ULTRAVIST 370

Clinical safety rating: caution

Comprehensive clinical and safety monograph for ULTRAVIST 370 (ULTRAVIST 370).

How it works

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.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for ULTRAVIST 370 (ULTRAVIST 370).

Breastfeeding

Ultravist 370 (iopromide) is excreted into breast milk in trace amounts (estimated infant dose <0.01% of maternal dose). M/P ratio not established. Due to low oral bioavailability and short half-life, breastfeeding can be resumed 12-24 hours after administration. Discard milk for 24 hours if concern. Considered compatible with breastfeeding.

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.

Warnings & precautions

■ FDA Black Box Warning

Not approved for intrathecal use. Inadvertent intrathecal administration may cause severe adverse reactions including seizure, cerebral hemorrhage, coma, and death.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Absolute: Hypersensitivity to iopromide or any component of the formulation","Absolute: Known history of anaphylactic reaction to any iodinated contrast agent","Relative: Pre-existing severe renal impairment (eGFR <30 mL/min/1.73m²) unless benefit outweighs risk","Relative: Uncontrolled hyperthyroidism or thyroid storm","Relative: Pregnancy (use only if clearly needed)"]

Clinical Precautions

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"]

Clinical Tips & Counseling

Drug interactions

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ULTRAVIST 370

Clinical safety rating: caution

Comprehensive clinical and safety monograph for ULTRAVIST 370 (ULTRAVIST 370).

How it works

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for ULTRAVIST 370 (ULTRAVIST 370).

Breastfeeding

Teratogenic Risk

Warnings & precautions

■ FDA Black Box Warning

Not approved for intrathecal use. Inadvertent intrathecal administration may cause severe adverse reactions including seizure, cerebral hemorrhage, coma, and death.