IOMERVU
Clinical safety rating: caution
Comprehensive clinical and safety monograph for IOMERVU (IOMERVU).
Iodinated radiocontrast agent that attenuates X-rays by increasing radiopacity of blood vessels and tissues, allowing visualization during imaging procedures.
| Metabolism | Primarily renal excretion via glomerular filtration; minimal hepatic metabolism. |
| Excretion | Iomeprol is almost exclusively eliminated via renal glomerular filtration, with 92-98% of the administered dose recovered unchanged in urine within 24 hours. Less than 2% is excreted in feces via biliary elimination. In patients with normal renal function, renal clearance approximates glomerular filtration rate. |
| Half-life | Terminal elimination half-life is approximately 1.5-2 hours in patients with normal renal function. In renal impairment, half-life is prolonged (up to 10-30 hours in severe impairment), necessitating dose adjustment and monitoring. The half-life is not significantly affected by hepatic impairment. |
| Protein binding | Iomeprol exhibits negligible protein binding (<1%), predominantly to albumin. The low binding is consistent with its hydrophilic nature and rapid distribution into extracellular fluid. |
| Volume of Distribution | Volume of distribution is approximately 0.25-0.35 L/kg, reflecting distribution primarily into extracellular fluid. This is consistent with its water solubility and limited cellular penetration. The Vd increases with extracellular fluid expansion (e.g., in heart failure or cirrhosis). |
| Bioavailability | Not applicable for oral administration as iomeprol is not absorbed orally. Intravenous and intra-arterial routes yield 100% bioavailability. Intrathecal administration results in complete systemic absorption over time, but bioavailability via CSF absorption is not quantifiable as a standard value; the drug distributes to blood and is renally eliminated. |
| Onset of Action | Intravascular injection: immediate appearance in vessels; arterial enhancement begins within seconds. Contrast enhancement of parenchymal organs (e.g., kidneys, liver) occurs within 30-60 seconds and peaks at 1-2 minutes. Intrathecal administration: onset of opacification is immediate, with peak visualization within minutes. |
| Duration of Action | Duration of diagnostic contrast enhancement is short, typically 5-15 minutes for initial vascular phase; renal parenchymal and excretory phase lasts up to 30-60 minutes. Intrathecal opacification persists for 30-60 minutes. In patients with renal impairment, duration may be prolonged due to delayed clearance, increasing risk of nephrotoxicity. |
Intravenous: 0.5-2 mL/kg of iomeprol 300-400 mg I/mL for imaging, not exceeding 200 mL total dose; arterial: up to 250 mL per procedure.
| Dosage form | SOLUTION |
| Renal impairment | Contraindicated in GFR <30 mL/min/1.73m²; GFR 30-59: image only if essential, ensure hydration, avoid metformin; no dose reduction recommended due to fixed imaging dose. |
| Liver impairment | No specific dose adjustment for Child-Pugh class A or B; use caution in severe hepatic impairment (Child-Pugh C) due to risk of contrast-induced nephropathy and altered elimination. |
| Pediatric use | Weight-based: 1-2 mL/kg intravenously for CT; maximum single dose 4 mL/kg or 250 mL; adjust for body weight and renal function. |
| Geriatric use | Use lowest effective dose; pre-hydrate; monitor renal function; avoid if eGFR <30 mL/min/1.73m²; consider increased risk of adverse reactions. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for IOMERVU (IOMERVU).
| Breastfeeding | Iomeprol is excreted into breast milk in negligible amounts (M/P ratio not determined). The estimated infant dose is less than 1% of the maternal dose. Breastfeeding can be continued without interruption. |
| Teratogenic Risk | Iomeprol is an iodinated contrast medium. No teratogenic effects have been observed in animal studies. In humans, elective use is avoided during pregnancy. Trimester 1: Theoretical risk of fetal hypothyroidism from free iodide. Trimester 2 and 3: No known teratogenicity; risk of transient neonatal hypothyroidism if high doses are used near term. |
■ FDA Black Box Warning
Risk of acute kidney injury, particularly in patients with pre-existing renal impairment, diabetes, dehydration, or concurrent nephrotoxic drug use.
| Serious Effects |
["Known hypersensitivity to iodinated contrast media","Clinically significant thyrotoxicosis"]
| Precautions | ["Hypersensitivity reactions (anaphylaxis, bronchospasm)","Thyroid dysfunction (hyperthyroidism in predisposed patients)","Cardiovascular complications (arrhythmias, heart failure)","Extravasation risk (tissue necrosis)"] |
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| Fetal Monitoring |
| Monitor maternal renal function before administration. During pregnancy, assess fetal heart rate if high dose is used near term. Postnatal monitoring of neonatal thyroid function if contrast was administered in late pregnancy. |
| Fertility Effects | No evidence of impaired fertility in animal studies. No human data on fertility effects. |