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Isovue
iopamidol
Black Box Warnings .
Risk with Inadvertent Intrathecal Administration
inadvertent intrathecal administration may cause death, convulsions, seizures, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, rhabdomyolysis, hyperthermia, and brain edema; for intra-arterial or IV use only
Adult Dosing .
Dosage forms: INJ: 200 mg per mL, 250 mg per mL, 300 mg per mL, 370 mg per mL
Special Note
- [strength clarification]
- Info: strength expressed as iodine concentration
- [equivalency or interchangeability info]
- Info: not interchangeable with intrathecal iopamidol products; do not substitute on a mg to mg basis
angiocardiography
- [selective coronary artery]
- Dose: 2-10 mL (370 mg per mL) intra-arterially x1; Max: cumulative dose 200 mL
- [nonselective coronary arteries]
- Dose: 25-50 mL (370 mg per mL) intra-arterially x1; Max: cumulative dose 200 mL
- [ventricle]
- Dose: 25-50 mL (370 mg per mL) intra-arterially x1; Max: cumulative dose 200 mL
aortography and selective visceral arteriography
- [aortic arch or celiac artery]
- Dose: up to 50 mL (370 mg per mL) intra-arterially x1; Max: cumulative dose 225 mL
- [renal arteries]
- Dose: up to 10 mL (370 mg per mL) intra-arterially x1; Max: cumulative dose 225 mL
cerebral arteriography
- [8-12 mL (300 mg per mL) intra-arterially x1]
- Max: cumulative dose 90 mL
peripheral arteriography
- [subclavian or femoral artery]
- Dose: 5-40 mL (300 mg per mL) intra-arterially x1; Max: cumulative dose 250 mL
- [aorta distal runoff]
- Dose: 25-50 mL (300 mg per mL) intra-arterially x1; Max: cumulative dose 250 mL
computed tomography
- [head]
- Dose: 130-240 mL (250 mg per mL) IV x1: Alt: 100-200 mL (300 mg per mL) IV x1
- [body]
- Dose: 130-240 mL (250 mg per mL) IV x1: Alt: 100-200 mL (300 mg per mL) IV x1; 80-160 mL (370 mg per mL) IV x1
- [abdomen or pelvis]
- Dose: 500-1000 mL (6 mg per mL or 9 mg per mL) PO x1; Start: 60min before procedure; Info: dilute 200 mg per mL, 250 mg per mL, 300 mg per mL, or 370 mg per mL INJ solution for PO use, see pkg insert
excretory urography
- [50-100 mL (250 mg per mL) IV x1]
- Alt: 50 mL (300 mg per mL) IV x1; 40 mL (370 mg per mL) IV x1
peripheral venography
- [25-150 mL (200 mg per mL) IV x1 per leg]
- Max: 350 mL/total dose; Alt: 15-100 mL (300 mg per mL) IV x1 per leg, max 230 mL/total dose
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised in hepatorenal disease
Peds Dosing .
- Dosage forms: INJ: 200 mg per mL, 250 mg per mL, 300 mg per mL, 370 mg per mL
Special Note
- [strength clarification]
- Info: strength expressed as iodine concentration
- [equivalency or interchangeability info]
- Info: not interchangeable with intrathecal iopamidol products; do not substitute on a mg to mg basis
angiocardiography
- [neonates]
- Dose: 0.5-2 mL/kg/dose (370 mg per mL) intra-arterially x1; Max: cumulative dose 5 mL/kg up to 40 mL
- [1-23 mo]
- Dose: 0.5-2 mL/kg/dose (370 mg per mL) intra-arterially x1; Max: cumulative dose 8 mL/kg up to 40 mL
- [2-4 yo]
- Dose: 0.5-2 mL/kg/dose (370 mg per mL) intra-arterially x1; Max: cumulative dose 8 mL/kg up to 50 mL
- [5-9 yo]
- Dose: 0.5-2 mL/kg/dose (370 mg per mL) intra-arterially x1; Max: cumulative dose 8 mL/kg up to 100 mL
- [10 yo and older]
- Dose: 0.5-2 mL/kg/dose (370 mg per mL) intra-arterially x1; Max: cumulative dose 8 mL/kg up to 125 mL
computed tomography
- [head]
- Dose: 1.2-3.6 mL/kg/dose (250 mg per mL) IV x1; Max: 120 mL/total dose; Alt: 1-3 mL/kg/dose (300 mg per mL) IV x1, max 100 mL/total dose
- [body]
- Dose: 1.2-3.6 mL/kg/dose (250 mg per mL) IV x1; Max: 120 mL/total dose; Alt: 1-3 mL/kg/dose (300 mg per mL) IV x1, max 100 mL/total dose
- [abdomen or pelvis, <3 yo]
- Dose: 50-300 mL (6 mg per mL or 9 mg per mL) PO x1; Start: 60min before procedure; Info: dilute 200 mg per mL, 250 mg per mL, 300 mg per mL, or 370 mg per mL INJ solution for PO use, see pkg insert
- [abdomen or pelvis, 3-5 yo]
- Dose: 300-360 mL (6 mg per mL or 9 mg per mL) PO x1; Start: 60min before procedure; Info: dilute 200 mg per mL, 250 mg per mL, 300 mg per mL, or 370 mg per mL INJ solution for PO use, see pkg insert
- [abdomen or pelvis, 6-11 yo]
- Dose: 360-500 mL (6 mg per mL or 9 mg per mL) PO x1; Start: 60min before procedure; Info: dilute 200 mg per mL, 250 mg per mL, 300 mg per mL, or 370 mg per mL INJ solution for PO use, see pkg insert
- [abdomen or pelvis, 12 yo and older]
- Dose: 500-1000 mL (6 mg per mL or 9 mg per mL) PO x1; Start: 60min before procedure; Info: dilute 200 mg per mL, 250 mg per mL, 300 mg per mL, or 370 mg per mL INJ solution for PO use, see pkg insert
excretory urography
- [1.2-3.6 mL/kg/dose (250 mg per mL) IV x1]
- Max: 120 mL/total dose; Alt: 1-3 mL/kg/dose (300 mg per mL) IV x1, max 100 mL/total dose
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined
hepatic dosing
- [not defined]
- hepatic impairment: not defined, caution advised in hepatorenal disease
Contraindications / Cautions .
- intrathecal use
- homocystinuria (angiography use)
- hypersensitivity to drug or ingredient
- caution: patients <3 yo
- caution: hypersensitivity to other iodinated contrast media
- caution: asthma
- caution: allergies, known
- caution: renal impairment
- caution: renal impairment risk
- caution: arterial disease, severe
- caution: venous disease, severe
- caution: hyperthyroidism
- caution: autonomously functioning thyroid nodule
- caution: cardiovascular disease
- caution: CHF
- caution: hepatorenal disease
- caution: cardiorenal disease
- caution: congenital cardiac conditions (peds patients)
- caution: thromboembolism risk (angiography use)
- caution: pheochromocytoma
- caution: myasthenia gravis
Drug Interactions .
Overview
iopamidol
contrast agent
Interaction Characteristics:
- lowers seizure threshold
- nephrotoxicity
- thrombogenic effects
Other Info
- avoid radioactive iodine during and up to 6wk after iopamidol tx; iopamidol may decr. thyroid uptake of radioactive iodine, efficacy
Contraindicated
- betamethasone
- cidofovir
- dexamethasone
- hydrocortisone
- methylprednisolone
Avoid/Use Alternative
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Caution Advised
- acetazolamide
- brivaracetam
- cannabidiol
- cannabis
- carbamazepine
- cenobamate
- clobazam
- clonazepam
- clorazepate
- cycloserine
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- pregabalin
- primidone
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- stiripentol
- tiagabine
- topiramate
- treosulfan
- valproic acid
- vigabatrin
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- cutaneous reaction, severe
- acute kidney injury
- hypotension
- shock
- cardiac arrest
- arrhythmia
- thromboembolism (angiography use)
- extravasation symptoms
- seizures
- pulmonary edema
Common Reactions
- pain
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; inadequate human data available; no known risk of fetal harm based on animal data at 1.4x and 2.7x recommended human dose
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm not expected based on minimal drug excretion into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for iopamidol: none; CYP450: none
Excretion: for iopamidol: urine primarily (100% unchanged); Half-life: 2h (intravascular route)
Subclass: Contrast Agents
Mechanism of Action
for iopamidol: attenuates X-ray beams and opacifies vessels and anatomical structures, enhancing visualization of normal and pathological tissue (nonionic iodine-based contrast medium)
Formulary .
No Formulary Selected
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