CONRAY

Clinical safety rating: caution

Comprehensive clinical and safety monograph for CONRAY (CONRAY).

How it works

Iothalamate meglumine is an ionic, high-osmolality radiopaque contrast agent that attenuates X-rays, allowing visualization of vascular structures and organs during radiographic procedures.

What the body does with it

Metabolism	Not metabolized; excreted unchanged by glomerular filtration.
Excretion	Primarily renal excretion via glomerular filtration; >90% of administered dose eliminated unchanged in urine within 24 hours. Less than 1% biliary or fecal.
Half-life	Terminal elimination half-life is approximately 2 hours in patients with normal renal function; prolonged in renal impairment.
Protein binding	Negligible (<2%); does not bind significantly to plasma proteins.
Volume of Distribution	Approximately 0.2–0.3 L/kg, reflecting distribution primarily in extracellular fluid.
Bioavailability	Not applicable for oral route; no significant absorption due to high polarity. Intravenous administration yields 100% bioavailability.
Onset of Action	Intravenous injection: immediate (within seconds to minutes) for enhancement of contrast; intra-arterial: immediate upon injection.
Duration of Action	Duration of vascular enhancement is 15–30 minutes for computed tomography; adequate for most angiographic procedures; rapid redistribution and elimination limit duration.

Classification & Brands

Dosing & administration

Intravenous: 20-60 mL for CT enhancement; intra-arterial: 5-80 mL per injection; concentration 282 mgI/mL (iothalamate meglumine). Dose based on procedure, body weight, and renal function.

Dosage form	INJECTABLE
Renal impairment	eGFR <30 mL/min/1.73m2: avoid use or use lowest necessary dose with adequate hydration; consider alternative imaging. eGFR 30-59: minimize dose, ensure hydration. No specific dose reduction formula established.
Liver impairment	No specific Child-Pugh based dose adjustments; use with caution in severe hepatic impairment due to potential for prolonged elimination.
Pediatric use	Intravenous: 1-3 mL/kg (282 mgI/mL) per injection, maximum total dose 4 mL/kg. Individualize based on age, weight, and imaging protocol.
Geriatric use	Increased risk of nephrotoxicity; assess renal function prior to administration; use lowest effective dose; ensure adequate hydration. No specific dose reduction beyond renal adjustment.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for CONRAY (CONRAY).

Breastfeeding

Iothalamate meglumine is excreted into human breast milk in trace amounts. M/P ratio not established. Due to low oral bioavailability and small quantity, risk to nursing infant is minimal. Manufacturer recommends caution; however, American College of Radiology suggests breastfeeding can continue without interruption after contrast administration.

Teratogenic Risk

CONRAY (iothalamate meglumine) is an iodinated radiocontrast agent. Teratogenicity: No adequate studies in pregnant women. In animal studies, no evidence of fetal harm. Pregnancy Category B. First trimester: theoretical risk from free iodide affecting fetal thyroid, but negligible with modern agents. Second and third trimesters: fetal hypothyroidism from excess iodide is possible but rare with single exposure. Overall, risk is low if clinically indicated.

Warnings & precautions

■ FDA Black Box Warning

"Risk of serious or fatal reactions including anaphylaxis, cardiac arrest, and renal failure. Resuscitative equipment and trained personnel should be immediately available."

Side Effect Profile

Serious Effects

Absolute Contraindications

Known hypersensitivity to iothalamate or other iodinated contrast agents; anuria; severe oliguria; concomitant administration of metformin (risk of lactic acidosis).

Clinical Precautions

Precautions

Risk of contrast-induced nephropathy (CIN), especially in patients with pre-existing renal impairment, diabetes, dehydration, or advanced age. Ensure adequate hydration before and after administration. Monitor renal function.

Clinical Tips & Counseling

Drug interactions

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CONRAY

Clinical safety rating: caution

Comprehensive clinical and safety monograph for CONRAY (CONRAY).

How it works

Iothalamate meglumine is an ionic, high-osmolality radiopaque contrast agent that attenuates X-rays, allowing visualization of vascular structures and organs during radiographic procedures.

What the body does with it

Metabolism	Not metabolized; excreted unchanged by glomerular filtration.
Excretion	Primarily renal excretion via glomerular filtration; >90% of administered dose eliminated unchanged in urine within 24 hours. Less than 1% biliary or fecal.
Half-life	Terminal elimination half-life is approximately 2 hours in patients with normal renal function; prolonged in renal impairment.
Protein binding	Negligible (<2%); does not bind significantly to plasma proteins.
Volume of Distribution	Approximately 0.2–0.3 L/kg, reflecting distribution primarily in extracellular fluid.
Bioavailability	Not applicable for oral route; no significant absorption due to high polarity. Intravenous administration yields 100% bioavailability.
Onset of Action	Intravenous injection: immediate (within seconds to minutes) for enhancement of contrast; intra-arterial: immediate upon injection.
Duration of Action	Duration of vascular enhancement is 15–30 minutes for computed tomography; adequate for most angiographic procedures; rapid redistribution and elimination limit duration.

Classification & Brands

Dosing & administration

Intravenous: 20-60 mL for CT enhancement; intra-arterial: 5-80 mL per injection; concentration 282 mgI/mL (iothalamate meglumine). Dose based on procedure, body weight, and renal function.

Dosage form	INJECTABLE
Renal impairment	eGFR <30 mL/min/1.73m2: avoid use or use lowest necessary dose with adequate hydration; consider alternative imaging. eGFR 30-59: minimize dose, ensure hydration. No specific dose reduction formula established.
Liver impairment	No specific Child-Pugh based dose adjustments; use with caution in severe hepatic impairment due to potential for prolonged elimination.
Pediatric use	Intravenous: 1-3 mL/kg (282 mgI/mL) per injection, maximum total dose 4 mL/kg. Individualize based on age, weight, and imaging protocol.
Geriatric use	Increased risk of nephrotoxicity; assess renal function prior to administration; use lowest effective dose; ensure adequate hydration. No specific dose reduction beyond renal adjustment.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for CONRAY (CONRAY).

Breastfeeding

Teratogenic Risk

Warnings & precautions

■ FDA Black Box Warning

"Risk of serious or fatal reactions including anaphylaxis, cardiac arrest, and renal failure. Resuscitative equipment and trained personnel should be immediately available."

Side Effect Profile

Serious Effects

Absolute Contraindications

Known hypersensitivity to iothalamate or other iodinated contrast agents; anuria; severe oliguria; concomitant administration of metformin (risk of lactic acidosis).