OPTIRAY 240
Clinical safety rating: caution
Comprehensive clinical and safety monograph for OPTIRAY 240 (OPTIRAY 240).
OPTIRAY 240 (ioversol) is a nonionic, iodinated, water-soluble radiographic contrast agent that attenuates X-rays, thereby enhancing the contrast of blood vessels and tissues during imaging procedures. Its mechanism is physical: the iodine atoms absorb X-rays, providing radiopacity.
| Metabolism | Ioversol is not significantly metabolized; it is predominantly excreted unchanged by the kidneys via glomerular filtration. No specific metabolic enzymes are involved. |
| Excretion | Primarily renal (glomerular filtration); >90% of administered dose excreted unchanged in urine within 24 hours; <1% biliary/fecal. |
| Half-life | Terminal elimination half-life approximately 2 hours in patients with normal renal function; prolonged in renal impairment (up to 30 hours in severe impairment). |
| Protein binding | <10% bound to plasma proteins; primarily to albumin. |
| Volume of Distribution | 0.2-0.3 L/kg; primarily distributes to extracellular fluid space. |
| Bioavailability | Not applicable (administered IV or intra-arterially; 100% bioavailability by these routes). |
| Onset of Action | Intravenous: immediate (within seconds); intra-arterial: immediate; oral: not applicable. |
| Duration of Action | Iodine contrast enhancement persists for 1-2 hours after injection; complete elimination by 24 hours. |
Intravenous administration: 50-150 mL of OPTIRAY 240 (iopamidol 240 mg iodine/mL) for adult computed tomography (CT) imaging, typically as a bolus or rapid infusion. Dose depends on procedure and patient size.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR <30 mL/min/1.73 m²: Use with caution; consider prophylactic hydration and minimize contrast volume. eGFR <15 mL/min: Avoid use unless dialysis is planned immediately post-procedure. No specific dose reduction formula; limit total iodine dose to ≤300 mg iodine/kg. |
| Liver impairment | No specific adjustment per Child-Pugh class. Use standard dosing with caution in severe hepatic impairment due to potential for prolonged elimination. |
| Pediatric use | Intravenous administration: 1-2 mL/kg (240 mg iodine/mL) for CT, typical dose up to 3 mL/kg for specific indications; maximum total dose rarely exceeds 4 mL/kg. Adjust for body weight and clinical indication. |
| Geriatric use | No specific dose adjustment, but consider reduced renal function (assess eGFR) and hydration status. Use lowest effective dose and monitor for nephrotoxicity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for OPTIRAY 240 (OPTIRAY 240).
| Breastfeeding | Iohexol is excreted into breast milk in trace amounts (M/P ratio ~0.05). Oral bioavailability in infant is <1%; no adverse effects reported. American College of Radiology recommends no interruption of breastfeeding after maternal exposure. |
| Teratogenic Risk | Iodinated contrast media cross the placenta. No teratogenic effects in animal studies; human data insufficient. First trimester: theoretical risk of fetal thyroid suppression from free iodide. Second/third trimesters: transient neonatal hypothyroidism possible if high doses or repeated exposure. |
■ FDA Black Box Warning
Serious, life-threatening, or fatal adverse reactions may occur: severe anaphylactoid reactions, cardiovascular collapse, cardiac arrest, and seizures. Resuscitative equipment and trained personnel must be available. Patients at increased risk include those with a history of severe reaction to iodinated contrast, renal impairment, or cardiovascular disease.
| Serious Effects |
["Absolute: Known hypersensitivity to ioversol or any component of the formulation","Relative: History of severe allergic reaction to other iodinated contrast agents; concurrent administration of metformin in patients with renal impairment (discontinue metformin); renal failure; severe cardiovascular disease; decompensated heart failure; multiple myeloma; pheochromocytoma; sickle cell disease"]
| Precautions | ["Risk of acute kidney injury, especially in patients with pre-existing renal impairment, diabetes, dehydration, or concurrent nephrotoxic drugs","Severe anaphylactoid reactions, including fatal anaphylaxis","Cardiovascular reactions (arrhythmias, hypotension, cardiac arrest)","Seizures, particularly in patients with a history of seizure disorder or CNS abnormalities","Thyroid storm in patients with hyperthyroidism or thyroid nodules","Sickle cell crisis in patients with sickle cell disease","Extravasation risk leading to tissue necrosis and compartment syndrome"] |
Loading safety data…
| Fetal Monitoring |
| Monitor maternal renal function prior to administration. Assess for allergic reactions. In neonate, monitor thyroid function if repeated or high-dose contrast used during pregnancy. |
| Fertility Effects | No evidence of impaired fertility in animal studies. No human data on fertility effects. |