Iopamidol

Iopamidol is a prescription medication used as a diagnostic tool or contrast agent in Angiography, Computed Tomography, and Urography. 

• Iopamidol is available under the following different brand names: Isovue, Scanlux

Common side effects of Iopamidol include:

• Chest pain,
• Slow heart rate,
• Hot flashes,
• Burning sensation,
• Flushing (warmth, redness, or tingly feeling),
• Nausea,
• Hives, and
• Dizziness

Serious side effects of Iopamidol include:

• Hives,
• Difficulty breathing,
• Swelling of the face, lips, tongue, or throat,
• Severe dizziness,
• Lightheadedness,
• Swelling,
• Rapid weight gain,
• Little or no urinating,
• Wheezing,
• Seizure,
• Swelling in the neck or throat (enlarged thyroid),
• Extreme tiredness,
• Dry skin,
• Joint pain or stiffness,
• Muscle pain,
• Weakness,
• Hoarseness,
• Weight gain,
• Increased sensitivity to cold temperatures,
• Chest pain or pressure,
• Pain spreading to the jaw or shoulder,
• Nausea,
• Sweating,
• Sudden cough,
• Shortness of breath,
• Coughing up blood,
• Sudden numbness or weakness (especially on one side of the body),
• Sudden severe headache,
• Slurred speech, and
• Problems with vision or balance

Rare side effects of Iopamidol include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

• Content expressed as organic bound iodine/mL
• Injectable solution
  • 200 mg/mL (41%)
  • 300 mg/mL (61%)
• Intravenous solution
  • 200 mg/mL (41%)
  • 250 mg/mL (51%)
  • 300 mg/mL (61%)
  • 370 mg/mL (76%)

Angiography

Adult dosage

Cerebral Arteriography

• 300 mg/mL: 8-12 mL intra-arterial, may repeat, not to exceed 90 mL

Peripheral Venography

• 200 mg/mL: 25-150 mL Intravenous per lower extremity; total not to exceed 350 mL

Coronary Arteriography

• 370 mg/mL: 2-10 mL Intravenous; monitor EKG; not to exceed 200 mL

Coronary Ventriculography

• 370 mg/mL: 25-50 mL Intravenous; monitor EKG; not to exceed 200 mL

Selective Visceral Arteriography

• 370 mg/mL: Up to 50 mL Intravenous; not to exceed 225 mL

Selective Visceral Aortography

• 370 mg/mL: Up to 50 mL Intravenous; not to exceed 225 mL

Peripheral Venography

• 200 mg/mL: 25-150 mL; not to exceed 350 mL

Pediatric dosage

For 370 mg/mL:

• Children below 2 years: 10-15 mL Intravenous, not to exceed 40 mL total
• Children between 2-9 years: 15-30 mL Intravenous, not to exceed 50 mL (2-4 years) or 100 mL (5-9 years)
• Children between 10-18 years: 20-50 mL Intravenous, not to exceed 125 mL

Computed Tomography

Adult dosage

CECT of the Head

• 250 mg/mL: 130-240 mL Intravenous; not to exceed 240 mL
• Alternatively, 300 mg/mL: 100-200 mL Intravenous; not to exceed 200 mL
• Imaging may be done immediately after completing the administration

CECT of the Body

• 250 mg/mL: 130-240 mL Intravenous; not to exceed 240 mL
• Alternatively, 300 mg/mL: 100-200 mL Intravenous; not to exceed 200 mL
• Imaging may be done immediately after completing the administration

Pediatric dosage

CECT of the Head

• 250 mg/mL: 1.2-3.6 mL/kg Intravenous; not to exceed 30 g of iodine
• Alternatively, 300 mg/mL: 1-3 mL/kg Intravenous; not to exceed 30 g of iodine

CECT of the Body

• 250 mg/mL: 1.2-3.6 mL/kg Intravenous; not to exceed 30 g of iodine OR
• 300 mg/mL: 1-3 mL/kg Intravenous; not to exceed 30 g of iodine

Urography

Adult dosage

Excretory Urography

• 250 mg/mL: 50-100 mL Intravenous OR
• 300 mg/mL: 50 mL Intravenous OR
• 370 mg/mL: 40 mL Intravenous

Pediatric dosage

Excretory Urography

• 250 mg/mL: 1.2-3.6 mL/kg Intravenous; not to exceed 30 g of iodine OR
• 300 mg/mL: 1-3 mL/kg Intravenous; not to exceed 30 g of iodine

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Iopamidol has no noted severe interactions with any other drugs.
• Iopamidol has no noted serious interactions with any other drugs.
• Iopamidol has no noted moderate interactions with any other drugs.
• Iopamidol has no noted minor interactions with any other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity to product or components
• Intrathecal injection concurrently with intrathecal corticosteroid administration (significant bacterial infection

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using iopamidol?”

Long-Term Effects

• See “What Are Side Effects Associated with Using iopamidol?”

Cautions

• Before examination patients should be well hydrated to prevent contrast-associated nephropathy
• Caution in patients with seizures, thromboembolic diseases including IM and stroke, chronic alcoholism, heart failure, hepatorenal insufficiency, hyperthyroidism, multiple myeloma, pheochromocytoma, renal disease, sickle cell disease
• Serious adverse events reported from inadvertent intrathecal administration of iodinated contrast that is not indicated for intrathecal use (Isovue and Isovue Multipack are not for intrathecal administration)
• Severe cutaneous adverse reactions (SCAR) may develop from 1 hour to several weeks after intravascular contrast agent administration; these include Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS); reaction severity may increase and time to onset may decrease with repeat administration of contrast agent; prophylactic medications may not prevent or mitigate severe cutaneous adverse reactions; avoid administering therapy to patients with a history of a severe cutaneous adverse reaction to the drug
• Thyroid dysfunction in pediatric patients
  • Advice parents/caregivers about the risk of developing thyroid dysfunction after therapy; advise parents/caregivers when to seek medical care for their child to monitor for thyroid function
  • Thyroid function tests indicative of thyroid dysfunction, characterized by hypothyroidism or transient thyroid suppression uncommonly reported after both single exposure and multiple exposures to iodinated contrast media in pediatric patients, including term and preterm neonates; some patients were treated for hypothyroidism; monitor pediatric patients 0-3 years of age closely, particularly those with one or more potential risk factors, for thyroid dysfunction
  • Pediatric patients with cardiac conditions may be at the greatest risk given that they often require high doses of contrast during invasive cardiac procedures, such as catheterization and computed tomography (CT)
  • Pediatric patients 0-3 years of age warrant closer monitoring because an underactive thyroid during early life may be harmful to motor, hearing, and cognitive development and may require transient T4 replacement therapy
  • Evaluate thyroid function in all pediatric patients 0-3 years of age within 3 weeks following exposure to iodinated contrast media, especially in term and preterm neonates; if thyroid dysfunction is detected, treat, and monitor thyroid function as clinically needed
  • Pediatric patients at higher risk of experiencing adverse events during contrast medium administration may include those having asthma, a sensitivity to medication and/or allergens, cyanotic heart disease, congestive heart failure, serum creatinine greater than 1.5 mg/dL or below 12 months of age
• FDA MedWatch
  • March 30, 2022: FDA recommended newborns and children aged below 3 years have follow-up thyroid monitoring within 3 weeks after receiving iodinated contrast media (ICM) for X-rays and other medical imaging procedures
  • Published studies found underactive thyroid and temporary decreases in thyroid hormone levels were uncommon; however, if identified and treated early, future complications may be prevented
  • Appropriately monitor for signs and symptoms of hypothyroidism and decreased thyroid hormone levels following ICM exposure; consider evaluating thyroid function within 3 weeks, especially in term and preterm neonates and children with some underlying conditions
  • If thyroid dysfunction is detected, treat, and monitor thyroid function as needed to avoid future complications
  • Certain pediatric patients are at increased risk, including newborns, or have very low birth weight, prematurity, or presence of cardiac or other conditions (. g, requiring care in neonatal or pediatric ICUs)
  • Patients with cardiac conditions may be at the greatest risk since they often require high doses of contrast during invasive cardiac procedures

Pregnancy and Lactation

• May be acceptable during pregnancy.
• Lactation
  • Excretion into breast milk unknown; not recommended