MD-76R

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MD-76R (MD-76R).

How it works

MD-76R is a radiopaque contrast agent that contains iodine, which attenuates X-rays, thereby enhancing the contrast of blood vessels and tissues during radiographic procedures. It functions by increasing the absorption of X-rays in areas where it is present, allowing for visualization of vascular structures and organ perfusion.

What the body does with it

Metabolism	MD-76R is not metabolized; it is excreted unchanged by the kidneys via glomerular filtration.
Excretion	Primarily renal; 95% eliminated unchanged in urine within 24 hours; <1% fecal.
Half-life	Terminal half-life 1-2 hours; prolonged in renal impairment.
Protein binding	<10% bound to plasma proteins.
Volume of Distribution	Vd 0.2-0.3 L/kg; primarily extracellular fluid.
Bioavailability	IV only; oral bioavailability negligible.
Onset of Action	IV: Immediate (within seconds).
Duration of Action	IV: 30-60 minutes for contrast enhancement; longer in renal impairment.

Classification & Brands

Dosing & administration

2–4 mL/kg intravenously, maximum 150 mL per procedure.

Dosage form	INJECTABLE
Renal impairment	GFR ≥30 mL/min: no adjustment; GFR <30 mL/min: avoid use or use minimum necessary dose with adequate hydration.
Liver impairment	No specific Child-Pugh based guidelines; use with caution in severe hepatic impairment due to risk of nephrotoxicity.
Pediatric use	0.5–2 mL/kg intravenously, maximum 3 mL/kg per procedure depending on weight and age.
Geriatric use	Use minimum effective dose; monitor renal function closely due to age-related decline in GFR.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for MD-76R (MD-76R).

Breastfeeding	Limited excretion into breast milk; M/P ratio unknown. Small amounts likely not expected to cause adverse effects in nursing infants. Caution recommended, especially with repeated exposure due to potential thyroid effects. Consider temporary cessation of breastfeeding for 12-24 hours post-administration if feasible.
Teratogenic Risk	FDA Category C. First trimester: Risk of fetal harm cannot be ruled out; iodine-containing contrast agents may affect fetal thyroid function leading to transient hypothyroidism. Second and third trimesters: Potential for neonatal hypothyroidism if administered near term; avoid if possible. No well-controlled studies in pregnant women.

Warnings & precautions

■ FDA Black Box Warning

Risk of serious adverse reactions, including anaphylaxis, cardiovascular collapse, and death, especially in patients with history of prior reaction to contrast media, asthma, or other allergies.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to MD-76R or any of its components","Severe oliguria or anuria due to renal failure","Concurrent administration of metformin in patients with renal impairment (risk of lactic acidosis)"]

Clinical Precautions

Precautions

["Risk of acute kidney injury, particularly in patients with pre-existing renal impairment, diabetes, or dehydration","Hypersensitivity reactions including anaphylaxis require immediate treatment","Thyroid dysfunction in patients with hyperthyroidism or thyroid tumors","Extravasation risk causing tissue necrosis","Avoid in pregnancy unless absolutely necessary"]

Clinical Tips & Counseling

Drug interactions

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MD-76R

Clinical safety rating: caution

Comprehensive clinical and safety monograph for MD-76R (MD-76R).

How it works

What the body does with it

Metabolism	MD-76R is not metabolized; it is excreted unchanged by the kidneys via glomerular filtration.
Excretion	Primarily renal; 95% eliminated unchanged in urine within 24 hours; <1% fecal.
Half-life	Terminal half-life 1-2 hours; prolonged in renal impairment.
Protein binding	<10% bound to plasma proteins.
Volume of Distribution	Vd 0.2-0.3 L/kg; primarily extracellular fluid.
Bioavailability	IV only; oral bioavailability negligible.
Onset of Action	IV: Immediate (within seconds).
Duration of Action	IV: 30-60 minutes for contrast enhancement; longer in renal impairment.

Classification & Brands

Dosing & administration

2–4 mL/kg intravenously, maximum 150 mL per procedure.

Dosage form	INJECTABLE
Renal impairment	GFR ≥30 mL/min: no adjustment; GFR <30 mL/min: avoid use or use minimum necessary dose with adequate hydration.
Liver impairment	No specific Child-Pugh based guidelines; use with caution in severe hepatic impairment due to risk of nephrotoxicity.
Pediatric use	0.5–2 mL/kg intravenously, maximum 3 mL/kg per procedure depending on weight and age.
Geriatric use	Use minimum effective dose; monitor renal function closely due to age-related decline in GFR.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for MD-76R (MD-76R).

Breastfeeding	Limited excretion into breast milk; M/P ratio unknown. Small amounts likely not expected to cause adverse effects in nursing infants. Caution recommended, especially with repeated exposure due to potential thyroid effects. Consider temporary cessation of breastfeeding for 12-24 hours post-administration if feasible.
Teratogenic Risk	FDA Category C. First trimester: Risk of fetal harm cannot be ruled out; iodine-containing contrast agents may affect fetal thyroid function leading to transient hypothyroidism. Second and third trimesters: Potential for neonatal hypothyroidism if administered near term; avoid if possible. No well-controlled studies in pregnant women.

Warnings & precautions

■ FDA Black Box Warning

Risk of serious adverse reactions, including anaphylaxis, cardiovascular collapse, and death, especially in patients with history of prior reaction to contrast media, asthma, or other allergies.