Ioversol is a non-ionic, iodinated contrast medium used for intravascular administration (e.g., intravenous, intra-arterial) in diagnostic imaging. These iodinated contrast agents are used to improve the visualization of body structures during medical imaging techniques such as computed tomography (CT), angiography, and other procedures. They work by absorbing X-rays more than the surrounding tissues, thus allowing vessels and structures filled with the contrast to become more visible on the imaging.

Ioversol (Optiray) is an organoiodine compound that contains a high amount of iodine and is used in various diagnostic procedures.

Ioversol Uses:

• Ioversol 74%:
  • Adults:
    • Peripheral and coronary arteriography, left ventriculography, body and head contrast-enhanced computed tomography imaging, IV excretory urography, IV digital subtraction angiography, and venography are all examples of angiography procedures.
  • Pediatric:
    • Angiocardiography.
• Ioversol 68%:
  • Adults:
    • Angiography of the whole cardiovascular system, including the head and body's contrast-enhanced CT scans, IV excretory urography, and cerebral, coronary, peripheral, visceral, renal, and venographic arteriography.
  • Pediatric:
    • IV excretory urography, head and body contrast-enhanced computed tomography imaging, and angiocardiography
• Ioversol 64%:
  • Adults:
    • angiography of the brain and body, IV excretory urography, venography, contrast-enhanced computed tomography imaging, and peripheral arteriography.
• Ioversol 51%:
  • Adults:
    • IV excretory urography, head- and body-specific contrast-enhanced computed tomography, cerebral angiography, and venography.

Ioversol dose in adults:

• The amount of ioversol you get depends on a lot of things, like the type of test you're having, how it's given to you (like through a vein), how old or heavy you are, and the specific product being used.
• For exact details about how much you'll get, you should look at the information that comes with the product.
• It's different for each case.

Ioversol Pregnancy Risk Category: B/C

• Ioversol can go from the mother to the baby while still in the womb.
• Studies have found it in the stomach of newborns.
• There's worry that the iodide in ioversol might be harmful to the baby.
• So, doctors say pregnant women should only use it if it's really needed for important medical tests that will help take care of the mother or baby.

Ioversol use during breastfeeding:

• Iodinated contrast media, like Ioversol, can get into breast milk.
• But, because only a tiny amount usually gets into the milk and even less is taken up by a baby's stomach, mothers can generally keep breastfeeding after they've had the media.
• However, the taste of the milk might change a bit because of it.
• If a mother is worried, she can choose to pump and throw away her milk for 8 to 24 hours after getting the contrast.
• To feed her baby during this time, she can pump and save some milk before the procedure and use that.
• But, it's up to the mother, considering the benefits of breastfeeding, the small risk to the baby, and the importance of the mother's treatment.

Ioversol dose in kidney disease:

• The company that makes the drug doesn't give special dosing instructions for people with certain health issues.
• But, if someone has very poor kidney function, no urine output, or both kidney and liver diseases, they should be extra careful when using this drug.

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Ioversol dose in Liver disease:

• There are no dosage adjustments present in the manufacturer’s labeling. Use caution in patients with combined hepatic and renal disease.

Common Side Effects of Ioversol:

• Gastrointestinal:
  • Nausea
• Miscellaneous:
  • Fever

Uncommon Side effects of Ioversol:

• Cardiovascular:
  • Bradycardia
  • Cardiac complications including
    • pulmonary artery systolic pressures
    • decreases in systolic
    • left ventricular systolic 
    • cardiac output
    • diastolic blood pressures
    • end-diastolic pressure
    • right ventricular systolic
• Central nervous system:
  • Disorientation
  • Headache
  • Vertigo
  • Drowsiness
  • Paresis (transient)
  • Seizure
• Ophthalmic:
  • Visual disturbance

Contraindications to Ioversol:

• The company that makes the drug doesn't list any situations where it shouldn't be used.
• However, in Canada, it's said that people shouldn't use it if they're allergic to ioversol or anything in it, or if they have serious issues with both their liver and kidneys.

Warnings and precautions

Contrast media reactions

• Using contrast media can sometimes cause bad side effects, even ones that show up later and can be really serious or life-threatening.
• People who've had reactions to dyes, iodine-based contrasts, or have known allergies (like asthma or food allergies) should be extra careful.
• Before giving the contrast, it's important to ask about any past allergies or reactions.
• Just testing ahead of time might not always show if someone will have a reaction.
• Taking allergy medicines beforehand might help reduce the chances or seriousness of a reaction.
• After getting the contrast, patients should be watched closely for 30 to 60 minutes.
• Those who are also getting general anesthesia might have a higher chance of side effects.

Contrast-associated Nephropathy

• The contrast can sometimes hurt the kidneys.
• People with existing kidney problems, or both kidney and liver issues, should be extra careful, especially if they need a big dose.
• It's a good idea for patients to drink plenty of water before and after the test to help protect their kidneys.

Dermatological effects

• The contrast can sometimes cause severe skin reactions, like rashes and blisters.
• These reactions can happen anywhere from 1 hour to several weeks after getting the contrast.
• If someone has had the contrast before, the reactions might be worse or happen faster the next time.
• If someone had a bad skin reaction to ioversol in the past, they should avoid using it again.

Extravasation:

• If the contrast leaks outside the vein, it can irritate or damage the skin and tissues.
• Before and while giving the contrast, make sure the needle or tube is correctly placed in the vein.
• Watch the area where it's given closely.
• Try to prevent any leaks.
• If it does leak, especially in people with major blood vessel problems, it can cause tissue to die.

Neurotoxicity:

• After some specific tests involving the brain and spinal cord blood vessels, serious nerve problems can happen, including not being able to move some parts of the body.
• It's not clear if the contrast itself is the cause because the patient's condition and the way the test is done might also play a role.
• It's best to avoid injecting the contrast into arteries after giving medications that tighten blood vessels.

Seizures:

• People with a history of epilepsy need to be careful, as seizures can happen, especially if given too much contrast.
• Those on seizure medicines should keep taking them.
• If a strong dose or a lot of contrast is needed, it might be a good idea to also give medicines that prevent seizures.
• Some drugs, especially those affecting the brain and making seizures more likely, should be stopped 1 to 3 days before a test where contrast is put into the spine and not taken again for a day after the test.

Events that are thromboembolic:

• There's a small chance of dangerous blood clots leading to heart attacks or strokes when using contrast during certain tests.
• These risks are there with both types of contrasts - ionic and nonionic.
• The ionic type can make blood more likely to clot compared to the nonionic type.
• It's crucial to be very careful when putting contrast into blood vessels.
• Blood might clot if it stays in syringes with nonionic contrast.
• Using plastic syringes instead of glass ones can reduce, but not totally get rid of, this risk.

Cardiovascular disease

• People with serious heart issues should be careful when using the contrast.
• It might temporarily change the balance of fluids in the blood.
• If someone has heart failure, they should be watched for several hours after the test because of possible delayed heart problems.
• Heart tests using contrast should only be done if the benefits are bigger than the risks.
• Also, making a patient with severe blood vessel disease go without fluids can harm their kidneys, so it's important they stay well-hydrated.

Diabetes:

• For people with diabetes who also have severe blood vessel disease, going without fluids can harm their kidneys.
• So, it's important they drink enough and stay well-hydrated.

Hepatic impairment

• If someone has both kidney and liver problems, they should be extra careful when using the contrast.

Homocystinuria

• People with homocystinuria should avoid tests using contrast, because they have a higher risk of blood clots and blockages.

Hyperthyroidism:

• After getting an iodinated contrast, people with an overactive thyroid or certain thyroid growths might experience a severe thyroid reaction called "thyroid storm."

Hypothyroidism:

• There have been rare cases where both adults and children, including babies, showed signs of an underactive thyroid or a temporary decrease in thyroid function after getting the contrast.
• Some of these people needed treatment for this underactive thyroid.

Multiple myeloma

• People with multiple myeloma should be careful when using the contrast.
• It might hurt their kidneys, especially if they are not well-hydrated.
• In fact, making these patients go without enough fluids before tests can cause protein to build up in the kidneys, so it's not a good idea for them.

Pheochromocytoma:

• For people who have, or might have, pheochromocytoma (a rare tumor), they need to be very careful when using the contrast.
• Use as little contrast as possible and keep a close eye on their blood pressure during the test.
• Medicines to treat very high blood pressure should be on hand just in case.

Pulmonary disease

• For people with chronic lung disease like emphysema, there are risks when doing a heart blood vessel test using contrast.
• It's important to decide if the test is really needed considering these risks.

Renal impairment

• People with serious kidney problems, both kidney and liver issues, or those who can't produce urine should be careful when using the contrast.
• It might make their kidney function worse or raise a blood marker for kidney function (serum creatinine).
• This is especially true for older people, diabetics, those with major blood vessel diseases, or those who aren't well-hydrated.

Sickle cell disease:

• People with the most severe form of sickle cell disease should be careful when using the contrast.
• It might cause their blood cells to change shape, which is called "sickling".

Ioversol: Drug Interaction

Risk Factor C (Monitor therapy)
Aldesleukin	Iodinated contrast agents may be more likely to cause allergic or hypersensitive responses.
Risk Factor D (Consider therapy modification)
MetFORMIN	Iodinated contrast agents may intensify MetFORMIN's unfavourable/toxic effects. Lactic acidosis linked with metformin can be brought on by renal impairment. Management: The guidance on management differs. For further information, consult the medication interaction monograph in its entirety.

Monitoring parameters:

ECG and Vital Signs:

• Watch the heart's electrical activity (ECG) and vital signs (like heart rate and blood pressure) during coronary arteriography and left ventriculography.

Hypersensitivity Signs:

• Look for signs of hypersensitivity (like allergic reactions) for at least 30 to 60 minutes after the procedure.

Kidney Function:

• Keep track of how the kidneys are functioning.

Renal Function:

• Check how well the kidneys are working.

Infusion Site Monitoring:

• Keep an eye on the spot where the contrast is being infused.

This helps ensure the safety and wellbeing of the patient during and after the procedure.

How to administer Ioversol?

Before and After the Procedure:

• Drink plenty of water before and after the procedure.
• Consider taking allergy medicines to reduce allergic reactions.
• Make sure the intravenous dose is warm (near body temperature) before giving it.

During Angiography:

• Be very careful when injecting the contrast to reduce blood clot risks:
  • Use plastic syringes.
  • Frequently flush the catheter.
  • Pay close attention when handling the catheter and guidewire.
• When giving big doses, wait a few minutes between injections.

Warnings:

• This medicine should not be put into the spine.
• The contrast can irritate or damage skin, so:
  • Make sure the needle or tube is correctly placed before and during giving the contrast.
  • Avoid any leaks (infiltration).

If the Contrast Leaks (Extravasation):

• Stop giving the contrast and remove the needle/tube.
• Lift up the affected body part.
• Trying to pull out the leaked contrast is not recommended.
• There are mixed opinions about using an enzyme called hyaluronidase for leaks:
  • The ACR doesn't recommend it.
  • But if it's used, there are detailed steps on how to inject it around the leak site.

Always prioritize patient safety and follow expert recommendations when handling and administering contrast agents.

Mechanism of action of Ioversol:

• The contrast media makes blood vessels and body parts show up clearly on X-rays because it lights up the areas it flows through.
• This makes it easier to see and study these areas with imaging tests.

Breaking Down the Drug:

• The body doesn't break it down.

How Long It Stays in the Body:

• It lasts about 1.5 hours in the body, but it stays longer if the kidneys aren't working well.

Getting Rid of the Drug:

• Over 95% of the drug leaves the body unchanged through urine within a day after taking it.

International Brands of Ioversol:

• Optiray 240 Ultraject
• Optiray 320 Ultraject
• Optiray 320
• Optiray 350
• Optiject
• Optiray
• Optiray 240
• Optiray 300
• Optiray 350 Ultraject

Ioversol Brand Names in Pakistan:

Not Available.