CONRAY 43
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CONRAY 43 (CONRAY 43).
Iodinated contrast agent that attenuates X-rays, enhancing vascular and tissue contrast during imaging.
| Metabolism | Not metabolized; excreted unchanged by glomerular filtration. |
| Excretion | Renal: >90% via glomerular filtration; unchanged drug. Biliary: <1%. Fecal: negligible. |
| Half-life | 2 hours (normal renal function); prolonged to 20-40 hours in severe renal impairment (CrCl <10 mL/min). |
| Protein binding | 1-2% bound to serum albumin (negligible). |
| Volume of Distribution | 0.2-0.3 L/kg (extracellular space, primarily vascular and interstitial compartments). |
| Bioavailability | Intravenous/intra-arterial: 100%. |
| Onset of Action | Intravenous: 5-10 minutes; Intra-arterial: 1-2 minutes; Oral: not applicable (not administered orally). |
| Duration of Action | Intravenous: 30-60 minutes (diagnostic opacification); Intra-arterial: 10-20 minutes. |
Intravenous: 0.5-1.0 mL/kg (20-43 mg I/kg) for CT; intra-arterial: 5-15 mL for selective studies; maximum single dose 150 mL.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR <30 mL/min: not recommended; eGFR 30-60: consider alternative or reduce dose by 50% and ensure hydration. |
| Liver impairment | No specific Child-Pugh-based adjustment; use with caution in severe hepatic impairment due to increased risk of adverse reactions. |
| Pediatric use | Intravenous: 0.5-1.0 mL/kg (20-43 mg I/kg) for CT; maximum 3 mL/kg total. |
| Geriatric use | Lower starting dose (0.5 mL/kg) recommended; minimize volume due to reduced renal function; ensure adequate hydration. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CONRAY 43 (CONRAY 43).
| Breastfeeding | Iodinated contrast agents are minimally excreted into breast milk (<1% of maternal dose). Estimated infant dose <0.01% of maternal weight-adjusted dose. M/P ratio unknown. American College of Radiology states breastfeeding can continue without interruption; however, some clinicians advise discarding milk for 12–24 hours post-procedure. |
| Teratogenic Risk | FDA Category B. Iodinated contrast agents cross the placenta. No evidence of teratogenicity in animal studies. First trimester: avoid unless essential; theoretical risk of fetal hypothyroidism due to free iodide. Second and third trimesters: possible transient neonatal hypothyroidism if high doses; recommended neonatal thyroid function screening post-exposure. |
■ FDA Black Box Warning
Risk of serious hypersensitivity reactions, including anaphylaxis; may be fatal. Premedication recommended for high-risk patients.
| Serious Effects |
Hypersensitivity to iothalamate or any component. Anuria. Decompensated congestive heart failure.
| Precautions | Risk of contrast-induced nephropathy; monitor renal function. Hypersensitivity reactions. Thyroid dysfunction. Severe cardiovascular disease. |
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| Fetal Monitoring | Monitor maternal renal function (serum creatinine) before administration; assess for acute kidney injury (AKI) post-exposure. Fetal monitoring: avoid in pregnancy unless absolutely necessary; if used, perform neonatal thyroid screening (TSH, free T4) within first week of life. |
| Fertility Effects | No known adverse effects on human fertility. Animal studies show no impairment of fertility. |