HEXABRIX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HEXABRIX (HEXABRIX).
Hexabrix is an ionic, high-osmolar iodinated contrast agent that attenuates X-rays, enhancing vascular and tissue contrast during radiographic procedures. Its mechanism is physical rather than pharmacological, based on iodine's atomic number and density.
| Metabolism | Not metabolized; eliminated unchanged via glomerular filtration by the kidneys. |
| Excretion | Renal: 95% unchanged via glomerular filtration; Biliary: <5%; Fecal: <1% |
| Half-life | Terminal elimination half-life: 1.5–2 hours in adults (prolonged in renal impairment; up to 30 hours in severe CKD) |
| Protein binding | Negligible (<5%); no specific binding proteins |
| Volume of Distribution | 0.3–0.4 L/kg (confined to extracellular space; does not cross intact blood-brain barrier) |
| Bioavailability | Intravenous/Intra-arterial: 100%; Oral: 0% (not absorbed) |
| Onset of Action | Intravenous: immediate (within seconds); Intra-arterial: immediate; Oral: not applicable (no GI absorption) |
| Duration of Action | Diagnostic opacification: 15–30 minutes for CT; up to 60 minutes for angiography; prolonged in renal impairment due to delayed clearance |
Intravenous: 0.3-0.6 mL/kg (maximum 100 mL) for urography; 40-80 mL for CT enhancement.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in patients with GFR <30 mL/min/1.73m². For GFR 30-59 mL/min, reduce dose by 50% and ensure adequate hydration. |
| Liver impairment | No specific Child-Pugh based adjustments; use caution in severe hepatic impairment due to risk of hepatorenal syndrome. |
| Pediatric use | Intravenous: 0.5-1 mL/kg (maximum 2 mL/kg) for urography; not recommended for neonates due to risk of acute renal failure. |
| Geriatric use | Reduce dose by 25-50% in patients >70 years; maintain hydration and monitor renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for HEXABRIX (HEXABRIX).
| Breastfeeding | Iodinated contrast agents are excreted into breast milk in very small amounts (<0.01% of maternal dose). The M/P ratio is not established. Breastfeeding can continue without interruption, but some sources suggest discarding milk for 12-24 hours if desired. |
| Teratogenic Risk | HEXABRIX (ioxaglate meglumine and ioxaglate sodium) is an iodinated contrast agent. In animal studies, no teratogenic effects were observed. In humans, there is no evidence of fetal harm from diagnostic doses, though theoretical risks from free iodide exist, especially in the third trimester. The American College of Radiology recommends use only if clearly needed, with minimal dose. |
■ FDA Black Box Warning
Risk of severe, life-threatening adverse reactions including anaphylaxis, cardiovascular collapse, and seizures. Use only when diagnostic information is essential. Resuscitative equipment and trained personnel must be immediately available.
| Common Effects | Application site reactions burning irritation itching and redness Dry skin |
| Serious Effects |
Absolute: Known hypersensitivity to iodinated contrast media, overt thyrotoxicosis, anuria or severe oliguria due to renal disease. Relative: Myeloma, pheochromocytoma, sickle cell disease, pregnancy, and concomitant use of nephrotoxic drugs.
| Precautions | Risk of acute renal failure, particularly in patients with pre-existing renal impairment, diabetes, or dehydration. Caution in patients with cardiovascular disease, asthma, or known hypersensitivity. Avoid extravasation. Thyroid function tests may be affected. Ensure adequate hydration before and after administration. |
Loading safety data…
| Fetal Monitoring | Monitor maternal renal function (serum creatinine) and hydration status. Assess for allergic reactions. Fetal monitoring is not routinely required, but consider fetal heart rate monitoring if there is a risk of fetal hypoxia from maternal hypotension. |
| Fertility Effects | No known adverse effects on fertility in animal or human studies. |