VISIPAQUE 270

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VISIPAQUE 270 (VISIPAQUE 270).

How it works

Iodinated radiocontrast agent; attenuates X-rays, providing vascular and tissue opacification.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for VISIPAQUE 270 (VISIPAQUE 270).

Breastfeeding	Iodinated contrast is excreted into breast milk in small amounts; less than 1% of maternal dose. M/P ratio not established. Consider pumping and discarding milk for 12-24 hours after administration if infant is preterm or has compromised thyroid function.
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.

Warnings & precautions

■ FDA Black Box Warning

Not for intrathecal use; risk of convulsions, coma, respiratory arrest, and death.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to iodinated contrast media.","Intrathecal administration (contraindicated)."]

Clinical Precautions

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."]

Clinical Tips & Counseling

Drug interactions

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VISIPAQUE 270

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VISIPAQUE 270 (VISIPAQUE 270).

How it works

Iodinated radiocontrast agent; attenuates X-rays, providing vascular and tissue opacification.

What the body does with it

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.

Classification & Brands

Dosing & administration

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.

Use during pregnancy

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

Clinical note

Comprehensive clinical and safety monograph for VISIPAQUE 270 (VISIPAQUE 270).

Breastfeeding	Iodinated contrast is excreted into breast milk in small amounts; less than 1% of maternal dose. M/P ratio not established. Consider pumping and discarding milk for 12-24 hours after administration if infant is preterm or has compromised thyroid function.
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.

Warnings & precautions

■ FDA Black Box Warning

Not for intrathecal use; risk of convulsions, coma, respiratory arrest, and death.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to iodinated contrast media.","Intrathecal administration (contraindicated)."]