ANGIOVIST 292
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANGIOVIST 292 (ANGIOVIST 292).
Angiovist 292 (diatrizoate meglumine and diatrizoate sodium) is an ionic, high-osmolar iodinated contrast agent. It functions by absorbing x-rays due to the high atomic number of iodine, thereby enhancing the radiopacity of vascular structures and organs during diagnostic imaging. It also increases the osmolarity of the intravascular compartment, which can lead to hemodynamic effects.
| Metabolism | Diatrizoate is not metabolized; it is excreted unchanged by the kidneys via glomerular filtration. |
| Excretion | Primarily renal; >90% of dose excreted unchanged in urine within 24 hours. Fecal excretion is negligible (<1%). |
| Half-life | Terminal elimination half-life is approximately 2 hours in patients with normal renal function; prolonged to >30 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | Approximately 40% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | 0.2-0.3 L/kg, indicating distribution primarily within extracellular fluid. |
| Bioavailability | Not applicable (only administered intravenously); oral bioavailability is <1% due to poor absorption. |
| Onset of Action | IV administration: visualization occurs within minutes (1-5 minutes) post-injection for angiography; oral route not applicable. |
| Duration of Action | IV: diagnostic enhancement lasts for 15-30 minutes for CT imaging; effects on renal function may persist for 24-48 hours in susceptible patients. |
Intravenous administration: 50-150 mL of a 292 mg iodine/mL solution for adults, depending on the imaging procedure, with a maximum total dose of 300 mL per procedure.
| Dosage form | INJECTABLE |
| Renal impairment | For GFR <30 mL/min/1.73 m²: use lowest necessary dose and ensure adequate hydration; consider alternative imaging if possible. No specific dose reduction formula established. For GFR 30-59 mL/min/1.73 m²: caution, maintain hydration. |
| Liver impairment | No specific Child-Pugh-based dose adjustment required. Use with caution in severe hepatic impairment due to potential nephrotoxicity risk. |
| Pediatric use | Weight-based dosing: 1.0-2.0 mL/kg of a 292 mg iodine/mL solution intravenously, with a maximum total dose of 3 mL/kg or 125 mL, whichever is less. |
| Geriatric use | Elderly patients: use lowest effective dose, ensure adequate hydration, and monitor renal function as age-related GFR decline increases risk of contrast-induced nephropathy. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANGIOVIST 292 (ANGIOVIST 292).
| Breastfeeding | Excreted in breast milk in small amounts; M/P ratio not established. The amount of iodine absorbed by the infant is negligible, but caution is advised due to potential direct iodine exposure. Pump and discard for 24-48 hours after administration is often recommended. |
| Teratogenic Risk | ANGIOVIST 292 (diatrizoate meglumine and diatrizoate sodium) is an iodinated contrast agent. In pregnancy, there is limited human data; animal studies have not shown teratogenicity. However, iodine exposure can cause fetal thyroid suppression, especially in the second and third trimesters. Risk is theoretical, with no established teratogenic effect in first trimester. |
■ FDA Black Box Warning
Not for intrathecal use. Severe adverse events including death, convulsions, and cerebral hemorrhage have occurred following intrathecal administration.
| Serious Effects |
["Known hypersensitivity to diatrizoate or any component","Intrathecal administration","Severe renal impairment (glomerular filtration rate <30 mL/min/1.73 m²) unless benefit outweighs risk","Anuria","Concurrent administration of metformin in patients with renal impairment (risk of lactic acidosis)"]
| Precautions | ["Risk of contrast-induced acute kidney injury (CI-AKI) in patients with pre-existing renal impairment, diabetes, or dehydration","Severe hypersensitivity reactions including anaphylaxis","Thyrotoxicosis in patients with hyperthyroidism or thyroid neoplasms","Sickle cell disease patients: increased risk of sickling","Vasodilation and hypotension following rapid injection","Pregnancy: not recommended unless essential"] |
| Food/Dietary | No specific food interactions. Maintain adequate hydration before and after administration. No dietary restrictions required. |
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| Fetal Monitoring | Monitor maternal renal function, thyroid function, and signs of hypersensitivity. Fetal monitoring recommended if significant maternal hypotension or anaphylaxis occurs. Post-administration thyroid function tests in neonates exposed in utero. |
| Fertility Effects | No known adverse effects on fertility in humans based on available data; animal studies showed no impairment. Paternal exposure is highly unlikely to affect fertility. |
| Clinical Pearls | Angiovist 292 (iothalamate meglumine) is a high-osmolar ionic contrast agent. Administer with caution in patients with renal impairment, diabetes, or multiple myeloma due to risk of contrast-induced nephropathy. Pre-hydration with normal saline (1 mL/kg/h for 6-12 hours before and after) reduces nephropathy risk. Have emergency equipment available for anaphylactoid reactions. Consider use of non-ionic low-osmolar agents in high-risk patients. |
| Patient Advice | Inform your healthcare provider of any allergies, especially to iodine or contrast agents. · Drink plenty of fluids before and after the procedure to help flush the contrast from your kidneys. · Report any symptoms such as hives, itching, difficulty breathing, or swelling of the face or throat immediately. · You may experience a warm sensation or metallic taste during injection; this is normal and temporary. · If you have diabetes, especially if taking metformin, your doctor may advise stopping metformin temporarily. |