Radiopaque, Omnipaque (Iohexol) is a non-ionic, water-soluble contrast agent that is used in radiological diagnostic procedures.

Iohexol (radiopaque) Uses:

• Imaging: Adults:

  • Intrathecal:

    • Iohexol 180, 240, and 300: contrast enhancement for CT (myelography, cisternography, ventriculography), and Myelography (lumbar, thoracic, cervical, and total columnar)

  • ---

    Intravascular:

    • Iohexol 140:

      • Intra-arterial digital subtraction angiography of head, neck, abdominal, renal, and peripheral vessels

    • Iohexol 240:

      • Contrast enhancement for CT head imaging and peripheral venography (phlebography)

    • Iohexol 300:

      • for Aortography (including studies of the arch of aorta, abdominal aorta, and its branches], contrast enhancement for CT head and body, peripheral venography i.e phlebography, cerebral arteriography, and excretory urography

    • Iohexol 350:

      • Angiocardiography (ventriculography, selective coronary arteriography), contrast enhancement for CT head and body, aortography (including studies of the root of the aorta, arch of aorta, ascending aorta, abdominal aorta [and branches]), intravenous digital subtraction angiography of head, neck, abdominal renal and peripheral vessels, peripheral arteriography, and excretory urography

    • Iohexol 300 (bulk) and 350 (bulk):

      • Contrast enhancement for CT head and body imaging (for IV administration with an appropriate automated contrast injection system, contrast management system, or contrast media transfer set)

  • ---

    Oral:

    • Iohexol 350:

      • Oral radiography examination of the gastrointestinal tract

  • Oral in conjunction with IV administration:

    • Iohexol 240, 300, and 350 (diluted; oral) and Iohexol 300 (IV):

      • Contrast-enhanced abdomen CT

    • Iohexol (oral solution 9 and 12) and Iohexol 300 (IV):

      • Contrast-enhanced abdomen CT

  • Intraarticular:

    • Iohexol 240, 300, and 350: Arthrography

  • Body cavity:

    • Iohexol 240:

      • Endoscopic retrograde pancreatography (ERP) and cholangiopancreatography (ERCP), herniography, and hysterosalpingography

    • Iohexol 300:

      • Hysterosalpingography

  • ---

    Oral:

    • Iohexol (Oraltag):

      • Contrast enhancement for CT abdomen and pelvis imaging to opacify bowel loops and delineate between normal loops and adjacent organs or areas of suspected pathology
  • Limitations of use:
    • Oraltag is not indicated for diagnostic examination of the GI tract.

• ---

  Imaging: Pediatrics:

  • Intrathecal:

    • Iohexol 180:

      • Myelography (lumbar, thoracic, cervical, and total columnar), and contrast enhancement for CT (myelography, cisternography)
  • Intravascular:

    • Iohexol 240:

      • Contrast enhancement for CT head and body imaging

    • Iohexol 300:

      • Angiocardiography (ventriculography), contrast enhancement for CT head and body imaging, and excretory urography

    • Iohexol 350:

      • Angiocardiography (ventriculography, pulmonary arteriography, venography, and studies of collateral arteries);
      • aortography, including the root of aorta, arch of aorta, ascending and descending aorta)

    • Iohexol 300 (bulk):

      • Contrast enhancement for CT head and body imaging (for IV administration with an appropriate automated contrast injection system, contrast management system, or contrast media transfer set)

  • Oral or rectal:

    • Iohexol 180, 240, and 300:

      • Oral and rectal radiographic examination of the gastrointestinal tract

  • Oral in conjunction with IV administration:

    • Iohexol 240, 300, and 350 (diluted; oral) and Iohexol 240 or 300 (IV):

      • Contrast-enhanced abdomen CT

    • Iohexol (oral solution 9 and 12) and Iohexol 240 or 300 (IV):

      • Contrast-enhanced abdomen CT

  • Body cavity:

    • Iohexol 240, 300, and 350 (diluted):

      • Voiding cystourethrography (VCUG)

  • Oral:

    • Iohexol (Oraltag):

      • Contrast enhancement for CT abdomen and pelvis imaging to opacify bowel loops and delineate between normal loops and adjacent organs or areas of suspected pathology

  • Limitations of use:

    • Oraltag is not indicated for diagnostic examination of the GI tract.

IohexolIohexol dose in adults:

Radiopaque (Iohexol) use in Intrathecal imaging:

Note:

• gI = grams of iodine; mgI = mg of iodine.
• Verify product prior to administration;
• some products are contraindicated for intrathecal administration.

• Myelography: Intrathecal: Iohexol 180, 240, or 300 only:

  • Lumbar (lumbar injection):

    • Iohexol 180: 10 to 17 mL (1.8 to 3.06 gI)
    • Iohexol 240: 7 to 12.5 mL (1.7 to 3 gI)

  • Thoracic (lumbar or cervical injection) or cervical (lumbar injection):

    • Iohexol 240: 6 to 12.5 mL (1.4 to 3 gI)
    • Iohexol 300: 6 to 10 mL (1.8 to 3 gI)

  • Cervical (c1-2 injection):

    • Iohexol 180: 7 to 10 mL (1.3 to 1.8 gI)
    • Iohexol 240: 6 to 12.5 mL (1.4 to 3 gI)
    • Iohexol 300: 4 to 10 mL (1.2 to 3 gI)

  • Total columnar (lumbar injection):

    • Iohexol 240: 6 to 12.5 mL (1.4 to 3 gI)
    • Iohexol 300: 6 to 10 mL (1.8 to 3 gI)

• Single myelographic procedure:

  • Do not exceed a concentration of 300 mgI/mL or total dose of iodine 3,100 mg. If a repeat procedure is required, wait at least 48 hours (5 to 7 days is preferred).

Radiopaque (Iohexol) use in Intravascular imaging:

Note: gI = grams of iodine; mgI = mg of iodine.

• Ventriculography:

  • Iohexol 350: 40 mL (range 30 to 60 mL) as a single dose;
  • may repeat as necessary; with multiple injections, do not exceed a total volume of 250 mL. May be combined with selective coronary arteriography.

• Selective coronary arteriography:

  • Iohexol 350: 5 mL (range 3 to 14 mL) per injection;
  • with multiple injections, do not exceed a total volume of 250 mL.

• Aortic root and arch studies:

  • Iohexol 350 (used alone): 50 mL (range: 20 to 75 mL)

• Aortography and selective visceral arteriography:

  • Iohexol 300 or 350 (may repeat up to a maximum total of 290 mL [iohexol 300] or 250 mL [iohexol 350]):
    • Aorta: 50 to 80 mL
    • Major branches, including celiac and mesenteric arteries: 30 to 60 mL
    • Renal arteries: 5 to 15 mL

• Cerebral arteriography: Iohexol 300:

  • Common carotid artery: 6 to 12 mL
  • Internal carotid artery: 8 to 10 mL
  • External carotid artery: 6 to 9 mL
  • Vertebral artery: 6 to 10 mL

• Contrast-enhanced CT:

  • Head imaging by injection:

    • Iohexol 300: 70 to 150 mL (21 to 45 gI)
    • Iohexol 350: 80 mL (28 gI)

  • Head imaging by infusion:

    • Iohexol 240: 120 to 250 mL (29 to 60 gI)

  • Body imaging by injection:

    • Iohexol 300: 50 to 200 mL (15 to 60 gI)
    • Iohexol 350: 60 to 100 mL (21 to 35 gI)

  • Digital subtraction angiography:

    • IV: Iohexol 350: 30 to 50 mL (using a pressure injector; rate: 7.5 to 30 mL/second); 3 or more injections may be required; maximum total dose: 250 mL.

• Intra-arterial: Iohexol 140:

  • • Aorta: 20 to 45 mL (rate: 8 to 20 mL/second)
    • Carotid: 5 to 10 mL (rate: 3 to 6 mL/second)
    • Femoral: 9 to 20 mL (rate: 3 to 6 mL/second)
    • Vertebral: 4 to 10 mL (rate: 2 to 8 mL/second)
    • Renal: 6 to 12 mL (rate: 3 to 6 mL/second)
    • Other aorta branches (subclavian, axillary, innominate and iliac): 8 to 25 mL (rate: 3 to 10 mL/second)

• Peripheral angiography:

  • Aortofemoral runoffs:

    • Iohexol 300: 30 to 90 mL
    • Iohexol 350: 20 to 70 mL

  • Selective arteriograms (femoral/iliac):

    • Iohexol 300: 10 to 60 mL
    • Iohexol 350: 10 to 30 mL

  • Venography/phlebography (per leg):

    • Iohexol 240: 20 to 150 mL
    • Iohexol 300: 40 to 100 mL

  • Excretory urography:

    • Iohexol 300 or 350: 0.6 to 1.2 mL/kg

radiopaque (Iohexol) use in body cavity imaging (Ora):

Note: gI = grams of iodine; mgI = mg of iodine.

Contrast-enhanced abdominal CT:

• Oral: Iohexol 240, 300, and 350 diluted to 6 to 12 mgI/mL or iohexol 9 and 12: 500 to 1,000 mL (use smaller volumes for higher concentrations); may administer all at once or over a period of up to 45 minutes
• IV (in conjunction with dilute oral iohexol): Iohexol 300: 100 to 150 mL (administered up to 40 minutes after consumption of oral iohexol)

Contrast-enhanced abdomen and pelvis CT:

• Oral (Oraltag): 500 mL to 1,000 mL administered 20 to 60 minutes before imaging; maximum total dose: 9 gI

Gastrointestinal tract examination:

• Oral: Iohexol 350 (undiluted): 50 to 100 mL (depending on patient size and the nature of the exam)

Radiopaque (Iohexol) use in Arthrography:

Note: Lower volumes recommended for double-contrast examinations; higher volumes recommended for single-contrast examinations.

• Knee joint:

  • Iohexol 240 or 300: 5 to 15 mL
  • Iohexol 350: 5 to 10 mL

• Shoulder joint:

  • Iohexol 240: 3 mL
  • Iohexol 300: 10 mL

• Temporomandibular joint:

  • Iohexol 300: 0.5 to 1 mL

• Endoscopic retrograde pancreatography, cholangiopancreatography:

  • Iohexol 240: 10 to 50 mL

• Hysterosalpingography:

  • Iohexol 240 or 300: 15 to 20 mL

• Herniography:

  • Iohexol 240: 50 mL

IohexolIohexol dose in childrens:

• Note:
  • Concentration, volume, and rate may depend on the equipment, condition of the injected vessel, size/condition of the patient, and imaging technique used.
  • Refer to prescribing information for detailed dosing and administration information.

Intrathecal imaging:

• Myelography (lumbar, thoracic, cervical, and total columnar): Intrathecal: Iohexol 180 mgI/mL (Omnipaque 180):

  • 0 to <3 months: 2 to 4 mL (0.36 to 0.72 gI)
  • 3 months to <3 years: 4 to 8 mL (0.72 to 1.44 gI)
  • 3 to <7 years: 5 to 10 mL (0.9 to 1.8 gI)
  • 7 to <13 years: 5 to 12 mL (0.9 to 2.16 gI)
  • 13 to 18 years: 6 to 15 mL (1.08 to 2.7 gI)

• For a single myelographic procedure:

  • Do not exceed a concentration of 180 mgI/mL or total dose of iodine 2,700 mg. If a repeat procedure is required, wait at least 48 hours (5 to 7 days is preferred).

Iohexol (radiopaque) use for Intravascular imaging:

Note: Method of administration variable determined by the imaging technique.

• Ventriculography:

  • Infants, Children, and Adolescents:

    • Iohexol 300 mgI/mL (Omnipaque 300): Injection:

      • 1.75 mL/kg; range: 1.5 to 2 mL/kg; if multiple injections are used, then maximum total dose: 5 mL/kg not to exceed a total volume of 291 mL

    • Iohexol 350 mgI/mL (Omnipaque 350):

      • Injection: 1.25 mL/kg; range: 1 to 1.5 mL/kg; if multiple injections are used, then maximum total dose: 5 mL/kg not to exceed a total volume of 250 mL

• Pulmonary angiography:

  • Infants, Children, and Adolescents:
    • Iohexol 350 mgI/mL (Omnipaque 350): Injection: 1 mL/kg

• Combined angiocardiographic procedures:

  • Infants, Children, and Adolescents: Maximum total dose for all procedures:

    • Iohexol 300 mgI/mL (Omnipaque 300):

      • Total volume of doses: 6 mL/kg not to exceed a volume of 291 mL

    • Iohexol 350 mgI/mL (Omnipaque 350):

      • Total volume of doses: 5 mL/kg not to exceed a volume of 250 mL

• Aortography (aortic root, aortic arch, ascending, and descending aorta):

  • Infants, Children, and Adolescents: Iohexol 350 mgI/mL (Omnipaque 350): Injection:
    • Usual dose: 1 mL/kg; maximum total dose: 5 mL/kg not to exceed a total volume of 250 mL

• Contrast-enhanced CT head imaging:

  • Infants, Children, and Adolescents:
    • Iohexol 240 mgI/mL (Omnipaque 240) or iohexol 300 mgI/mL (Omnipaque 300):
      • Injection: 1 to 2 mL/kg;
      • The maximum dose, product dependent:
      • Omnipaque 240: 28 gI/dose or
      • Omnipaque 300: 35 gI/dose

• Excretory urography:

  • Infants, Children, and Adolescents:
    • Iohexol 300 mgI/mL (Omnipaque 300): Injection:
      • Usual dose: 1 to 1.5 mL/kg;
      • range: 0.5 to 3 mL/kg;
      • maximum total dose: 3 mL/kg total

Iohexol (radiopaque) use in body cavity imaging (Oral):

• Pass-through gastrointestinal examination:

Note: When administered rectally, larger volumes may be used.

• • <3 months:
    • Iohexol 180 mgI/mL (Omnipaque 180), undiluted: Oral, Rectal: 5 to 30 mL
  • 3 months to 3 years:
    • Iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300), undiluted: Oral, Rectal: Up to 60 mL
  • 4 to 10 years:
    • Iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300), undiluted: Oral, Rectal: Up to 80 mL
  • >10 years and Adolescents:
    • Iohexol 180 mgI/mL, 240 mgI/mL, or 300 mgI/mL (Omnipaque 180, 240, or 300), undiluted: Oral, Rectal: Up to 100 mL

• Contrast enhanced pelvis CT:

  • Infants and Children <3 years:
    • Iohexol 9 mgI/mL (Oraltag): Oral: 120 mL to 300 mL (depending on size of patient) administered 20 to 60 minutes before imaging;
    • maximum total iodine dose: 4.5 gI (500 mL) total
  • 3 to 18 years:
    • Iohexol 9 mgI/mL (Oraltag): Oral: 280 mL to 750 mL (depending on size of patient) administered 20 to 60 minutes before imaging;
    • maximum total iodine dose: 9 gI (1,000 mL) total

• Contrast enhanced abdomen CT:

  • Oraltag:

    • Infants and Children <3 years:
      • Iohexol 9 mgI/mL (Oraltag): Oral: 120 mL to 300 mL (depending on size of patient) administered 20 to 60 minutes before imaging;
      • maximum total iodine dose: 4.5 gI (500 mL) total 3 to 18 years:
      • Iohexol 9 mgI/mL (Oraltag): Oral: 280 mL to 750 mL (depending on size of patient) administered 20 to 60 minutes before imaging;
      • maximum total iodine dose: 9 gI (1,000 mL) total

  • Omnipaque:

    • Infants, Children, and Adolescents:
    • Diluted Iohexol 9 to 21 mgI/mL (Omnipaque):
      • Oral: 180 to 750 mL; use smaller volumes for higher concentrations;
      • may administer all at once or over 30 to 45 minutes;
      • maximum total iodine dose is age dependent: <3 years: 5 gI total; 3 to 18 years: 10 gI total
    • Diluted Iohexol 240 or 300 mgI/mL (Omnipaque 240 or 300):
      • IV: 2 mL/kg; range: 1 to 2 mL/kg;
      • maximum total IV dose: 3 mL/kg total;
      • use in combination with oral diluted iohexol and administer ~30 to 60 minutes after oral diluted iohexol dose

• Voiding cystourethrography (VCU):

  • Iohexol diluted to 50 to 100 mgI/mL (Omnipaque): Intraurethral:
    • Use a volume sufficient to fill the bladder;
    • dependent on patient age and size; usual volume ranges from 50 to 300 mL at a concentration of 100 mgI/mL or 50 to 600 mL at a concentration of 50 mgI/mL

Iohexol (radiopaque) Pregnancy Risk Category: B

• Iohexol passes the placental barrier
• The theory that free iodide could adversely affect the foetus is a reason to avoid its use.

Use of Iohexol while breastfeeding

• Breast milk contains Iohexol.
• Breastfeeding may continue after the use of iodinated contrast agent is overdue due to the low expected excretion and low absorption rates from infants' GI tract.
• Theoretically speaking, milk's taste could be affected if it contains contrast media.
• Women who choose to temporarily stop breastfeeding can express breast milk or discard it from one breast for a period of between 10 and 24 hours after administration of contrast media.
• They can store and pump milk before the procedure, then bottle-feed the milk stored during that time.
• According to the manufacturer breastfeeding during therapy is a decision that should be made after considering the risks to infants and the benefits to mothers.

Iohexol (radiopaque) Dose in Kidney Disease:

• There are no dosage adjustments provided in the drug manufacturer's labeling.
• Use with caution and use the lowest dose necessary.

Iohexol (radiopaque) Dose in Liver disease:

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

Common Side Effects of Iohexol (radiopaque):

• Cardiovascular:

  • Cardiac Arrhythmia

• Central Nervous System:

  • Pain
  • Sensation Of Pressure
  • Headache
  • Localized Warm Feeling

• Gastrointestinal:

  • Diarrhea
  • Nausea
  • Vomiting

• Neuromuscular & Skeletal:

  • Leg Pain

• Ophthalmic:

  • Vision Disturbance
  • Blurred Vision

• Miscellaneous:

  • Swelling

Less Common Side Effects of Iohexol (radiopaque):

• Cardiovascular:

  • Angina Pectoris
  • Hypotension
  • Transient Ischemic Attacks
  • Abdominal Distress
  • Bradycardia
  • Chest Pain
  • Hypertension
  • Syncope
  • Tachycardia

• Central Nervous System:

  • Drowsiness
  • Dizziness
  • Malaise
  • Myasthenia
  • Vertigo

• Dermatologic:

  • Urticaria

• Gastrointestinal:

  • Flatulence
  • Abdominal Pain
  • Dysgeusia

• Local:

  • Hematoma At Injection Site

• Neuromuscular & Skeletal:

  • Back Pain
  • Neck Pain
  • Stiffness
  • Tremor

• Ophthalmic:

  • Blurred vision

• Miscellaneous:

  • Fever
  • Sialadenitis

Side effects of radiopaque (Iohexol) (frequency not defined)

• Central nervous system:

  • Seizure

• Hypersensitivity:

  • Anaphylactoid reaction
  • Anaphylaxis
  • Hypersensitivity reaction

• Respiratory:

  • Bronchospasm

• Miscellaneous:

  • Sialadenitis

Contraindications to Iohexol (radiopaque):

• Hypersensitivity to iohexol and any component of the formulation.
• Clinically significant impairments of renal and hepatic function
• Intrathecal
  • Intrathecal use of Iohexol 140 or 350 is not recommended.
• Oral solution (9-12):
  • Contraindicated for parenteral use

Warnings and precautions

• Cardiovascular events

  • Parenteral iohexol administration has been associated with life-threatening or fatal cardiovascular events (eg, hypotension or shock, cardiac arrest). Fatal events are rare but can occur within 5-10 minutes of administration.
  • The most aggravating factor is cardiovascular disease.
  • Cardiac decompensation and serious arrhythmias can occur during ventriculography or coronary arteriography.
  • Patients with heart failure should receive the lowest dose. During administration, trained personnel and emergency resuscitation equipment should be readily available.
  • For severe reactions to the heart, monitor all patients.

• Dermatological effects

  • From 1 hour after administration, severe cutaneous adverse reactions have been reported (including Stevens Johnson syndrome [SJS], toxic epidermal necrlysis [TEN], acute exanthematous pustulsis [AGEP], drug response with eosinophilia or systemic symptoms [DRESS]).
  • Repeat administration may result in a greater severity of the reaction and a shorter time for onset.
  • Patients who have had a history of severe cutaneous reactions to iohexol should be avoided

• Extravasation:

  • It could be a vesicant (higher volumes and/or osmolol contrast are associated with a greater risk);
  • Before and during administration, ensure that the needle/ catheter/line is correctly placed.
  • Monitor infusion site.
  • Avoid infiltration
  • Iohexol 140 and 180 have osmolalities that are 1.1 to 3x higher than plasma.
  • Extravasation can lead to tissue necrosis or compartment syndrome in patients with severe arterial and venous disease.

• Hypersensitivity

  • Iohexol can cause severe or fatal hypersensitivity reactions including anaphylaxis.
  • There have been several manifestations, including angioedema and shock, as well as laryngospasm and bronchospasm.
  • The most severe reactions occur within 3 minutes of injection. However, reactions can be delayed up to hours.
  • Patients with known hypersensitivity, such as bronchial asthma, medication allergies, or other hypersensitivities, are at greater risk of developing hypersensitivity.
  • Although it does not prevent life-threatening reactions, medication with antihistamines and corticosteroids can reduce their severity.
  • Before administering, obtain allergy and hypersensitivity information.
  • Before administering iohexol, it is important to have trained personnel and emergency resuscitation equipment.
  • Hypersensitivity reactions should be monitored in all patients.

• Nephrotoxicity:

  • After parenteral administration of iohexol, acute kidney injury or renal failure may occur.
  • Preexisting renal impairment, diabetes mellitus and congestive heart disease are all risk factors.
  • Patients with impaired renal function should be given the lowest possible dose.
  • Hydrate patients properly before and after parenteral Iohexol administration.
  • Do not use diuretics, laxatives or prepare for dehydration before iohexol administration.

• Events that are thromboembolic:

  • Both ionic as well as nonionic contrast media have been implicated in serious, but rarely fatal, thromboembolic events that can cause MI and stroke.
  • Contrast media containing ionic iodinated contrast media can inhibit blood coagulation more than nonionic media.
  • To minimize risk, use precise intravascular administration techniques during angiograms.
  • Clotting can be caused by in vitro blood remaining in contact with nonionic contrast media.
  • Plastic syringes can be used in place of glass to reduce the risk of in vitro Clotting.
  • Avoid angiocardiography for patients with homocystinuria due to the possibility of embolism/thrombosis.

• Hyperthyroidism:

  • Patients with hyperthyroidism, or with an independent thyroid nodule, have experienced a thyroid storm after intravascular administrations of iodinated contrast medium.
  • evaluate risk.

• Hypothyroidism:

  • Thyroid function tests that indicate hypothyroidism (or transient thyroid suppression) have been reported in both pediatric and adult patients, including infants.
  • Hypothyroidism was treated in some cases.

• Pheochromocytoma:

  • After the use of iodinated contrast agent in pheochromocytoma, hypertensive crises have been reported.
  • Patients with pheochromocytoma (known, suspected) should be used with caution.
  • For intravascular administration, reduce the amount of contrast agent and monitor blood pressure throughout the procedure.
  • It is important to have access to therapy for hypertension.

• Seizures:

  • Patients with epilepsy history should be cautious.
  • It is important to continue antiepileptic treatment.
  • Patients with a history of seizure should consider prophylactic anticonvulsant treatment.
  • CNS-acting agents, primarily those which lower seizure threshold (eg, phenothiazines, MAO inhibitors, tricyclic antidepressants, SSRIs), should be discontinued 24 to 72 hours prior to intrathecal use and not resumed for 24 hours post-procedure.
  • Major motor seizures involving nonionic myelographic media can be associated with one or more the following situations (avoid this situation).
    • Deviations from the recommended procedures or myelographic management
    • Use in epilepsy patients who have had epilepsy before.
    • overdose;
    • The intracranial entry and premature diffusion of high medium concentrations;
    • Prescription of antinausea drugs such as phenothiazine or neuroleptic drugs;
    • Failure to maintain head height during and after the procedure;
    • Excessive and active patient movement/straining.

• Sickle cell disease:

  • Take care when treating sickle cells disease. Iodinated contrast agents can cause sickling in patients who are homozygous for the disease.
  • Hydrate patients before and after radiopaque administration
  • If the information required for imaging cannot be obtained using other imaging methods, iohexol should only be used.

Monitoring parameters (Iohexol, radiopaque):

• Monitor blood pressure if pheochromocytoma or catecholamine-secreting paraganglioma is suspected.
• Monitor infusion site for extravasation during IV administration;
• monitor for signs/symptoms of hypersensitivity reactions and cardiovascular reactions

How to administer Iohexol (radiopaque)?

• Hydrate well prior to and following administration.

• Intravascular:

  • Draw into the syringe immediately prior to administration.
  • Intravenous doses should be at body temperature or room temperature prior to administration.
  • In angiography, use meticulous intravascular administration technique to minimize thrombotic events including the use of plastic syringes, frequent catheter flushing, and close attention to catheter and guidewire manipulation.
  • After administering large individual volumes (ie, for ventriculography or aortography), wait for some time between each injection to allow possible hemodynamic disturbances to subside.
  • Do not mix with other medications;
  • do not administer in the same line containing other medications or parenteral nutrition. Iohexol 300 and 350 (bulk) may be administered simultaneously with saline when utilizing an automated contrast injection system.
  • It may be a vesicant (higher osmolar contrast and/or higher volumes are associated with a higher risk);
  • ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

• Extravasation management:

  • In case extravasation occurs, immediately.
  • Discontinue infusion and disconnect;
  • remove needle/cannula and elevate extremity.
  • Aspiration of extravasated contrast media is not suggested.
  • 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;
  • other sources suggest its use in extravasation management.

If using hyaluronidase:

• Intradermal or SubQ:

  • Inject a total of 1 to 1.7 mL (15 units/mL) as Five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into sites of extravasation at the leading edge in a clockwise manner or injection of a total of FIVE mL (150 units/mL) as 5 separate 1 mL injections around the extravasation site has also been used successfully.

• Intrathecal administration:

  • Draw into the syringe immediately prior to administration.
  • Intrathecal doses should be administered slowly over 1 to 2 minutes (to avoid excessive mixing with CSF) through a lumbar or cervical needle under fluoroscopic control.
  • Note: Use caution in product selection. Use iohexol 180, 240, or 300 only. Iohexol 140 and 350 are not made for intrathecal use.
  • Discontinue neuroleptic medications (including phenothiazines) at least 48 hours before the procedure.
  • May maintain a normal diet up to 2 hours before the procedure.
  • Ensure hydration fluids up to the procedure (hydrate well prior to and following administration).
  • During the procedure, when positioning keep the patient's head elevated above the highest level of the spine;
  • Do not lower the head of the table more than 15° in moving contrast medium cranially; consider a lateral position (administration and medium movement) in patients with lordosis;
  • to maintain as a bolus, move medium very slowly to the distal area;
  • avoid intracranial entry of a bolus;
  • avoid early and high cephalad medium dispersion;
  • avoid abrupt or active patient movement.
  • After the procedure, raise the head of the stretcher to at least 30° prior to transferring patient on to it;
  • move the patient slowly, maintaining a head-up position;
  • before moving patient to a bed, raise the head to 30° to 45°;
  • advise patient to remain still in bed, in a sitting or semi-sitting position, at least for the first few hours;
  • observe closely for at least 12 hours; encourage oral fluids/diet as tolerated;
  • if nausea and vomiting occur, do not use phenothiazines for management of nausea/vomiting;
  • utilize prompt fluid replacement in the event of nausea/vomiting to prevent dehydration.

Oral:

• Omnipaque:
  • Large volumes of the dilute oral solution may be administered all at once or over up to 45 minutes (if difficult to consume the entire volume).
• Oraltag:
  • If the patient has problems consuming the required volume, a higher concentration of the solution (up to 21 mg/mL) can be made and a smaller volume administered. Administer 20 to 60 minutes before imaging.

Mechanism of action of Iohexol (radiopaque):

• Radiographic visualization is possible by opacifying vessels and anatomical structures along the flow path of the contrast media.

Duration:

• CNS: ~30 minutes following intrathecal administration, 60 minutes following intravenous administration
• Serum: 15 to 120 seconds

Absorption:

• Oral: Poorly absorbed

Metabolism:

• Not significantly metabolized

Protein binding:

• Minimal

Excretion:

• Urine (Intrathecal, Intravascular: ~88% to 90%, as unchanged drug; Oral: <1%)

International Brands of Iohexol:

• Omnipaque
• Omnipaque 240
• Omnipaque 300
• Contrapaque
• Diapac 350
• Hexosure
• Illusof
• Imiro 350
• Iobrix
• Medixol 350
• Omnipak
• Omnipaque
• Radiopaque
• Tomohexol
• Unipak

Iohexol Brand Names in Pakistan: