LIPIODOL
Clinical safety rating: caution
Comprehensive clinical and safety monograph for LIPIODOL (LIPIODOL).
Lipiodol is an iodinated ethyl ester of the fatty acids of poppyseed oil. It acts as a radiopaque contrast agent for imaging due to its iodine content, and in chemoembolization, it selectively accumulates in hepatocellular carcinoma (HCC) via tumor neovasculature and is retained due to lack of lymphatic drainage, allowing targeted delivery of chemotherapeutic agents.
| Metabolism | Lipiodol is not metabolized; it is eliminated by phagocytosis and slowly cleared from tissues, with iodine being released and excreted renally. |
| Excretion | Primarily eliminated via biliary/fecal route as unchanged drug; less than 1% excreted renally. |
| Half-life | Terminal elimination half-life is approximately 50-60 days, reflecting slow clearance from lipid-rich tissues. |
| Protein binding | Essentially 100% bound to plasma lipoproteins and lipids. |
| Volume of Distribution | Estimated to be 10-15 L/kg, indicating extensive distribution into adipose and lipid-rich tissues. |
| Bioavailability | Bioavailability is 100% following intra-arterial injection; not administered via other routes. |
| Onset of Action | Almost immediate upon intravascular injection; clinical effect (radiopacity) appears within seconds. |
| Duration of Action | Radiopacity persists for 10-15 minutes during imaging; local therapeutic effect (e.g., chemoembolization) may last weeks. |
Lymphangiography: 5-20 mL injected slowly into lymphatic vessels. Uterine/Fallopian tube imaging: 3-20 mL injected through cervix. Hepatic chemoembolization: 5-15 mL mixed with chemotherapeutic agents injected into hepatic artery.
| Dosage form | OIL |
| Renal impairment | No specific dose adjustments recommended in renal impairment. Caution in severe renal dysfunction due to potential for embolic events; consider risk-benefit. |
| Liver impairment | No specific dose adjustments recommended in hepatic impairment. Caution in severe hepatic impairment (Child-Pugh C) due to increased risk of pulmonary embolism. |
| Pediatric use | Not routinely used in pediatrics. If indicated, dose based on body weight and imaging requirements; typical dose 1-5 mL per procedure, adjusted for age and condition. |
| Geriatric use | No specific dose adjustments. Use with caution due to increased incidence of comorbid conditions and reduced physiological reserve; monitor for embolic complications. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for LIPIODOL (LIPIODOL).
| Breastfeeding | Iodinated contrast agents are excreted into breast milk in minimal amounts. The relative infant dose is <1% of maternal dose. M/P ratio not established. Risk of thyroid suppression in nursing infant is negligible. No need to interrupt breastfeeding. |
| Teratogenic Risk | Lipiodol is an iodinated contrast agent. In pregnancy, fetal thyroid function becomes iodine-sensitive after 10-12 weeks gestation. Exposure to excess iodine can cause fetal thyroid suppression and goiter. Risk is highest in second and third trimesters. Avoid use unless benefit clearly exceeds risk. |
■ FDA Black Box Warning
Lipiodol is not indicated for use in bronchography or myelography due to risk of severe pulmonary embolism and neurologic complications.
| Serious Effects |
Hypersensitivity to iodine or any component; active hyperthyroidism; severe hepatic or renal impairment; pregnancy (particularly during hysterosalpingography); acute pelvic inflammatory disease (for hysterosalpingography).
| Precautions | Risk of hypersensitivity reactions including anaphylaxis; pulmonary embolism if injected intravascularly; thyroid dysfunction (hyperthyroidism or hypothyroidism) due to iodine load; interference with thyroid function tests; aspiration pneumonitis if administered into the tracheobronchial tree. |
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| Fetal Monitoring |
| Monitor maternal vital signs and oxygen saturation during administration. Assess for hypersensitivity reactions. Post-procedure, monitor fetal heart rate if applicable. Assess maternal thyroid function if high cumulative iodine load. |
| Fertility Effects | No known adverse effects on fertility. Lipiodol is used in hysterosalpingography for infertility evaluation and may improve fertility by flushing tubal debris. |