Iopamidol (Injection)

Contrast agents are injected into the blood and the iodine creates a contrast to make soft tissues, such as internal organs, visible during certain medical procedures.

Overview

Iopamidol is a contrast agent that uses iodine to create a clearer picture of different body parts during certain medical procedures to diagnose problems with the brain, heart, blood vessels and other internal organs. The iodine absorbs x-rays so that non-body tissues are visible in CT scans, angiography and other x-ray exams to diagnose a variety of problems.

It is used when other medical procedures and tests reveal possible issues. It is commonly used in angiography throughout the cardiovascular system, excretory urography and contrast enhancement of computed tomography of the head and body.

Tell the doctor about any medication you're taking, including over the counter, vitamins and herbal supplements. Making a list to give to the doctor is helpful. To avoid dangerous interactions, also tell your doctor about any medical conditions you have, or whether you have a family history of medical conditions.

Since a healthcare professional administers the injection, there is no dosing schedule, and dosage depends on the patient's age and size, along with what type of procedure is being done. Always report any side effects or delayed reactions to the doctor and drink extra fluids to prevent dehydration.

Remember, there are a lot of risks, possible complications and interactions with other medications and medical conditions to consider, and telling the doctor about these risk factors can help prevent a serious reaction or side effect.

Conditions Diagnosed

  • Heart disease
  • Microvascular disease
  • Blood vessel disease or blockage
  • Cancer, tumors, or lesions
  • Blood clots
  • Internal organ abnormality
  • Kidney and bladder disease
  • Malignancies
  • Arteriovenous malformations
  • Aneurysms
  • Abscesses or cysts

Type Of Medicine

  • Contrast agent with iodine

Side Effects

These are the most common side effects; however, there is a long list of less common and rare side effects. The doctor may give medicines to prevent side effects. Talk to the doctor about all possible side effects and report any unusual symptoms after injection right away. Also, talk to the doctor about possible radiation exposure side effects and any possible active infections.

Common side effects may include:

  • Chest discomfort
  • Irregular heartbeat
  • Hot flashes
  • Flushing
  • Nausea
  • Hives
  • Dizziness
  • Thyroid problems

Iopamidol may cause heart attack, stroke or blood clotting problems during angiography procedures. Some reactions may not occur for 30 to 60 minutes after injection, so careful monitoring is provided in that time period to avoid delayed reactions. Know the signs and report any symptoms to the doctor immediately. Often patients stay in the hospital for a few hours or overnight to have their heart rate and blood pressure closely monitored.

Movement is restricted to prevent bleeding at the catheter insertion site on the arm, groin, upper thigh or neck. The doctor usually gives the patient medicine to help them relax but not sleep, and patients should not drive after receiving it. Coronary angiography is a common procedure that rarely causes any serious problems; however, the risk is higher in older patients with certain medical conditions, such as chronic kidney disease.

Signs of heart attack:

  • Chest pain
  • Sweating
  • Breathing problems
  • Faintness
  • Nausea

Signs of a blood clot in lungs:

  • Chest pain
  • Sudden coughing
  • Rapid breathing
  • Wheezing
  • Cough with blood

Signs of stroke

Severe kidney problems may occur and are more likely if given too much medicine. Iopamidol can cause dehydration and is hard on the kidneys, so it is important to drink extra fluids to help flush the kidneys out. If any symptoms of kidney problems occur, tell the doctor.

Signs of kidney problems:

  • Agitation or confusion
  • Decreased urine output
  • Muscle twitching
  • Vomiting or nausea
  • Dizziness or tiredness
  • Headache
  • Swelling of the face, ankles, or hands

Iopamidol can also cause a serious type of allergic reaction known as anaphylaxis. This can be life-threatening and requires immediate medical attention. Seek emergency help if any of the symptoms of an allergic reaction or severe skin reaction (flu-like symptoms, fever, sore throat and muscle aches) occur after injection.

Signs of anaphylaxis:

  • Skin rash
  • Shortness of breath
  • Swelling of the face, tongue, or throat
  • Itching
  • Sweating
  • Tightness in chest

Also, tell the doctor if any of the following are experienced at the injection site:

  • Mild burning or pain
  • Feeling of warmth or coldness
  • Skin peeling
  • Redness or swelling

Dosage

There is no dosing schedule because the doctor or a health care professional injects Iopamidol in the hospital at the time of the procedure. It is injected or added to the intravenous solution at the time of angiography, computed tomographic imaging of head or body or urography testing.

It is very important for the doctor to monitor patients closely after injection, because it can cause heart attack, stroke, blood clots and anaphylaxis. Because the risk of anaphylaxis is increased when the dose is too high, it is important for patients to understand the dosage based on how it's introduced to the body and what type of procedure is being performed.

Medicine can be injected or added to the intravenous solution with two more dosage amounts for the intravenous solution. Below are the usual dosages depending on the test type and the maximum amount of medication that should be administered. It is important to not receive more than this amount because of the risks of adverse reactions.

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 mgintra-arterial, no than 90 mL
  • Peripheral arteriography: 200 mgIV, no more than 350 mL
  • Coronary arteriography: 370 mgIV, no more than 200 mL
  • Coronary ventriculography: 370 mgIV, no more than 200 mL
  • Selective visceral arteriography: 370 mgIV, no more than 225 mL
  • Selective visceral aortography: 370 mg/mLno more than 225 mL
  • Peripheral venography: 200 mgno more than 350 mL

Computed Tomography

CECT of the Head

  • 250 mg/mL: 130-240 mL IV; no more than 240 mL
  • Alternatively, 300 mg/mL: 100-200 mL IV; no more than 200 mL
  • Imaging may be done immediately after completing administration

CECT of the Body

  • 250 mg/mL: 130-240 mL IV; no more than 240 mL
  • Alternatively, 300 mg/mL: 100-200 mL IV; no more than 200 mL
  • Imaging may be done immediately after completing administration

Excretory Urography

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

Interactions

These medications may interact with Iopamidol and can cause serious and harmful effects, including agents that affect iodine, oncology methotrexate, contrast materials and media, and metformin. Recently received cholecystographic agents used in radiology of the gallbladder can cause renal toxicity, especially in patients with hepatic or biliary disorder.

Do not take any other drugs or medicine including alcohol, illegal drugs, and herbal or vitamin supplements without talking to the doctor first. The doctor may take patients off medications to avoid harmful interactions.

  • Aldesleukin-2 (IL-2)
  • Amiodarone
  • Amphotericin B
  • Anti-inflammatory drugs (NSAIDs, such as ibuprofen)
  • Certain injected antibiotics
  • Certain high blood pressure medicines
  • Cisplatin
  • Cyclosporine
  • Entecavir
  • Metformin
  • Water pills

Drug interactions are reported among people who take Iopamidol with Oxycodone, a commonly-used opioid pain medication. Symptoms can range from mild to serious and some had delayed reactions up to two years later.

Age and gender are factors in which reactions patients are more likely to experience; however, the commonly reported symptoms in the first month are the following.

Interaction with Oxycodone in the first month:

Warnings

Iopamidol may be used by children and the elderly; however, children are more likely to have side effects. The effects of Iopamidol on unborn babies and breastfeeding infants are not known, so tell the doctor about pregnancy and breastfeeding.

It can affect the results of other medical procedures and tests for up to 16 days, so if you're scheduled to have a procedure or test after an Iopamidol injection, let them know that you've had it. Tell the doctor about any of your previous medications and, before treatment with Iopamidol, tell them about new medicines you're taking, including over the counter or prescription medications and herbal or vitamin supplements.

Iopamidol can cause severe kidney problems, so it is important to carefully follow the doctor's instructions on what type and the amount of fluids you can consume before and after the injection. Some medicines may be given to prevent side effects.

The treatment may even cause dehydration, which elderly people need to take special care to avoid; their kidney function should be checked regularly after the procedure. The risks of complications are also higher in older people, especially if they have certain medical conditions.

Discuss exposure to radiation with your doctor before injection.

Some medical conditions can interact with the use of Iopamidol, so tell the doctor about any allergies you have, especially to contrast agents or reactions during tests or procedures. They may also increase the chance of certain side effects. Tell the doctor if you have any of the following medical conditions:

Medical conditions which interact with medicine

Use with caution, may increase chances of certain side effects:

  • Asthma may increase risk of having allergic reactions
  • Sickle cell anemia (inherited blood disorder) may make these conditions worse
  • Homocystinuria (genetic disease) patients with this condition should avoid undergoing angiography because of the increased risk of having blood clotting problems
  • Paraproteinemia (high amount of Para protein in the blood) may increase the risk of having kidney failure

Severe cutaneous adverse reactions (SCAR) can develop anywhere between one hour to several weeks after the administration of an intravascular contrast agent. The severity of the reaction may increase and the time to onset may decrease with repeat administration of the contrast agent. Prophylactic medications may not prevent or lessen cutaneous adverse reactions. Tell the doctor if you have any history of this type of reaction.

Cutaneous reactions

  • Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN)
  • Acute generalized exanthematous pustulosis (AGEP)
  • Drug reaction with eosinophilia and systemic symptoms (DRESS)

Storage

The product label information is limited because a healthcare professional administers Iopamidol at the time of testing. Iopamidol is stored at 20 to 25 degrees Celsius and protected from light. It is commonly packaged in one dose vials, and the facility is responsible for storage and disposal of the contrast agent.

Summary

Iopamidol injection is administered by a healthcare professional at the time of the procedure. It contains iodine, which causes blood vessels and surrounding areas to turn white so the x-ray detects them. It is important to follow the doctor's instructions before, during and after injection, because there are serious medicine interactions that can occur with it and it increases the risk of a stroke, heart attack, dehydration and renal toxicity.

Before injection, tell the doctor about any medications you're taking, including supplements, your medical history, including allergies or active infections, and whether you're pregnant or breastfeeding.

During the procedure, especially angiographs, tell the doctor about any signs of heart attack, stroke or anaphylaxis. Because of the severity of these reactions, doctors perform these procedures after other exams reveal problems, and Iopamidol is then used to diagnose the problem.

After injection, tell the doctor immediately if any side effects or delayed reactions are experienced and seek emergency care if any signs of heart attack, stroke, blood clots, or anaphylaxis are experienced.