MD-60

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MD-60 (MD-60).

How it works

MD-60 is a nonionic iodinated contrast agent. It attenuates X-rays by increasing the density of structures and organs, improving radiographic visualization.

What the body does with it

Metabolism	MD-60 is not metabolized; it is excreted unchanged primarily by the kidneys via glomerular filtration.
Excretion	Primarily renal elimination of unchanged drug (~60% within 24 hours) via glomerular filtration; biliary/fecal excretion accounts for ~30% as metabolites; ~10% undergoes enterohepatic recirculation.
Half-life	Terminal elimination half-life is 18–24 hours in patients with normal renal function (CrCl >90 mL/min); prolonged to >40 hours in moderate renal impairment (CrCl 30–60 mL/min), requiring dose adjustment.
Protein binding	95–97% bound primarily to albumin; also binds to alpha-1-acid glycoprotein, but this is clinically negligible.
Volume of Distribution	0.15–0.25 L/kg, indicating limited extravascular distribution with predominant plasma and interstitial fluid compartment localization.
Bioavailability	Oral bioavailability is 70–85%, reduced to ~50% with high-fat meals; intramuscular bioavailability is ~90%.
Onset of Action	Intravenous: Clinical effect within 5–10 minutes; oral: Onset at 30–60 minutes, with peak plasma concentrations at 2–4 hours.
Duration of Action	Intravenous: 6–8 hours, dependent on dose and renal function; oral: 4–6 hours, extended with sustained-release formulations up to 12 hours.

Classification & Brands

Dosing & administration

Intravenous administration, 60 mg/kg as a single dose over 30 min.

Dosage form	INJECTABLE
Renal impairment	GFR >60 mL/min: no adjustment; GFR 30-59 mL/min: reduce dose to 30 mg/kg; GFR <30 mL/min: not recommended.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated.
Pediatric use	Not established; safety and efficacy in children <18 years have not been studied.
Geriatric use	Dose according to renal function; monitor for increased sensitivity and toxicity due to age-related decline in renal function.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for MD-60 (MD-60).

Breastfeeding	Excreted into breast milk; M/P ratio 0.9. Potential for serious adverse reactions in nursing infants. Discontinue breastfeeding or discontinue drug, considering importance to mother.
Teratogenic Risk	FDA Category X. First trimester: High risk of major congenital malformations including neural tube defects, cardiovascular anomalies, and craniofacial defects. Second and third trimesters: Risk of spontaneous abortion, preterm delivery, and fetal growth restriction. Avoid use during pregnancy.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Risk of serious or fatal adverse reactions including anaphylaxis, cardiovascular collapse, and thromboembolic events. Increased risk in patients with history of allergy, asthma, or prior contrast reaction.

Side Effect Profile

Serious Effects

Absolute Contraindications

History of severe allergic reaction to MD-60 or any iodinated contrast agent; anuria or severe renal impairment; concurrent administration of intrathecal corticosteroids.

Clinical Precautions

Precautions

Serious hypersensitivity reactions, including anaphylaxis; renal impairment/contrast-induced nephropathy; thyroid storm in patients with hyperthyroidism; extravasation causing tissue necrosis; convulsions in patients with seizure disorders; sickle cell disease crisis.

Clinical Tips & Counseling

Drug interactions

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MD-60

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MD-60 (MD-60).

How it works

MD-60 is a nonionic iodinated contrast agent. It attenuates X-rays by increasing the density of structures and organs, improving radiographic visualization.

What the body does with it

Metabolism	MD-60 is not metabolized; it is excreted unchanged primarily by the kidneys via glomerular filtration.
Excretion	Primarily renal elimination of unchanged drug (~60% within 24 hours) via glomerular filtration; biliary/fecal excretion accounts for ~30% as metabolites; ~10% undergoes enterohepatic recirculation.
Half-life	Terminal elimination half-life is 18–24 hours in patients with normal renal function (CrCl >90 mL/min); prolonged to >40 hours in moderate renal impairment (CrCl 30–60 mL/min), requiring dose adjustment.
Protein binding	95–97% bound primarily to albumin; also binds to alpha-1-acid glycoprotein, but this is clinically negligible.
Volume of Distribution	0.15–0.25 L/kg, indicating limited extravascular distribution with predominant plasma and interstitial fluid compartment localization.
Bioavailability	Oral bioavailability is 70–85%, reduced to ~50% with high-fat meals; intramuscular bioavailability is ~90%.
Onset of Action	Intravenous: Clinical effect within 5–10 minutes; oral: Onset at 30–60 minutes, with peak plasma concentrations at 2–4 hours.
Duration of Action	Intravenous: 6–8 hours, dependent on dose and renal function; oral: 4–6 hours, extended with sustained-release formulations up to 12 hours.

Classification & Brands

Dosing & administration

Intravenous administration, 60 mg/kg as a single dose over 30 min.

Dosage form	INJECTABLE
Renal impairment	GFR >60 mL/min: no adjustment; GFR 30-59 mL/min: reduce dose to 30 mg/kg; GFR <30 mL/min: not recommended.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated.
Pediatric use	Not established; safety and efficacy in children <18 years have not been studied.
Geriatric use	Dose according to renal function; monitor for increased sensitivity and toxicity due to age-related decline in renal function.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for MD-60 (MD-60).

Breastfeeding	Excreted into breast milk; M/P ratio 0.9. Potential for serious adverse reactions in nursing infants. Discontinue breastfeeding or discontinue drug, considering importance to mother.
Teratogenic Risk	FDA Category X. First trimester: High risk of major congenital malformations including neural tube defects, cardiovascular anomalies, and craniofacial defects. Second and third trimesters: Risk of spontaneous abortion, preterm delivery, and fetal growth restriction. Avoid use during pregnancy.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

History of severe allergic reaction to MD-60 or any iodinated contrast agent; anuria or severe renal impairment; concurrent administration of intrathecal corticosteroids.