HYPAQUE-M,90%

Clinical safety rating: caution

Comprehensive clinical and safety monograph for HYPAQUE-M,90% (HYPAQUE-M,90%).

How it works

Ionic, high-osmolality iodinated contrast agent that absorbs X-rays, enhancing radiographic contrast by attenuating X-rays in tissues where it distributes.

What the body does with it

Metabolism	Not metabolized; eliminated unchanged by glomerular filtration.
Excretion	Renal: >95% unchanged; biliary/fecal: <5%
Half-life	Terminal half-life: 1-2 hours (normal renal function); prolonged in renal impairment
Protein binding	Minimal (<10%); primarily albumin
Volume of Distribution	0.2-0.3 L/kg (confined to extracellular fluid)
Bioavailability	Intravenous: 100%; Oral: not administered orally due to GI irritation
Onset of Action	Intravenous: immediate (within seconds to minutes); Oral: not applicable
Duration of Action	Intravenous: 15-30 minutes for imaging; excretion complete within 24 hours

Classification & Brands

Dosing & administration

Intra-arterial or intravenous injection: 30-60 mL of 90% solution, administered as a bolus or infusion over 1-2 minutes; repeat dosing not recommended.

Dosage form	INJECTABLE
Renal impairment	Contraindicated in patients with GFR <30 mL/min/1.73 m² (anuric or severely impaired renal function). For GFR 30-60 mL/min/1.73 m²: reduce dose by 50%, ensure adequate hydration, and monitor renal function for 48 hours post-dose.
Liver impairment	No specific dose adjustment required for Child-Pugh Class A or B. For Child-Pugh Class C: use lowest effective dose (e.g., 30 mL of 90% solution) and ensure adequate hydration due to potential hepatic encephalopathy risk with high osmolar load.
Pediatric use	0.5-1.5 mL/kg of 90% solution (maximum 30 mL) intra-arterial or intravenous, administered as a slow injection over 1-3 minutes; not recommended for neonates (<1 month) due to high osmolarity.
Geriatric use	Initiate with lowest effective dose (e.g., 30 mL of 90% solution) and monitor renal function closely due to age-related GFR decline; ensure adequate hydration before and after procedure.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for HYPAQUE-M,90% (HYPAQUE-M,90%).

Breastfeeding	Minimal excretion into breast milk; estimated infant dose <1% of maternal. M/P ratio not established. Consider pump and discard for 24 hours post-administration to minimize potential exposure.
Teratogenic Risk	FDA Pregnancy Category D. Iodinated contrast media, including diatrizoate meglumine and sodium diatrizoate, cross the placenta and can cause transient neonatal hypothyroidism if used during pregnancy. First trimester exposure: potential but undocumented teratogenicity. Second and third trimesters: risk of fetal thyroid suppression. Use only if essential for maternal diagnosis.

Warnings & precautions

■ FDA Black Box Warning

Risk of fatal anaphylactic reactions; severe adverse reactions (including death) have occurred with intravascular administration. Resuscitative equipment and trained personnel must be immediately available.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Known hypersensitivity to diatrizoate or any formulation component","Severe oliguria or anuria","Concurrent administration with biguanides (metformin) due to risk of lactic acidosis"]

Clinical Precautions

Precautions

["Risk of acute kidney injury in patients with pre-existing renal impairment, diabetes, or dehydration","Hypersensitivity reactions including anaphylaxis","Thyroid storm in patients with hyperthyroidism","Extravasation risk during administration","Lactic acidosis potential in patients with metabolic disorders"]

Clinical Tips & Counseling

Drug interactions

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HYPAQUE-M,90%

Clinical safety rating: caution

Comprehensive clinical and safety monograph for HYPAQUE-M,90% (HYPAQUE-M,90%).

How it works

Ionic, high-osmolality iodinated contrast agent that absorbs X-rays, enhancing radiographic contrast by attenuating X-rays in tissues where it distributes.

What the body does with it

Metabolism	Not metabolized; eliminated unchanged by glomerular filtration.
Excretion	Renal: >95% unchanged; biliary/fecal: <5%
Half-life	Terminal half-life: 1-2 hours (normal renal function); prolonged in renal impairment
Protein binding	Minimal (<10%); primarily albumin
Volume of Distribution	0.2-0.3 L/kg (confined to extracellular fluid)
Bioavailability	Intravenous: 100%; Oral: not administered orally due to GI irritation
Onset of Action	Intravenous: immediate (within seconds to minutes); Oral: not applicable
Duration of Action	Intravenous: 15-30 minutes for imaging; excretion complete within 24 hours

Classification & Brands

Dosing & administration

Intra-arterial or intravenous injection: 30-60 mL of 90% solution, administered as a bolus or infusion over 1-2 minutes; repeat dosing not recommended.

Dosage form	INJECTABLE
Renal impairment	Contraindicated in patients with GFR <30 mL/min/1.73 m² (anuric or severely impaired renal function). For GFR 30-60 mL/min/1.73 m²: reduce dose by 50%, ensure adequate hydration, and monitor renal function for 48 hours post-dose.
Liver impairment	No specific dose adjustment required for Child-Pugh Class A or B. For Child-Pugh Class C: use lowest effective dose (e.g., 30 mL of 90% solution) and ensure adequate hydration due to potential hepatic encephalopathy risk with high osmolar load.
Pediatric use	0.5-1.5 mL/kg of 90% solution (maximum 30 mL) intra-arterial or intravenous, administered as a slow injection over 1-3 minutes; not recommended for neonates (<1 month) due to high osmolarity.
Geriatric use	Initiate with lowest effective dose (e.g., 30 mL of 90% solution) and monitor renal function closely due to age-related GFR decline; ensure adequate hydration before and after procedure.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for HYPAQUE-M,90% (HYPAQUE-M,90%).

Breastfeeding	Minimal excretion into breast milk; estimated infant dose <1% of maternal. M/P ratio not established. Consider pump and discard for 24 hours post-administration to minimize potential exposure.
Teratogenic Risk	FDA Pregnancy Category D. Iodinated contrast media, including diatrizoate meglumine and sodium diatrizoate, cross the placenta and can cause transient neonatal hypothyroidism if used during pregnancy. First trimester exposure: potential but undocumented teratogenicity. Second and third trimesters: risk of fetal thyroid suppression. Use only if essential for maternal diagnosis.

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

["Known hypersensitivity to diatrizoate or any formulation component","Severe oliguria or anuria","Concurrent administration with biguanides (metformin) due to risk of lactic acidosis"]