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Drug Interactions between mannitol and Urografin 325

This report displays the potential drug interactions for the following 2 drugs:

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Moderate

mannitol diatrizoate

Applies to: mannitol and Urografin 325 (diatrizoate)

MONITOR: Forced diuresis during administration of radiocontrast agents may increase the risk of renal impairment in patients who are at high risk for contrast-induced nephropathy. Patients considered at high risk include those with diabetes (especially diabetic nephropathy), preexisting renal insufficiency (serum creatinine >1.5 mg/dL or GFR <60 mL/min/1.73 m2), volume depletion, advanced age (>70 years), congestive heart failure, and/or concurrent use of nephrotoxic drugs (e.g., NSAIDs). Diuretics have been studied for use in the prevention of contrast-induced nephropathy because investigators theorized that they may reduce medullary ischemia by decreasing oxygen demands. In published studies, however, maintenance intravenous fluids plus forced diuresis with furosemide, mannitol, or a combination of both given at the time of radiocontrast exposure generally produced similar or even higher rates of nephropathy compared with intravenous fluids alone. Meta-analyses of published data suggest that furosemide-based interventions significantly increase the risk of contrast-induced nephropathy compared with hydration alone, and one study found that hospitalization for all patients who developed contrast-induced nephropathy was increased by 4 days in those who received concomitant diuretic therapy. Contrast-induced nephropathy is most commonly defined as an increase in serum creatinine >=0.5 mg/dL or 25% from baseline within 48 to 72 hours of intravascular contrast administration in the absence of alternative etiologies, although nephropathy may occur up to a week after contrast exposure. While the condition is usually transient and asymptomatic, it can be associated with increased risk of renal failure, dialysis, prolonged hospitalization, significant long-term morbidity, and mortality.

MANAGEMENT: Whenever possible, alternative imaging techniques should be considered in patients who are at high risk for contrast-induced nephropathy. Otherwise, some experts recommend discontinuing diuretics 1 to 2 days before administration of contrast media, depending on the clinical feasibility of doing so. The smallest effective dose of a nonionic, hypo- or iso-osmolar contrast medium (e.g., iohexol, iodixanol, iopamidol) should be used, since the risk of nephropathy is increased with increasing contrast dose and/or osmolarity. Repeat procedures with contrast media, if necessary, should not occur until at least 72 hours after the previous contrast exposure and renal function has fully recovered. Although it is not necessary to measure the serum creatinine levels of every patient before contrast administration, measurements should generally be made in patients receiving contrast agent by intraarterial administration (which is associated with increased risk of nephropathy relative to intravenous administration) and patients with a history of kidney disease, proteinuria, kidney surgery, diabetes, hypertension, gout, or other risk factors for nephropathy. Creatinine measurements should be continued for 24 to 48 hours after administration of contrast medium. It is important that patients be adequately hydrated with either saline or sodium bicarbonate.

References

  1. (2007) "Product Information. Lasix (furosemide)." sanofi-aventis
  2. Weinstein J-M, Heyman S, Brezis M (1992) "Potential deleterious effect of furosemide in radiocontrast nephropathy." Nephron, 62, p. 413-5
  3. Solomon R, Werner C, Mann D, D'Elia J, Silva P (1994) "Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents." N Engl J Med, 331, p. 1416-20
  4. Costa N (2004) "Understanding contrast media." J Infus Nurs, 27, p. 302-12
  5. Stevens MA, McCullough PA, Tobin KJ, et al. (1999) "A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P.R.I.N.C.E. Study. Prevention of Radiocontrast Induced Nephropathy Clinical Evaluation." J Am Coll Cardiol, 33, p. 403-11
  6. Barrett BJ, Parfrey PS (2006) "Clinical practice. Preventing nephropathy induced by contrast medium." N Engl J Med, 354, p. 379-86
  7. Briguori C, Marenzi G (2006) "Contrast-induced nephropathy: Pharmacological prophylaxis." Kidney Int, 69(S100), S30-S38
  8. Tepel M, Aspelin P, Lameire N (2006) "Contrast-induced nephropathy: a clinical and evidence-based approach." Circulation, 113, p. 1799-806
  9. Meschi M, Detrenis S, Musini S, Strada E, Savazzi G (2006) "Facts and fallacies concerning the prevention of contrast medium-induced nephropathy." Crit Care Med, 34, p. 2060-80
  10. Stacul F, Adam A, Becker CR, et al. (2006) "Strategies to reduce the risk of contrast-induced nephropathy." Am J Cardiol, 98(6S1), p. 59-77
  11. Ho KM, Sheridan DJ (2006) "Meta-analysis of frusemide to prevent or treat acute renal failure." BMJ, 333, p. 420
  12. Kelly AM, Dwamena B, Cronin P, Bernstein SJ, Carlos RC (2008) "Meta-analysis: effectiveness of drugs for preventing contrast-induced nephropathy." Ann Intern Med, 148, p. 284-94
  13. Venkataraman R (2008) "Can we prevent acute kidney injury?" Crit Care Med, 36(4 Suppl), S166-71
  14. Fishman EK, Reddan D (2008) "What are radiologists doing to prevent contrast-induced nephropathy (CIN) compared with measures supported by current evidence? A survey of European radiologists on CIN associated with computed tomography." Acta Radiol, 49, p. 310-20
  15. Massicotte A (2008) "Contrast medium-induced nephropathy: strategies for prevention." Pharmacotherapy, 28, p. 1140-50
View all 15 references

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Drug and food interactions

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Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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