Omnipaque

Radiodiagnostic Agents

For storage information, see specific product information within the How Supplied section.
 
Patients should be well hydrated prior to and after iohexol injection administration. A suggested common regimen in eligible patients (e.g., those patients in which fluid administration would not be contraindicated) is 1 mL/kg/hour of 0.9% Sodium Chloride Injection starting at least 4 hours prior to and continuing for at least 12 hours after the procedure or exam.
In patients with a history of allergic reaction to contrast media, those with a history of asthma or allergic reactions to drugs or foods, nonionic contrast media should be used. In addition, consider administering prednisone 50 mg PO (or equivalent dose of other steroids) 13 hours, 7 hours, and 1 hour prior to the exam or procedure plus diphenhydramine 50 mg IM/PO 1 hour prior to the procedure. The administration of prophylactic steroids and antihistamines does not prevent all hypersensitivity reactions, but reduces the likelihood and may decrease the severity of the reaction.
Use the lowest dose necessary to obtain adequate visualization. Individualize the volume, strength, and rate of administration of iohexol injection. Consider factors such as age, body weight, vessel size, blood flow rate within the vessel, anticipated pathology, degree and extent of opacification required, structures or area to be examined, disease processes affecting the patient, and equipment and technique to be employed.

Oral Administration Oral Liquid Formulations

Administer oral dose all at once or over a period of up to 45 minutes if there is difficulty consuming the required volume.
In patients receiving both oral and intravenous contrast, give the oral contrast first.
Adults: Administer intravenous dose up to 40 minutes after the oral dose.
Pediatric patients: Administer intravenous dose up to 60 minutes after the oral dose.
Commercially available as a 9 mg iodine/mL and 12 mg iodine/mL oral solution. Alternatively, intravenous formulations (i.e., Omnipaque 240, 300, 350) may be administered orally either undiluted or mixed with water, carbonated beverages, milk, infant formula, or juice.
Dilutions of iohexol injection should be prepared just prior to use; discard the unused portion after the procedure.
To achieve 1,000 mL at a final concentration of iohexol 6 mg iodine/mL, add 25 mL of iohexol 240 mg iodine/mL (Omnipaque 240) to 975 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 6 mg iodine/mL, add 20 mL of iohexol 300 mg iodine/mL (Omnipaque 300) to 980 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 6 mg iodine/mL, add 17 mL of iohexol 350 mg iodine/mL (Omnipaque 350) to 983 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 9 mg iodine/mL, add 38 mL of iohexol 240 mg iodine/mL (Omnipaque 240) to 962 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 9 mg iodine/mL, add 30 mL of iohexol 300 mg iodine/mL (Omnipaque 300) to 970 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 9 mg iodine/mL, add 26 mL of iohexol 350 mg iodine/mL (Omnipaque 350) to 974 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 12 mg iodine/mL, add 50 mL of iohexol 240 mg iodine/mL (Omnipaque 240) to 950 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 12 mg iodine/mL, add 40 mL of iohexol 300 mg iodine/mL (Omnipaque 300) to 960 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 12 mg iodine/mL, add 35 mL of iohexol 350 mg iodine/mL (Omnipaque 350) to 965 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 15 mg iodine/mL, add 63 mL of iohexol 240 mg iodine/mL (Omnipaque 240) to 937 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 15 mg iodine/mL, add 50 mL of iohexol 300 mg iodine/mL (Omnipaque 300) to 950 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 15 mg iodine/mL, add 43 mL of iohexol 350 mg iodine/mL (Omnipaque 350) to 957 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 18 mg iodine/mL, add 75 mL of iohexol 240 mg iodine/mL (Omnipaque 240) to 925 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 18 mg iodine/mL, add 60 mL of iohexol 300 mg iodine/mL (Omnipaque 300) to 940 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 18 mg iodine/mL, add 52 mL of iohexol 350 mg iodine/mL (Omnipaque 350) to 948 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 21 mg iodine/mL, add 88 mL of iohexol 240 mg iodine/mL (Omnipaque 240) to 912 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 21 mg iodine/mL, add 70 mL of iohexol 300 mg iodine/mL (Omnipaque 300) to 930 mL of diluent.
To achieve 1,000 mL at a final concentration of iohexol 21 mg iodine/mL, add 60 mL of iohexol 350 mg iodine/mL (Omnipaque 350) to 940 mL of diluent.

Injectable Administration

Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. The solution should be clear and colorless to pale yellow. If discoloration or particulate matter is present, do not use.
Iohexol injection may be administered at either body (37 degrees C) or room temperature.[28963]

Intravenous Administration

Bulk packaging
For use only with an automated contrast injection system, contrast management system, or contrast media transfer set approved for use with iohexol.
Bulk packaging is to be used only in a room designated for radiological procedures that involve intravascular administration of a contrast agent.
Use aseptic technique when transferring iohexol from the bulk packaging. The container closure may be penetrated only 1 time with a suitable sterile component of the automated contrast injection system, contrast management system, or contrast media transfer set approved for use with iohexol.
If 0.9% Sodium Chloride Injection is used, the IV administration port of the 0.9% Sodium Chloride Injection container may be penetrated only 1 time with a suitable sterile component of the contrast management system approved for use with iohexol.
Once the iohexol container is punctured, maintain the bottle in an inverted position.
Do not remove the bulk packaging from work area once the container enclosure is punctured. Discard if the integrity of the bulk packaging, 0.9% Sodium Chloride Injection, and delivery system cannot be assured through direct continuous supervision.
Storage: A maximum use time of 8 hours from initial closure entry is permitted to complete fluid transfer. Discard any unused iohexol and 0.9% Sodium Chloride Injection 8 hours after initial puncture of the stopper.[62671]
 
Single-dose bottles
Use aseptic technique for all handling and administration of iohexol for intravascular administration.
Storage: A maximum use time of 4 hours from initial closure entry is permitted with a contrast media management system. Each bottle is intended for 1 procedure only. Discard any unused portion.[28963]
 
Intravenous injection
Do not mix iohexol with, or inject in intravenous lines containing, other drugs or total nutritional admixtures.
Avoid extravasation when administering iohexol injection intravascularly, especially in patients with severe arterial or venous disease.
Hydrate patients before and after intravascular administration of iohexol injection.[28963]
 
Automated contrast injection system
Iohexol may be used for computed tomography (CT) of the head and body with an automated contrast injection system cleared for use with contrast media. See device labeling for information on device indications, instructions for use, and techniques to help assure safe use.[28963] [62671]
 
Contrast media management system
Iohexol bulk packaging and 300 and 350 mg iodine/mL in 150 mL single-dose bottles may be used for CT of the head and body with a contrast media management system cleared for such use. See device labeling for information on device indications, instructions for use, and techniques to help assure safe use.
The container closure may be penetrated only 1 time with a suitable sterile component of the contrast media management system.
Once the container is punctured, do not remove the bottle from the work area during the entire period of use.[28963] [62671]

Intrathecal Administration

NOTE: Use care to avoid inadvertent intrathecal administration of iohexol 140 mg iodine/mL (Omnipaque 140) or 350 mg iodine/mL (Omnipaque 350). These concentrations are not intended for intrathecal use. Only iohexol 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300) concentrations may be administered via the intrathecal route.
Inject slowly, over 1 to 2 minutes, to minimize excessive mixing of the solution with cerebrospinal fluid (CSF). In addition, slow injection will minimize premature cephalad (cranial) dispersion of iohexol. Depending on the volume of contrast medium estimated to be required, a small amount of CSF may be removed to minimize distention of the subarachnoid spaces. Once the contrast medium is injected, the needle can be removed.
Neuroleptic drugs (including phenothiazines) should be held for at least 48 hours before and for at least 24 hours after the procedure.
 
Management of patients during procedure
The patient should remain still during the procedure and not move unless instructed. Abrupt activity can cause excessive mixing of iohexol with CSF. If the patient must be moved, it is preferable for trained personnel to move the patient slowly.
Avoid early and high cephalad dispersion, and an intracranial bolus. To maintain iohexol solution as a bolus, the medium can be moved distally very slowly under fluoroscopic control. The patient's head should remain elevated above the highest level of the spine. The head of the table should not be lowered more than 15 degrees during thoraco-cervical procedures. In patients with excessive curvature of the lumbar spine, consider a lateral position for the injection and movement of the medium cephalad.
Management of patients post-procedure
Patients should remain in a bed with the head raised (30 to 45 degrees angle) for 12 to 24 hours post procedure. Advise patients to remain quiet and still for the first 24 hours with their head in the up position. Closely observe the patient during this time period
Alternatively, recent evidence suggests that maintaining patients in an upright position post myelography (via a wheelchair or ambulation) may help minimize adverse effects.

Other Injectable Administration

Intra-Arterial Administration
Mechanical or hand injection can be used to administer 1 or more bolus intra-arterial injections of iohexol.
Use aseptic technique for all handling and administration of iohexol for intravascular administration.
Do not mix iohexol with other drugs.
Avoid extravasation when administering iohexol injection intravascularly, especially in patients with severe arterial or venous disease.
Hydrate patients before and after intravascular administration of iohexol injection.
 
Intra-Articular Administration
Arthrography is usually performed under local anesthesia.
Fluoroscopic control should be used to ensure proper needle placement, prevent extracapsular injection, and prevent dilution of contrast medium.
Do not exert undue pressure during injection.
 
Intra-Uterine Administration
In an effort to reduce pain during the procedure, injection pressure and volume should be such that disruptive distention of the ducts examined is minimized.
 
Intravesical (Bladder) Instillation Administration
Fill the bladder at a steady rate, exercising caution to avoid excessive pressure.
May be diluted with Sterile Water for Injection.
Dilutions should be prepared just prior to use; discard the unused portion after the procedure.
For a final concentration of iohexol 100 mg iodine/mL, add 140 mL of Sterile Water for Injection to 100 mL of iohexol 240 mg iodine/mL (Omnipaque 240).
For a final concentration of iohexol 100 mg iodine/mL, add 200 mL of Sterile Water for Injection to 100 mL of iohexol 300 mg iodine/mL (Omnipaque 300).
For a final concentration of iohexol 100 mg iodine/mL, add 250 mL of Sterile Water for Injection to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350).
For a final concentration of iohexol 90 mg iodine/mL, add 167 mL of Sterile Water for Injection to 100 mL of iohexol 240 mg iodine/mL (Omnipaque 240).
For a final concentration of iohexol 90 mg iodine/mL, add 233 mL of Sterile Water for Injection to 100 mL of iohexol 300 mg iodine/mL (Omnipaque 300).
For a final concentration of iohexol 90 mg iodine/mL, add 289 mL of Sterile Water for Injection to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350).
For a final concentration of iohexol 80 mg iodine/mL, add 200 mL of Sterile Water for Injection to 100 mL of iohexol 240 mg iodine/mL (Omnipaque 240).
For a final concentration of iohexol 80 mg iodine/mL, add 275 mL of Sterile Water for Injection to 100 mL of iohexol 300 mg iodine/mL (Omnipaque 300).
For a final concentration of iohexol 80 mg iodine/mL, add 338 mL of Sterile Water for Injection to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350).
For a final concentration of iohexol 70 mg iodine/mL, add 243 mL of Sterile Water for Injection to 100 mL of iohexol 240 mg iodine/mL (Omnipaque 240).
For a final concentration of iohexol 70 mg iodine/mL, add 330 mL of Sterile Water for Injection to 100 mL of iohexol 300 mg iodine/mL (Omnipaque 300).
For a final concentration of iohexol 70 mg iodine/mL, add 400 mL of Sterile Water for Injection to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350).
For a final concentration of iohexol 60 mg iodine/mL, add 300 mL of Sterile Water for Injection to 100 mL of iohexol 240 mg iodine/mL (Omnipaque 240).
For a final concentration of iohexol 60 mg iodine/mL, add 400 mL of Sterile Water for Injection to 100 mL of iohexol 300 mg iodine/mL (Omnipaque 300).
For a final concentration of iohexol 60 mg iodine/mL, add 483 mL of Sterile Water for Injection to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350).
For a final concentration of iohexol 50 mg iodine/mL, add 380 mL of Sterile Water for Injection to 100 mL of iohexol 240 mg iodine/mL (Omnipaque 240).
For a final concentration of iohexol 50 mg iodine/mL, add 500 mL of Sterile Water for Injection to 100 mL of iohexol 300 mg iodine/mL (Omnipaque 300).
For a final concentration of iohexol 50 mg iodine/mL, add 600 mL of Sterile Water for Injection to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350).

Severe

bradycardia / Rapid / 1.0-1.0
cardiac arrest / Early / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
bronchospasm / Rapid / Incidence not known
laryngeal edema / Rapid / Incidence not known
angioedema / Rapid / Incidence not known
anuria / Delayed / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known
oliguria / Early / Incidence not known
arachnoiditis / Early / Incidence not known
rhabdomyolysis / Delayed / Incidence not known
myocardial infarction / Delayed / Incidence not known
ventricular fibrillation / Early / Incidence not known
visual impairment / Early / Incidence not known
tissue necrosis / Early / Incidence not known
skin necrosis / Early / Incidence not known
thrombosis / Delayed / Incidence not known
myelitis / Delayed / Incidence not known
thromboembolism / Delayed / Incidence not known
retroperitoneal bleeding / Delayed / Incidence not known
stroke / Early / Incidence not known
renal tubular necrosis / Delayed / Incidence not known
seizures / Delayed / Incidence not known
aseptic meningitis / Delayed / Incidence not known
coma / Early / Incidence not known
Guillain-Barre syndrome / Delayed / Incidence not known
apnea / Delayed / Incidence not known
asystole / Rapid / Incidence not known
disseminated intravascular coagulation (DIC) / Delayed / Incidence not known
hypertensive crisis / Early / Incidence not known
pulmonary edema / Early / Incidence not known
cyanosis / Early / Incidence not known
Stevens-Johnson syndrome / Delayed / Incidence not known
acute generalized exanthematous pustulosis (AGEP) / Delayed / Incidence not known
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) / Delayed / Incidence not known
toxic epidermal necrolysis / Delayed / Incidence not known

Moderate

angina / Early / 8.0-8.0
hypotension / Rapid / 0-2.5
hypertension / Early / 1.0-1.0
hematoma / Early / 0.7-0.7
wheezing / Rapid / Incidence not known
proteinuria / Delayed / Incidence not known
hypothyroidism / Delayed / Incidence not known
hyperthyroidism / Delayed / Incidence not known
hyperthermia / Delayed / Incidence not known
paresis / Delayed / Incidence not known
peripheral vasodilation / Rapid / Incidence not known
hot flashes / Early / Incidence not known
erythema / Early / Incidence not known
bleeding / Early / Incidence not known
neuropathic pain / Delayed / Incidence not known
photophobia / Early / Incidence not known
ataxia / Delayed / Incidence not known
hypertonia / Delayed / Incidence not known
amblyopia / Delayed / Incidence not known
confusion / Early / Incidence not known
hyperesthesia / Delayed / Incidence not known
peripheral neuropathy / Delayed / Incidence not known
hyperreflexia / Delayed / Incidence not known
aphasia / Delayed / Incidence not known
hallucinations / Early / Incidence not known
myoclonia / Delayed / Incidence not known
depression / Delayed / Incidence not known
hostility / Early / Incidence not known
meningitis / Delayed / Incidence not known
psychosis / Early / Incidence not known
hypovolemia / Early / Incidence not known
involuntary movements / Delayed / Incidence not known
amnesia / Delayed / Incidence not known
peripheral edema / Delayed / Incidence not known
hypoxia / Early / Incidence not known
dyspnea / Early / Incidence not known
sinus tachycardia / Rapid / Incidence not known
conjunctivitis / Delayed / Incidence not known
chest pain (unspecified) / Early / Incidence not known
nystagmus / Delayed / Incidence not known
neutropenia / Delayed / Incidence not known
hematuria / Delayed / Incidence not known
urinary retention / Early / Incidence not known

Mild

diarrhea / Early / 36.0-42.0
headache / Early / 0-20.0
vomiting / Early / 6.0-9.0
abdominal pain / Early / 2.0-7.0
nausea / Early / 5.0-5.0
urticaria / Rapid / 2.0-2.0
dizziness / Early / 0-2.0
flatulence / Early / 2.0-2.0
nasal congestion / Early / Incidence not known
rash / Early / Incidence not known
maculopapular rash / Early / Incidence not known
pruritus / Rapid / Incidence not known
sneezing / Early / Incidence not known
flushing / Rapid / Incidence not known
injection site reaction / Rapid / Incidence not known
back pain / Delayed / Incidence not known
fever / Early / Incidence not known
irritability / Delayed / Incidence not known
restlessness / Early / Incidence not known
diplopia / Early / Incidence not known
asterixis / Delayed / Incidence not known
weakness / Early / Incidence not known
insomnia / Early / Incidence not known
fatigue / Early / Incidence not known
agitation / Early / Incidence not known
muscle cramps / Delayed / Incidence not known
tinnitus / Delayed / Incidence not known
drowsiness / Early / Incidence not known
vertigo / Early / Incidence not known
syncope / Early / Incidence not known
anxiety / Delayed / Incidence not known
cough / Delayed / Incidence not known
polyuria / Early / Incidence not known
ecchymosis / Delayed / Incidence not known
tremor / Early / Incidence not known
diaphoresis / Early / Incidence not known
malaise / Early / Incidence not known
dysgeusia / Early / Incidence not known
purpura / Delayed / Incidence not known
paresthesias / Delayed / Incidence not known
anorexia / Delayed / Incidence not known
lacrimation / Early / Incidence not known
hyperhidrosis / Delayed / Incidence not known
xerostomia / Early / Incidence not known
chills / Rapid / Incidence not known
dyspepsia / Early / Incidence not known
pallor / Early / Incidence not known
rhinitis / Early / Incidence not known
petechiae / Delayed / Incidence not known

Intrathecal administration

Iohexol 140 mg iodine/mL and 350 mg iodine/mL concentrations are contraindicated for intrathecal administration; however, iohexol 180 mg iodine/mL, 240 mg iodine/mL, and 300 mg iodine/mL concentrations can be administered by this route. Severe and fatal neurotoxic adverse reactions including convulsions, cerebral hemorrhage, unconsciousness, paralysis, inflammation of the arachnoid membrane, hyperthermia, and brain edema have been reported when inadvertent intrathecal administration of nonionic contrast media occurs. In addition, renal failure, cardiac arrest, and rhabdomyolysis have been reported.

Omnipaque

Rx

Iodinated nonionic, low-osmolar radiopaque contrast agent used during angiography, urography, and enhancement of CT imaging. Can be used orally for GI radiographic examinations and administered into body cavities and joints for radiographic examinations. An intrathecal formulation is available for use during myelography and enhancement of myelographic CT imaging.

For use in angiography via intravascular administration. For use as a contrast in cerebral arteriography. Intra-arterial dosage Adults

6 to 12 mL of iohexol 300 mg iodine/mL (Omnipaque 300) for visualization of the common carotid artery, 8 to 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) for visualization of the internal carotid artery, 6 to 9 mL of iohexol 300 mg iodine/mL (Omnipaque 300) for visualization of the external carotid artery, and 6 to 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) for visualization of the vertebral artery.

For use as a contrast in peripheral arteriography. Intra-arterial dosage Adults

20 to 70 mL of iohexol 350 mg iodine/mL (Omnipaque 350) or 30 to 90 mL of iohexol 300 mg iodine/mL (Omnipaque 300) for aortofemoral runoffs can be used; for selective arteriograms (femoral or iliac), 10 to 30 mL of iohexol 350 mg iodine/mL (Omnipaque 350) or 10 to 60 mL of iohexol 300 mg iodine/mL (Omnipaque 300) can be used.

For use as a contrast in peripheral venography (phlebography). Intravenous dosage Adults

20 to 150 mL of iohexol 240 mg iodine/mL (Omnipaque 240) or 40 to 100 mL iohexol 300 mg iodine/mL (Omnipaque 300) per leg to be visualized can be used. After the procedure, flush the venous system with normal saline or 5% Dextrose Injection. Massage and elevation of the affected limb may help in clearing the contrast medium from the extremity.

For use as a contrast in selective visceral arteriography and aortography. Intra-arterial dosage

NOTE: When using large volumes as a single injection (i.e., during ventriculography or aortography), several minutes between repeat injections should lapse to allow for correction of hemodynamic disturbances.

Adults

50 to 80 mL of iohexol 300 mg iodine/mL (Omnipaque 300) or iohexol 350 mg iodine/mL (Omnipaque 350) for larger vessels, such as the aorta (aortic arch or ascending aorta); 30 to 60 mL of iohexol 300 mg iodine/mL (Omnipaque 300) or iohexol 350 mg iodine/mL (Omnipaque 350) for abdominal aorta and its major branches (i.e., celiac, mesenteric, hepatic, and splenic arteries); 5 to 15 mL of iohexol 300 mg iodine/mL (Omnipaque 300) or iohexol 350 mg iodine/mL (Omnipaque 350) for renal arteries. If repeated injections are required, do not exceed 87.5 mg of iodine, which is equivalent to 290 mL of iohexol 300 mg iodine/mL (Omnipaque 300) or 250 mL of iohexol 350 mg iodine/mL (Omnipaque 350).

Infants, Children, and Adolescents

1 mL/kg of iohexol 350 mg iodine/mL (Omnipaque 350) for viewing aortic root, aortic arch, and descending aorta. If repeated injections are required, up to 5 mL/kg and a volume of 250 mL can be used.

For use as a contrast in adult angiocardiography including ventriculography and coronary arteriography. Intra-arterial dosage Adults

40 mL (range 30 to 60 mL) of iohexol 350 mg iodine/mL (Omnipaque 350) for ventriculography or 5 mL (range 3 to 14 mL) of iohexol 350 mg iodine/mL (Omnipaque 350) for right or left coronary arteriography. Multiple vascular systems and organs can be visualized during a single radiographic examination. The maximum dosage for multiple procedures is 87.5 g of iodine or 250 mL of iohexol 350 mg iodine/mL (Omnipaque 350). ECGs and vital signs should be routinely monitored during this procedure.

For use as a contrast during pediatric angiocardiography. Intra-arterial dosage Infants, Children, and Adolescents

For ventriculography, the usual single injection dosage is 1.25 mL/kg of body weight (range 1 to 1.5 mL/kg) of iohexol 350 mg iodine/mL (Omnipaque 350). Alternatively, 1.75 mL/kg of body weight (range 1.5 to 2 mL/kg) of iohexol 300 mg iodine/mL (Omnipaque 300) can be used. For pulmonary angiography, the usual single injection dosage is 1 mL/kg of iohexol 350 mg iodine/mL (Omnipaque 350). If multiple injections are given or visualization of multiple vascular systems and organs are desired during a single procedure, the total dose should not exceed 5 mL/kg up to a total volume of 250 mL of iohexol 350 mg iodine/mL (Omnipaque 350) or 6 mL/kg up to a total volume of 291 mL of iohexol 300 mg iodine/mL (Omnipaque 300). NOTE: When using large volumes as a single injection, several minutes between repeat injections should lapse to allow for correction of hemodynamic disturbances. ECGs and vital signs should be routinely monitored during this procedure.

For use as a contrast in digital subtraction angiography (DSA).
NOTE: Mechanical or hand injections can be used to administer one or more bolus intra-arterial and intravenous injections. The volume and rate of injection will depend on the type of equipment, technique used, and the vascular areas to be visualized.
Intra-arterial dosage Adults

20 to 45 mL of iohexol 140 mg iodine/mL (Omnipaque 140) at a rate of 8 to 20 mL/second for visualization of the aorta; 8 to 25 mL of iohexol 140 mg iodine/mL (Omnipaque 140) at a rate of 3 to 10 mL/second for visualization of the other branches of the aorta (subclavian, axillary, innominate, iliac arteries); 5 to 10 mL of iohexol 140 mg iodine/mL (Omnipaque 140) at a rate of 3 to 6 mL/second for visualization of the carotid arteries; 9 to 20 mL of iohexol 140 mg iodine/mL (Omnipaque 140) at a rate of 3 to 6 mL/second for visualization of the femoral artery; 4 to 10 mL of iohexol 140 mg iodine/mL (Omnipaque 140) at a rate of 2 to 8 mL/second for visualization of the vertebral arteries; and 6 to 12 mL of iohexol 140 mg iodine/mL (Omnipaque 140) at a rate of 3 to 6 mL/second For visualization of the renal arteries.

Intravenous dosage Adults

30 to 50 mL of iohexol 350 mg iodine/mL (Omnipaque 350) IV per injection at 7.5 to 30 mL/second using a pressure injector. Usually, 3 or more injections are required up to a total volume of 250 mL.

For use as contrast enhancement during computed tomography (CT) imaging of the head, body, or abdomen. For use as contrast enhancement during CT imaging of the head. Intravenous dosage Adults

70 to 150 mL of iohexol 300 mg iodine/mL (Omnipaque 300) or 80 mL of 350 mg iodine/mL (Omnipaque 350) via rapid IV injection. Alternatively, 120 to 150 mL of iohexol 240 mg iodine/mL (Omnipaque 240) via IV infusion.

Infants, Children, and Adolescents

1 to 2 mL/kg of iohexol 240 mg iodine/mL (Omnipaque 240) or 300 mg iodine/mL (Omnipaque 300) via rapid IV injection. The maximum single dose is 3 mL/kg [Max: 116 mL; 28 g of iodine of iohexol 240 mg iodine/mL (Omnipaque 240) or 35 g of iodine of iohexol 300 mg iodine/mL (Omnipaque 300)]. 

Neonates

1 to 2 mL/kg of iohexol 300 mg iodine/mL (Omnipaque 300) via rapid IV injection. The maximum single dose is 3 mL/kg.

For use as contrast enhancement during CT imaging of the body. Intravenous dosage Adults

50 to 200 mL of iohexol 300 mg iodine/mL (Omnipaque 300) or 60 to 100 mL of iohexol 350 mg iodine/mL (Omnipaque 350) via rapid IV injection.

Infants, Children, and Adolescents

1 to 2 mL/kg of iohexol 240 mg iodine/mL (Omnipaque 240) or 300 mg iodine/mL (Omnipaque 300) via rapid IV injection. The maximum single dose is 3 mL/kg [Max: 116 mL; 28 g of iodine of iohexol 240 mg iodine/mL (Omnipaque 240) or 35 g of iodine of iohexol 300 mg iodine/mL (Omnipaque 300)].

Neonates

1 to 2 mL/kg of iohexol 300 mg iodine/mL (Omnipaque 300) via rapid IV injection. The maximum single dose is 3 mL/kg.

For use in contrast enhanced computed tomography of the abdomen/GI tract.
NOTE: Dilute oral plus intravenous iohexol injection may be useful when unenhanced imaging does not provide sufficient delineation between normal loops of bowel and adjacent organs or areas of suspected pathology.
Oral dosage Adults

500 to 1,000 mL PO of iohexol 9 or 12 mg iodine/mL (Omnipaque oral solution 9 or 12) or diluted iohexol injection (Omnipaque 240, 300, or 350) at 6 to 12 mg iodine/mL in conjunction with IV iohexol. May give oral dosage all at once or over a period of 45 minutes.

Children and Adolescents 3 to 17 years

180 to 750 mL PO of iohexol 9 or 12 mg iodine/mL (Omnipaque oral solution 9 or 12) or diluted iohexol injection (Omnipaque 240, 300, or 350) at 9 to 21 mg iodine/mL in conjunction with IV iohexol. Do not exceed 10 g of iodine PO. May give oral dosage all at once or over a period of 45 minutes.

Infants and Children 1 to 2 years

180 to 750 mL PO of iohexol 9 or 12 mg iodine/mL (Omnipaque oral solution 9 or 12) or diluted iohexol injection (Omnipaque 240, 300, or 350) at 9 to 21 mg iodine/mL in conjunction with IV iohexol. Do not exceed 5 g of iodine PO. May give oral dosage all at once or over a period of 45 minutes.

Intravenous dosage Adults

100 to 150 mL of iohexol 300 mg iodine/mL (Omnipaque 300) IV in conjunction with PO iohexol. May administer IV up to 40 minutes after the oral dose.

Infants, Children, and Adolescents

1 to 2 mL/kg of iohexol 240 mg iodine/mL (Omnipaque 240) or 300 mg iodine/mL (Omnipaque 300) IV in conjunction with PO iohexol. Do not exceed 3 mL/kg IV. May administer IV up to 60 minutes after the oral dose.

For use as a contrast in excretory urography.
NOTE: Because temporary suppression of urine formation is possible, it is recommended that a suitable interval lapse before excretory urography is repeated.
For use during voiding cystourethrography (VCU).
NOTE: VCU is often performed in conjunction with excretory urography.
Intravesical dosage Infants, Children, and Adolescents

50 to 300 mL of diluted iohexol injection (Omnipaque 240, 300, or 350) at 100 mg iodine/mL or 50 to 600 mL of diluted iohexol injection (Omnipaque 240, 300, or 350) at 50 mg iodine/mL. Sufficient volume should be instilled so that the bladder is filled.

Intravenous dosage Adults

0.6 to 1.2 mL/kg of iohexol 300 mg iodine/mL (Omnipaque 300) or iohexol 350 mg iodine/mL (Omnipaque 350) is indicated IV.

Infants, Children, and Adolescents

0.5 to 3 mL/kg of iohexol 300 mg iodine/mL (Omnipaque 300) IV. The usual dosage for children is 1 to 1.5 mL/kg. Dosages for infants and children should be administered in proportion to body weight. The total administered dose should not exceed 3 mL/kg.

For oral pass-through radiographic examination of the gastrointestinal (GI) tract (gastrointestinal radiography).
NOTE: Iohexol is useful in this indication when barium is contraindicated as in those patients with suspected bowel perforation or when aspiration of the contrast medium is a possibility.
Oral dosage Adults

50 to 100 mL PO of undiluted iohexol injection 350 mg iodine/mL (Omnipaque 350).

Children 11 to 12 years and Adolescents

Up to 100 mL PO of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300).

Children 4 to 10 years

Up to 80 mL PO of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300).

Infants 3 to 11 months and Children 1 to 3 years

Up to 60 mL PO of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300).

Infants younger than 3 months

5 to 30 mL PO of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180).

Rectal dosage Children 11 to 12 years and Adolescents

Up to 100 mL PR of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300). When given rectally, larger volumes may be used.

Children 4 to 10 years

Up to 80 mL PR of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300). When given rectally, larger volumes may be used.

Infants 3 to 11 months and Children 1 to 3 years

Up to 60 mL PR of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300). When given rectally, larger volumes may be used.

Infants younger than 3 months

5 to 30 mL PR of undiluted iohexol injection 180 mg iodine/mL (Omnipaque 180). When given rectally, larger volumes may be used.

For use during endoscopic retrograde pancreatography (ERP) or endoscopic retrograde cholangiopancreatography (ERCP). Intraductal dosage Adults

10 to 50 mL of iohexol 240 mg iodine/mL (Omnipaque 240). The dosage may vary depending on individual anatomy and/or disease state.

For use as a contrast during hysterosalpingography. Intrauterine dosage Adult females

15 to 20 mL of iohexol 240 mg iodine/mL (Omnipaque 240) or 300 mg iodine/mL (Omnipaque 300). Individual dosages may vary depending on the patient's anatomy and and/or disease state.

For use as a contrast during herniography. Parenteral dosage Adults

50 mL of iohexol 240 mg iodine/mL (Omnipaque 240); dosages may vary depending on individual anatomy and/or disease state.

For use as a contrast in arthrography.
NOTE: Arthrography is usually performed under local anesthesia. The dosages listed below are a guide as more or less contrast medium may be required for optimal visualization. In general, lower dosages are recommended for double-contrast examinations (using 15 to 100 mL of air); higher dosages are recommended for single-contrast examination. The contrast media can be dispersed through the joint space by passive or active manipulation.
Intra-articular dosage Adults

5 to 15 mL of iohexol 240 mg iodine/mL (Omnipaque 240) or 300 mg iodine/mL (Omnipaque 300) for radiography of the knee. Alternatively, 5 to 10 mL of iohexol 350 mg iodine/mL (Omnipaque 350) can be used. For radiography of the shoulder, 3 mL of iohexol 240 mg iodine/mL (Omnipaque 240) or 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) is recommended. For radiography of the temporomandibular joint, 0.5 to 1 mL of iohexol 300 mg iodine/mL (Omnipaque 300) is recommended.

For use in neuroradiology including myelography.
NOTE: Only iohexol 180 mg iodine/mL (Omnipaque 180), 240 mg iodine/mL (Omnipaque 240), or 300 mg iodine/mL (Omnipaque 300) should be used intrathecally.
NOTE: Per the manufacturer, neuroleptic drugs (including phenothiazines) should be held for at least 48 hours before and for at least 24 hours after the procedure. NOTE: A minimum interval of 48 hours should pass between repeat examinations; however, 5 to 7 days between examinations is preferable when possible. Only one injection of iohexol should be given per procedure when used intrathecally.
NOTE: The pediatric dosages listed are based on age rather than weight because the brain and CSF volume are independent of weight. However, dosage may vary based on individual factors such as patient height, suspected pathology, patient condition, and technique.
NOTE: The following recommended dosages apply whether conventional myelography or contrast enhanced computerized tomography is used. For use as a contrast in lumbar myelography (via lumbar injection). Intrathecal dosage Adults

10 to 17 mL of iohexol 180 mg iodine/mL (Omnipaque 180). Alternatively, 7 to 12.5 mL of iohexol 240 mg iodine/mL (Omnipaque 240) can be used.

Adolescents

6 to 15 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 7 to 12 years

5 to 12 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 3 to 6 years

5 to 10 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Infants and Children 3 months to 2 years

4 to 8 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Neonates and Infants 1 to 2 months

2 to 4 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

For use as a contrast in thoracic myelography (via lumbar or cervical injection).
NOTE: Only thoracic myelography via lumbar puncture is indicated for pediatric patients.
Intrathecal dosage Adults

6 to 12.5 mL of iohexol 240 mg iodine/mL (Omnipaque 240). Alternatively, 6 to 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) can be used.

Adolescents

6 to 15 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 7 to 12 years

5 to 12 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 3 to 6 years

5 to 10 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Infants and Children 3 months to 2 years

4 to 8 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Neonates and Infants 1 to 2 months

2 to 4 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

For use as a contrast in cervical myelography (via lumbar injection). Intrathecal dosage Adults

6 to 12.5 mL of iohexol 240 mg iodine/mL (Omnipaque 240). Alternatively, 6 to 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) can be used.

Adolescents

6 to 15 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 7 to 12 years

5 to 12 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 3 to 6 years

5 to 10 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Infants and Children 3 months to 2 years

4 to 8 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Neonates and Infants 1 to 2 months

2 to 4 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

For use as a contrast in cervical myelography (via C1 to C2 injection). Intrathecal dosage Adults

7 to 10 mL of iohexol 180 mg iodine/mL (Omnipaque 180) can be used. Alternatively, 6 to 12.5 mL of iohexol 240 mg iodine/mL (Omnipaque 240) or 4 to 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) can be used.

For use as a contrast in total columnar myelography (via lumbar injection). Intrathecal dosage Adults

6 to 12.5 mL of iohexol 240 mg iodine/mL (Omnipaque 240). Alternatively, 6 to 10 mL of iohexol 300 mg iodine/mL (Omnipaque 300) can be used.

Adolescents

6 to 15 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 7 to 12 years

5 to 12 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Children 3 to 6 years

5 to 10 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Infants and Children 3 months to 2 years

4 to 8 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Neonates and Infants 1 to 2 months

2 to 4 mL of iohexol 180 mg iodine/mL (Omnipaque 180).

Hepatic Impairment

Specific guidelines for dosage adjustment in hepatic impairment are not available; it appears no dosage adjustments are needed.

Renal Impairment

Specific guidelines for dosage adjustment in renal impairment are not available; however, iohexol can cause acute renal failure and this risk is higher in patients with underlying renal insufficiency. Patients with renal insufficiency should be well-hydrated and the smallest volume of contrast media should be used.

Acebutolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Acetaminophen; Aspirin, ASA; Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Acetaminophen; Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Acetaminophen; Caffeine; Dihydrocodeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Acetaminophen; Caffeine; Pyrilamine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Acetaminophen; Chlorpheniramine; Phenylephrine : (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Acetaminophen; Dextromethorphan; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Acetaminophen; Guaifenesin; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Acetaminophen; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Acyclovir: (Moderate) Concomitant use of acyclovir and contrast agents should be avoided when possible, as use of these drugs together may increase the risk for nephrotoxicity.
Aldesleukin, IL-2: (Moderate) Patients have reported 'recall reactions' of aldesleukin therapy and delayed reactions to contrast when used concomitantly with radiopaque contrast agents. The reactions responded to supportive therapy. Such recall reactions were minimized by using nonionic contrast media and waiting four weeks between aldesleukin treatment and radiopaque contrast agents.
Aliskiren; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Alogliptin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Amiloride: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Amiloride; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Aminoglycosides: (Moderate) Because the use of other nephrotoxic drugs, such as aminoglycoside antibiotics, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, concomitant use should be avoided when possible.
Amiodarone: (Major) When injected directly into coronary arteries, contrast media can cause bradycardia and QT interval prolongation; these reactions tend to be less common with nonionic low-osmolar contrast media. In a retrospective review of 21 patients on amiodarone therapy who underwent cardiac catheterization with iohexol, the QTc interval was significantly prolonged 12-24 hours post catheterization from a baseline QTc interval of 433 msec (95%CI 419-483 msec) to 480 msec (95%CI, 422-483 msec) (p< 0.001). No significant change in the QTc interval was seen in non-amiodarone treated control patients. Until more data are available, clinicians should closely monitor patients taking amiodarone during cardiac catheterization with radiopaque contrast agents; EKG monitoring during intra-coronary artery injection of radiopaque contrast agents is recommended.
Amitriptyline: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Amoxapine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Amoxapine should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Amphetamine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Amphetamines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Amphetamine; Dextroamphetamine Salts: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Amphetamines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Amphetamine; Dextroamphetamine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Amphetamines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Amphotericin B: (Moderate) Because the use of other nephrotoxic drugs, including amphotericin B, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, concomitant use should be avoided when possible.
Angiotensin II: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Angiotensin-converting enzyme inhibitors: (Moderate) Because the use of other nephrotoxic drugs, including ACE inhibitors, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, ACE inhibitor therapy should be withheld, when possible, during radiopaque contrast agent administration.
Aprotinin: (Moderate) The manufacturer recommends using aprotinin cautiously in patients that are receiving drugs that can affect renal function, such as radiopaque contrast agents, as the risk of renal impairment may be increased.
Aripiprazole: (Major) Aripiprazole lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Articaine; Epinephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Asenapine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure. The frequency of seizure activity with asenapine was low during clinical trials; however, seizures have been associated with other antipsychotics and caution is advised.
Aspirin, ASA; Butalbital; Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Aspirin, ASA; Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Aspirin, ASA; Caffeine; Orphenadrine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Atenolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Atenolol; Chlorthalidone: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure. (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Azilsartan; Chlorthalidone: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Barium Sulfate: (Major) Delay the administration of non-ionic contrast media in patients who have recently received an oral cholecystographic contrast agent, such as barium. Renal toxicity has been reported in patients with liver dysfunction who were given an oral cholecystographic agent followed by intravascular iodinated contrast agents.
Benazepril; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Benzphetamine: (Major) Sympathomimetics lower the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Beta-blockers: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Betamethasone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., betamethasone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Betaxolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Bictegravir; Emtricitabine; Tenofovir Alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Bisoprolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Bisoprolol; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure. (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Brexpiprazole: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics such as brexpiprazole should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post procedure.
Brimonidine; Timolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Brompheniramine; Dextromethorphan; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Brompheniramine; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Bumetanide: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Bupivacaine; Epinephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Bupropion: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Bupropion should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Bupropion; Naltrexone: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Bupropion should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Butalbital; Acetaminophen; Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Butalbital; Acetaminophen; Caffeine; Codeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Butalbital; Aspirin; Caffeine; Codeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure. (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Caffeine; Sodium Benzoate: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Calcium, Magnesium, Potassium, Sodium Oxybates: (Major) Sodium oxybate lowers seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Canagliflozin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Candesartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Capreomycin: (Major) Because the use of other nephrotoxic drugs, including capreomycin, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, concomitant use should be avoided when possible. Monitor patients for changes in renal function if these drugs are coadministered.
Captopril; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Carteolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Carvedilol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Celecoxib; Tramadol: (Major) Tramadol lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Chlordiazepoxide; Amitriptyline: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Chlorothiazide: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Chlorpheniramine; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Chlorthalidone: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Chlorthalidone; Clonidine: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Cisplatin: (Moderate) Closely monitor renal function if concomitant use with cisplatin and non-ionic contrast media is necessary. Both drugs can cause nephrotoxicity, which may be additive when used together.
Clindamycin: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
Clomipramine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Clonazepam: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. Patients should be instructed to continue using benzodiazepines during procedures or exams that require the use of intrathecal radiopaque contrast agents as abrupt discontinuation of benzodiazepines may also increase seizure risk.
Clozapine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Cocaine: (Major) Use of medications that lower the seizure threshold, such as cocaine, should be carefully evaluated when considering intrathecal radiopaque contrast agentsl. While the contributory role of such medications has not been established, some physicians discontinue these drugs at least 48 hours before and for at least 24 hours after intrathecal use.
Codeine; Phenylephrine; Promethazine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Colistimethate, Colistin, Polymyxin E: (Major) Because the use of other nephrotoxic drugs, including colistimethate sodium, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, concomitant use should be avoided when possible. Monitor patients for changes in renal function if these drugs are coadministered.
Colistin: (Major) Because the use of other nephrotoxic drugs, including colistimethate sodium, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, concomitant use should be avoided when possible. Monitor patients for changes in renal function if these drugs are coadministered.
Cortisone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., cortisone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Cyclobenzaprine: (Major) Use of medications that lower the seizure threshold, such as cyclobenzaprine, should be carefully evaluated when considering intrathecal radiopaque contrast agents. Cyclobenzaprine should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Cyclosporine: (Moderate) Because the use of other nephrotoxic drugs, including cyclosporine, is an additive risk factor for nephrotoxicity in patients receiving radiopaque contrast agents, when possible, cyclosporine should be withheld during radiopaque contrast agent administration.
Dapagliflozin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Deferasirox: (Moderate) Acute renal failure has been reported during treatment with deferasirox. Coadministration of deferasirox with other potentially nephrotoxic drugs, including radiopaque contrast agents, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly.
Desipramine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Dexamethasone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., dexamethasone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Dextroamphetamine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Amphetamines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Dextromethorphan; Bupropion: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Bupropion should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Dextromethorphan; Diphenhydramine; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Dextromethorphan; Guaifenesin; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Diethylpropion: (Major) Use of medications that lower the seizure threshold, such as diethylpropion, should be carefully evaluated when considering non-ionic contrast media. Such medications should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Diphenhydramine; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Dopamine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Doravirine; Lamivudine; Tenofovir disoproxil fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Dorzolamide; Timolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Doxepin: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Droxidopa: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Empagliflozin; Linagliptin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Empagliflozin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Emtricitabine; Tenofovir alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Enalapril; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Entecavir: (Moderate) Because entecavir is primarily eliminated by the kidneys and radiopaque contrast agents can affect renal function, concurrent administration with radiopaque contrast agents may increase the serum concentrations of entecavir and adverse events. The manufacturer of entecavir recommends monitoring for adverse effects when these drugs are coadministered.
Ephedrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Ephedrine; Guaifenesin: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Epinephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Eprosartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Ergotamine; Caffeine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Ertugliflozin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Esmolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Ethacrynic Acid: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Fosinopril; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Furosemide: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Glipizide; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Glyburide; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Green Tea: (Major) Some, but not all, green tea products contain caffeine. Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Caffeine and caffeine containing products including green tea should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Guaifenesin; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Haloperidol: (Major) Haloperidol lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Hydrochlorothiazide, HCTZ; Methyldopa: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Hydrochlorothiazide, HCTZ; Moexipril: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Hydrocortisone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., hydrocortisone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Ibandronate: (Moderate) Theoretically, coadministration of intravenous ibandronate with other potentially nephrotoxic drugs, such as radiopaque contrast agents, may increase the risk of developing nephrotoxicity.
Iloperidone: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure. Iloperidone has not been associated with seizure activity more frequently than placebo in clinical trials; however, lowering of the seizure threshold is generally a class effect among antipsychotics and caution is advised.
Imipramine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Irbesartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Labetalol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Levobunolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Lidocaine; Epinephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Linagliptin; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Linezolid: (Major) Discontinue linezolid at least 48 hours before myelography with iohexol and do not resume for at least 24 hours post procedure due to increased seizure risk. In non-elective procedures in patients on these drugs, consider prophylactic use of anticonvulsants.
Lisdexamfetamine: (Major) Use of medications that lower the seizure threshold, such as lisdexamfetamine, should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Lisinopril; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Loop diuretics: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Lorazepam: (Moderate) The use of intrathecal radiopaque contrast agents is associated with a risk of seizures. Patients should be instructed to continue using benzodiazepines during procedures or exams that require the use of intrathecal radiopaque contrast agents as abrupt discontinuation of benzodiazepines may also increase seizure risk.
Losartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Loxapine: (Major) Loxapine lower the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Lurasidone: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours post-procedure.
Maprotiline: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Maprotiline should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Metformin; Repaglinide: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Metformin; Rosiglitazone: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Metformin; Saxagliptin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Metformin; Sitagliptin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Methamphetamine: (Major) Methamphetamine lowers the seizure threshold and should be discontinued at least 48 hours before and for at least 24 hours after intrathecal use of contrast media.
Methyclothiazide: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Methylphenidate Derivatives: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Methylphenidate derivatives should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Methylprednisolone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., methylprednisolone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Metolazone: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Metoprolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Metoprolol; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure. (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Midodrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Molindone: (Major) Molindone lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Monoamine oxidase inhibitors: (Major) Discontinue monoamine oxidase inhibitors (MAOIs) at least 48 hours before myelography with iohexol and do not resume for at least 24 hours post procedure due to increased seizure risk. In non-elective procedures in patients on these drugs, consider prophylactic use of anticonvulsants.
Nadolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Nebivolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Nebivolol; Valsartan: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Nonsteroidal antiinflammatory drugs: (Moderate) Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk for nephrotoxicity when given to patients receiving a contrast agents. When possible, withhold NSAID therapy during administration of a contrast agent.
Norepineph

rine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Nortriptyline: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Olanzapine: (Major) Atypical antipsychotics may lower the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Olanzapine; Fluoxetine: (Major) Atypical antipsychotics may lower the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Olanzapine; Samidorphan: (Major) Atypical antipsychotics may lower the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Olmesartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Oxaliplatin: (Major) Avoid coadministration of oxaliplatin with non-ionic contrast media due to the risk of increased oxaliplatin-related adverse reactions. Non-ionic contrast media is known to be potentially nephrotoxic; because platinum-containing drugs like oxaliplatin are eliminated primarily through the kidney, oxaliplatin clearance may be decreased by coadministration with nephrotoxic agents.
Pamidronate: (Moderate) Coadministration of pamidronate with other nephrotoxic drugs may increase the risk of developing nephrotoxicity following pamidronate administration, even in patients who have normal renal function.
Perphenazine; Amitriptyline: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Phendimetrazine: (Major) Phendimetrazine lowers the seizure threshold and should be discontinued at least 48 hours before and for at least 24 hours after intrathecal use of contrast media.
Phenothiazines: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Phenothiazines should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Phentermine: (Major) Phentermine lowers the seizure threshold and should be discontinued at least 48 hours before and for at least 24 hours after intrathecal use of contrast media.
Phentermine; Topiramate: (Major) Phentermine lowers the seizure threshold and should be discontinued at least 48 hours before and for at least 24 hours after intrathecal use of contrast media.
Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Pimozide: (Major) Pimozide lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Pindolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Pioglitazone; Metformin: (Major) Discontinue metformin at the time of, or before, administration of non-ionic contrast media to patients with an eGFR of 30 to 60 mL/minute/1.73 m2, history of liver disease, alcoholism, or heart failure, or who will be administered intra-arterial iodinated contrast. Reevaluate eGFR 48 hours after the imaging procedure; restart metformin if renal function is stable. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function.
Potassium-sparing diuretics: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Prednisolone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., prednisolone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Prilocaine; Epinephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Promethazine; Phenylephrine: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Propranolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Propranolol; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure. (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Protriptyline: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Quetiapine: (Major) Quetiapine lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Quinapril; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Risperidone: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Sodium Iodide: (Moderate) Administration of non-ionic contrast media may interfere with thyroid uptake of radioactive sodium iodide (I-131) and decrease therapeutic and diagnostic efficacy in patients with carcinoma of the thyroid. The decrease in efficacy lasts for 6 to 8 weeks.
Sodium Oxybate: (Major) Sodium oxybate lowers seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Sotalol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Spironolactone: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Spironolactone; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Telmisartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Tenofovir Alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Tenofovir Alafenamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions.
Tenofovir Disoproxil Fumarate: (Moderate) Tenofovir-containing products should be avoided with concurrent or recent use of a nephrotoxic agent, such as radiopaque contrast agents. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. Drugs that decrease renal function may also increase concentrations of tenofovir. Renal impairment, which may include hypophosphatemia, has been reported with the use of tenofovir with a majority of the cases occurring in patients who have underlying systemic or renal disease or who are concurrently taking nephrotoxic agents. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus.
Thiazide diuretics: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Thiothixene: (Major) Use of medications that lower the seizure threshold, such as thiothixene, should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Timolol: (Moderate) Use caution when administering non-ionic contrast media to patients taking beta-blockers. Beta-blockers lower the threshold for and increase the severity of contrast reactions and reduce the responsiveness of treatment of hypersensitivity reactions with epinephrine.
Torsemide: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Tramadol: (Major) Tramadol lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Tramadol; Acetaminophen: (Major) Tramadol lowers the seizure threshold and should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Triamcinolone: (Major) Serious adverse events, including death, have been observed during intrathecal administration of both corticosteroids (i.e., triamcinolone) and radiopaque contrast agents (i.e., iohexol); therefore, concurrent use of these medications via the intrathecal route is contraindicated. Cases of cortical blindness, stroke, spinal cord infarction, paralysis, seizures, nerve injury, brain edema, and death have been temporally associated (i.e., within minutes to 48 hours after injection) with epidural administration of injectable corticosteroids. In addition, patients inadvertently administered iohexol formulations not indicated for intrathecal use have experienced seizures, convulsions, cerebral hemorrhages, brain edema, and death. Administering these medications together via the intrathecal route may increase the risk for serious adverse events.
Triamterene: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Triamterene; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Tricyclic antidepressants: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Trimipramine: (Major) Use of medications that lower the seizure threshold should be carefully evaluated when considering the use of intrathecal radiopaque contrast agents. Tricyclic antidepressants should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Valacyclovir: (Moderate) Concomitant use of valacyclovir and contrast agents should be avoided when possible, as use of these drugs together may increase the risk for nephrotoxicity.
Valsartan; Hydrochlorothiazide, HCTZ: (Major) Do not use diuretics before non-ionic contrast media administration. Concomitant use of diuretics and non-ionic contrast media may increase the risk for acute kidney injury, including renal failure.
Vasopressin, ADH: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Vasopressors: (Major) Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects.
Voclosporin: (Moderate) Concomitant use of voclosporin and non-ionic contrast media may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
Ziprasidone: (Major) Use of medications that lower the seizure threshold, such as ziprasidone, should be carefully evaluated when considering intrathecal radiopaque contrast agents. Antipsychotics should be discontinued at least 48 hours before myelography and should not be resumed for at least 24 hours postprocedure.
Zoledronic Acid: (Moderate) Theoretically, the chronic coadministration of zoledronic acid with other nephrotoxic drugs, such as radiopaque contrast agents, may increase the risk of developing nephrotoxicity, even in patients who have normal renal function.

Omnipaque Intra-Articular Inj Sol: 1mL, 302mg, 388mg, 518mg, 647mg, 755mg
Omnipaque Intrathecal Inj Sol: 1mL, 388mg, 518mg, 647mg
Omnipaque Intravascular Inj Sol: 1mL, 302mg, 388mg, 518mg, 647mg, 755mg
Omnipaque Intravenous Inj Sol: 1mL, 647mg
Omnipaque Oral Inj Sol: 1mL, 302mg, 388mg, 518mg, 647mg, 755mg
Omnipaque Oral Sol: 1mL, 19mg, 26mg
Omnipaque Rectal Inj Sol: 1mL, 302mg, 388mg, 518mg, 647mg, 755mg

Adults

Do not exceed recommended volume or concentration for the particular indication; 87.5 grams iodine (250 mL of 350 mg iodine/mL or 291 mL of 300 mg iodine/mL) via intravascular administration; 3.06 grams iodine and a concentration of 300 mg iodine/mL via intrathecal administration.

Geriatric

Do not exceed recommended volume or concentration for the particular indication; 87.5 grams iodine (250 mL of 350 mg iodine/mL or 291 mL of 300 mg iodine/mL) via intravascular administration; 3.06 grams iodine and a concentration of 300 mg iodine/mL via intrathecal administration.

Adolescents

Do not exceed the recommended volume or concentration for the particular indication; 87.5 grams of iodine (5 mL/kg or 250 mL of 350 mg iodine/mL or 6 mL/kg or 291 mL of 300 mg iodine/mL) via intravascular administration; 2.7 grams iodine (15 mL) of 180 mg iodine/mL via intrathecal administration.

Children

7 to 12 years: Do not exceed the recommended volume or concentration for the particular indication; 87.5 g of iodine (5 mL/kg or 250 mL of 350 mg iodine/mL or 6 mL/kg or 291 mL of 300 mg iodine/mL) via intravascular administration; 2.16 g of iodine (12 mL) of 180 mg iodine/mL via intrathecal administration.
3 to 6 years: Do not exceed the recommended volume or concentration for the particular indication; 5 mL/kg of 350 mg iodine/mL or 6 mL/kg of 300 mg iodine/mL) via intravascular administration; 1.8 g of iodine (10 mL) of 180 mg iodine/mL via intrathecal administration.
1 to 2 years: Do not exceed the recommended volume or concentration for the particular indication; 5 mL/kg of 350 mg iodine/mL or 6 mL/kg of 300 mg iodine/mL) via intravascular administration; 1.44 g of iodine (8 mL) of 180 mg iodine/mL via intrathecal administration.

Infants

3 to 11 months: Do not exceed the recommended volume or concentration for the particular indication; 5 mL/kg of 350 mg iodine/mL or 6 mL/kg of 300 mg iodine/mL) via intravascular administration; 1.44 g of iodine (8 mL) of 180 mg iodine/mL via intrathecal administration.
1 to 2 months: Do not exceed the recommended volume or concentration for the particular indication; 5 mL/kg of 350 mg iodine/mL or 6 mL/kg of 300 mg iodine/mL) via intravascular administration; 0.72 g of iodine (4 mL) of 180 mg iodine/mL via intrathecal administration.

Neonates

Do not exceed the recommended volume or concentration for the particular indication; 3 mL/kg of 300 mg iodine/mL via intravascular administration; 0.72 g of iodine (4 mL) of 180 mg iodine/mL via intrathecal administration.

Iohexol is an iodinated contrast media used to visualize the anatomical structures of the body including blood vessels, tissues, organs, and body cavities. Iodine is the radiopaque component of iohexol, allowing for opacification of vessels in the path of the blood flow of contrast media during angiography and urography. After iohexol injection, internal structures of the human body can be visualized until significant hemodilution occurs. Iohexol can be injected directly into body cavities and provide density sufficient for enhanced radiographic visualization.
 
Iohexol enhances computed tomographic (CT) imaging through augmentation of radiographic efficiency. The degree of enhancement is directly related to the iodine content in the administered dose; peak iodine blood levels usually occur immediately and dramatically decrease within 5—10 minutes. During CT brain imaging, a lag between contrast media administration and maximum contrast enhancement of up to one hour occurs most likely because the accumulation of iodine within the lesion and the outside blood pool is necessary for visualization; the mechanism by which this occurs is not clear. Because contrast media does not cross the blood-brain barrier, contrast media does not accumulate in normal brain tissue; contrast enhancement of normal brain tissue is most likely secondary to iohexol accumulation within the blood pool. If the presence of a malignant tumor causes a break in the blood-brain barrier, contrast media does accumulate within the interstitial tissues of the tumor; however, adjacent normal brain tissue does not contain contrast medium. During computed tomographic (CT) imaging of the body, enhancement is related to blood flow, concentration of the contrast medium, and extraction of the contrast medium by interstitial tissue of tumors since no barrier exists. In contrast to brain imaging, contrast enhancement during body imaging is due to the relative differences in extravascular diffusion of contrast media between normal and abnormal tissue

Iohexol can be administered orally or can be injected into body cavities or joints. Iohexol can also be administered intravascularly (intravenously or intra-arterially) or intrathecally. Care should be taken to administer only iohexol 180 mg iodine/mL, 240 mg iodine/mL, or 300 mg iodine/mL concentrations intrathecally.

Oral Route

Iohexol is not significantly absorbed following oral administration; only 0.1% to 0.5% of an administered dose is excreted by the kidneys. This amount may increase in the presence of bowel perforation or obstruction. Iohexol is well tolerated and readily absorbed if leakage into the peritoneal cavity occurs.

Intravenous Route

After IV administration in 16 adult subjects receiving 500 to 1,500 mg iodine/kg, the Vd of iohexol was 165 mL/kg (range: 108 to 219 mL/kg). The elimination half-life was 12.6 hours, and the clearance was 131 mL/minute (range: 98 to 165 mL/minute); clearance does not appear to be dose dependent. Iohexol does not undergo any significant metabolism, deiodination, or biotransformation, but is primarily eliminated through the kidneys via glomerular filtration. Approximately 90% of the drug is excreted unchanged in the urine within the first 24 hours, with the peak urine concentrations occurring within the first hour after administration.

Other Route(s)

Intravascular administration
Iohexol demonstrates 2-compartment model pharmacokinetics. Following intravascular administration, peak plasma concentrations occur rapidly allowing for quick visualization of the blood, liver, spleen and other organs followed by slow urinary excretion. Iohexol immediately distributes into circulating blood volume and then into the interstitial space; after equilibrium, distribution into the extracellular space occurs. It does not appear that iohexol is significantly deposited into normal tissue. Iohexol is not significantly bound to plasma or serum proteins and does not cross the blood-brain barrier; iohexol probably crosses the placental barrier by simple diffusion. Iohexol does not undergo any significant metabolism, deiodination, or biotransformation but is primarily eliminated through the kidneys via glomerular filtration. The elimination half-life of all iodinated contrast media is approximately 2 hours in patients with normal renal function. Approximately 90% of an intravascular dose is excreted in the urine within the first 24 hours. Maximal opacification of the renal passages may be possible as early as one minute after intravenous injection; urograms become apparent 1 to 3 minutes after injection with optimal contrast occurring in 5 to 15 minutes. In patients with renal impairment, visualization may be delayed or lacking. Maximum contrast enhancement during computed tomography brain imaging can occur up to one hour after injection depending on the type of lesion to be visualized whereas contrast enhancement during computed tomography of the body appears to be greatest soon after bolus administration of the contrast medium. The greatest enhancement for body imaging can be detected by a series of consecutive 2 to 3 second scans (e.g., dynamic computed tomography imaging) performed within 30 to 90 seconds after injection.
 
Intrathecal administration
Following intrathecal administration, iohexol is rapidly absorbed into the bloodstream from the cerebrospinal fluid (CSF); the mean maximum plasma concentration of iohexol occurs approximately 3.8 hours after intrathecal administration. Once absorbed into the bloodstream, the distribution, metabolism and excretion of iohexol is the same as intravascular administration; 88% of an intrathecal dose is excreted in the urine within the first 24 hours. After intrathecal injection, diagnostic contrast will be provided for up to 30 minutes using conventional radiography; after one hour, contrast of diagnostic quality is usually negligible. However, sufficient contrast for enhanced myelographic computed tomography will be available for several hours post administration. If contrast enhanced CT myelography is to follow conventional myelography, a delay of several hours between procedures should be considered as after administration into the lumbar subarachnoid space, computed tomography shows the presence of contrast medium in the thoracic region in 1 hour, in the cervical region in 2 hours, and the basal cisterns in 3 to 4 hours.
 
Body cavity/joint administration
When administered into the majority of body cavities or joints, iohexol is rapidly absorbed into the surrounding tissue and the distribution, metabolism and excretion is the same as intravascular administration. When iohexol is used for bladder or uterine examinations, the contrast media is drained from the cavity after completion of the radiographic examination.

Pregnancy

Iohexol for hysterosalpingography is contraindicated during pregnancy or suspected pregnancy, within 6 months after termination of pregnancy, or within 30 days after conization or curettage. Hysterosalpingography is contraindicated in pregnant women due to the potential risk to the fetus from an intrauterine procedure. Data with iohexol use in pregnant women are insufficient to determine if there is a drug-associated risk of adverse developmental outcomes. Iohexol does cross the placenta and reach fetal tissues in small amounts. In animal reproduction studies, no adverse developmental effects were noted after IV administration to pregnant rats and rabbits during organogenesis at doses up to 0.4 and 0.5 times, respectively, the maximum recommended human IV dose. The American College of Radiology (ACR) manual on contrast media states that iodinated contrast crosses the human placenta and enters the fetus in measurable quantities; however, the risk to the fetus is unknown. Therefore, the ACR recommends iodinated contrast be administered during pregnancy only if necessary and only after informed consent is obtained. In contrast, the Guidelines for Computed Tomography and Magnetic Resonance Imaging in Pregnancy and Lactation state that use of iodinated contrast during pregnancy appears to be safe and should be administered as per usual. It is advised to screen neonates whose mothers received iodinated contrast during pregnancy for hypothyroidism.

Data are limited regarding use of iohexol during breast-feeding; however, exposure of the breast-fed infant to iodine is expected to be minimal. Iodinated contrast agents are excreted unchanged in human milk in very low amounts with poor absorption from the gastrointestinal tract of a breast-fed infant. Limited data demonstrate that breast-feeding after iohexol administration would result in the infant receiving an oral dose of 0.5% to 0.7% of the maternal weight-adjusted dose. To minimize potential exposure to the breast-fed infant, a lactating woman may consider interrupting breast-feeding and pumping and discarding breast milk for 10 hours (approximately 5 half-lives) after iohexol administration. The Guidelines for Computed Tomography and Magnetic Resonance Imaging Use During Pregnancy and Lactation and the American College of Radiology (ACR) manual on contrast media state that lactating women receiving iodinated contrast can continue to breast-feed without interruption. Previous American Academy of Pediatrics recommendations considered iohexol as compatible with breast-feeding. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for iohexol and any potential adverse effects on the breast-fed infant from iohexol or the underlying maternal condition.