ANGIO-CONRAY
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANGIO-CONRAY (ANGIO-CONRAY).
Angio-Conray (iothalamate meglumine) is a radiopaque contrast agent that attenuates X-rays, providing vascular opacification for angiographic procedures.
| Metabolism | Iothalamate meglumine is not metabolized; it is excreted unchanged primarily by glomerular filtration in the kidneys. |
| Excretion | Renal: >95% unchanged via glomerular filtration; biliary/fecal: <5%. |
| Half-life | Terminal elimination half-life: 1-2 hours; prolonged in renal impairment. |
| Protein binding | ~10% bound to plasma proteins (albumin). |
| Volume of Distribution | 0.3-0.5 L/kg; reflects distribution primarily in extracellular fluid. |
| Bioavailability | Intravenous: 100%; not administered orally. |
| Onset of Action | Intravenous: immediate (seconds); intra-arterial: immediate (seconds). |
| Duration of Action | Rapid distribution and elimination; imaging window minutes; complete clearance within 24 hours. |
Intravenous: 0.5-1 mL/kg (maximum 100 mL) of a 60% solution for computed tomography; intra-arterial: varies by procedure, typically 5-80 mL of 60% or 76% solution.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR < 30 mL/min: contraindicated. eGFR 30-59 mL/min: use with caution, limit dose to 60 mL of 60% solution. eGFR ≥ 60 mL/min: no adjustment needed. |
| Liver impairment | No specific Child-Pugh adjustments; use with caution in severe hepatic impairment due to increased risk of adverse effects. |
| Pediatric use | Intravenous: 1-2 mL/kg (maximum 50 mL) of 60% solution for CT; less than 6 months: use with extreme caution. |
| Geriatric use | Reduce dose by 50% or use minimum effective dose due to reduced renal function and increased risk of nephrotoxicity; monitor hydration. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANGIO-CONRAY (ANGIO-CONRAY).
| Breastfeeding | Iodinated contrast agents are excreted into breast milk in very small amounts (less than 1% of maternal dose). M/P ratio not reported for Angio-Conray. The American College of Radiology states that breastfeeding can be continued without interruption or pumping and discarding. Infant exposure is negligible. |
| Teratogenic Risk | Iodinated contrast agents, including Angio-Conray (sodium iothalamate), are generally considered to have low teratogenic risk. Animal studies have not shown fetal harm. In humans, there is no evidence of teratogenicity from limited data. However, because ionizing radiation exposure from the procedure may pose risk, benefits must outweigh risks. First trimester: theoretical risk from radiation. Second and third trimesters: minimal risk from contrast alone; radiation risk remains. Avoid unnecessary exposure. |
■ FDA Black Box Warning
Not for intrathecal use. Risk of severe adverse reactions including anaphylaxis, cardiovascular collapse, and death, especially in patients with a history of prior reaction to contrast media, bronchial asthma, or allergies.
| Serious Effects |
["Absolute: Known hypersensitivity to iothalamate or other iodine-containing contrast media; anuria; severe oliguria; concurrent administration of metformin in patients with renal impairment.","Relative: Pregnancy (unless essential), severe hepatic impairment, uncompensated heart failure, advanced renal disease (eGFR <30 mL/min/1.73 m²)."]
| Precautions | ["Risk of acute renal failure, especially in patients with pre-existing renal impairment, diabetes mellitus, or dehydration.","Potential for hypersensitivity reactions including anaphylaxis.","Exercise caution in patients with pheochromocytoma, sickle cell disease, hyperthyroidism, or multiple myeloma.","Avoid extravasation as it can cause tissue necrosis."] |
| Food/Dietary | No known food interactions. Maintain adequate hydration; avoid dehydration. No specific dietary restrictions required. |
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| Fetal Monitoring | Monitor maternal renal function (serum creatinine, eGFR) before administration due to risk of contrast-induced nephropathy. Assess for allergic reactions. In pregnancy, monitor fetal heart rate during procedure if available. Post-procedure, monitor maternal hydration status and renal function. No specific fetal monitoring required for contrast alone. |
| Fertility Effects | No specific studies on Angio-Conray and fertility. Iodinated contrast agents are not known to affect human fertility. Animal studies have not shown impaired fertility. Theoretical risk from radiation exposure during imaging may affect gonadal tissue, but this is not contrast-related. |
| Clinical Pearls | Angio-Conray (iothalamate meglumine) is an ionic high-osmolar contrast agent. Pre-hydration with normal saline (1 mL/kg/h for 6-12 hours) reduces risk of contrast-induced nephropathy. Screen for metformin use; discontinue metformin 48 hours prior and hold for 48 hours post procedure. Consider prophylactic therapy for allergic reactions in patients with prior hypersensitivity. Use lowest possible dose to achieve diagnostic image. |
| Patient Advice | You may feel warm or have a metallic taste during the injection. · Inform your doctor if you have ever had a reaction to contrast dye. · Tell your doctor if you have kidney problems, diabetes, or take metformin. · You may need to stop taking metformin for 2 days before and after the procedure. · You may experience nausea, headache, or flushing after the procedure. · Drink plenty of liquids before and after the procedure unless told otherwise. · Seek immediate medical attention if you have hives, difficulty breathing, or swelling. |