CYSTO-CONRAY II
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CYSTO-CONRAY II (CYSTO-CONRAY II).
Iodinated radiopaque contrast agent that attenuates X-rays, thereby enhancing vascular and tissue contrast during imaging. It is a high-osmolality ionic monomer that distributes in the extracellular fluid space and is excreted unchanged by glomerular filtration.
| Metabolism | Not metabolized; excreted unchanged primarily by glomerular filtration in the kidneys. |
| Excretion | Renal: >95% unchanged via glomerular filtration; biliary/fecal: <1% |
| Half-life | Terminal elimination half-life: 1.5-2 hours in normal renal function; prolonged significantly in renal impairment |
| Protein binding | Negligible (<1%); no significant binding to plasma proteins |
| Volume of Distribution | 0.2-0.3 L/kg; distributes primarily in extracellular fluid with minimal intracellular penetration |
| Bioavailability | Oral: negligible (not administered orally); IV: 100% |
| Onset of Action | Intravenous: immediate (within seconds); intra-arterial: immediate; other routes: N/A |
| Duration of Action | Radiographic visualization: several minutes; clinical effects resolve within 1-2 hours post-injection due to rapid renal clearance |
Intravenous injection or infusion: 50-150 mL of a 282 mgI/mL solution (as sodium iothalamate and meglumine iothalamate) for adults; dose based on procedure and patient size.
| Dosage form | SOLUTION |
| Renal impairment | Contraindicated in patients with anuria. For GFR <30 mL/min/1.73m2, use with caution and minimize dose; consider alternative imaging if possible. |
| Liver impairment | No specific dose adjustment required for hepatic impairment; use standard dosing. |
| Pediatric use | Intravenous: 1-2 mL/kg (maximum 50 mL) of a 282 mgI/mL solution; adjust based on age, weight, and imaging procedure. |
| Geriatric use | No specific dose adjustment; use lowest effective dose due to increased risk of renal impairment and dehydration in elderly. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CYSTO-CONRAY II (CYSTO-CONRAY II).
| Breastfeeding | Iothalamate meglumine is excreted in breast milk in small amounts. The M/P ratio is approximately 0.5. Risk to nursing infant is low, but caution is advised due to potential allergic reactions or direct effects. Interrupt breastfeeding for 24 hours after administration. |
| Teratogenic Risk | Iodinated contrast agents such as Cysto-Conray II (iothalamate meglumine) cross the placenta. Fetal exposure may cause transient neonatal hypothyroidism, especially in the third trimester. No teratogenic effects have been documented in humans, but caution is advised. Use only if essential for maternal diagnosis. |
■ FDA Black Box Warning
Not for intrathecal use. Severe adverse reactions, including death, have occurred following intrathecal administration of ionic contrast media. This drug is contraindicated for myelography.
| Serious Effects |
["Hypersensitivity to iodinated contrast agents","Intrathecal administration (myelography)","Anuria or severe renal impairment (e.g., dialysis patients) unless benefit outweighs risk","Clinically significant hyperthyroidism or thyroid storm","Pregnancy: avoid unless absolutely necessary (crosses placenta)"]
| Precautions | ["Risk of severe anaphylactoid reactions (including fatal ones) requiring emergency resuscitation equipment","Acute kidney injury, especially in patients with pre-existing renal impairment, diabetes, dehydration, or multiple contrast exposures","Cardiovascular adverse effects (arrhythmias, hypotension, myocardial depression) in patients with heart disease","Thyroid toxicity: Risk of hyperthyroidism or thyroid storm in patients with hyperthyroidism or thyroid nodules","Extravasation: may cause local tissue injury (necrosis, compartment syndrome)","Sickle cell crisis in patients with homozygous sickle cell disease","Pheochromocytoma: hypertensive crisis possible during angiography","Myasthenia gravis exacerbation","Interference with laboratory tests (thyroid function, protein assays)"] |
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| Fetal Monitoring | Monitor maternal renal function, hydration status, and for signs of allergic reaction. Fetal monitoring is not routine but check neonatal thyroid function if exposure occurred in third trimester. |
| Fertility Effects | No known effects on human fertility. Animal studies have not reported impairment of fertility. |