VISIPAQUE 270
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VISIPAQUE 270 (VISIPAQUE 270).
Iodinated radiocontrast agent; attenuates X-rays, providing vascular and tissue opacification.
| Metabolism | Not metabolized; excreted unchanged by glomerular filtration. |
| Excretion | Renal excretion via glomerular filtration; >95% of administered dose eliminated unchanged in urine within 24 hours. Minimal biliary or fecal excretion (<1%). |
| Half-life | Terminal elimination half-life is approximately 1.5–2 hours in patients with normal renal function (creatinine clearance >60 mL/min). Prolonged in renal impairment, correlating with degree of kidney dysfunction. |
| Protein binding | Negligible protein binding (<1%); iodixanol does not significantly bind to plasma proteins. |
| Volume of Distribution | Volume of distribution (Vd) approximately 0.26 L/kg, indicating distribution primarily in extracellular fluid. Clinically reflects limited tissue penetration. |
| Bioavailability | 100% following intravenous administration. Oral or rectal bioavailability negligible (<1%) as not intended for systemic uptake. |
| Onset of Action | Immediate following intravenous injection; contrast enhancement observed within seconds. For oral or rectal routes, not applicable due to lack of intended systemic absorption. |
| Duration of Action | Contrast enhancement lasts approximately 1–2 hours post-injection; imaging window typically 30–90 minutes. Rapid redistribution and elimination; prolonged in renal impairment. |
| Molecular Weight | 1550.19 |
Intraarterial or intravenous administration; dose depends on procedure, age, weight, cardiac output, and clinical condition. Typical adult dose: 50-150 mL of 270 mg I/mL (50-80 mL for coronary arteriography, 30-50 mL for left ventriculography; up to 250 mL total for multiple injections).
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in patients with GFR <30 mL/min/1.73 m² due to risk of contrast-induced nephropathy; for GFR 30-60 mL/min/1.73 m², use lowest necessary dose, ensure adequate hydration, and consider discontinuation of nephrotoxic drugs. |
| Liver impairment | No specific dose adjustment required for Child-Pugh class A or B; use with caution in severe hepatic impairment (Child-Pugh class C) due to potential for delayed elimination and increased risk of adverse reactions. |
| Pediatric use | Dose based on weight and procedure: 1.0-2.0 mL/kg (270 mg I/mL) intravenously for contrast-enhanced CT; maximum total dose 4 mL/kg. For angiography, dose individualized. |
| Geriatric use | Use lowest effective dose; assess renal function (eGFR) before administration; ensure adequate hydration due to increased risk of contrast-induced nephropathy and volume depletion. |
| 1st trimester | Limited human data; animal studies not available. Iodinated contrast crosses the placenta. Use only if essential and benefits outweigh risks. |
| 2nd trimester | Use only if clearly needed. Potential fetal hypothyroidism from free iodide exposure. |
| 3rd trimester | Risk of neonatal hypothyroidism if administered near term. Caution advised. |
Clinical note
Comprehensive clinical and safety monograph for VISIPAQUE 270 (VISIPAQUE 270).
| Placental transfer | Iodixanol crosses the placenta. In human studies, fetal plasma concentrations reach up to 5-10% of maternal levels. |
| Breastfeeding | Iodixanol is excreted in breast milk in very small amounts (less than 0.01% of maternal dose). Risk to nursing infant is negligible. A breastfeeding interruption is not required. |
■ FDA Black Box Warning
Not for intrathecal use; risk of convulsions, coma, respiratory arrest, and death.
| Serious Effects |
Hypersensitivity to iodixanol or any componentsClinically significant thyrotoxicosis
| Precautions | Risk of contrast-induced nephropathy (CIN); assess renal function before administration., Anaphylactoid reactions may occur; have resuscitation equipment available., Thyroid storm risk in hyperthyroid patients., Sickle cell disease: risk of intravascular hemolysis. |
| Food/Dietary | No direct food interactions. Patients scheduled for contrast procedures may be instructed to avoid solid foods for 4-6 hours prior to reduce the risk of aspiration or nausea/vomiting, but clear liquids are often encouraged up to 2 hours before to maintain hydration. No specific dietary restrictions after the procedure, but increased fluid intake is recommended to facilitate contrast excretion. |
Loading safety data…
| Lactation Rating |
| L1 (Safe) |
| Teratogenic Risk | Iodinated contrast agents cross the placenta. First trimester exposure not associated with increased risk of major malformations. Second and third trimester exposure may transiently depress fetal thyroid function; neonatal thyroid function should be assessed if exposure occurs. |
| Fetal Monitoring | Monitor maternal renal function (serum creatinine, eGFR) prior to administration. Assess fetal heart rate during procedure if applicable. Neonatal thyroid function tests (TSH, T4) recommended if exposure occurred in third trimester. |
| Fertility Effects | No known adverse effects on fertility in males or females. Transient effects on sperm motility or morphology have not been reported with iodinated contrast. |
| Clinical Pearls | VISIPAQUE 270 (iodixanol) is an iso-osmolar, nonionic, dimeric iodinated contrast agent with an osmolality of 290 mOsm/kg water, approximating plasma. It is indicated for intrathecal administration (myelography) and intravascular use (angiography, CT). Due to its iso-osmolarity, it carries a lower risk of contrast-induced nephropathy (CIN) compared to low-osmolar agents, especially in high-risk patients (e.g., chronic kidney disease, diabetes, dehydration). However, pre-existing renal impairment is the strongest predictor of CIN; therefore, assess renal function (eGFR) before use. Prophylactic hydration is recommended in at-risk patients (e.g., 1 mL/kg/hour normal saline for 12 hours pre- and post-procedure). The incidence of delayed hypersensitivity reactions (skin rash, pruritus) is ~1-3%, typically occurring 3-96 hours after administration. Premedication (e.g., prednisone 50 mg PO q6h for 3 doses plus diphenhydramine 50 mg IV/IM) may reduce risk in patients with prior contrast reaction. For myelography, use a 22-25 gauge spinal needle and inject slowly to minimize CSF disturbance; headache is the most common adverse effect (up to 30%). VISIPAQUE 270 contains no calcium disodium EDTA; thus, it does not interfere with calcium measurements in laboratory assays. |
| Patient Advice | Inform your healthcare provider if you have any allergies, especially to contrast media, iodine, or any medications. · Tell your doctor if you have kidney problems, diabetes, asthma, heart disease, sickle cell disease, or if you are taking metformin (a diabetes medicine). · You may need to stop taking metformin for 48 hours before and after the procedure to prevent lactic acidosis; follow your doctor's instructions. · You should drink plenty of fluids before and after the procedure to help your kidneys remove the contrast agent, unless otherwise instructed by your doctor. · Notify your provider if you are pregnant, breastfeeding, or think you might be pregnant, as the risk to the fetus is not fully known. · After the procedure, report any symptoms such as rash, hives, itching, difficulty breathing, swelling of the face or throat, chest pain, palpitations, or severe headache to your healthcare provider immediately. |