Mechanism of effect
Diatrizoate is an iodine-containing X-ray contrast agent. Iodine is known to be particular electron-dense and to effectively scatter or stop X-rays. A good contrast agent requires a high density of electron-dense atoms. Therefore, the more iodine, the more "dense" the x-ray effect. Iodine based contrast media are water soluble and harmless to the body. These contrast agents are sold as clear colorless water solutions, the concentration is usually expressed as mg I/ml. Modern iodinated contrast agents can be used almost anywhere in the body. Most often they are used intravenously, but for various purposes they can also be used intraarterially, intrathecally (the spine) and intraabdominally - just about any body cavity or potential space.
Pharmacodynamic
Depending on how the radiopaque agent is given, it localizes or builds up in certain areas of the body. The resulting high level of iodine allows the x-rays to make a "picture" of the area. The areas of the body in which the radiopaque agent localizes will appear white on the x-ray film. This creates the needed distinction, or contrast, between one organ and other tissues. The contrast will help the doctor see any special conditions that may exist in that organ or part of the body.
Pharmacokinetics
Protein binding: Poor binding to albumin
Half-life: 100 min
Excretion: Urine; feces
Drug indications
Used alone or in combination for a wide variety of diagnostic imaging methods, including angiography, urography, cholangiography, computed tomography, hysterosalpingography, and retrograde pyelography. It can be used for imaging the gastrointestinal tract in patients allergic to barium.
Dosage
Adult
Aortography
15-40 mL IV or intra-arterially once; may repeat if necessary; not to exceed 160 mL
Contrast Enhancement of CT Brain Imaging
Tumors or non-neoplastic conditions: 1.3 mL/kg IV; not to exceed 125 mL; adequately hydrate patient prior to procedure
Excretory Urography
20 mL IV; may administer 40 mL dose if inadequate visualization occurs
Digital Subraction Angiography
20-60 mL IV; may repeat PRN; hydrate patient adequately prior to procedure
Peripheral Arteriography
Visualization of entire extremity: 20-40 mL
Visualization of lower or uper half of extremity: 10-20 mL
Radiographic Exam of GI Tract Segments
Oral: 30-90 mL
Rectal enema: Dilute 240 mL in 1000 mL tap water
Selective Renal Arteriography
5-10 mL; may repeat PRN; not to exceed 60 mL
Tomography
Dilute 25-77 mL in 1000 mL tap water; administer 240 mL of this solution PO 15-30 min prior to imaging
Pediatric
Angiocardiography
Infants and children (<5 years): 10-20 mL
5-10 years: 20-30 mL; not to exceed 100 mL
Aortography
<16 years: Safety & efficacy not established
>16 years: 15-40 mL IV or intra-arterially once; may repeat if necessary; not to exceed 160 mL
Excretory Urography
<6 months: 4 mL
6-12 months: 6 mL
1-2 years: 8 mL
2-5 years: 10 mL
5-7 years: 12 mL
8-10 years: 14 mL
11-15 years: 16 mL
Radiographic Exam of GI Tract Segments
<5 years: 30 mL PO; may dilute 1:1 in a recommended liquid; alternatively may administer enema by diluting in tab water at 1:5 ration
5-10 years: 60 mL PO; may dilute 1:1 in a recommended liquid; alternatively may administer enema by diluting 90 mL in 500 mL tap water
Side effects
Oral/Rectal
Diarrhea , Urticaria , Dyspnea , Anaphylaxis , Hypoxia , Erythema , Tachyarrhythmia , Nausea , Vomiting
Injection
Arterial thrombosis, cardiac arrhythmia, brachial plexopathy, chest pain, choking sensation, ECG changes, edema, flushing, hypertension, hypotension, myocardial infarction, venous pain, ventricular fibrillation, chills, headache, pallor, nausea, hypothyroidism, pruritus, skin rash, urticaria, neutropenia, anaphylactoid reaction, burning sensation at injection site, muscle cramps, sneezing, wheezing, conjunctival petechiae, lacrimation
Interactions
Acyclovir , Amphotericin B , Amikacin , Adefovir , Streptozocin , Streptomycin , Oxaprozin , Gallium Nitrate , etodolac , Etidronate , Colistimethate , Moxetumomab pasudotox , edetate disodium , Edetate Calcium Disodium , Bromfenac , Temsirolimus , Nabumetone , inotersen , Balsalazide , Plazomicin , Foscarnet , Telavancin , Rofecoxib , Celecoxib , Capreomycin , Sulindac , Ibandronate , Netilmicin , cobicistat , Ketoprofen , fenoprofen , Salsalate , Diflunisal , Efavirenz , Deferoxamine , Phenylbutazone , flurbiprofen , Tobramycin , Bacitracin , Neomycin , Clofarabine , Vancomycin , Kanamycin , Pentamidine , lithium , Methoxyflurane , Cidofovir , Lamivudine , Methotrexate , Mefenamic acid , Meloxicam , Ketorolac , Valacyclovir , Diclofenac , Zoledronic acid , Sulfasalazine , Sirolimus , Cisplatin , Cyclosporine , Piroxicam , Tacrolimus , Tolmetin , Gentamicin , Deferasirox , Penicillamine , Everolimus , Ibuprofen , Ifosfamide , Indomethacin , Pamidronate , Polymyxin b sulfateAlerts
Personal or family history of bronchial asthma, significant allergies, or previous reactions to contrast agents
Iodine sensitivity
Aspiration may occur following oral administration that may result in serious complications
May cause hypovolemia and hypotension due to fluid loss from hypertonic oral/rectal contrast solutions
Serious thromboembolic events including myocardial infarction and stroke reported with intravascular administration
Severe cutaneous adverse reactions (SCAR) may develop from 1 hour to several weeks after intravascular contrast agent administration; these reactions include Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS); reaction severity may increase and time to onset may decrease with repeat administration of contrast agent; prophylactic medications may not prevent or mitigate severe cutaneous adverse reactions; avoid administering MD-76R to patients with a history of a severe cutaneous adverse reaction to MD-76R
Black Box Warnings
Indicated for retrograde pyelography, CT, and angiography
Not for intrathecal use
Points of recommendation
- Thyroid problems have happened after use of diatrizoate meglumine and diatrizoate sodium. Some people had to be treated for these thyroid problems.
- A very bad and sometimes deadly reaction has happened with diatrizoate meglumine and diatrizoate sodium. Most of the time, this reaction has signs like fever, rash, or swollen glands with problems in body organs like the liver, kidney, blood, heart, muscles and joints, or lungs. Talk with the doctor.
- If you have sickle cell disease, talk with your doctor.
- This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take diatrizoate meglumine and diatrizoate sodium.
- Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using diatrizoate meglumine and diatrizoate sodium while you are pregnant.
- Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.
- You will need to be sure that you are not dehydrated before getting diatrizoate meglumine and diatrizoate sodium. Check with your doctor to see if you need to drink extra fluids before getting diatrizoate meglumine and diatrizoate sodium.
- Drink lots of noncaffeine liquids after using diatrizoate meglumine and diatrizoate sodium unless told to drink less liquid by your doctor.
Pregnancy level
BCategory: B (oral); C (parenteral)
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