ULTRAVIST 370
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ULTRAVIST 370 (ULTRAVIST 370).
Iodinated non-ionic contrast agent that attenuates X-rays due to its high iodine content (370 mg I/mL), enhancing vascular and tissue contrast during imaging. Does not bind to plasma proteins and has minimal pharmacological effects.
| Metabolism | Not metabolized; excreted unchanged by the kidneys via glomerular filtration with negligible plasma protein binding. |
| Excretion | Renal: 95% unchanged within 24 hours via glomerular filtration; Biliary/Fecal: <5%; negligible biliary excretion. |
| Half-life | Terminal elimination half-life: 2 hours (normal renal function); prolonged to up to 36 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | Low: approximately 1-2% bound to plasma proteins (albumin). |
| Volume of Distribution | 0.2–0.3 L/kg; primarily extracellular fluid with minimal intracellular penetration. |
| Bioavailability | Intravenous: 100%; not administered orally (non-absorbable, gastrointestinal studies use direct administration). |
| Onset of Action | Intravenous: immediate opacification within seconds; Intra-arterial: within 1-2 seconds; oral or other non-vascular routes not applicable. |
| Duration of Action | IV contrast enhancement lasts 15-30 minutes for CT; excreted within 24 hours; delayed clearance in renal impairment. |
| Molecular Weight | 770 |
Adult: IV administration of 370 mg iodine/mL at 1-1.5 mL/kg (370-555 mg I/kg) for CT; up to 300 mL total. Rate: 1-5 mL/sec.
| Dosage form | INJECTABLE |
| Renal impairment | eGFR <30 mL/min/1.73m²: Avoid use or consider lowest necessary dose with adequate hydration. eGFR 30-45: Use minimal dose and ensure hydration. No adjustment for eGFR >45. |
| Liver impairment | Child-Pugh A, B, C: No dose adjustment required; however, caution in severe hepatic impairment due to potential systemic effects. |
| Pediatric use | Children: 1-2 mL/kg (370-740 mg I/kg) IV, not to exceed 3 mL/kg or 100 mL total. Adjust for age and weight; neonates may require lower doses. |
| Geriatric use | Elderly (>65 years): Use lowest effective dose (0.5-1 mL/kg). Monitor renal function; ensure adequate hydration. Increased risk of contrast-induced nephropathy. |
| 1st trimester | Contraindicated due to potential teratogenicity (fetal thyroid suppression). Use only if absolutely necessary and iodine exposure is unavoidable. |
| 2nd trimester | Use only if benefits outweigh risks; may cause transient neonatal hypothyroidism. Monitor thyroid function. |
| 3rd trimester | Use only if benefits outweigh risks; may cause transient neonatal hypothyroidism. Monitor thyroid function. |
Clinical note
Comprehensive clinical and safety monograph for ULTRAVIST 370 (ULTRAVIST 370).
| Placental transfer | Crosses placenta; free iodine may accumulate in fetal thyroid, causing hypothyroidism. |
| Breastfeeding | Excreted in breast milk in small amounts; minimal risk of thyroid suppression in infant. Discontinue breastfeeding for 24 hours after administration as a precaution. |
■ FDA Black Box Warning
Not approved for intrathecal use. Inadvertent intrathecal administration may cause severe adverse reactions including seizure, cerebral hemorrhage, coma, and death.
| Serious Effects |
Hypersensitivity to iopromide or other iodinated contrast mediaManifest hyperthyroidismDecompensated cardiac insufficiencyAcute pancreatitis
| Precautions | Risk of contrast-induced acute kidney injury (CI-AKI), especially in patients with pre-existing renal impairment, diabetes, or volume depletion, Anaphylactic/anaphylactoid reactions including fatal anaphylaxis; prophylactic corticosteroids and antihistamines may be considered in high-risk patients, Severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome or toxic epidermal necrolysis, Thyroid function disturbance; contrast-induced thyrotoxicosis in patients with hyperthyroidism or thyroid nodules, Extravasation risk causing tissue necrosis and compartment syndrome, Sickle cell disease patients may experience vaso-occlusive crises |
| Food/Dietary | No specific food interactions. Advise patients to maintain adequate hydration with water before and after the procedure; avoid alcohol and caffeine as they may contribute to dehydration. No restrictions on food intake unless otherwise directed. |
Loading safety data…
| Lactation Rating |
| L2 (Probably Compatible) |
| Teratogenic Risk | Iodinated contrast agents cross the placenta. Embryotoxicity and teratogenicity have been observed in animal studies at high doses. In humans, first trimester exposure is associated with limited data; theoretical risk of fetal thyroid dysfunction due to free iodide. Second and third trimester exposure may cause transient neonatal hypothyroidism. Overall, risk of major malformations not significantly increased, but use only when clearly needed. |
| Fetal Monitoring | Monitor maternal renal function (serum creatinine) before administration. Assess fetal thyroid function (cord blood TSH, T4) at birth if exposure during pregnancy. Observe neonate for signs of respiratory distress or allergic reaction. No specific fetal monitoring required during administration. |
| Fertility Effects | No evidence of impaired fertility in animal studies. No human data on fertility effects. Transient effects on spermatogenesis reported with some iodinated agents, but clinically insignificant. No known impact on ovarian function. |
| Clinical Pearls | Ultravist 370 (iopromide) is a low-osmolar, nonionic iodinated contrast medium used for CT, angiography, and urography. Pre-warm to body temperature to reduce viscosity and improve tolerability. Ensure adequate hydration before and after administration to reduce risk of contrast-induced nephropathy (CIN), especially in patients with pre-existing renal impairment (eGFR <30 mL/min). Have emergency resuscitation equipment available due to risk of anaphylactoid reactions. In patients with pheochromocytoma, consider pretreatment with alpha-blockers to prevent hypertensive crisis. Use caution in patients with multiple myeloma, diabetes, or hyperthyroidism. For intravascular use, maximum dose is typically 1.5-2.0 mL/kg; do not exceed 250 mL per procedure. Extravasation can cause tissue irritation; stop injection immediately and apply cold compresses. |
| Patient Advice | Inform your doctor if you have kidney disease, diabetes, asthma, a history of allergic reactions to contrast agents, or if you are pregnant or breastfeeding. · You may be asked to drink plenty of fluids before and after the procedure to help protect your kidneys. · You might experience a warm sensation or metallic taste during injection, which is normal. · Rare but serious allergic reactions can occur; seek immediate medical attention if you develop hives, difficulty breathing, or swelling of the face or throat. · If you are taking metformin for diabetes, it may need to be temporarily stopped before and after the procedure; follow your doctor's instructions. |