NEPHROFLOW

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NEPHROFLOW (NEPHROFLOW).

How it works

NEPHROFLOW is a vasodilator that increases renal blood flow by selectively dilating afferent arterioles, leading to enhanced glomerular filtration rate (GFR). It also inhibits sodium reabsorption in the proximal tubule, promoting diuresis.

What the body does with it

Metabolism	Primarily metabolized by hepatic CYP3A4; undergoes glucuronidation; renal excretion of unchanged drug accounts for <10%.
Excretion	Primarily renal (85% unchanged); 15% biliary/fecal. In renal impairment, half-life doubles.
Half-life	4.2 hours (terminal) in normal renal function; prolongs in CKD.
Protein binding	92% bound to albumin.
Volume of Distribution	0.45 L/kg (confined to extracellular fluid).
Bioavailability	Oral: 55% (first-pass effect).
Onset of Action	IV: 5-10 min; Oral: 30-60 min.
Duration of Action	4-6 hours (variable: dose-dependent).

Classification & Brands

Dosing & administration

NEPHROFLOW (Ioversol) 350 mg iodine/mL: 1 mL/kg intravenously up to 150 mL maximum for contrast imaging.

Dosage form	INJECTABLE
Renal impairment	eGFR <30 mL/min/1.73 m²: Use lowest necessary dose; ensure adequate hydration; consider alternative imaging. eGFR 30-59: No dose reduction needed but maintain hydration.
Liver impairment	No specific dose adjustment required for hepatic impairment based on Child-Pugh class.
Pediatric use	Weight-based: 1.0-1.5 mL/kg intravenously, maximum 150 mL per study.
Geriatric use	No specific dose adjustment except based on renal function; monitor hydration status and renal function pre- and post-administration.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for NEPHROFLOW (NEPHROFLOW).

Breastfeeding	Excreted into breast milk in low concentrations (M/P ratio 0.15). Not recommended during breastfeeding due to potential neonatal renal toxicity. Monitor infant renal function if use is unavoidable.
Teratogenic Risk	First trimester: Increased risk of congenital anomalies including renal agenesis and oligohydramnios sequence. Second and third trimesters: Fetal nephrotoxicity with potential irreversible renal impairment, oligohydramnios, and neonatal renal failure.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Not recommended for use in patients with severe hypotension (systolic BP < 90 mmHg) due to risk of renal hypoperfusion.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to NEPHROFLOW or any component; severe hypotension; anuria; concurrent use with strong CYP3A4 inhibitors (e.g., ketoconazole).

Clinical Precautions

Precautions

Monitor blood pressure closely; may cause hypotension. Use with caution in patients with hepatic impairment. Risk of electrolyte imbalances (e.g., hypokalemia) with prolonged use.

Clinical Tips & Counseling

Drug interactions

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NEPHROFLOW

Clinical safety rating: caution

Comprehensive clinical and safety monograph for NEPHROFLOW (NEPHROFLOW).

How it works

What the body does with it

Metabolism	Primarily metabolized by hepatic CYP3A4; undergoes glucuronidation; renal excretion of unchanged drug accounts for <10%.
Excretion	Primarily renal (85% unchanged); 15% biliary/fecal. In renal impairment, half-life doubles.
Half-life	4.2 hours (terminal) in normal renal function; prolongs in CKD.
Protein binding	92% bound to albumin.
Volume of Distribution	0.45 L/kg (confined to extracellular fluid).
Bioavailability	Oral: 55% (first-pass effect).
Onset of Action	IV: 5-10 min; Oral: 30-60 min.
Duration of Action	4-6 hours (variable: dose-dependent).

Classification & Brands

Dosing & administration

NEPHROFLOW (Ioversol) 350 mg iodine/mL: 1 mL/kg intravenously up to 150 mL maximum for contrast imaging.

Dosage form	INJECTABLE
Renal impairment	eGFR <30 mL/min/1.73 m²: Use lowest necessary dose; ensure adequate hydration; consider alternative imaging. eGFR 30-59: No dose reduction needed but maintain hydration.
Liver impairment	No specific dose adjustment required for hepatic impairment based on Child-Pugh class.
Pediatric use	Weight-based: 1.0-1.5 mL/kg intravenously, maximum 150 mL per study.
Geriatric use	No specific dose adjustment except based on renal function; monitor hydration status and renal function pre- and post-administration.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for NEPHROFLOW (NEPHROFLOW).

Breastfeeding	Excreted into breast milk in low concentrations (M/P ratio 0.15). Not recommended during breastfeeding due to potential neonatal renal toxicity. Monitor infant renal function if use is unavoidable.
Teratogenic Risk	First trimester: Increased risk of congenital anomalies including renal agenesis and oligohydramnios sequence. Second and third trimesters: Fetal nephrotoxicity with potential irreversible renal impairment, oligohydramnios, and neonatal renal failure.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Not recommended for use in patients with severe hypotension (systolic BP < 90 mmHg) due to risk of renal hypoperfusion.

Side Effect Profile

Serious Effects

Absolute Contraindications

Hypersensitivity to NEPHROFLOW or any component; severe hypotension; anuria; concurrent use with strong CYP3A4 inhibitors (e.g., ketoconazole).

Clinical Precautions

Precautions

Monitor blood pressure closely; may cause hypotension. Use with caution in patients with hepatic impairment. Risk of electrolyte imbalances (e.g., hypokalemia) with prolonged use.

Clinical Tips & Counseling

Drug interactions

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