants to keep giving her baby breast milk, she can pump and save some milk before the procedure and then feed the baby with that saved milk during the break.

Iothalamate meglumine Dose in Kidney Disease:

• The company that makes the drug doesn't give any special instructions about changing the dose.
• But if someone has serious kidney problems or both kidney and liver diseases, be very careful when using this drug.

Iothalamate meglumine Dose in Liver disease:

• The company that makes the drug doesn't give any special instructions about changing the dose.
• But if someone has serious kidney problems or both kidney and liver diseases, be very careful when using this drug.

Side effects of Iothalamate meglumine:

Reactions may be class effects rather than specific to this product.

• Cardiovascular:
  • Bradycardia
  • Cardiac Arrhythmia
  • Cardiac Fibrillation
  • Cerebrovascular Accident
  • Chest Tightness
  • Coronary Insufficiency
  • Decreased Blood Pressure
  • Duodenal Wall Intravasation
  • Facial Edema
  • Facial Flushing
  • Flushing
  • Hypotensive Shock
  • Peripheral Edema
  • Syncope
  • Tachycardia
  • Thrombophlebitis
  • Thrombosis
  • Vasoconstriction
  • Vasodilation
  • Venospasm
• Central Nervous System:
  • Amnesia
  • Aphasia
  • Chills
  • Choking Sensation
  • Coma
  • Convulsions
  • Dizziness
  • Flushing Sensation
  • Headache
  • Localized Burning Paresthesia
• Dermatologic:
  • Acute Generalized Exanthematous Pustulosis
  • Diaphoresis
  • DRESS Syndrome
  • Ecchymoses
  • Erythema
  • Gangrene
  • Maculopapular Rash
  • Pruritus
  • Skin Discoloration
  • Stevensjohnson Syndrome
  • Toxic Epidermal Necrolysis
  • Urticaria
• Endocrine & Metabolic:
  • Altered Thyroid Hormone Levels (Transient Suppression; Premature Infants And Infants With Underlying Medical Conditions May Be More Vulnerable; FDA Safety Alert 2015)
  • Hypothyroidism
• Gastrointestinal:
  • Nausea
  • Pancholangitis
  • Pancreatitis
  • Severe Abdominal Pain
  • Vomiting
  • Xerostomia
• Hematologic & Oncologic:
  • Abnormal Erythropoiesis
  • Disseminated Intravascular Coagulation
  • Erythrocyte Agglutination
  • Hematoma
  • Hemorrhage
  • Interference In Clot Formation
• Hepatic:
  • Hepatic Abscess
• Hypersensitivity:
  • Anaphylaxis
  • Angioedema
• Infection:
  • Septicemia
• Local:
  • Extravasation
• Neuromuscular & Skeletal:
  • Arthralgia
  • Brachial Plexus Injury
  • Laryngospasm
  • Muscle Spasm
  • Tremor
• Ophthalmic:
  • Conjunctival Abnormalities
• Renal:
  • Renal Disease
  • Renal Failure
• Respiratory:
  • Apnea
  • Bronchospasm
  • Cough
  • Cyanosis
  • Dyspnea
  • Exacerbation Of Asthma
  • Nasal Congestion
  • Pulmonary Edema
  • Sneezing
  • Wheezing
• Miscellaneous:
  • Fever
  • Tissue Necrosis

Contraindications to Iothalamate meglumine:

People shouldn't use iothalamate meglumine if they:

• Are allergic to it or any of its ingredients.
• Need it injected into the space around their spinal cord.
• Need it given into blood vessels when using the version meant for placing directly into body parts.
• Need it for imaging of the spinal canal using the version meant for injection.

Warnings and precautions

Contrast media reactions

• Some people can have bad reactions to iodine-based contrast media. While many reactions are mild, some can be severe and sudden, similar to allergies.
• People with asthma, allergies (including food), a family history of allergies, or past reactions to contrast agents are more at risk.
• Before giving the contrast, it's important to ask patients about any allergies or past reactions.
• Testing beforehand doesn't always show if someone will have a reaction.
• For those at high risk, consider giving allergy medicines and steroids before the contrast. This can help reduce the chance and severity of a reaction.
  • Steroids should start early before the contrast and keep going for 24 hours after.
  • Allergy medicines should be given about 30 minutes before the contrast.
• Watch patients closely for 30 to 60 minutes after giving the contrast. Stop right away if they show signs of a severe reaction.
• If they have a mild reaction, you might slow down or pause the contrast until they feel better.
• There's a higher chance of reactions in patients getting general anesthesia at the same time.

Dermatological effects

• Serious skin reactions can happen after taking iothalamate. These reactions can include:
  • Stevens-Johnson syndrome (SJS)
  • Toxic epidermal necrolysis (TEN)
  • Acute generalized exanthematous pustulosis (AGEP)
  • Drug reaction with eosinophilia and systemic symptoms (DRESS)
• These reactions can start from 1 hour to several weeks after getting the drug. If someone has had the drug before, the reaction might be more severe and might happen more quickly.
• If someone has had a severe skin reaction to iothalamate in the past, they should avoid using it again.

Extravasation:

• Some contrast media, especially ones that are more concentrated or given in large amounts, can damage tissues if they leak out of blood vessels.
• Before and during giving the drug, make sure the needle or tube is correctly placed in the vessel.
• Keep an eye on where the drug is being given to make sure it doesn’t leak.
• Ioxaglate meglumine has a high concentration. If it leaks, it can cause burning pain, bruises, blood collections, inflammation of veins, and even tissue death.

Neurotoxicity:

• After certain procedures that involve injecting contrast media into blood vessels of the brain or spine, serious nerve problems can happen.
• This includes permanent paralysis.
• Don't use contrast media after giving drugs that tighten blood vessels (vasopressors). This can make the nerve effects worse.

Failure of the renal system:

• Kidney failure can happen in certain patients after they take iodinated contrast by mouth and then have it injected into their blood vessels. This risk is higher in:
  • Patients with liver problems.
  • Diabetic patients with kidney problems.
  • Older patients with hidden or existing kidney issues, especially if they also have diabetes or high blood pressure.
• To help prevent this:
  • Don't let these patients become dehydrated. Make sure they drink enough fluids.
  • Be extra careful with infants, young children, older adults, those with existing kidney issues, those with bone marrow cancer, those with major blood vessel diseases, and diabetics. Dehydrating before the procedure can make their kidney failure risk even higher.

Events that are thromboembolic:

• Sometimes, serious and even deadly blood clots can happen during procedures that use contrast media. These clots can cause heart attacks (MI) and strokes.
• Ionic iodinated contrast media can slow down blood clotting more than nonionic types.
• To lower the risk:
  • Be very careful when giving the contrast into blood vessels.
  • Blood can clot when it stays in syringes with nonionic contrast. Using plastic syringes instead of glass ones might help, but it doesn't completely get rid of the risk.

Cardiovascular disease

• If patients with serious blood vessel diseases are made to dehydrate before a procedure, they might get kidney damage.
• So, make sure they drink enough fluids and aren't kept from drinking before the procedure.

Cerebral lesions:

• After getting contrast for brain CT scans, some patients with brain abnormalities (whether they started there or spread from elsewhere) have had seizures.

Diabetes:

• If diabetic patients are made to dehydrate before a procedure, they might have kidney damage.
• So, it's important to let them drink enough and not limit their fluids before the procedure.

Endotoxemia:

• If a patient has endotoxemia, be extra careful when doing studies that use contrast media.

Hepatic impairment

• Be careful when using this in patients who have both kidney and liver issues, as their body might not get rid of the drug properly.

Homocystinuria

• Don't do angiography (blood vessel imaging) on patients with homocystinuria, as they have a higher risk of blood clots and blockages.

Hyperthermia

• If a patient has a high body temperature, be extra careful when doing studies that use contrast media.

Hyperthyroidism:

• Some patients with an overactive thyroid or certain thyroid nodules have experienced a severe thyroid reaction called 'thyroid storm' after getting iodinated contrast in their blood vessels.

Hypothyroidism:

• Both adults and kids, including babies, have occasionally shown signs of an underactive thyroid after treatment.
• Some of these patients needed treatment for this condition.

Multiple myeloma

• Be very careful when giving contrast agents to patients with multiple myeloma.
• These agents can cause permanent kidney damage, reduced urine output, and even death in these patients.
• Dehydration can play a role in these problems.
• So, it's not a good idea to dehydrate these patients before procedures, as it might cause proteins from the cancer to block kidney tubes.

Pheochromocytoma:

• Be very careful when using contrast agents in patients who have or might have pheochromocytoma.
• If giving it into blood vessels, use as little as possible and watch the patient's blood pressure closely during the procedure.
• Be ready with treatments in case their blood pressure goes dangerously high.

Renal impairment

• Be cautious when using this in patients with serious kidney issues. Their body might struggle to get rid of the drug. Use it only if it's really necessary.
• People who also have liver problems, very high blood pressure, heart failure, or who recently got a kidney transplant are more at risk of this issue.
• If these patients are made to dehydrate before a procedure, it can increase the risk of further kidney damage, especially if they already had kidney problems.

Sickle cell disease:

• Be careful when using this in patients with full-blown sickle cell disease.
• It might make their condition worse.
• It's also not a good idea to limit their fluid intake.

Subarachnoid hemorrhage:

• Giving contrast to patients with this type of brain bleeding can be risky.
• It might worsen their condition, even leading to seizures or death.
• Use it with great care.

Infection of the urinary tract:

• If using the version of the solution that's placed directly into body parts, be careful with patients who currently have a UTI.

Iothalamate meglumine: 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	Iodinated contrast agents may intensify MetFORMIN's unfavorable/toxic effects. 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
• Hydration levels
• Watch for any leakage during IV injection.
• Check for allergic reactions for at least 30 to 60 minutes.

Direct Cholangiography (imaging of bile ducts):

• Watch the patient for at least 24 hours to catch any bile leaks or bleeding.

Endoscopic Retrograde Cholangiopancreatography (ERCP, a procedure to check bile and pancreatic ducts):

• Monitor the patient for 24 hours.

Peripheral Arteriography/Venography (imaging of peripheral blood vessels):

• Monitor blood pressure for 10 minutes after the injection.

How to administer Iothalamate meglumine?

Solution for Injection:

• Warning: Don't use it in the spinal fluid.
• How to Administer: Specifics depend on the product. Always check the label.
• Preparation:
  • Warm the contrast media to body temperature before injecting.
  • Skip the meal before the exam.
  • If needed, give calming medicines like barbiturates, tranquilizers, or painkillers.
  • If the patient has allergies, consider giving:
    • An antihistamine 30 minutes before.
    • Corticosteroids before and for a day after the contrast.
• Risks: Some contrasts can damage tissues (especially if they're strong or in large amounts). Make sure the needle is in the right place.
• If Leakage Happens (Extravasation):
  • Stop and remove the needle.
  • Lift the affected body part.
  • Don't try to pull out the leaked contrast.
  • There's a debate on using a medicine called hyaluronidase. Some sources say it helps, others don't recommend it.
    • If you use hyaluronidase: Inject it around the leak area, either with smaller or larger amounts depending on the source you follow.

Solution for Instillation:

• Warning: Don't use it in the spinal fluid or blood vessels.
• How to Administer:
  • Put it into the bladder using a special set or syringe. Don't force it in.
  • Consider giving a laxative the night before.
  • For allergic patients, think about pre-medicating with an antihistamine or corticosteroid.

Mechanism of action of Iothalamate meglumine:

• This agent makes blood vessels show up on X-rays.
• When it flows through the vessels, it allows doctors to see inside the body's structures using radiography (X-ray imaging).

Distribution:

• It spreads quickly in the body after being injected into the blood vessels.

Half-Life Elimination:

• It takes about 90 minutes for the body to get rid of half of the injected substance.

Excretion:

• The body gets rid of it mostly through urine, and a small amount goes out through the feces.

 

International Brands of Iothalamate meglumine:

• Conray 30
• Conray 43
• Conray
• Cysto-Conray II

Iothalamate meglumine Brand Names in Pakistan:

Not Available.