OMNIPAQUE 9

Clinical safety rating: caution

Comprehensive clinical and safety monograph for OMNIPAQUE 9 (OMNIPAQUE 9).

How it works

Iodinated nonionic contrast agent that attenuates X-rays, enhancing vascular and tissue contrast. Its iodine content (350 mg/mL) provides radiopacity, while low osmolality reduces adverse hemodynamic effects.

What the body does with it

Metabolism	Primarily eliminated unchanged by renal glomerular filtration. No significant hepatic metabolism. Minimal protein binding (<5%).
Excretion	Renal: >95% unchanged via glomerular filtration; fecal: <1%.
Half-life	Terminal elimination half-life: 1–2 hours in patients with normal renal function; prolonged to >24 hours in severe renal impairment (CrCl <30 mL/min), necessitating dose adjustment.
Protein binding	Negligible (<1%); does not bind significantly to plasma proteins.
Volume of Distribution	0.2–0.3 L/kg; distributes primarily in extracellular fluid, with minimal intracellular penetration.
Bioavailability	Oral: negligible (<1%) due to poor gastrointestinal absorption; intravenous: 100%.
Onset of Action	Intravenous: within 1–2 minutes for contrast enhancement; oral: for CT of GI tract, onset ~30 minutes; rectal: onset ~15 minutes.
Duration of Action	Intravenous: contrast effect lasts 1–2 hours for CT; oral/rectal: GI opacification persists 30–90 minutes depending on transit time.

Classification & Brands

Dosing & administration

Omnipaque 9 (iohexol 9 mg I/mL) is administered intravenously. For CT enhancement, typical adult dose is 50-100 mL (450-900 mg I) by slow IV injection.

Dosage form	SOLUTION
Renal impairment	In patients with GFR 30-59 mL/min: reduce dose by 50% and ensure adequate hydration. With GFR <30 mL/min: avoid use or use only if essential with minimum dose (e.g., 10-20 mL) and nephrology consult.
Liver impairment	No specific dose adjustment for Child-Pugh class; however, monitor for contrast-induced nephropathy in ascites (volume status). Use lowest effective dose with hydration.
Pediatric use	Children: 1-2 mL/kg (9-18 mg I/kg) IV; maximum 50 mL total. For neonates: 0.5-1 mL/kg IV slowly.
Geriatric use	Elderly: use minimum dose (e.g., 25-50 mL) to achieve diagnostic result; pre-hydrate and monitor renal function closely due to age-related GFR decline.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for OMNIPAQUE 9 (OMNIPAQUE 9).

Breastfeeding	Iohexol (active component) is excreted in breast milk in minimal amounts; estimated infant dose <1% of maternal. M/P ratio not established. Discontinue breastfeeding for 24 hours post-administration as precaution.
Teratogenic Risk	FDA Category C. No adequate studies in pregnant women. Iodinated contrast crosses placenta. First trimester: theoretical risk of fetal hypothyroidism if administered; third trimester: transient neonatal hypothyroidism reported. Benefits must outweigh risks.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Not to be used for intrathecal administration unless specifically indicated for myelography. Risk of severe adverse reactions including anaphylaxis, cardiac arrest, and seizures. Must have emergency resuscitation equipment available.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Absolute: History of anaphylaxis to iodinated contrast media.","Absolute: Known or suspected pregnancy (unless benefit outweighs risk).","Relative: Severe renal impairment (eGFR <30 mL/min/1.73 m²) without dialysis.","Relative: Untreated hyperthyroidism."]

Clinical Precautions

Precautions

["Risk of contrast-induced acute kidney injury (CI-AKI), especially in patients with pre-existing renal impairment, diabetes, or dehydration.","Serious hypersensitivity/anaphylactoid reactions, including bronchospasm, laryngeal edema, and hypotension.","Thyroid dysfunction: Iodine exposure may induce hyperthyroidism in predisposed patients.","Cardiovascular: Avoid in patients with severe heart failure or pulmonary hypertension due to risk of hemodynamic decompensation.","Neurologic: Intrathecal use may cause seizures, arachnoiditis, or meningitis."]

Clinical Tips & Counseling

Drug interactions

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OMNIPAQUE 9

Clinical safety rating: caution

Comprehensive clinical and safety monograph for OMNIPAQUE 9 (OMNIPAQUE 9).

How it works

What the body does with it

Metabolism	Primarily eliminated unchanged by renal glomerular filtration. No significant hepatic metabolism. Minimal protein binding (<5%).
Excretion	Renal: >95% unchanged via glomerular filtration; fecal: <1%.
Half-life	Terminal elimination half-life: 1–2 hours in patients with normal renal function; prolonged to >24 hours in severe renal impairment (CrCl <30 mL/min), necessitating dose adjustment.
Protein binding	Negligible (<1%); does not bind significantly to plasma proteins.
Volume of Distribution	0.2–0.3 L/kg; distributes primarily in extracellular fluid, with minimal intracellular penetration.
Bioavailability	Oral: negligible (<1%) due to poor gastrointestinal absorption; intravenous: 100%.
Onset of Action	Intravenous: within 1–2 minutes for contrast enhancement; oral: for CT of GI tract, onset ~30 minutes; rectal: onset ~15 minutes.
Duration of Action	Intravenous: contrast effect lasts 1–2 hours for CT; oral/rectal: GI opacification persists 30–90 minutes depending on transit time.

Classification & Brands

Dosing & administration

Omnipaque 9 (iohexol 9 mg I/mL) is administered intravenously. For CT enhancement, typical adult dose is 50-100 mL (450-900 mg I) by slow IV injection.

Dosage form	SOLUTION
Renal impairment	In patients with GFR 30-59 mL/min: reduce dose by 50% and ensure adequate hydration. With GFR <30 mL/min: avoid use or use only if essential with minimum dose (e.g., 10-20 mL) and nephrology consult.
Liver impairment	No specific dose adjustment for Child-Pugh class; however, monitor for contrast-induced nephropathy in ascites (volume status). Use lowest effective dose with hydration.
Pediatric use	Children: 1-2 mL/kg (9-18 mg I/kg) IV; maximum 50 mL total. For neonates: 0.5-1 mL/kg IV slowly.
Geriatric use	Elderly: use minimum dose (e.g., 25-50 mL) to achieve diagnostic result; pre-hydrate and monitor renal function closely due to age-related GFR decline.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for OMNIPAQUE 9 (OMNIPAQUE 9).

Breastfeeding	Iohexol (active component) is excreted in breast milk in minimal amounts; estimated infant dose <1% of maternal. M/P ratio not established. Discontinue breastfeeding for 24 hours post-administration as precaution.
Teratogenic Risk	FDA Category C. No adequate studies in pregnant women. Iodinated contrast crosses placenta. First trimester: theoretical risk of fetal hypothyroidism if administered; third trimester: transient neonatal hypothyroidism reported. Benefits must outweigh risks.
Fetal Monitoring