Drug information of Iopamidol

Mechanism of effect

Radiographic visualization achieved through the opacification of vessels and anatomical structures in the path of flow of the contrast media

Pharmacodynamic

Iopamidol is an organic iodine compound and used as a non-ionic water soluble radiographic contrast medium. Iopamidol blocks x-rays as they pass through the body, thereby allowing body structures not containing iodine to be visualized. The degree of opacity produced by iopamidol is directly proportional to the total amount of the iodinated contrast agent in the path of the x-rays. The visualization of body structures is dependent upon the distribution and elimination of iopamidol.

Pharmacokinetics

Absorption : Not Available

Metabolism : Not Available

Half-life : 2 hours

Elimination : Prolonged in renal impairment

Excretion : Urine (80% to 90% unchanged)

Drug indications

ISOVUE (lopamidol Injection) is indicated for angiography throughout the cardiovascular system, including cerebral and peripheral arteriography, coronary arteriography and ventriculography, pediatric angiocardiography, selective visceral arteriography and aortography, peripheral venography (phlebography), and adult and pediatric intravenous excretory urography and intravenous adult and pediatric contrast enhancement of computed tomographic (CECT) head and body imaging .

Dosage

Adult dose:

injectable solution

• 200mg/mL (41%)
• 300mg/mL (61%)

intravenous solution

• 200mg/mL (41%)
• 250mg/mL (51%)
• 300mg/mL (61%)
• 370mg/mL (76%)

Angiography

Cerebral Arteriography

• 300 mg/mL: 8-12 mL intra-arterial, may repeat, not to exceed 90 mL

Peripheral Venography

• 200 mg/mL: 25-150 mL IV per lower extremity; total not to exceed 350 mL

Coronary Arteriography

• 370 mg/mL: 2-10 mL IV; monitor EKG; not to exceed 200 mL

Coronary Ventriculography

• 370 mg/mL: 25-50 mL IV; monitor EKG; not to exceed 200 mL

Selective Visceral Arteriography

• 370 mg/mL: Up to 50 mL IV; not to exceed 225 mL

Selective Visceral Aortography

• 370 mg/mL: Up to 50 mL IV; not to exceed 225 mL

Peripheral Venography

• 200 mg/mL: 25-150 mL; not to exceed 350 mL

Computed Tomography

CECT of the Head

• 250 mg/mL: 130-240 mL IV; not to exceed 240 mL
• Alternatively, 300 mg/mL: 100-200 mL IV; not to exceed 200 mL
• Imaging may be done immediately after completing administration

CECT of the Body

• 250 mg/mL: 130-240 mL IV; not to exceed 240 mL
• Alternatively, 300 mg/mL: 100-200 mL IV; not to exceed 200 mL
• Imaging may be done immediately after completing administration

Urography

Excretory Urography

• 250 mg/mL: 50-100 mL IV OR
• 300 mg/mL: 50 mL IV OR
• 370 mg/mL: 40 mL IV 

Pediatric dose:

injectable solution

• 200mg/mL (41%)
• 300mg/mL (61%)

intravenous solution

• 200mg/mL (41%)
• 250mg/mL (51%)
• 300mg/mL (61%)
• 370mg/mL (76%)

Angiocardiography

For 370 mg/mL:

<2 years: 10-15 mL IV, not to exceed 40 mL total

2-9 years: 15-30 mL IV, not to exceed 50 mL (2-4 years) or 100 mL (5-9 years)

10-18 years: 20-50 mL IV, not to exceed 125 mL

Computed Tomography

CECT of the Head

• 250 mg/mL: 1.2-3.6 mL/kg IV; not to exceed 30 g of iodine
• Alternatively, 300 mg/mL: 1-3 mL/kg IV; not to exceed 30 g of iodine

CECT of the Body

• 250 mg/mL: 1.2-3.6 mL/kg IV; not to exceed 30 g of iodine OR
• 300 mg/mL: 1-3 mL/kg IV; not to exceed 30 g of iodine

Urography

Excretory Urography

• 250 mg/mL: 1.2-3.6 mL/kg IV; not to exceed 30 g of iodine OR
• 300 mg/mL: 1-3 mL/kg IV; not to exceed 30 g of iodine

Drug contraindications

Hypersensitivity to this drug or components , Intrathecal injection concurrently with intrathecal corticosteroid administration (significant bacterial infection

Side effects

flushing , Bradycardia , urticaria , Angina pectoris , Hypotension , Hot flashes , Cyanotic heart disease , Right ventricular abnormalities , Abnormal pulmonary circulation

Interactions

Aldesleukin , Promethazine , Doxepin , Sibutramine , Metoclopramide , Piperazine , Kanamycin , Tapentadol , codeine , Phenylpropanolamine , Dexmethylphenidate , Promazine , Clofarabine , Ibandronate , Netilmicin , Grepafloxacin , Dexfenfluramine , Molindone , Trimeprazine , Asenapine , Olsalazine , Balsalazide , Apalutamide , Nelarabine , Valdecoxib , edetate disodium , Cariprazine , Oxymorphone , Levomilnacipran , Oxaprozin , Gallium Nitrate , Naltrexone and Bupropion , Oxtriphylline , Cefiderocol

1. Agents With Seizure Threshold Lowering Potential: May enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased
2. Aldesleukin: May enhance the potential for allergic or hypersensitivity reactions to Iodinated Contrast Agents.
3. Metformin: Iodinated Contrast Agents may enhance the adverse/toxic effect of Metformin. Renal dysfunction that may be caused by iodinated contrast agents may lead to metformin-associated lactic acidosis

Alerts

• Before examination patients should be well hydrated to prevent contrast associated nephropathy
• Caution in patients with seizures, thromboembolic diseases including IM and stroke, chronic alcoholism, heart failure, hepatorenal insufficiency, hyperthyroidism, multiple myeloma, pheochromocytoma, renal disease, sickle cell disease
• Hypothyroidism and transient thyroid suppression reported
• Severe cutaneous adverse reactions (SCAR) may develop from 1 hour to several weeks after intravascular contrast agent administration; these include Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematouspustulosis (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 therapy to patients with a history of a severe cutaneous adverse reaction to the drug

Points of recommendation

Serious adverse reactions have been reported due to the inadvertent intrathecal administration of iodinated contrast media that are not indicated for intrathecal use.

Pregnancy level

B

Related drugs

Iopromide , iohexol (Omnipaque) , Barium sulfate , Metrizamide , Iodixanol