ANGIOVIST 370
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANGIOVIST 370 (ANGIOVIST 370).
Angiovist 370 (diatrizoate meglumine) is a water-soluble iodinated radiographic contrast agent that attenuates X-rays, thereby enhancing the contrast of vascular structures and organs during imaging procedures.
| Metabolism | Diatrizoate is not metabolized; it is excreted unchanged in the urine via glomerular filtration. |
| Excretion | Primarily renal excretion of unchanged drug via glomerular filtration; approximately 95% eliminated in urine within 24 hours, with less than 1% biliary/fecal. |
| Half-life | Terminal elimination half-life approximately 2 hours; prolonged in renal impairment (up to 30-40 hours in severe impairment). |
| Protein binding | Highly polar, minimal protein binding (<2%); does not bind significantly to plasma proteins. |
| Volume of Distribution | 0.26 L/kg (approximately 18 L in a 70 kg adult), indicating distribution primarily in extracellular fluid. |
| Bioavailability | Not applicable orally; 100% bioavailability with intravenous administration. |
| Onset of Action | Immediate following intravenous injection; contrast enhancement observed within seconds during imaging. |
| Duration of Action | Approximately 15-30 minutes for diagnostic imaging; contrast rapidly redistributes and declines, with elimination complete within 24 hours. |
Intravenous injection: 1-2 mL/kg (370 mg I/mL) up to 150 mL total for CT imaging; intra-arterial injection: 5-80 mL depending on procedure. Rate: 1-5 mL/sec.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR <30 mL/min/1.73 m²: avoid use unless necessary; consider alternative imaging. eGFR 30-45: minimize dose and ensure hydration. No specific dose reduction formula. |
| Liver impairment | No dose adjustment required for Child-Pugh A or B; Child-Pugh C: use caution due to potential contrast-induced nephropathy risk, monitor renal function. |
| Pediatric use | Intravenous: 1-2 mL/kg (370 mg I/mL), maximum 3 mL/kg; intra-arterial: 1-2 mL/kg per injection, maximum 4 mL/kg total. For neonates, ensure high osmolality caution. |
| Geriatric use | Use lowest effective dose; assess renal function (eGFR) before administration; ensure adequate hydration; monitor for adverse effects due to reduced renal reserve. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANGIOVIST 370 (ANGIOVIST 370).
| Breastfeeding | Low levels of iodinated contrast are excreted into breast milk (estimated <0.01% of maternal dose). M/P ratio not established for iopamidol. American College of Radiology recommends no interruption of breastfeeding after contrast administration. However, consider expressing and discarding breast milk for 24 hours if maternal anxiety. Risk to infant is negligible. |
| Teratogenic Risk | ANGIOVIST 370 (iopamidol) is an iodinated contrast agent. No well-controlled studies in pregnant women. Animal studies have not shown teratogenic effects. Iodinated contrast crosses the placenta and can cause transient neonatal hypothyroidism if administered during the third trimester. Risk classification: FDA Category B. First trimester: theoretical risk from free iodide; second trimester: low risk; third trimester: risk of neonatal hypothyroidism. |
■ FDA Black Box Warning
Not recommended for intrathecal use; severe adverse reactions including seizures, cerebral hemorrhage, and death have occurred following inadvertent intrathecal administration.
| Serious Effects |
["Known hypersensitivity to diatrizoate or other iodinated contrast agents","Intrathecal administration"]
| Precautions | ["Risk of serious hypersensitivity reactions including anaphylaxis","Acute kidney injury in patients with pre-existing renal impairment or diabetes","Potential for thyroid storm in patients with hyperthyroidism","Caution in patients with congestive heart failure due to fluid overload"] |
| Food/Dietary | No specific food interactions. Avoid dehydration; encourage oral fluid intake before and after the procedure. Fasting is not required unless specified by the imaging protocol. If the patient is on a low-iodine diet for thyroid conditions, inform the radiologist. |
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| Fetal Monitoring | Monitor maternal renal function prior to administration. Consider neonatal thyroid function tests (TSH, T4) within 3-7 days after birth if contrast given during third trimester. Evaluate for hypersensitivity reactions during infusion; have resuscitation equipment available. Fetal assessment not routinely required. |
| Fertility Effects | No known adverse effects on fertility or reproductive function based on animal studies and clinical experience. No data indicate impairment of fertility in humans. |
| Clinical Pearls | Angiovist 370 (ioversol 370 mg I/mL) is a nonionic, low-osmolality iodinated contrast agent. Pre-warming to body temperature reduces viscosity and improves tolerability. Ensure adequate hydration before and after administration to reduce risk of contrast-induced nephropathy. Use with caution in patients with renal impairment, diabetes, or multiple myeloma. Have emergency equipment available for hypersensitivity reactions. Avoid concurrent use of metformin; discontinue 48 hours prior and for 48 hours after, or check renal function. For intra-arterial injections, use a power injector with careful monitoring to prevent air embolism. |
| Patient Advice | You will receive an iodine-based contrast dye for your imaging procedure. · It is important to drink plenty of water before and after the exam to protect your kidneys. · Tell your doctor if you have any allergies, especially to iodine or seafood. · Inform your healthcare provider if you are pregnant, breastfeeding, or have kidney disease, diabetes, or multiple myeloma. · If you take metformin for diabetes, you may need to stop it temporarily as directed by your doctor. · You may feel a warm sensation or a metallic taste when the contrast is injected; this is normal. · Report any symptoms like hives, itching, difficulty breathing, or swelling immediately. · After the procedure, drink extra fluids for 24 hours to help flush the contrast from your body. |