UROVIST MEGLUMINE DIU/CT
Clinical safety rating: caution
Comprehensive clinical and safety monograph for UROVIST MEGLUMINE DIU/CT (UROVIST MEGLUMINE DIU/CT).
Urovist Meglumine DIU/CT is a contrast agent containing meglumine diatrizoate, an ionic monomeric iodinated radiopaque medium. It attenuates X-rays, enhancing vascular and tissue contrast during imaging. The diatrizoate ion increases plasma osmolality, potentially causing vasodilation and hemodynamic effects.
| Metabolism | Diatrizoate is not metabolized; it is excreted unchanged by glomerular filtration. |
| Excretion | Renal: >95% unchanged within 24 hours by glomerular filtration. Biliary/fecal: <5%. |
| Half-life | Terminal elimination half-life 1–2 hours in patients with normal renal function. Prolonged to >20 hours with severe renal impairment (CrCl <30 mL/min). |
| Protein binding | Negligible (<1%) primarily to albumin. |
| Volume of Distribution | 0.2–0.3 L/kg, indicating distribution primarily in extracellular fluid. |
| Bioavailability | Intravenous: 100%. Not absorbed orally. |
| Onset of Action | Intravenous: immediate (within seconds) for radiographic contrast enhancement; intravesical/subarachnoid: <5 minutes. |
| Duration of Action | Intravenous: 30–60 minutes for contrast enhancement (equilibrium phase); intravesical: 1–2 hours; subarachnoid: 2–3 hours for myelography. |
| Molecular Weight | 809.5 |
Intravenous administration: 100-200 mL of a 30% solution (containing 30% meglumine diatrizoate) infused over 10-30 minutes for CT imaging. Repeated doses may be given up to a maximum total dose equivalent to 4.0 mL/kg.
| Dosage form | INJECTABLE |
| Renal impairment | GFR >30 mL/min: No adjustment. GFR 15-30 mL/min: Use minimum effective dose with adequate hydration; consider alternative if possible. GFR <15 mL/min: Contraindicated due to risk of contrast-induced nephropathy. |
| Liver impairment | No specific dose adjustment based on Child-Pugh class; however, caution in severe hepatic impairment due to potential for altered contrast clearance. |
| Pediatric use | Weight-based: 1.0-2.0 mL/kg (up to 100 mL) of 30% solution intravenously; administered as a bolus or infusion over 10-30 minutes. Do not exceed 4.0 mL/kg total dose. |
| Geriatric use | Elderly patients may have reduced renal function; assess GFR prior to administration. Use minimum effective dose (e.g., 1.0-1.5 mL/kg) with adequate hydration to minimize nephrotoxicity risk. |
| 1st trimester | Iodinated contrast agents cross the placenta and are associated with neonatal hypothyroidism if administered during pregnancy. Use only if essential; risk of fetal hypothyroidism. |
| 2nd trimester | Same risks as first trimester; avoid unless diagnostic benefit outweighs potential fetal thyroid suppression. |
| 3rd trimester | Risk of neonatal hypothyroidism; consider alternative imaging if possible. If necessary, monitor neonatal thyroid function post-delivery. |
Clinical note
Comprehensive clinical and safety monograph for UROVIST MEGLUMINE DIU/CT (UROVIST MEGLUMINE DIU/CT).
| Placental transfer | Crosses placenta; fetal exposure occurs. Thyroid blockade risk for fetus. |
| Breastfeeding | Minimal excretion into breast milk; very small amount absorbed orally by infant. Consider pumping and discarding milk for 24 hours after contrast administration to minimize exposure, though risk is considered low. |
■ FDA Black Box Warning
Not for intrathecal use. Inadvertent intrathecal administration may cause severe adverse reactions including coma, convulsions, and death.
| Serious Effects |
Known hypersensitivity to iodinated contrast mediaSevere thyrotoxicosisHereditary fructose intolerance (due to sorbitol content)
| Precautions | Risk of severe hypersensitivity reactions including anaphylaxis, Acute kidney injury in patients with renal impairment or dehydration, Thyroid storm in patients with hyperthyroidism, Extravasation risk during injection, Sickle cell disease exacerbation, Interference with thyroid function tests |
| Food/Dietary | No specific food interactions. Maintain adequate hydration; avoid excessive caffeine or alcohol before procedure as they may dehydrate. No dietary restrictions required. |
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| Lactation Rating | L2 - Safer |
| Teratogenic Risk | Animal studies have not been conducted with diatrizoate meglumine; however, iodinated contrast agents cross the placenta. First-trimester exposure: theoretical risk of fetal hypothyroidism due to free iodide. Second/third trimesters: transient neonatal hypothyroidism possible after in utero exposure; prolonged exposure may cause fetal goiter. Risk of fetal injury is low with single diagnostic dose. Use only if clearly needed. |
| Fetal Monitoring | Monitor maternal renal function (serum creatinine, GFR) prior to administration given risk of contrast-induced nephropathy. Observe for immediate hypersensitivity reactions (urticaria, bronchospasm, anaphylaxis). In pregnancy, monitor fetal heart rate and uterine activity if late gestation; post-procedure neonatal thyroid function test (TSH) at birth. |
| Fertility Effects | No known effect on human fertility. Animal reproductive studies not performed. Theoretical transient ovarian exposure to radiation during CT may impact fertility, but contrast agent itself is not expected to impair fertility. |
| Clinical Pearls | Urovist Meglumine DIU/CT is a radiopaque contrast agent used for CT imaging and intravenous urography. Pre-hydrate patients with normal saline to reduce risk of contrast-induced nephropathy. Avoid in patients with history of anaphylaxis to iodinated contrast. Monitor renal function (eGFR) before administration; hold metformin for 48 hours post-procedure if eGFR < 30 or if contrast-induced nephropathy occurs. Have resuscitation equipment available due to risk of severe allergic reactions. |
| Patient Advice | You will receive an iodine-based contrast dye through an IV before your CT scan or X-ray. · Inform your doctor if you have had an allergic reaction to contrast dye, iodine, or shellfish. · Tell your doctor about all medications, especially metformin for diabetes, and any kidney problems. · You may experience a warm sensation or metallic taste during injection; this is normal. · Drink plenty of water before and after the procedure unless instructed otherwise. · Report any symptoms like hives, difficulty breathing, or swelling after the injection immediately. |