ANGIOVIST 282
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANGIOVIST 282 (ANGIOVIST 282).
Angiovist 282 (diatrizoate meglumine and diatrizoate sodium) is a radiographic contrast agent that contains iodine, which attenuates X-rays, allowing visualization of vascular structures and organs. It increases the contrast between blood vessels and surrounding tissues by absorbing X-rays.
| Metabolism | Diatrizoate is not metabolized; it is excreted unchanged in the urine via glomerular filtration. Approximately 85-90% is eliminated within 24 hours. |
| Excretion | Renal excretion via glomerular filtration; unchanged drug: >95% within 24 hours. Biliary/fecal: <5%. |
| Half-life | Terminal elimination half-life: 1.5–2 hours in patients with normal renal function; prolonged in renal impairment. |
| Protein binding | Minimal; <10% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | 0.2–0.3 L/kg; reflects distribution primarily in extracellular fluid compartments. |
| Bioavailability | IV: 100%; intra-arterial: 100%; not administered orally. |
| Onset of Action | IV: immediate (seconds to minutes); intra-arterial: within seconds; oral (if applicable): not applicable. |
| Duration of Action | IV: approximately 1–2 hours for imaging enhancement; due to rapid renal clearance, contrast density declines quickly. |
Iohexol (ANGIOVIST 282) is a nonionic iodinated contrast medium. Typical adult dose: 50-200 mL intravenously or intra-arterially, depending on procedure (e.g., CT: 75-150 mL IV).
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (GFR <30 mL/min/1.73 m2) due to risk of contrast-induced nephropathy. For GFR 30-59, use lowest effective dose and ensure adequate hydration. No dose adjustment formula. |
| Liver impairment | No specific dose adjustment for hepatic impairment per Child-Pugh class. Use with caution in severe hepatic impairment due to potential fluid/electrolyte disturbances. |
| Pediatric use | Weight-based: 1-2 mL/kg IV (max 4 mL/kg) for CT; lower doses for angiography. Adjust for body weight and procedure. |
| Geriatric use | Use lowest effective dose due to increased risk of renal impairment and dehydration. Ensure adequate hydration and monitor renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANGIOVIST 282 (ANGIOVIST 282).
| Breastfeeding | Iodinated contrast agents are excreted into breast milk in minimal amounts (<1% of maternal dose orally absorbed). M/P ratio not established. For diatrizoate, peak milk concentration occurs at 1 hour, with rapid decline. Although risk of infant iodine exposure is very low, pump and discard milk for 24 hours after administration to minimize risk to breastfeeding infant. |
| Teratogenic Risk | ANGIOVIST 282 (diatrizoate meglumine 60%) is an ionic iodinated contrast medium. In pregnancy, based on limited human data and animal studies, there is no clear evidence of teratogenicity. However, as a precaution, use only if clearly needed, especially during first trimester due to potential fetal hypothyroidism from free iodide. Second and third trimester: risk is theoretical; thyroid suppression from excess iodide is minimal with modern formulations, but avoid if possible. |
■ FDA Black Box Warning
Risk of serious hypersensitivity reactions, including anaphylaxis, which can be fatal. In patients with congestive heart failure, acute renal failure, or hemodynamic instability, the osmotic load may cause fluid overload and pulmonary edema. Not for intrathecal administration.
| Serious Effects |
["Known hypersensitivity to diatrizoate or any component of the formulation","Intrathecal administration (risk of convulsions, coma, and death)","Severe renal impairment (anuria or oliguria) unless dialysis is readily available","Thyrotoxicosis (uncontrolled)"]
| Precautions | ["Hypersensitivity reactions: Serious, life-threatening, or fatal anaphylactic reactions may occur; premedication may be considered in high-risk patients.","Acute kidney injury: Increased risk in patients with pre-existing renal impairment, diabetes, dehydration, or those receiving nephrotoxic drugs.","Thyroid dysfunction: Iodinated contrast may induce hyperthyroidism or thyroid storm in patients with underlying thyroid disease.","Cardiovascular effects: May precipitate arrhythmias, hypotension, or heart failure in patients with unstable cardiovascular status.","Seizures: Increased risk in patients with primary brain tumors, epilepsy, or other seizure disorders.","Extravasation: Can cause tissue necrosis and compartment syndrome."] |
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| Fetal Monitoring | Monitor fetal heart rate during administration, especially if known fetal compromise. Monitor maternal renal function, hydration status, and signs of allergic reaction. Assess thyroid function in neonate if contrast was used near term. Evaluate for neonatal hypothyroidism if multiple doses or high iodide exposure. |
| Fertility Effects | No known adverse effects on fertility in human studies. Animal studies have not shown impairment of fertility at clinically relevant doses. Theoretical concern: high-dose iodide exposure may cause transient thyroid dysfunction, but not linked to direct reproductive toxicity. |
| Food/Dietary | No specific food interactions. However, ensure adequate hydration with water before and after the procedure. Avoid alcohol prior to contrast administration as it may increase risk of adverse effects. |
| Clinical Pearls | ANGIOVIST 282 (ioxaglate meglumine and ioxaglate sodium) is a low-osmolar ionic dimeric contrast agent. Pre-warming to body temperature reduces viscosity and improves tolerability. Ensure adequate hydration pre- and post-procedure to minimize nephrotoxicity. Screen for history of previous contrast reaction, asthma, or allergy. Have emergency equipment ready. In patients with renal impairment (eGFR <30), consider acetylcysteine prophylaxis and hold metformin for 48 hours. For intravascular use, rate of injection should be adjusted based on vessel size and flow rate. Monitor for delayed reactions (e.g., rash, arthralgia) which may occur 3–7 days post-exposure. |
| Patient Advice | Tell your doctor if you have ever had an allergic reaction to contrast dye, or if you have asthma, diabetes, kidney disease, or thyroid problems. · You will be asked to drink plenty of fluids before and after the procedure to help protect your kidneys. · You may feel a warm sensation or a metallic taste in your mouth when the dye is injected; this is normal. · If you take metformin for diabetes, you may need to stop it for 48 hours after the procedure. · Contact your doctor immediately if you develop hives, difficulty breathing, or swelling of the face or throat during or after the procedure. · Delayed reactions such as skin rash or joint pain may occur up to a week later; report these to your doctor. |