HYPAQUE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HYPAQUE (HYPAQUE).
Hypaque (diatrizoate sodium/diatrizoate meglumine) is an ionic, high-osmolar iodinated contrast agent. It attenuates X-rays by increasing the atomic density in tissues, providing radiographic contrast. It is not pharmacologically active but may cause physiological effects due to hyperosmolality.
| Metabolism | Diatrizoate is not metabolized; it is excreted unchanged by the kidneys via glomerular filtration. |
| Excretion | The drug is excreted unchanged primarily by the kidneys via glomerular filtration. Renal excretion accounts for >95% of elimination; biliary/fecal excretion is negligible (<5%). |
| Half-life | The terminal elimination half-life is approximately 1-2 hours in patients with normal renal function. In renal impairment, half-life is prolonged and may exceed 20 hours in severe cases, requiring dose adjustment. |
| Protein binding | Protein binding is minimal at approximately 1-5% bound to plasma albumin. Binding is negligible and clinically insignificant. |
| Volume of Distribution | Volume of distribution is approximately 0.2-0.3 L/kg, reflecting distribution primarily within extracellular fluid. In neonates or dehydrated patients, Vd may be lower. |
| Bioavailability | Bioavailability is near 100% for intravenous administration. Oral bioavailability is negligible due to lack of absorption from gastrointestinal tract; it acts as a local contrast agent. |
| Onset of Action | Following intravenous administration, peak plasma concentrations occur immediately; radiographic contrast enhancement is evident within 1-2 minutes. For oral administration, onset of visualization is within 15-30 minutes. |
| Duration of Action | Duration of contrast enhancement is 10-30 minutes for intravenous use, sufficient for imaging. For oral administration, gastrointestinal opacification lasts 1-3 hours, depending on transit time. |
Intravenous: 50-300 mL of 30-60% solution depending on procedure; maximum 5 mL/kg. Intra-arterial: 5-80 mL per injection. Intrathecal: Not recommended due to neurotoxicity.
| Dosage form | INJECTABLE |
| Renal impairment | GFR 30-59 mL/min: reduce dose by 50% or use low-osmolar agent. GFR <30 mL/min: contraindicated or use alternative. |
| Liver impairment | No specific adjustment; caution in severe impairment due to risk of hepatorenal syndrome. |
| Pediatric use | 0.5-3 mL/kg IV per dose; maximum 5 mL/kg total. Use lowest effective dose. |
| Geriatric use | Start with low end of dosing range; monitor renal function; ensure adequate hydration. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for HYPAQUE (HYPAQUE).
| Breastfeeding | Excreted in breast milk in small amounts; M/P ratio unknown. Oral bioavailability negligible; risk to infant low. CDC suggests no need to discontinue breastfeeding, but some sources advise pumping and discarding for 24 hours. |
| Teratogenic Risk | HYPAQUE (diatrizoate) is an iodinated contrast agent. In pregnancy, Category D due to potential fetal hypothyroidism from free iodide. First trimester: Risk from radiation exposure; consider alternative. Second/third trimester: Use only if essential; transient fetal thyroid suppression possible. |
■ FDA Black Box Warning
Not available
| Serious Effects |
["History of severe adverse reaction to diatrizoate or other iodinated contrast agents","Patients with anuria or known anuric renal failure","Concurrent administration with oral cholecystographic agents","Hysterosalpingography in known or suspected pregnancy","Relative: severe thyrotoxicosis, bleeding disorders, or patients on beta-blockers without adequate preparation"]
| Precautions | ["Risk of severe hypersensitivity reactions including anaphylaxis","Contrast-induced nephropathy, particularly in patients with pre-existing renal impairment or diabetes","Thyroid storm in patients with hyperthyroidism","Cardiovascular instability in patients with heart failure or known arrhythmias","Increased risk of seizures in patients with primary brain tumors or history of epilepsy","Sickle cell crisis in homozygous sickle cell disease patients (due to hyperosmolality)","Requires adequate hydration before and after administration"] |
Loading safety data…
| Fetal Monitoring |
| Monitor maternal thyroid function (TSH, free T4) before and after exposure due to iodide load. Fetal ultrasound may be considered if high dose used. Assess for allergic reactions; have resuscitation equipment available. |
| Fertility Effects | No known adverse effects on human fertility based on limited data. Animal studies show no impairment at clinical doses. |