Iodixanol (Injection)

Overview

Iodixanol belongs to a group of medications known as radiopaque contrast agents. It contains iodine, a substance which absorbs x-rays. It is used to help organs, blood vessels and other non-bony tissues to appear much more clearly on CT scans and x-ray exams. It is typically used to help diagnose various disorders of the blood vessels, brain, kidneys, heart and other internal organs.

This medication is available under the brand name Visapique and is currently the only iso-osmolar contrast agent available. It has the same osmolality as blood (290 mOsm per kg of H20). While it is primarily used to facilitate diagnosis during CT scans and x-rays, it can also be prescribed off-label for a variety of other uses, at the discretion of the prescribing doctor.

Since 2017, Iodixanol has been approved for diagnostic use in coronary computed tomography angiography, or CCTA, to allow healthcare professionals to quickly, easily and accurately diagnose suspected coronary artery disease in patients above the age of 12 years old.

Type Of Medicine

  • Radiopaque contrast agent

Conditions Treated

  • Non-invasive diagnostic evaluations

Side Effects

Like many other medications, Iodixanol can cause some unwanted side effects along with its desired effects. The most commonly reported side effects in patients undergoing treatment with Iodixanol include the following:

  • Chest pain or discomfort
  • Fainting
  • Irregular or fast heartbeat
  • Sweating
  • Nausea
  • Arm, jaw or back pain
  • Heaviness or tightness in the chest

As the patient continues to receive treatment with this medicine as prescribed, some - if not all - of the previously mentioned side effects should begin to lessen. If side effects persist over time or appear to get worse, the patient should inform their doctor or healthcare provider immediately. In some instances, a doctor may be able to recommend ways to alleviate certain side effects.

The majority of patients will only experience minimal side effects while using Iodixanol, if they observe any whatsoever. The drug is designed to help healthcare professionals diagnose serious illnesses of the organs and blood vessels, and as such the benefits of undergoing treatment with it far outweigh the risks of experiencing temporary side effects.

Other side effects, which are experienced less frequently (albeit often enough to mention) include the following:

  • Vomiting
  • Swelling of the face, hands, fingers, lower legs, ankles, or feet
  • Sudden slurring of speech
  • Sudden loss of coordination
  • Stupor
  • Severe or sudden headache
  • Seizures
  • Redness of the face, neck, arms, and occasionally, upper chest
  • Rapid weight gain
  • Noisy breathing
  • Muscle twitching
  • Lethargy
  • Irritability
  • Irregular breathing
  • Hostility
  • Headache
  • Feeling of warmth
  • Fainting
  • Extreme fatigue
  • Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • Dizziness
  • Dilated neck veins
  • Difficulty breathing
  • Depression
  • Decreased urine output
  • Cough
  • Confusion
  • Coma
  • Blurred vision
  • Agitation
  • Itching
  • Skin rash
  • Changes in taste
  • Feeling of movement/spinning sensation
  • Diarrhea
  • Unpleasant aftertaste

The following side effects occur incredibly rarely, to the point where incidence levels are not known:

  • Belching
  • Ringing or buzzing noise in the ears
  • Decreased responsiveness or awareness
  • General feeling of illness or discomfort
  • Loss of hearing
  • Heartburn
  • Hyperventilation
  • Hives and/or welts
  • Indigestions
  • Restlessness
  • Shaking
  • Severe sleepiness
  • Stomach discomfort, pain or upset
  • Anxiety
  • Dry mouth

It is worth noting that Iodixanol can affect the psychology of the patient, which means that they may experience mood swings or depressive episodes. The use of this drug should therefore be taken with caution in patients with a history of mental health conditions including schizophrenia, bipolar disorder and/or depression.

Iodixanol can also affect the coordination of the patient. Patients are therefore advised against driving or operating heavy machinery until it has been observed that they are safe to do so after undergoing treatment with this drug. This is so that the risk of injury to the patient and/or other road users is reduced.

Not all side effects may have been reported. Patients who experience side effects which are not listed on the packaging provided with the medication are advised to consult their doctor and to report their findings to the FDA.

Dosage

It is very important for patients to only be administered with Iodixanol under the supervision of a qualified radiographer. Patients should not receive any more Iodixanol than advised, either in terms of dose size or frequency. In addition to this, patients should not receive any further treatment with this substance if a doctor decides it is no longer safe - even if a supply of Iodixanol remains.

Iodixanol is available in concentrations of 270mgl per mL and 320mgl per mL - it can be used to facilitate several different types of scan or diagnostic test. Standard doses per test and body area are as follows:

Intra-arterial digital subtraction angiography:

  • Carotid arteries - 5 to 8mL (320mgl per mL concentration)
  • Vertebral arteries - 5 to 8 mL (320mgl per mL concentration)
  • Renal arteries - 10 to 25mL (270mgl per mL concentration)
  • Aortal branches - 5 to 30mL (270mgl per mL concentration)
  • Aortofemoral runoffs - 6 to 15mL (320mgl per mL concentration)
  • Peripheral arteries - 3 to 15mL (320mgl per mL concentration)

Computed tomography:

  • Intravenous administration of Iodixanol injection is recommend for computed tomography. For tomography of the head, a bolus infusion of 75 to 150mL of Iodixanol is recommended with 270mgl or 320mgl per mL concentrations. For tomography of the body, a bolus infusion of 100 to 150mL is recommended, again with either concentration of Iodixanol.

Urography:

  • For excretory urography in patients with normal renal function, 1mL per kg Iodixanol to a maximum volume of 100mL is recommended.

Venography:

  • 50 to 100mL of Iodixanol 270mgl/mL concentration is recommended per lower extremity during venography.

Peripheral arteriography:

  • 15 to 30mL of 320mgl per mL concentration of Iodixanol should be administered intra-arterially for scans of the peripheral arteries.

Cerebral arteriography:

  • Carotid arteries: 10 to 14mL (320mgl per mL concentration)
  • Vertebral arteries: 10 to 12mL (320mgl per mL concentration)

Coronary arteriography:

  • Right coronary artery: 3 to 8mL (320mgl per mL concentration)
  • Left coronary artery: 3 to 10mL (320mgl per mL concentration)
  • Left ventricle: 20 to 45mL (320mgl per mL concentration)

Aortography:

  • Aortography: 30 to 70mL (320mgl per mL concentration)
  • Major branches of the aorta: 10 to 70mL (320mgl per mL concentration)
  • Aortofemoral runoffs: 20 to 90mL (320mgl per mL concentration)

Renal arteriography:

  • Renal arteries: 8 to 8mL (320mgl per mL concentration)

While the manufacturer of Iodixanol provides general dosage instructions, it should be reiterated that these are merely guidelines which can be altered by the patient's doctor. Factors discussed between patient and physician will influence dose sizes, as will the age, height, weight and condition of the patient.

Interactions

All drugs have the potential to interact with other drugs or chemicals within the human body. In some cases, interactions can cause one or more medicines to become ineffective in treating the conditions they were combined to alleviate. In other instances, interactions can potentially cause dangerous side effects. Because these risks exist, patients are advised to keep a detailed record of all medications they are currently undergoing treatment with.

The following is a partial list of medicines known to interact negatively with Iodixanol. Patients who are currently undergoing treatment with one or more of these medicines should inform their doctor or healthcare provider prior to undergoing their first course of Iodixanol-based diagnostic therapy:

  • Zoledronic Acid
  • Vancomycin
  • Valdecoxib
  • Valacyclovir
  • Tolmetin
  • Tobramycin
  • Temsirolimus
  • Telavancin
  • Tacrolimus
  • Sulindac
  • Sulfasalazine
  • Streptozocin
  • Streptomycin
  • Sirolimus
  • Salsalate
  • Rofecoxib
  • Polymyxin B
  • Piroxicam
  • Phenylbutazone
  • Pentamidine
  • Penicillamine
  • Pamidronate
  • Oxaprozin
  • Olsalazine
  • Netilmicin
  • Neomycin
  • Naproxen/Sumatriptan
  • Naproxen/Pseudoephedrine
  • Naproxen
  • Nabumetone
  • Methoxyflurane
  • Methotrexate
  • Metformin/Sitagliptin
  • Metformin/Saxagliptin
  • Metformin/Rosiglitazone
  • Metformin/Repaglinide
  • Metformin/Pioglitazone
  • Metformin
  • Mesalamine
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Lithium
  • Linagliptin/Metformin
  • Lansoprazole/Naproxen
  • Ketorolac
  • Ketoprofen
  • Kanamycin
  • Indomethacin
  • Ifosfamide/Mesna
  • Ifosfamide
  • Ibuprofen/Pseudoephedrine
  • Ibuprofen/Phenylephrine
  • Ibuprofen/Oxycodone
  • Ibuprofen
  • Ibandronate
  • Hydrocodone/Ibuprofen
  • Glyburide/Metformin
  • Glipizide/Metformin
  • Gentamicin
  • Gallium Nitrate
  • Foscarnet
  • Flurbiprofen
  • Fenoprofen
  • Famotidine/Ibuprofen
  • Everolimus
  • Etodolac
  • Etidronate
  • Esomeprazole/Naproxen
  • Emtricitabine/Nelfinavir/Tenofovir
  • Emtricitabine/Lopinavir/Ritonavir/Tenofovir
  • Empagliflozin/Metformin
  • Efavirenz/Emtricitabine/Tenofovir
  • Edetate Disodium (Edta)
  • Edetate Calcium Disodium
  • Diphenhydramine/Naproxen
  • Diphenhydramine/Ibuprofen
  • Diflunisal
  • Diclofenac/Misoprostol
  • Diclofenac
  • Deferoxamine
  • Deferasirox
  • Dapagliflozin/Metformin
  • Cyclosporine
  • Colistimethate
  • Clofarabine
  • Cisplatin
  • Cidofovir
  • Chlorpheniramine/Ibuprofen/Pseudoephedrine
  • Celecoxib
  • Capreomycin
  • Canagliflozin/Metformin
  • Bromfenac
  • Balsalazide
  • Baclofen/Flurbiprofen/Lidocaine Topical
  • Bacitracin
  • Amphotericin B Liposomal
  • Amphotericin B Lipid Complex
  • Amphotericin B Cholesteryl Sulfate
  • Amphotericin B
  • Amikacin
  • Alogliptin/Metformin
  • Adefovir
  • Acyclovir

Warnings

Iodixanol is not suitable for use in patients who have recently taken a stool-softening medication. Patients who have eating disorders or those who have not eaten properly recently may not be suitable for therapy with Iodixanol.

Patients who have previously had any type of allergic reaction to Iodixanol or any other contrast agent are advised to consult their doctor or healthcare provider prior to undergoing treatment with this medication.

To ensure treatment with Iodixanol is safe, patients who have ever experienced the following conditions or diseases should inform their doctor prior to undergoing treatment:

Patients who feel any swelling, burning or pain around the site of the IV needle when the Iodixanol is injected should inform their healthcare provider immediately.

Extra fluids should be taken on board by the patient before and after any radiologic test. This is because Iodixanol can cause the body to become dehydrated, and this can lead to potentially dangerous effects on the kidneys.

Geriatric patients may need to take further special care to avoid becoming dehydrated. In some instances, they may require monitoring in a clinical setting.

Iodixanol can potentially interfere with various medical examinations up to 16 days after treatment. Patients who are booked in for medical tests in the immediate days after treatment with Iodixanol should inform their doctor that they have recently used this medication.

In patients with thyroid cancer, Iodixanol can make radioactive iodine less effective. This effect can last for up to two months and can interfere with radioactive iodine l-131 or l-123. Patients scheduled to undergo treatment with these forms of iodine should inform their doctor if they have received treatment with Iodixanol.

Storage

Iodixanol is typically administered in a clinical setting. The storage and administration of this medicine is therefore the responsibility of the patient's healthcare provider, who should ensure that it is stored, used and disposed of in accordance with FDA guidelines and state law.

Summary

While Iodixanol is a hugely beneficial substance which facilitates radiological diagnosis, it can also pose a risk to patients who do not communicate properly with their doctors and/or healthcare providers. As a radiopaque contrast agent, it allows radiographers to identify any potential illnesses of the organs, blood vessels and non-bony tissues. However, it can also cause several painful and debilitating side effects such as chest pain, nausea, dizziness and anxiety among others. These side effects can impair the day-to-day functioning of the patient and even cause them to end up in perilous situations if the correct precautions are not taken.

Because of this, it is important that the patient is honest and up-front with their doctor about any personal medical issues. There are hundreds of medications which can react adversely with Iodixanol, so it is therefore in the best interests of the patient to provide their doctor with as much information as possible.

When taken correctly, Iodixanol can assist with the diagnosis of internal problems which may have previously gone undetected. In some instances, this can mean identifying an illness early on in its development, allowing for fast and effective treatment before the disease spreads or otherwise becomes untreatable. To achieve this, patient and doctor must work together to ascertain whether Iodixanol is a suitable contrast agent, and at what dose it will be most effective in helping to diagnose any issues the patient may have.