Cholecystographic Agent (Oral)

Patients consume a cholecystographic agent prior to receiving x-rays to increase the contrast of the x-ray, making it easier to determine what it depicts.

Overview:

Cholecystographic agents are used to help diagnose certain medical conditions. Cholecystographic agents are part of the radiopaque agents family, which contain iodide and affect x-rays. Iodide concentrations appear as white in x-rays, which raise the contrast and make it easier to examine the state of different organs, enabling doctors to give more accurate diagnoses. Since the development of cholecystographic agents, more advanced tests have been developed. In some cases, ultrasounds or CT scans may be preferable to cholecystography.

Delivered orally, cholecystographic agents are used to better examine the biliary tract and the gallbladder, among other areas.

Cholecystographic agents are available under a variety of brand names, including:

  • Bar-Test
  • Hypaque Sodium (Amersham Health Inc.)
  • Entero VU
  • Varibar (Bracco Diagnostics Inc.)

Conditions Treated:

Not applicable

Type of Medicine:

  • Radiopaque agent

Side Effects:

Cholecystographic agents can cause a wide variety of different side effects, some of which can be be serious. This has contributed to the development of alternatives to cholecystography, since many patients are unhappy suffering these unpleasant side effects just to make their x-rays more effective. Patients who begin to experience any of the following symptoms should notify their doctor immediately. Medical treatment may be necessary.

  • Itching
  • Rash
  • Hives
  • Unusual or unexplained bleeding
  • Rogue bruising

Not all side effects are necessarily serious. Cholecystographic agents can be hard on the body. Some of the symptoms patients experience after taking them can be explained simply by the body trying to process the new medication. Patients who experience any of the following side effects should contact their doctor to determine the best way to mitigate or lessen any unpleasant side effects.

  • Diarrhea
  • Nausea
  • Vomiting
  • Abdominal or stomach pain
  • Difficult or painful urination
  • Unusually frequent urges to urinate
  • Headache
  • Heartburn
  • Dizziness

This is not necessarily a complete list of side effects. Patients who begin to experience new effects or worsening symptoms after taking a cholecystographic agent should contact their doctor immediately. Patients can report new side effects to the FDA at 1 800 FDA 1088 or on the web at www.fda.gov/medwatch.

Dosage:

Cholecystographic agents should be taken the night before the patient plans to be x-rayed. Patients should take the cholecystographic agent after their evening meal with a glass of water. After taking the cholecystographic agent patients should not eat or drink anything until their x-ray has been completed. The exception to this rule is water, which patients are encouraged to consume a healthy amount of, per best medical practice. In addition to not eating, patients are usually asked to abstain from chewing gum or smoking.

Patients who regularly take medications in the morning should consult with their doctor on whether or not they should take it the morning before their x-ray. In some cases, the benefit of the medicine is outweighed by the possibility of it interfering with the x-ray.

Depending on the purpose of the x-rays, the doctor may ask that the patient follow a certain diet (typically a low fat diet) or even an enema prior to the x-ray. Patients should do their best to comply with these requests.

Cholecystographic agents are available in a variety of different forms, including creams, tablets, capsules, and solutions in suspension.

Often times, patients who choose the capsule or tablet forms of the cholecystographic agent will take as many as six pills, sometimes taken hourly. A patient should follow their doctor’s directions to ensure they properly take the cholecystographic agent.

Patients should rely on their doctor to give them the directions for the proper dosage and procedure for cholecystographic agents. Patients should ensure that they fully understand the dosage and dosage procedure before they attempt to take any cholecystographic agent. Patients who do not understand how or how much of the cholecystographic agent to take should contact their doctor for clarification.

Interactions:

Drugs can interact in the body in a wide variety of unique ways. Patients who are about to take a cholecystographic agent should make sure they disclose a full list of all medications, drugs and supplements to their doctor before they do so.

Patients should be aware that cholecystographic agents can affect the outcomes of thyroid tests. Patients who regularly take thyroid tests or might need to take a thyroid test may want to consider alternatives to cholecystographic agents. Patients should ensure that their doctor is aware that they have taken cholecystographic agents if they must take a thyroid test. The results of thyroid tests can be affected even months after taking cholecystographic agents.

Cholecystographic agents can include different types of acids which can interact with drugs in different ways. Patients should consult with their doctor to determine which type of cholecystographic agent is safe for them to take.

This is not necessarily a complete list of interactions. Patients should look to their doctor to identify any possible interactions between the medicines, drugs, or supplements they are currently taking and any medications, drugs, or supplements they plan to take.

Warnings:

Patients who have had allergic reactions to any radiopaque agent or iodide before should not take any cholecystographic agents. Severe allergic reactions are possible. Patients should be vigilant for signs of an allergic reaction, which can include:

  • Anaphylaxis
  • Hives
  • Rash
  • Swelling of the throat and or neck

Additionally, patients who react negatively to penicillin have an increased risk of allergic reaction to cholecystographic agents.

The effectiveness of cholecystographic agents can be impacted by a variety of different medical conditions. To ensure safety and effectiveness, patients should inform their doctor of any and all medical conditions they suffer from.

The following medical conditions are known to interact negatively with cholecystographic agents:

  • Asthma, hay fever, or various other allergenic effects on the lungs
  • Heart disease (may cause low blood pressure, depressed heart rate, or other problems)
  • Kidney disease
  • Liver disease (patients with severe kidney disease who take cholecystographic agents may suffer renal impairment)
  • Overactive thyroid (may exacerbate symptoms, such as heart palpitations, nervousness, fatigue, sweating, and muscle weakness)

Cholecystographic agents can sometimes contain different types of acids, which might affect different medical conditions. Patients should consult with their doctor to ensure that the type of cholecystographic agent is safe for them to take.

The effects of cholecystographic agents have not been properly studied in pediatric or geriatric groups of patients. Although there is no evidence to suggest that a cholecystographic agent will produce different effects in a pediatric or geriatric patient, it is not possible to determine whether or not the drug is safe for those populations.

Cholecystographic agents have not been properly studied in pregnant women and thus cannot be deemed safe. In rare occasions, some radiopaque agents have caused hypothyroidism in babies when administered to the mother late in the pregnancy.

In general, x-rays of pregnant women are inadvisable, as they expose the fetus to radiation while it is in an extremely vulnerable state. Pregnant patients who require x-rays should consult with their doctor to determine the best way to handle the situation.

Cholecystographic agents are known to be excreted through breast milk. However, there is insufficient evidence to date to determine whether or not it is harmful to the infant.

Overdose on cholecystographic agents is possible, although unlikely considering cholecystographic agents have almost no capacity for abuse. The symptoms of overdose can include:

  • Severe diarrhea
  • Severe nausea
  • Severe vomiting
  • Painful, difficult, or otherwise affected urination

These symptoms are all also side effects of cholecystographic agents. As a result, patients should be vigilant when they are taking cholecystographic agents, ensuring that they are receiving the correct dose. Patients who suspect they may have overdosed should contact their doctor immediately or call poison control at 1 800 222 1222.

Storage:

Cholecystographic agents should be stored at room temperature, away from extreme temperatures or moisture. Shelf life can vary between brands and delivery system.

Cholecystographic agents are usually one time use medications. Patients should safely dispose of any remaining cholecystographic agent after they complete their treatment.

Summary:

Cholecystographic agents are very good at what they do, which is increasing the contrast in patients' x-rays. Unfortunately, these agents are active on the thyroid and can exacerbate some medical conditions, along with causing an unpleasant set of side effects. Patients who are able to should consider alternative scans to x-rays which may be less obtrusive and not require them to ingest any cholecystographic agents.

Patients who must receive x-rays and need to ingest cholecystographic agents should ensure that no potential interactions exist between the cholecystographic agents and any drugs, medications, supplements, or medical conditions they already have. If they do not, the patient should find the drug relatively risk free, even if the treatment is uncomfortable.