Isovue-M 300 (iopamidol)
Intrathecal Vial (ML)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Generic name: iopamidol
Therapeutic class: Diagnostic Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Isovue-M 300
Indications
The following indications are listed for Isovue-M 300:
- Diagnostic Imaging
Also known as: Diagnostic Imaging Exam, Diagnostic Imaging Procedure, Diagnostic Radiography, Diagnostic Radiology.
Dosing
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
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There are no contraindication interactions for this drug.
Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
Iodinated Contrast Materials/Metformin
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: Use of iodinated contrast materials may result in acute changes in renal function, resulting in a decrease in metformin clearance.(1-3)
CLINICAL EFFECTS: Use of iodinated contrast materials may increase levels of metformin, which may result in lactic acidosis.(1-3)
PREDISPOSING FACTORS: Pre-existing renal dysfunction may contribute to decreased clearance of metformin. Other factors which may increase the risk for lactic acidosis include age greater than 65 years, dehydration, metabolic acidosis, sepsis, a history of hepatic impairment, alcoholism, or heart failure.(1-4)
PATIENT MANAGEMENT: Evaluate renal function prior to contrast procedure. According to manufacturer recommendations, discontinue metformin at the time of, or prior to, the contrast imaging procedure in patients with a history of liver disease, alcoholism, heart failure, or if contrast is to be administered intra-arterially. When contrast is to be administered by other routes, discontinue metformin at the time of, or prior to, the procedure for patients with an estimated glomerular filtration rate (eGFR) of 30 to 60 mL/min/1.73 m2. Re-evaluate eGFR 48 hours after the imaging procedure and restart metformin if renal function is stable. Discontinuation of metformin is not required if eGFR is > 60 mL/min/1.73 m2.(4) According to American College of Radiology guidelines, discontinue metformin at the time of, or prior to, the contrast imaging procedure in patients with acute kidney injury or chronic kidney disease (Stage IV or V or eGFR < 30 mL/min/1.73 m2), or who are undergoing arterial catheter studies that might result in emboli (atheromatous or other) to the renal arteries. Re-evaluate eGFR 48 hours after the imaging procedure and restart metformin if renal function is normal. Discontinuation of metformin is not required in patients with no evidence of acute kidney injury and with eGFR >= 30 mL/min/m2.(5)
DISCUSSION: An FDA review of the medical literature showed that metformin may be safely used in patients with mild or moderate renal impairment, resulting in modifications of prescribing recommendations and method for evaluation of renal function.(4) A clinical review of 33 patients on metformin who had received contrast media showed elevations in serum creatinine of the four patients with baseline elevations. The 29 patients with normal baseline renal function showed no elevations after administration of contrast media. The authors recommend that a baseline serum creatinine is obtained for all patients and that metformin should only be discontinued in patients with baseline elevations.(6) A retrospective study of ninety-seven patients currently taking metformin underwent a radiologic procedure with contrast media. Of these patients, 4 developed contrast material associated nephropathy and eight patients had an increased risk of lactic acidosis, with a baseline serum creatinine <1.5mg/dl.(7) A prospective clinical trial with 50 diabetic patients on metformin with baseline serum creatinine <1.47mg/dl showed no statistical difference in renal function before and 48 hours after administration of contrast media. The authors recommend a baseline serum creatinine for all patients and suggest that temporary discontinuation of metformin may not be necessary when baseline renal function is <1.47mg/dl.(8) A systematic review of the literature reveals that 17 of 18 case reports of metformin-induced lactic acidosis involved patients with renal dysfunction prior to administration of contrast media. The authors recommend a baseline serum creatinine in all patients and if renal dysfunction is present, metformin should be discontinued for 48 hours before and after administration of contrast media. The authors recommend follow-up creatinine measurement in patients with prior renal impairment or known comorbidities affecting lactate levels.(9)
Iodinated Contrast Media/Methotrexate (ONCOLOGY-INJECTION)
SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.
MECHANISM OF ACTION: One possible mechanism is renal dysfunction caused by the nephrotoxicity of both agents.
CLINICAL EFFECTS: Concurrent use of iodinated contrast media may result in methotrexate toxicity, leading to increased risk of severe neurotoxicity, stomatitis, and myelosuppression, including neutropenia.
PREDISPOSING FACTORS: Risk factors for methotrexate toxicity include: - High-dose oncology regimens - Impaired renal function, ascites, or pleural effusions
PATIENT MANAGEMENT: It is recommended that the use of iodinated contrast media in patients receiving high dose methotrexate therapy be avoided until the serum methotrexate level is 0.1 mcmol/L or lower. With lower dose methotrexate therapy, iodinated contrast media should be used with caution and preventative measures should be considered.(1)
DISCUSSION: There are three case reports of patients receiving concurrent iodinated contrast agents and methotrexate therapy developing methotrexate toxicity. One patient received iodinated contrast media the day after receiving a methotrexate infusion while the other two patients received contrast media 30 hours and 4.5 hours after methotrexate therapy.(1,2)
Moderate Interaction: Assess the risk to the patient and take action as needed.
Iodinated Contrast Med/Methotrexate (LOW STRENGTH INJ, ORAL)
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: One possible mechanism is renal dysfunction caused by the nephrotoxicity of both agents.
CLINICAL EFFECTS: Concurrent use of iodinated contrast media may result in methotrexate toxicity, leading to increased risk of severe neurotoxicity, stomatitis, and myelosuppression, including neutropenia.
PREDISPOSING FACTORS: Renal impairment
PATIENT MANAGEMENT: It is recommended that the use of iodinated contrast media in patients receiving high dose methotrexate therapy be avoided until the serum methotrexate level is 0.1 mcmol/L or lower. With lower dose methotrexate therapy, iodinated contrast media should be used with caution and preventative measures should be considered.(1)
DISCUSSION: There are three case reports of patients receiving concurrent iodinated contrast agents and methotrexate therapy developing methotrexate toxicity. One patient received iodinated contrast media the day after receiving a methotrexate infusion while the other two patients received contrast media 30 hours and 4.5 hours after methotrexate therapy.(1,2)
Contraindications
There is no enhanced messaging for this drug.
There are no contraindication contraindications for this drug.
- Chronic heart failure
- Dehydration
- Hyperthyroidism
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Pheochromocytoma
- Seizure disorder
- Sickle cell disease
- Diabetes mellitus
- Kidney disease with likely reduction in glomerular filtration rate (GFr)
- Peripheral vascular disease
Adverse reactions
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More Frequent
- Drug-induced hot flash
Less Frequent
- Bradycardia
- Hypotension
- Urticaria
Rare or Very Rare
- Acute generalized exanthematous pustulosis
- Acute myocardial infarction
- Allergic dermatitis
- Anaphylaxis
- Angioedema
- Apnea
- Arterial thrombosis
- Asthma
- Ataxia
- Bronchospastic pulmonary disease
- Cardiac arrhythmia
- Choking sensation
- Coma
- Dermal necrosis
- DRESS syndrome
- Dyspnea
- Extravasation injury
- Hallucinations
- Hemorrhage
- Hypertension
- Hypothyroidism
- Laryngeal edema
- Myocardial ischemia
- Neutropenic disorder
- Paralysis
- Pulmonary edema
- Renal failure
- Seizure disorder
- Skin rash
- ST segment changes
- Stevens-johnson syndrome
- Syncope
- Throat constriction
- Thrombophlebitis
- Thyrotoxicosis crisis
- Toxic epidermal necrolysis
- Transient blindness
- Venous thrombosis
- Ventricular fibrillation
- Ventricular tachycardia
More Frequent
- Nausea
Less Frequent
- Abnormal vasomotor function
- Back pain
- Flushing
- Kidney disease with reduction in glomerular filtration rate (GFr)
- Leg pain
- Neck pain
- Pain
- Sensation of warmth
Rare or Very Rare
- Abdominal pain with cramps
- Acute cognitive impairment
- Angina
- Anorexia
- Blurred vision
- Chest pain
- Chest tightness
- Chills
- Conjunctivitis
- Cough
- Cramps in legs
- Diarrhea
- Dizziness
- Drowsy
- Dysgeusia
- Dysuria
- Erythema
- Esophageal pain
- Eye tearing
- Facial edema
- Fatigue
- Fever
- General weakness
- Headache disorder
- Heartburn
- Hematuria
- Hyperhidrosis
- Hypoesthesia
- Injection site pain
- Injection site sequelae
- Irritability
- Lip swelling
- Malaise
- Memory impairment
- Muscle spasm
- Muscle weakness
- Nasal congestion
- Oral paresthesia
- Pallor
- Paresthesia
- Periorbital edema
- Petechiae
- Pruritus of skin
- Rhinitis
- Sciatica
- Sneezing
- Stinging of skin
- Tachycardia
- Tremor
- Urinary retention
- Vasodilation of blood vessels
- Visual changes
- Vomiting
Precautions
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ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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