DIATRIZOATE-60

Clinical safety rating: caution

Comprehensive clinical and safety monograph for DIATRIZOATE-60 (DIATRIZOATE-60).

How it works

Diatrizoate is an ionic, monomeric, high-osmolar iodinated contrast agent that absorbs X-rays due to its iodine content, enhancing radiographic imaging by attenuating X-ray beams. It distributes in the extracellular fluid and is excreted unchanged by glomerular filtration.

What the body does with it

Metabolism	Not metabolized; excreted unchanged by the kidneys via glomerular filtration.
Excretion	Primarily renal (glomerular filtration); >95% excreted unchanged in urine within 24 hours. Negligible biliary or fecal elimination.
Half-life	Terminal half-life approximately 1-2 hours in patients with normal renal function. Prolonged in renal impairment (up to 20-30 hours in anuria).
Protein binding	Very low; less than 5% bound, primarily to albumin.
Volume of Distribution	Approximately 0.2-0.3 L/kg, confined to extracellular fluid; no significant tissue penetration.
Bioavailability	Bioavailability is 100% for intravenous and intra-arterial routes; oral bioavailability near 0% (not absorbed).
Onset of Action	Intravenous: immediate (within seconds). Intra-arterial: immediate. Oral: not absorbed (used for GI opacification, no systemic effect).
Duration of Action	For IV urography: opacification persists 30-60 minutes; for angiography: seconds to minutes. Limited by rapid renal excretion.

Classification & Brands

Dosing & administration

1-2 mL/kg IV bolus up to 150 mL total for contrast-enhanced CT; repeat doses may be given based on imaging needs.

Dosage form	INJECTABLE
Renal impairment	eGFR >60 mL/min: no adjustment. eGFR 30-60: reduce dose by 50% or use alternative if possible. eGFR <30: avoid use; if essential, use minimum dose (0.5 mL/kg) with pre-hydration and N-acetylcysteine.
Liver impairment	No specific dose adjustment for Child-Pugh class; use cautiously in severe hepatic impairment due to risk of nephrotoxicity.
Pediatric use	0.5-2 mL/kg IV based on imaging protocol; maximum 150 mL. Adjust for weight: infants: 1-2 mL/kg, children: 1-1.5 mL/kg.
Geriatric use	Lower initial doses (0.5-1 mL/kg) with careful monitoring of renal function; avoid in eGFR <30 mL/min.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for DIATRIZOATE-60 (DIATRIZOATE-60).

Breastfeeding	Diatrizoate is excreted into breast milk in very low quantities (<0.01% of maternal dose). The M/P ratio is not well defined but is low. The American College of Radiology suggests no special precautions are needed, and breastfeeding can be continued normally after contrast exposure.
Teratogenic Risk	Diatrizoate is an iodinated contrast agent. There is no evidence of teratogenicity in humans based on limited data; however, as a precaution, avoid use in the first trimester when organogenesis occurs. Inadvertent exposure during pregnancy has not been associated with an increased risk of major birth defects. Use only if clearly needed and risk-benefit justifies exposure.

Warnings & precautions

■ FDA Black Box Warning

Not recommended for intrathecal use; severe neurological complications including seizures, paralysis, and death can occur if administered into the subarachnoid space.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Known hypersensitivity to diatrizoate or any component","Intrathecal administration (absolute)","Severe renal impairment (relative, use with caution)"]

Clinical Precautions

Precautions

["Risk of acute kidney injury (AKI) in patients with pre-existing renal impairment, diabetes, or dehydration","Anaphylactoid reactions, including hypotension, bronchospasm, and angioedema","Contrast-induced nephropathy (CIN)","Hypersensitivity reactions"]

Clinical Tips & Counseling

Drug interactions

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DIATRIZOATE-60

Clinical safety rating: caution

Comprehensive clinical and safety monograph for DIATRIZOATE-60 (DIATRIZOATE-60).

How it works

What the body does with it

Metabolism	Not metabolized; excreted unchanged by the kidneys via glomerular filtration.
Excretion	Primarily renal (glomerular filtration); >95% excreted unchanged in urine within 24 hours. Negligible biliary or fecal elimination.
Half-life	Terminal half-life approximately 1-2 hours in patients with normal renal function. Prolonged in renal impairment (up to 20-30 hours in anuria).
Protein binding	Very low; less than 5% bound, primarily to albumin.
Volume of Distribution	Approximately 0.2-0.3 L/kg, confined to extracellular fluid; no significant tissue penetration.
Bioavailability	Bioavailability is 100% for intravenous and intra-arterial routes; oral bioavailability near 0% (not absorbed).
Onset of Action	Intravenous: immediate (within seconds). Intra-arterial: immediate. Oral: not absorbed (used for GI opacification, no systemic effect).
Duration of Action	For IV urography: opacification persists 30-60 minutes; for angiography: seconds to minutes. Limited by rapid renal excretion.

Classification & Brands

Dosing & administration

1-2 mL/kg IV bolus up to 150 mL total for contrast-enhanced CT; repeat doses may be given based on imaging needs.

Dosage form	INJECTABLE
Renal impairment	eGFR >60 mL/min: no adjustment. eGFR 30-60: reduce dose by 50% or use alternative if possible. eGFR <30: avoid use; if essential, use minimum dose (0.5 mL/kg) with pre-hydration and N-acetylcysteine.
Liver impairment	No specific dose adjustment for Child-Pugh class; use cautiously in severe hepatic impairment due to risk of nephrotoxicity.
Pediatric use	0.5-2 mL/kg IV based on imaging protocol; maximum 150 mL. Adjust for weight: infants: 1-2 mL/kg, children: 1-1.5 mL/kg.
Geriatric use	Lower initial doses (0.5-1 mL/kg) with careful monitoring of renal function; avoid in eGFR <30 mL/min.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for DIATRIZOATE-60 (DIATRIZOATE-60).

Breastfeeding	Diatrizoate is excreted into breast milk in very low quantities (<0.01% of maternal dose). The M/P ratio is not well defined but is low. The American College of Radiology suggests no special precautions are needed, and breastfeeding can be continued normally after contrast exposure.
Teratogenic Risk	Diatrizoate is an iodinated contrast agent. There is no evidence of teratogenicity in humans based on limited data; however, as a precaution, avoid use in the first trimester when organogenesis occurs. Inadvertent exposure during pregnancy has not been associated with an increased risk of major birth defects. Use only if clearly needed and risk-benefit justifies exposure.

Warnings & precautions

■ FDA Black Box Warning

Not recommended for intrathecal use; severe neurological complications including seizures, paralysis, and death can occur if administered into the subarachnoid space.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Known hypersensitivity to diatrizoate or any component","Intrathecal administration (absolute)","Severe renal impairment (relative, use with caution)"]