ULTRAVIST 150
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ULTRAVIST 150 (ULTRAVIST 150).
Nonionic iodinated contrast medium that attenuates X-rays, enhancing vascular and tissue contrast due to iodine content. It distributes in extracellular fluid and is excreted unchanged by glomerular filtration.
| Metabolism | Not metabolized; eliminated unchanged via glomerular filtration. |
| Excretion | Primarily renal (glomerular filtration, >95% of injected dose excreted unchanged in urine within 24 hours; negligible biliary/fecal excretion <2%) |
| Half-life | Terminal elimination half-life approximately 2 hours (range 1.5–3 hours) in patients with normal renal function; prolonged in renal impairment (up to 30 hours in severe impairment) |
| Protein binding | Negligible (<2%) bound to plasma proteins (primarily albumin) |
| Volume of Distribution | Approximately 0.3–0.4 L/kg, reflecting distribution primarily in extracellular fluid space; does not cross intact blood-brain barrier |
| Bioavailability | Intravenous: 100% (administered directly into bloodstream); no oral bioavailability due to degradation in GI tract; other routes not relevant |
| Onset of Action | Intravenous: immediate (within seconds to 1 minute) for contrast enhancement in CT or angiography; intra-arterial: immediate upon injection |
| Duration of Action | Intravenous: imaging window approximately 15–30 minutes for CT; redistribution and elimination reduce diagnostic contrast within 1 hour; complete clearance by 24 hours |
| Molecular Weight | 791.1 |
Intravascular administration: 1-2 mL/kg of ULTRAVIST 150 (150 mg iodine/mL) as a bolus or rapid infusion. Typical adult dose ranges from 50-200 mL depending on procedure and patient weight. Not to exceed 7.5 mL/kg.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR 30-59 mL/min/1.73m²: Use lowest diagnostic dose, ensure adequate hydration, consider alternative imaging if possible. eGFR <30 mL/min/1.73m²: Avoid use unless essential; if necessary, use minimum dose, hydrate, and monitor renal function for 48-72 hours. Hemodialysis patients: Use only if clearly indicated; no dose adjustment needed but contrast removal via dialysis is minimal. |
| Liver impairment | No specific dose adjustment required for hepatic impairment. Caution in severe hepatic disease due to increased risk of contrast-induced nephropathy. |
| Pediatric use | Weight-based: 1-2 mL/kg intravenously, not to exceed total dose of 5 mL/kg. Specific protocols: CT head: 1-2 mL/kg; CT body: 2 mL/kg. Administer as slow bolus or infusion. |
| Geriatric use | Use lowest diagnostic dose. Ensure adequate hydration before and after procedure. Monitor renal function (eGFR) and adjust volume accordingly. Higher risk of adverse reactions, especially in frail elderly with comorbidities. |
| 1st trimester | Iodinated contrast agents are generally avoided in the first trimester unless essential, due to theoretical risk of fetal thyroid dysfunction from free iodide. Use only if benefit outweighs risk. |
| 2nd trimester | Limited data suggest no documented teratogenic effects. However, fetal thyroid maturation begins at 12 weeks; exposure may theoretically cause transient neonatal hypothyroidism. Use with caution. |
| 3rd trimester | Near term, fetal thyroid is functional; exposure can cause transient neonatal hypothyroidism. Use only if clearly needed and consider neonatal thyroid screening after delivery. |
Clinical note
Comprehensive clinical and safety monograph for ULTRAVIST 150 (ULTRAVIST 150).
| Placental transfer | Iopromide crosses the placenta. In animal studies, levels in fetal tissues are low. In humans, fetal exposure occurs via placental transfer; the degree is limited but sufficient to potentially affect fetal thyroid function. |
| Breastfeeding |
■ FDA Black Box Warning
Not approved for intrathecal use; severe adverse reactions including seizures, coma, and death have occurred with inadvertent intrathecal administration.
| Serious Effects |
History of life-threatening anaphylactoid reaction to iopromide or other iodinated contrast agentsThyrotoxicosis (overt hyperthyroidism) due to risk of thyroid stormAnuria or severe renal impairment without dialysis capability (relative contraindication; may be used with caution if dialysis is available)
| Precautions | Risk of acute kidney injury in patients with pre-existing renal impairment, diabetes, or dehydration, Hypersensitivity reactions including anaphylaxis, Thyroid storm in patients with hyperthyroidism, Extravasation leading to tissue necrosis, Sickle cell crisis in susceptible individuals, Interference with thyroid function tests |
| Food/Dietary | No specific food interactions. However, patients with phenylketonuria should be informed that ULTRAVIST 150 contains no phenylalanine. Avoid alcohol consumption before the procedure as it may affect hydration status. |
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| Iodinated contrast agents are excreted into breast milk in very small amounts (<1% of maternal dose). The amount absorbed by the infant is negligible. The American College of Radiology states that breastfeeding can continue without interruption after contrast administration. However, some sources suggest pump and discard for 24 hours if mother is concerned. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | ULTRAVIST 150 (iopromide) is a nonionic iodinated contrast medium. Animal studies have not shown teratogenic effects. In humans, the risk of fetal harm is considered low with standard diagnostic use. However, fetal hypothyroidism may occur if the agent crosses the placenta, particularly in the second and third trimesters, as iodine can affect fetal thyroid function. Transient neonatal hypothyroidism has been reported. The risk is dose-dependent and higher with repeated exposure. Generally, use is avoided in pregnancy unless essential, and if used, neonatal thyroid function should be assessed. |
| Fetal Monitoring | No specific maternal or fetal monitoring is routinely required after diagnostic use. However, if administered during pregnancy, consider neonatal thyroid function testing (TSH, free T4) within 1-2 weeks after birth to rule out transient hypothyroidism. Maternal renal function should be assessed prior to administration due to contrast-induced nephropathy risk. |
| Fertility Effects | No known adverse effects on fertility in animal studies or human data. Transient, reversible effects on sperm motility and morphology have been reported with other iodinated contrast agents, but specific data for ULTRAVIST 150 are lacking. Clinically, no significant impact on fertility is expected. |
| Clinical Pearls | ULTRAVIST 150 (iopromide) is a low-osmolar nonionic iodinated contrast medium. Pre-warming to 37°C reduces viscosity and improves tolerability. Monitor renal function before administration; hold metformin for 48h if eGFR <30 mL/min. Have emergency equipment ready for anaphylactoid reactions. For pediatric dosing, adjust volume based on body weight and imaging protocol. |
| Patient Advice | Inform your healthcare provider if you have kidney disease, diabetes, or are on metformin. · Drink plenty of fluids before and after the procedure to help your kidneys eliminate the contrast. · You may feel a warm sensation or a metallic taste during injection; this is common and temporary. · Report any skin rash, breathing difficulty, or swelling of the face/throat immediately. · If you have a history of allergic reactions to contrast, you may need premedication. |