CARDIOGRAFIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CARDIOGRAFIN (CARDIOGRAFIN).
Cardiografin is an ionic, high-osmolar iodinated contrast agent used for radiographic imaging. It enhances contrast by attenuating X-rays, primarily due to the iodine content. It distributes in the extracellular space and is excreted unchanged by glomerular filtration.
| Metabolism | Not metabolized; excreted unchanged by the kidneys via glomerular filtration. |
| Excretion | Primarily renal (glomerular filtration) with >90% of dose excreted unchanged in urine within 24 hours; less than 1% biliary/fecal; negligible metabolism. |
| Half-life | Terminal elimination half-life ~2 hours (normal renal function). May be prolonged to >20 hours in severe renal impairment (e.g., CrCl <30 mL/min). |
| Protein binding | Minimal binding to plasma proteins (<5%), primarily weak association with albumin. |
| Volume of Distribution | 0.2-0.3 L/kg (restricted to extracellular fluid space; does not cross intact blood-brain barrier). |
| Bioavailability | Intravenous or intra-arterial: 100% (complete); oral/rectal: negligible (<1%) due to lack of absorption and rapid elimination; only intended for intravascular use. |
| Onset of Action | Intravenous: immediate visualization within 1-2 minutes; Intra-arterial: within seconds; Oral/rectal: not applicable (not absorbed systemically). |
| Duration of Action | Sufficient for diagnostic imaging (e.g., angiography, urography) lasting 30-60 minutes post-injection due to rapid renal clearance; complete hemodynamic effects resolve within 1-2 hours. |
Adult: 50-100 mL of CARDIOGRAFIN (diatrizoate meglumine and diatrizoate sodium) 76% intravenously as a bolus or rapid infusion. For cardiac ventriculography, 40-50 mL into the left ventricle. For coronary arteriography, 5-10 mL selective injection per artery.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in patients with anuria. In severe renal impairment (eGFR <30 mL/min/1.73 m²), use only if necessary and with adequate hydration; consider alternative imaging. No specific dosing adjustment provided by manufacturer; risk of contrast-induced nephropathy. |
| Liver impairment | No specific dosing adjustments for hepatic impairment; use with caution in severe hepatic disease due to potential for hepatotoxicity and altered contrast clearance. |
| Pediatric use | 0.5-1 mL/kg (maximum 25 mL) intravenously, not to exceed adult dose. Dilute to 50% concentration for infants and young children (e.g., 76% diluted 1:1 with saline). Exact dosing per procedure varies; consult specific guidelines for pediatric coronary angiography or ventriculography. |
| Geriatric use | Use lower doses within the adult range; consider reduced renal function (lowest effective dose). Ensure adequate hydration before and after administration. Monitor for adverse effects due to increased vascular fragility and comorbid conditions. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CARDIOGRAFIN (CARDIOGRAFIN).
| Breastfeeding | Excreted into breast milk in trace amounts. M/P ratio not established for CARDIOGRAFIN. American College of Radiology recommends breastfeeding can continue without interruption after contrast administration; however, the lactating woman may choose to pump and discard milk for 12-24 hours if concerned. |
| Teratogenic Risk | CARDIOGRAFIN (diatrizoate meglumine and diatrizoate sodium) is an iodinated contrast agent. In first trimester, risk is likely low based on limited human data; theoretical risk from free iodide exposure. Second and third trimesters: potential for transient neonatal hypothyroidism if high doses of free iodide are absorbed. Overall, teratogenic risk is considered low when used as indicated. |
■ FDA Black Box Warning
Risk of acute renal failure in patients with pre-existing renal impairment, diabetes, or dehydration. Not for intrathecal use.
| Serious Effects |
["Hypersensitivity to iodinated contrast agents.","Myelography (intrathecal administration) due to neurotoxicity.","Significant renal impairment (e.g., eGFR <30 mL/min/1.73m²) unless dialysis is available.","Pregnancy (relative contraindication, except when benefits outweigh risks)."]
| Precautions | ["Acute renal failure, particularly in patients with chronic kidney disease, diabetes, or dehydration.","Anaphylactoid reactions, including severe hypotension, bronchospasm, and laryngeal edema.","Thyroid storm in patients with hyperthyroidism or thyroid nodules.","Avoid extravasation due to risk of tissue necrosis."] |
| Food/Dietary | No specific food interactions. Patients should avoid alcohol and maintain adequate hydration before and after the procedure to reduce renal stress. |
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| Fetal Monitoring | Monitor maternal vital signs during administration for hypersensitivity reactions. In neonates exposed in utero, consider thyroid function testing if high dose or repeated exposure occurred. No specialized fetal monitoring required. |
| Fertility Effects | No known effect on fertility based on available data. Iodinated contrast agents are not known to impair reproductive function. |
| Clinical Pearls | CARDIOGRAFIN (diatrizoate meglumine and diatrizoate sodium) is a high-osmolar ionic iodinated contrast agent used for angiography. Pre-warming to body temperature reduces viscosity and improves patient tolerance. Verify renal function and hydration status prior to administration; consider N-acetylcysteine or sodium bicarbonate for prophylaxis in high-risk patients. Have emergency equipment available for hypersensitivity reactions. For coronary angiography, use low osmolality or iso-osmolar agents to reduce risk of contrast-induced nephropathy. Monitor for delayed reactions, especially in patients with prior contrast allergy. |
| Patient Advice | Inform your doctor if you have any allergies, especially to iodine or contrast agents. · Drink plenty of fluids before and after the procedure to help your kidneys eliminate the contrast. · Tell your doctor if you are pregnant, breastfeeding, or have kidney problems, diabetes, or sickle cell disease. · You may experience warmth, flushing, or a metallic taste during injection; this is normal. · Seek immediate medical attention if you experience hives, difficulty breathing, swelling, or severe nausea after the procedure. |