Diatrizoates (Systemic)


VA CLASSIFICATION
Primary: DX102

Commonly used brand name(s): Angiovist 282; Angiovist 292; Angiovist 370; Gastrografin; Hypaque Meglumine 30%; Hypaque Meglumine 60%; Hypaque Oral; Hypaque Sodium 25%; Hypaque Sodium 50%; Hypaque Sodium Oral Powder; Hypaque Sodium Oral Solution; Hypaque-76; Hypaque-M 18%; Hypaque-M 30%; Hypaque-M 60%; Hypaque-M 75%; Hypaque-M 76%; MD-76; MD-Gastroview; Reno-Dip; Reno-M-60; Renografin-60; Renografin-76; Renovist; Renovist II; Urovist Meglumine DIU/CT; Urovist Sodium 300.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:

Note: Diatrizoate is an ionic radiopaque contrast agent.



Diagnostic aid, radiopaque (cardiac disease)—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque (vascular disease)—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque (joint disease)—Diatrizoate Meglumine Injection;

Diagnostic aid, radiopaque (biliary tract disorders)—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque (brain disorders)—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque (disk disease)—Diatrizoate Meglumine Injection;

Diagnostic aid, radiopaque (gastrointestinal disorders)—Diatrizoate Meglumine and Diatrizoate Sodium Solution; Diatrizoate Sodium Solution; Diatrizoate Sodium for Solution;

Diagnostic aid, radiopaque (splenic and portal vein disorders)—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque (urinary tract disorders)—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque contrast enhancer in computed tomography—Diatrizoate Meglumine Injection; Diatrizoate Meglumine and Diatrizoate Sodium Injection; Diatrizoate Sodium Injection;

Diagnostic aid, radiopaque contrast enhancer adjunct in computed tomography—Diatrizoate Meglumine and Diatrizoate Sodium Solution;

Diagnostic aid, radiopaque (pregnancy disorders)—Diatrizoate Meglumine Injection;

Osmotic agent (meconium ileus)—Diatrizoate Meglumine and Diatrizoate Sodium Solution; Diatrizoate Sodium Solution{02};

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Oral/Rectal
Radiography, gastrointestinal—Oral or rectal diatrizoate sodium, and diatrizoate meglumine and diatrizoate sodium combination solutions are indicated for radiographic examination of the gastrointestinal tract when the administration of barium sulfate is not recommended (e.g., for patients with known or suspected gastrointestinal tract perforation in whom barium suspensions could be harmful). {55} {95} {98} {99} {102} {105}

Body imaging, computed tomographic, adjunct—Oral diatrizoate meglumine and diatrizoate sodium combination solution is indicated in low concentration to delineate the stomach and intestinal loops in computed tomography (CT) of the body. {02} {60} {106}

[Meconium ileus (treatment)]1—Rectal diatrizoate sodium, and diatrizoate meglumine and diatrizoate sodium combination solutions have been used to treat meconium ileus in infants. {02} {15} {54} {55} {60}

Intravascular
Angiocardiography—Parenteral diatrizoate meglumine and diatrizoate sodium combination is indicated to visualize lesions or malformations of the heart and obstructions or anomalies of the major thoracic blood vessels. Parenteral diatrizoate meglumine is also indicated in angiocardiography; however, the combination containing diatrizoate meglumine and diatrizoate sodium is usually preferred because it causes less severe adverse hemodynamic, neurotoxic, and cardiotoxic effects. {01} {02} {88} {90} {91} {103}

Angiography
Aortography
Arteriography or
Venography—Parenteral diatrizoates are indicated to visualize specific regions of the vascular system and the blood flow in such areas to help in the diagnosis and evaluation of neoplasms (known or suspected) or vascular diseases (congenital or acquired) that may cause changes in normal vascular anatomy or physiology. Parenteral diatrizoate meglumine is indicated in cerebral angiography, aortography, arteriography (peripheral or selective renal1 ), and peripheral venography. Parenteral diatrizoate meglumine and diatrizoate sodium combination is indicated in intravenous digital subtraction arteriography, cerebral angiography, aortography, arteriography (coronary, selective coronary, peripheral, selective renal, and selective visceral), and venography (central, peripheral, or renal)1 . Parenteral diatrizoate sodium is indicated in cerebral angiography1 , aortography1 , arteriography (peripheral or selective renal)1 , and intraosseous venography. {01} {87} {88} {89} {90} {91} {92} {93} {94} {103} {109} {110} {111}
—Diatrizoate meglumine is preferred for cerebral or peripheral angiography because, when administered intra-arterially, it generally causes less severe neurotoxic and local and generalized hemodynamic side effects than diatrizoate sodium or diatrizoate combinations. The sodium ion is probably responsible for the increased neurotoxicity of diatrizoate sodium since it may increase the extravascular diffusion of the medium into the brain tissue. Diatrizoate meglumine is considered at least as safe as, and possibly preferable to, diatrizoate meglumine and diatrizoate sodium combination injection for aortography not involving the ascending aorta. Only in the latter situation may the contrast medium enter the coronary circulation where it is important to have at least some small amount of sodium to prevent cardiotoxic effects. {01} {02} {41}

Cholangiography, direct, operative—Parenteral diatrizoate meglumine, diatrizoate meglumine and diatrizoate sodium combination1 , and diatrizoate sodium are indicated for use during surgery to visualize the biliary ducts and evaluate the cause and location of biliary obstructions such as calculi or strictures, and after surgery to rule out the presence of retained calculi. {01} {100} {104}

Cholangiography, direct, postoperative T-tube—Parenteral diatrizoate meglumine, diatrizoate meglumine and diatrizoate sodium combination1 , and diatrizoate sodium are indicated to visualize, and thus ensure the patency of, the biliary ducts before removal of a surgically placed T-tube. {87} {92} {100} {104}

Cholangiography, percutaneous transhepatic1—Parenteral diatrizoate meglumine, diatrizoate meglumine and diatrizoate sodium combination, and diatrizoate sodium are indicated for this procedure. Percutaneous transhepatic cholangiography is used in some patients to determine the cause and site of biliary obstruction when other examinations of the biliary system have not provided the needed information. {92} {100} {104}

Brain imaging, computed tomographic—Parenteral diatrizoate meglumine, diatrizoate meglumine and diatrizoate sodium combination, and diatrizoate sodium are indicated for computed tomographic brain imaging (CT of the brain) to determine the presence and extent of neoplasms or other lesions such as cerebral infarction or infection. {86} {87} {93} {99} {100} {102} {103} {109}

Body imaging, computed tomographic—Parenteral diatrizoate meglumine and the diatrizoate meglumine and diatrizoate sodium combination are indicated for computed tomographic body imaging (CT of the body). {03} {28} {89} {103} {109}

Splenoportography—Parenteral diatrizoate meglumine, diatrizoate meglumine and diatrizoate sodium combination, and diatrizoate sodium1 are indicated for splenoportography, to determine the site of the portal obstruction, or visualize collateral pathways of blood flow or esophageal varices in patients with portal hypertension or portal venous obstruction. It should be noted that splenoportography is being replaced by other procedures in which the portal system may be evaluated by late films of the celiac and superior mesenteric arterial systems (their venous phases). In other cases, it is being replaced by direct portography via the transhepatic (direct percutaneous or transjugular) route. {87} {92} {94} {100} {110}

Urography, excretory—Parenteral diatrizoate meglumine, diatrizoate meglumine and diatrizoate sodium combination, and diatrizoate sodium are indicated by intravenous injection or infusion in excretion urography to evaluate abnormalities of the urinary tract such as urinary tract obstructions. {86} {87} {88} {89} {90} {91} {93} {94} {99} {102} {103} {109} {111}

Urography, retrograde1—Parenteral diatrizoate meglumine and parenteral diatrizoate sodium are indicated to determine the site of the urinary tract obstruction when excretion urography has not provided sufficient information or is contraindicated. {02} {28} {59}

Nephrotomography—Parenteral diatrizoate meglumine and diatrizoate sodium combination is indicated at high dosage to prolong and intensify the nephrographic effect, especially with tomography, for the examination of the renal parenchyma when excretion urography has not provided sufficient information. Nephrotomography may be useful in the preoperative differentiation of renal masses and damage to the renal parenchyma such as that caused by infarcts or infections. {01} {103}

[Amniography]1—Parenteral diatrizoate meglumine has been used for amniography. {02} {106}

Intrasynovial
Arthrography—Parenteral diatrizoate meglumine is indicated for arthrography in diagnosis of post-traumatic or degenerative joint diseases or synovial rupture, for visualization of communicating bursae or cysts, and in meniscography. {28} {87} {92} {100} {110}

Intradiskal
Diskography—Parenteral diatrizoate meglumine is indicated for diskography, to determine the presence of disk pathology, degeneration, retropulsion, or rupture. {87} {92} {100} {106} {110}

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    Diatrizoate meglumine: 809.13 {101}
    Diatrizoate sodium: 635.90


Osmolality
    High. The osmolality of the injection with iodine concentration of 370 mg per mL ranges from 1940 to 2140 mOsmol per kg of water, depending on product {38} {59}.

Mechanism of action/Effect:

Diagnostic aid, radiopaque—Organic iodine compounds block x-rays as they pass through the body, thereby allowing body structures containing iodine to be delineated in contrast to those structures that do not contain iodine. The degree of opacity produced by these iodinated organic compounds is directly proportional to the total amount (concentration and volume) of the iodinated contrast agent in the path of the x-rays. {04} {34} {41} {59} {60} {86} {87}

Osmotic agent (meconium ileus)—The osmotic effect of diatrizoate sodium, and diatrizoate meglumine and diatrizoate sodium combination solutions draws fluid into the intestine, thus helping to dislodge the meconium impaction. {02} {55}


Other actions/effects:

Anticoagulant (inhibitory effect on platelet aggregation and blood clotting); vasodilating effects. {41} {59} {68}

Absorption:

Oral—Minimally absorbed from gastrointestinal tract. {02} {55} {58}

Intravertebral disk or spleen injection (for diatrizoate meglumine only): Rapidly absorbed. {106}

Intravesical instillation: Small amounts absorbed through the bladder. {106}

Distribution:

Intravascular—Rapidly distributed throughout extracellular fluid following intravascular administration. {02} {59}

Protein binding:

Very low. {86}

Half-life:
{01}{59}{86}
Normal renal function—30 to 60 minutes.

Severe renal function impairment—20 to 140 hours.

Time to peak concentration:

Immediate, after rapid intravenous administration, but concentration falls rapidly within 5 to 10 minutes. {02} {28} {100} {106}


Time to peak opacification {06} {33}


Angiography:

Immediate, after intravascular administration. {59}



Urography:

Renal parenchyma including the renal cortex: 1 minute following rapid injection of contrast media. Peak opacification is directly dependent on peak plasma iodine concentration and glomerular filtration rate of the kidney. {59}

Calyces, pelves, and ureters: 10 to 15 minutes after bolus injection of contrast media. Peak opacification is dependent on both the final urinary iodine concentration and the volume of urine within the respective regions of the urinary tract. {59}


Elimination:


Renal—
        Normal renal function: 95 to 100% of intravascular dose excreted unchanged (via glomerular filtration) within 24 hours. {59} {86} {100} {106}



Fecal—
        Normal renal function: 1 to 2% of intravascular dose excreted via biliary elimination and possibly via the intestinal mucosa {02} {86} {100} {106}.
        Severe renal function impairment: 10 to 50% of intravascular dose; up to 20% of the administered dose has been recovered in feces within 48 hours. {100} {106}



In dialysis—
        Removed by peritoneal dialysis or hemodialysis. {02} {37} {106}



Precautions to Consider

Cross-sensitivity and/or related problems

Patients sensitive to iodine or other iodinated contrast media may be sensitive to these agents also. {01} {02} {03} {45} {59}

Pregnancy/Reproduction

Pregnancy—
Diatrizoates, when administered intravenously, cross the placenta and are evenly distributed in fetal tissues. Intra-amniotic injection of diatrizoates has been reported to suppress the fetal thyroid gland. {01} {12} {59} {100}


For parenteral solutions

Studies with diatrizoates have not been done in humans.

Studies with diatrizoates have not been done in animals.

FDA Pregnancy Category C. {86} {87} {102}



For oral/rectal solutions

Elective contrast radiography of the abdomen is usually not recommended during pregnancy because of the risks to the fetus from radiation exposure. Studies with diatrizoates have not been done in humans. {02} {86}

For diatrizoate sodium—Studies in animals have not shown that diatrizoate sodium causes adverse effects in the fetus. {97}

FDA Pregnancy Category B. {97}


Breast-feeding

Although problems in humans have not been documented, since diatrizoates are distributed unchanged into breast milk, temporary discontinuation of breast-feeding is recommended for at least 24 hours following their administration. {59} {86} {102}

Pediatrics

Convulsions are more likely to occur in infants than in other age groups with the administration of diatrizoate meglumine, and diatrizoate meglumine and diatrizoate sodium combination injections, especially after repeated injections. {02} {11} {88} {103}

Difficulty in breathing, slow or irregular heartbeat, and unusual feeling of tiredness and depression are more likely to occur in cyanotic infants administered diatrizoate meglumine and diatrizoate meglumine and diatrizoate sodium combination injections. {02} {88} {91}

Dehydration and/or the risk of renal failure may be exacerbated in infants and young children, especially those with polyuria, oliguria, diabetes, or pre-existing dehydration, by the contrast media; adequate hydration is recommended before and subsequent to administration of diatrizoates. {02} {55} {60} {86} {93}

For oral/rectal solutions—In infants and young children (weighing under 10 kg), the hypertonic solutions of contrast media may draw excessive amounts of fluid into the intestine, possibly resulting in hypovolemia, which may cause a shock-like state. Further dilution of contrast solution is recommended for use in pediatric patients. {97}


Geriatrics


Although overall prevalence of adverse effects has been reported to be less in patients 50 years of age and older, the severity of the reactions may be greater in this age group than in younger patients. {05} {62} {81}

Dehydration and/or the risk of renal failure may be exacerbated in geriatric patients, especially those with polyuria, oliguria, diabetes, or pre-existing dehydration, by the contrast media; adequate hydration is recommended before administration of diatrizoates. {60} {93}

The elderly may be more sensitive to the effects of diatrizoates on thyroid function. Iodine-induced thyrotoxicosis may occur 4 to 12 weeks following contrast radiography. Thyroid function monitoring may be needed in geriatric patients. {121}

For oral/rectal solutions—In elderly patients, the hypertonic solutions of contrast media may draw excessive amounts of fluid into the intestine, possibly resulting in hypovolemia, which may cause a shock-like state. Further dilution of contrast solution is recommended for use in geriatric patients. {97}

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Beta-adrenergic blocking agents    (concurrent intravascular administration of diatrizoates with beta-adrenergic blocking agents may increase the risk of moderate to severe anaphylactoid reaction; also, hypotensive effects may be exacerbated; discontinuation of the beta-adrenergic blocking agent may be advisable before administration of contrast media in patients with other risk factors {22} {23} {59} {66} {83} {85} {112})


Cholecystographic agents, oral    (may increase the risk of renal toxicity when closely followed by intravenous diatrizoates, especially in patients with hepatic function impairment {86})


» Chymopapain    (concurrent use with diatrizoates may increase the risk of toxicity, especially if either agent enters the subarachnoid space; it is strongly recommended that diskography not be performed as part of the chemonucleolysis procedure {96} {107})


Hypotension-producing medications, other (See Appendix II )    (concurrent intravascular administration of diatrizoates with other hypotension-producing medication may result in excessive hypotension {59})


Interleukin-2    (incidence of delayed [more than 1 hour after administration] reactions [e.g., hypersensitivity, fever, skin rash, flu-like symptoms, joint pain, flushing, pruritus, emesis, hypotension, dizziness] to intravenous contrast media may be increased in patients who have received interleukin-2; some symptoms may resemble a ``recall'' reaction to interleukin-2; supportive medical treatment may be necessary if symptoms are significant; there is some evidence that incidence is reduced if contrast media administration is delayed until 6 weeks after interleukin-2 administration {72} {73} {74} {75} {76} {77})


Nephrotoxic medications, other (See Appendix II )    (concurrent intravascular administration of diatrizoates with other nephrotoxic medications may increase the potential for nephrotoxicity {59})


Vasopressors (See Appendix II)    (neurologic effects, including paraplegia, of diatrizoates may increase during aortography when diatrizoates are administered after hypertensive agents used to increase contrast; this increase is due to contraction of vessels in the splanchic circulation, which forces more of the contrast material into the vessels leading to the spine and spinal cord {02} {15} {28})


Diagnostic interference
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With other diagnostic test results
Blood pool imaging    (imaging of blood pool may be impaired because of decreased technetium Tc 99m-labeling of red blood cells caused by the intravascular administration of diatrizoates {13} {59} {86})


Leukocyte counts and
Red cell counts    (may be decreased {86})


Phenolsulfonphthalein (PSP) excretion test    (test results may be affected, especially in patients with severely impaired renal function, who are also given intravascular diatrizoates; diatrizoates are also in part secreted by the renal tubules, thus resulting in decreased tubular excretion of PSP; therefore, concurrent use of intravascular diatrizoates is not recommended in patients receiving PSP excretion test {02} {07} {63})


Prothrombin time (PT) and
Thromboplastin time    (may be increased since diatrizoates significantly inhibit all stages of coagulation {07} {59} {68} {86})


Skeletal imaging    (possible renal and hepatic uptake of technetium Tc 99m medronate, technetium Tc 99m oxidronate, technetium Tc 99m pyrophosphate, and technetium Tc 99m [pyro- and trimeta-] phosphates if diatrizoates are administered intravenously immediately after one of these technetium Tc 99m-labeled agents {08})


Thyroid function determinations and
Thyroid imaging    (diatrizoates may cause an increase of serum protein–bound iodine [PBI] and a decrease in radioactive iodine or pertechnetate ion uptake for a period varying from 1 week to several months; thyroid test should be performed prior to administration of diatrizoates. Other thyroid function tests not based on measurement of iodine, such as resin triiodothyronine uptake, are not affected {02} {03} {08} {59} {97})

With physiology/laboratory test values
Amylase, serum    (concentrations may be increased temporarily 6 to 18 hours after injection of diatrizoates during direct cholangiography since drug may enter pancreatic duct {02} {94})


Creatinine, serum    (may be increased temporarily; peak rise in serum creatinine is usually delayed, occurring 3 to 5 days following contrast media administration and generally returning to baseline values in 7 to 10 days {53} {59} {60} {69})


Platelet aggregation    (may be decreased by high levels of plasma diatrizoates {59} {68} {86})


Protein, urine    (may be increased; false positive results may occur with Lowry's and sulphosalicylic assays or with protein reagent strips {70} {71})


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problems exist

For all procedures requiring intravascular administration of diatrizoates {02} {03} {04} {05}:
» Allergic reaction (anaphylaxis) to penicillins or to skin allergens, previous    (increased risk of anaphylactoid reaction {85})


» Allergies or asthma, history of    (increased risk of idiosyncratic response or anaphylactoid reaction {23} {27} {62} {67} {83} {85})


» Cardiovascular disease, severe    (intravenous administration may produce a transitory increase in circulatory osmotic load and may aggravate condition; increased risk of anaphylactoid reaction {62} {83})


» Dehydration, especially associated with diabetes mellitus, azotemia, or multiple myeloma    (osmotic diuretic action of diatrizoates may exacerbate dehydration and increase the risk of acute renal failure {35} {36} {41} {62})


Hyperthyroidism    (intravascular administration may precipitate thyroid storm {86} {102})


» Pheochromocytoma    (intravascular administration may precipitate severe hypertension; amount of medium injected should be kept to a minimum and blood pressure should be monitored during the procedure; also, pretreatment with the alpha-adrenergic blocking agent phentolamine is recommended {53} {62} {86} {102})


» Renal function impairment    (intravenous administration may increase risk of acute renal failure in the presence of renal insufficiency [serum creatinine ³ 132.6 micromoles/L]; preventive measures recommended to prevent contrast-associated nephropathy include reducing the dose or volume of contrast medium administered, lengthening the time between radiologic procedures, volume expansion with 0.9% sodium chloride, using drug therapy such as furosemide or mannitol or calcium antagonists, and administering low-osmolality contrast media; however, validity of some of these recommendations remains controversial {36} {37} {39} {59} {69} {82} {112})


» Seizures, recent    (increased risk for reoccurence {62} {106})


» Sensitivity to iodinated contrast media    (increased risk of anaphylactoid reaction in patients with a history of previous anaphylactoid reaction to iodinated contrast media {01} {23} {27} {64} {85})


Sickle cell disease    (intravenous or intra-arterial administration may promote sickling in patients who are homozygous for sickle cell disease {53} {59} {86} {100} {102})


For gastrointestinal radiography:
Dehydration    (hypertonic solutions of medium may lead to intraluminal movement of fluid with resulting hypovolemia; this loss of plasma fluid may result in a shock-like state {59} {95} {105})


Gastrointestinal obstruction    (increase in acid concentration due to delayed gastric emptying may precipitate diatrizoates; resultant diatrizoate precipitate may cause gastrointestinal mucosal irritation, erosion, and bleeding; aspiration of gastric contents or alkalinization is recommended before administration of diatrizoates {59})


For angiocardiography:
Angina, unstable    (increased risk of severe cardiac reaction {81})


Aortic stenosis    (intravascular administration may cause decreased coronary artery perfusion due to the systemic hypotension produced {41})


Cardiac failure, incipient    (fluid overload, pressure changes, and expansion of blood volume may aggravate condition {41} {103})


Cyanosis, in infants    (increased risk of apnea, bradycardia and other arrhythmias, lethargy and depression, and a tendency to acidosis in cyanotic infants {11} {103})


Mitral stenosis    (increased blood flow may produce an increase in the mitral diastolic pressure gradient {106})


Myocardial ischemia    (systemic hypotension and resultant diminished cardiac perfusion may cause increased risk for patient {106})


» Pulmonary hypertension, severe    (hypervolemic effect of diatrizoates may further increase pulmonary artery and venous pressures due to an increase in cardiac output and a rise in left ventricular end-diastolic and left atrial pressures {34} {59} {60} {103})


For cerebral angiography:
Arteriosclerosis, advanced or
Cardiac decompensation or
Cerebral embolism, recent or
Hemorrhage, subarachnoid or
Hypertension, severe or
Migraine or
Senility or
Thrombosis, recent    (increased risk of vessel occlusion; clinical deterioration, convulsions, and serious temporary or permanent neurological complications may occur {11} {87} {100} {106})


» Homocystinuria    (procedure may increase risk of thrombosis and embolism {02} {100} {104})


For peripheral arteriography:
» Buerger's disease    (procedure may induce severe arterial or venous spasm {11} {28} {94} {104})


» Ischemia, severe, associated with ascending infection{28}{94}{103}{104}
For percutaneous transhepatic cholangiography:
» Coagulation defects, such as prolonged prothrombin times    (procedure may increase risk of internal bleeding {87} {104})


For CT of the brain:
» Cerebral lesions, primary or metastatic    (intravascular administration may precipitate convulsions {87} {100} {106})


» Hemorrhage, cranial subarachnoid    (intravascular administration may cause death {100} {106})


For splenoportography:
» Coagulation defects, such as prolonged prothrombin times and significant thrombocytopenia, or{100}
Inflammation of spleen    (procedure may increase risk of rupture of the spleen {02} {87} {100})


For excretory urography:
» Anuria or
» Diabetes mellitus    (may increase risk of acute renal failure {19} {90} {102})


For retrograde urography:
» Obstruction to endoscopy or ureteral catheterization, such as in extensive urinary tuberculosis, bladder tumors, ureteral obstructions, and prostate enlargement{59}{106}
» Urinary tract infection, upper, acute    (procedure may increase risk of complications {59} {106})


For peripheral venography:
Infection, local, or
Ischemia, severe, or
Phlebitis or
Thrombosis or
Venous stasis or
Venous system obstruction    (procedure may cause venous inflammatory changes, thrombosis, and ischemic changes; irrigation with normal saline is recommended following the procedure to decrease risk of thrombosis {11} {28} {60})


For arthrography:
» Infection, in or near joint to be examined    (procedure may increase risk of complications {87} {100})


For diskography:
» Infection or open injury near region to be examined    (procedure may increase risk of complications {87} {100})


» Respiratory infection, upper    (cervical diskography procedure may increase risk of complications {100})



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Blood pressure determinations    (may be required during examination with intravascular administration of diatrizoates, especially in patients with known or suspected pheochromocytoma or hemodynamic compromise or instability {60} {100})


Electrocardiogram (ECG)    (recommended for early detection of arrhythmias during coronary arteriography and angiocardiography {01} {106})


Thyroid function determinations    (iodine-induced thyrotoxicosis may occur 4 to 12 weeks following contrast radiography in geriatric patients; thyroid function monitoring may be needed {121})




Side/Adverse Effects

Note: Adverse effects may vary directly with the concentration of the agent, the amount and technique used, and the underlying pathology. Increases in osmolality, volume, concentration, viscosity, and rate of administration of the solution may tend to increase the incidence and severity of adverse effects. {02} {32} {34} {38} {41} {59} {62} {81}
Systemic adverse effects, similar to those that occur with direct intravascular injection of diatrizoates, may also occur with oral or rectal administration in cases of perforation. {95}
Thromboembolic events causing myocardial infarction and stroke have been reported rarely during angiographic procedures with ionic contrast media. {18} {40}
Convulsions and death may occur with inadvertent subarachnoid injection, especially during aortography by the translumbar technique. Use of diatrizoates is contraindicated in myelography or for examination of dorsal cysts or sinuses that might communicate with the subarachnoid space. {02} {11} {34} {87} {88}
Skin necrosis of the foot has been reported following extravasation of diatrizoates injection during administration into a dorsal vein of the foot. {02} {100}
Acute renal failure has been reported following intravascular administration of diatrizoates during excretory urography, especially in patients with diabetic nephropathy and susceptible nondiabetic patients. Also, a higher incidence of contrast-induced renal failure has been associated with severe congestive heart failure, in patients who have had multiple contrast studies within 72 hours, those receiving large volumes of contrast agent, and those with elevated uric acid levels. Renal function may also be slightly and temporarily impaired following intravascular administration of diatrizoates during selective renal arteriography. {02} {35} {36} {37} {39} {41} {42} {43} {51} {53}
Dehydration and/or the risk of renal failure may be exacerbated, and in some cases may cause a shock-like state, in infants and young children, and in geriatric, azotemic, and dehydrated or debilitated patients, by the hypertonic contrast solutions of diatrizoates. {01} {02} {41}
Cortical blindness has been reported rarely after cardiac angiography; vision has returned within 24 to 48 hours. {80}
In addition to those side/adverse effects listed below as needing medical attention, other severe reactions such as loss of consciousness, shock, and cardiac arrest may occur rarely during or a few minutes after intravascular administration of diatrizoates. {02} {03} {04} {05} {41} {62}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent or rare
For all procedures
    
Pseudo-allergic reaction (skin rash or hives, stuffy nose, swelling of face or skin, thickening of tongue, wheezing, tightness in chest, or troubled breathing{01}{23}{34}{41}{48}{53}{59}{60}{62})

Note: Pseudo-allergic reactions are usually transient. However, they may be an initial manifestation of a more severe anaphylactoid reaction. The anaphylactoid reaction may progress to respiratory arrest and vasomotor collapse if appropriate treatment is not administered. {85}


With intravascular administration
    
Bronchospasm or pulmonary edema (severe wheezing or troubled breathing{34}{41}{49}{59}{62}{67}{79})
    
cardiotoxic effects, with decreased contractile force and ventricular fibrillation (irregular heartbeat{34}{38}{41}{49}{59})
    
convulsions, especially in patients with convulsive disorders{34}{62}
    
swelling of the larynx{53}
    
vasovagal effects, with bradycardia and hypotension (slow heartbeat; severe tiredness or weakness{34}{38}{41}{47}{62}{78})




Those indicating need for medical attention only if they continue or are bothersome {03} {04} {05}
Incidence more frequent
With intravascular administration
    
Cough —during right ventricular and pulmonary angiography{41}{44}{51}
    
arteriolar vasodilation (pain or burning at injection site{34}{41} , unusual warmth and flushing of skin{34}{38}{41}{53}{59})

Note: Vasodilatory activity is directly related to the osmolality of the contrast agent's formulation and the volume injected. {38} {59}


With intrasynovial administration
    
Joint pain or exacerbation of existing pain{92}

With intradiskal administration
    
Pain at injection site{92}


Incidence less frequent
For all procedures
    
Psychosomatic reaction{84} (chills, dizziness or lightheadedness, headache, nausea or vomiting, sweating, unusual thirst)

Note: Psychosomatic reactions are associated with patient anxiety, fatigue, inadequate hydration, and poor nutrition; usually self-limited and of short duration; may also be initial manifestations of more severe reaction. {03} {05} {41} {62}


With oral or rectal administration
    
Hyperosmotic effect{59}{95}{105} (diarrhea or laxative effect, nausea or vomiting)






Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Radiopaque Agents (Diagnostic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Description of use
Action in the body:

• Oral/rectal administration; visualization of radiopacity in gastrointestinal tract possible with x-rays


• Injection into vein or artery; visualization of radiopacity in blood vessels, heart, brain, and other organs possible with x-rays


• Direct injection into region to be studied; visualization of joint spaces


Before having this test
»   Conditions affecting use, especially:
Sensitivity to iodine or other iodinated contrast media {59}

Pregnancy—Cross the placenta; risk to the fetus from radiation exposure; may cause hypothyroidism in neonate





Breast-feeding—Distributed into breast milk; temporary discontinuation of breast-feeding for at least 24 hours is recommended





Use in children—Increased risk of severe adverse reactions, especially in children with other medical problems; possible exacerbation of dehydration






Use in the elderly—Increased risk of severe adverse effects; possible exacerbation of dehydration; increased risk of thyrotoxicosis
Other medications, especially chymopapain (for diskography)
Other medical problems, especially allergies or asthma (history of), anuria, cardiovascular disease, dehydration, diabetes mellitus, pheochromocytoma, previous allergic reaction to penicillins or skin allergens, renal function impairment, and seizures

Preparation for this test
Adequate intake of fluids to prevent dehydration

Special diet or use of laxative may be prescribed; patient should inquire in advance

Not eating for several hours before examination to prevent possible aspiration of gastric contents; moderate amounts of clear liquids may be permitted

Precautions after having this test
Possible interference with future thyroid tests


Side/adverse effects
Signs of potential side effects, especially pseudo-allergic reaction and cardiac or pulmonary problems that may occur immediately or within minutes of administration


General Dosing Information
The manufacturer's literature should be consulted for specific techniques and procedures for administering contrast media.

Sensitivity test doses are not usually recommended, since severe or fatal reactions to contrast media are not predictable from a patient's history or a sensitivity test. On some occasions severe or fatal reactions have occurred with a test dose or with a full dose in patients who did not react to the test dose. {02} {05} {23} {27} {50} {59} {60} {85}

Pretreatment with corticosteroids and/or with antihistamines has been used to minimize the incidence and severity of reactions in patients with a history of severe reactions to contrast media and other high-risk conditions (e.g., asthma or history of allergies, positive allergy history to skin allergens or penicillin, dehydration, history of seizures, pheochromocytoma). In some studies, the additional use of ephedrine has been shown to be beneficial in preventing anaphylactoid reactions (except in patients with a history of hypertension or cardiovascular disease). When considering the use of a contrast agent, the following protocols are recommended: {01} {23} {24} {25} {26} {27} {28} {29} {30} {31} {33} {41} {45} {48} {59} {60} {62} {81} {85} {100} {112} For high-risk patients

   • Use of a high-osmolality contrast agent plus pretreatment with a corticosteroid (oral prednisone, 50 mg administered 13 hours, 7 hours, and 1 hour before procedure) and an antihistamine (intramuscular, intravenous, or oral diphenhydramine, 50 mg administered one hour prior to procedure) or {21} {26} {30} {33} {60} {62} {64} {85} {112}
   • Use of a low-osmolality agent if pretreatment is not feasible or {33} {41} {45} {48} {60} {62} {112}
   • Use of a low-osmolality agent plus corticosteroid pretreatment. {33} {41} {45} {48} {60} {112}
For low-risk patients

   • Use of a high-osmolality contrast agent or {33} {41} {45} {48} {60} {112}
   • Use of a high-osmolality agent and corticosteroid pretreatment {33} {41} {45} {48} {60} {112}.


No food should be ingested for several hours before an examination to prevent aspiration of gastric contents if vomiting occurs. However, moderate amounts of clear liquids are permissible and even recommended by some clinicians to prevent dehydration. {02} {59}

During and for at least 30 to 60 minutes after administration of contrast media, the patient should be observed for possible severe reactions, and competent personnel and emergency facilities should be available during this period. {01} {02} {62} {64} {100}

For oral dosage forms only
In very young or debilitated children, and elderly cachectic patients, dilution of the oral solution with water may be necessary to avoid the risk of shock caused by a decrease in circulating plasma volume due to osmosis when the contrast medium passes through the stomach and small intestine. {01} {97}


For gastrointestinal radiography:
Adequate hydration of the patient is recommended before and after the examination. {02}


For parenteral dosage forms only
Injections of diatrizoate sodium should not be prepared from diatrizoate powder or oral or rectal solutions. {02}

Dosage and concentration of diatrizoates for intravascular administration should be individualized and are usually in proportion to the size of the specific region of the vascular system to be visualized and the anticipated degree of hemodilution in the region. {01} {02}

Intravascular or intramuscular administration of diatrizoates may produce osmotic diuresis. {02}

Subcutaneous extravasation of hyperosmolar diatrizoates injections may cause transient stinging, and skin necrosis has also been reported; cold compresses, elevation of the area, or movement of the digits is recommended to promote venous return. {02}

Adequate hydration is especially important in infants, young children, or geriatric or azotemic patients receiving intravascular diatrizoates since dehydration may be further increased by the osmotic diuretic effect of the contrast medium. {59} {100} {103} {106}

Preparatory partial dehydration has been used to increase the urinary concentration of, and contrast produced by, diatrizoates. However, in general, dehydration is not recommended because, with modern contrast media and recommended doses, it is no longer necessary and may do harm. Dehydration is particularly contraindicated in patients with multiple myeloma since it may predispose to irreversible precipitation of myeloma protein in the renal tubules. In these patients fluids should be administered and urine should be made alkaline. {86}

Thromboembolic events causing myocardial infarction and stroke, reported rarely during angiographic procedures, may have resulted from atherosclerotic lesions rather than from coagulation of blood that has come in contact with the contrast agent outside the body. Nonetheless, it is recommended that risk factors for blood cell aggregation be minimized by performing the procedure in the shortest time possible, using plastic rather than glass syringes, and flushing catheters with heparinized saline solutions. {18} {40} {60} {68}


For CT of the brain:
Administration of parenteral diazepam is recommended immediately prior to injection of contrast medium, when very high doses are used, to prevent seizures in patients with brain metastases. {102}



For splenoportography:
Fasting is recommended for several hours before examination, in case the patient may require surgery on an emergency basis. Also, a local anesthetic and a sedative may be given before the procedure. {02}



For excretory urography:
Administration of a laxative at bedtime the evening before the examination is recommended to eliminate gas from the intestine. {100}


For treatment of adverse effects {11} {14} {15} {23} {47} {60} {62} {65}
Recommended treatment consists of the following

   • For major or life-threatening reactions, careful monitoring of vital signs and emergency therapy, including artificial respiration with oxygen, if needed for respiratory depression, and cardiac massage in the event of cardiac arrest.
   • To restore blood pressure, administration of intravenous fluids and/or vasopressors. If hypotension requires the use of vasopressors, slow infusion of 0.008 to 0.012 mg per minute of norepinephrine or 0.1 to 0.18 mg per minute of phenylephrine, appropriately diluted. If hypotension is due to increased vagal activity (vasovagal reaction), intravenous administration of 1 mg of atropine, repeated in one to two hours if needed. {14} {15} {47}
   • Other specific treatment may include— {62} Diphenhydramine: For minor allergic-like reactions (i.e., urticaria)—An antihistamine such as diphenhydramine hydrochloride (except in epileptic patients) may be administered intravenously. Epinephrine: For acute allergic-like or anaphylactoid reactions—Slow intravenous infusion of 0.1 mg of epinephrine (1:10,000) may be used.For mild to moderate bronchospasm—0.1 to 0.2 mg of epinephrine (1:1000) may be administered subcutaneously, except in hypotension. In extreme emergency, 0.1 mg of epinephrine (1:10,000) may be given slowly by intravenous route, followed by a continuous intravenous infusion at an initial rate of 0.001 mg per minute; the rate may be increased to 0.004 mg per minute if necessary.Patients on beta-adrenergic blocking agents should not receive epinephrine since they are at risk of unopposed alpha-adrenergic stimulation, which may result in hypertension, reflex bradycardia, and heart block. In these patients, isoproterenol and norepinephrine are used instead of epinephrine to overcome bronchospasm and hypotension, respectively.For cardiac arrest—0.1 to 1 mg of epinepherine may be administered by the intravenous route. Diazepam or phenobarbital: To control convulsions—5 to 10 mg of diazepam by slow, intravenous administration or phenobarbital sodium intravenously or intramuscularly at a rate not to exceed 30 to 60 mg per minute may be given.


Oral or Rectal Dosage Forms

DIATRIZOATE MEGLUMINE AND DIATRIZOATE SODIUM SOLUTION USP

Usual adult and adolescent dose
Gastrointestinal tract radiographic examination
Oral, 30 to 90 mL. {01} {02} {03} {106} {108}

Rectal, 240 mL in 1000 mL of tap water. {01} {02} {03} {106} {108}

CT of the body, adjunct
Oral, 240 mL of a dilute solution administered fifteen to thirty minutes before imaging. {106}

Note: Solution may be prepared by diluting 25 mL of diatrizoate meglumine and diatrizoate sodium solution with tap water up to 1 liter. {03}



Usual pediatric dose
Gastrointestinal tract radiographic examination


Oral:
Children up to 5 years of age—30 mL. {106} {108}

Children 5 to 10 years of age—60 mL. {108}

Note: In debilitated children and in those weighing less than 10 kg, the dose should be diluted using 1 part of contrast solution and 3 parts of water. For other children the dose may be diluted with an equal volume of water, carbonated beverage, or milk. {108}




Rectal:
Children up to 5 years of age—1 part of the contrast solution may be diluted with 5 parts of water. {108}

Children 5 years of age and over—90 mL diluted with 500 mL of water. {108}



Usual geriatric dose
See Usual adult and adolescent dose.

Note: Geriatric patients may be more sensitive to the effects of the usual adult dose.
In elderly cachectic patients, the oral dose may be diluted with an equal volume of water, carbonated beverage, or milk. {108}


Strength(s) usually available
U.S.—


66% (660 mg per mL) of diatrizoate meglumine and 10% (100 mg per mL) of diatrizoate sodium with 36.7% (367 mg per mL) of iodine (Rx) [Gastrografin] [MD-Gastroview]

Canada—


66% (660 mg per mL) of diatrizoate meglumine and 10% (100 mg per mL) of diatrizoate sodium with 37% (370 mg per mL) of iodine (Rx) [Gastrografin]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container. Protect from freezing. {06}

Note: For oral or rectal use only.


Additional information:
Oral solution may be ingested directly or given by tube. {108}


DIATRIZOATE SODIUM SOLUTION USP

Usual adult and adolescent dose
Gastrointestinal tract radiographic examination
Oral, 90 to 180 mL of a solution containing the equivalent of 155 mg to 250 mg of iodine per mL. {01} {02} {03} {105}

Rectal, 500 to 1000 mL of a solution containing the equivalent of 93 mg to 155 mg of iodine per mL. {01} {02} {03} {105}


Usual pediatric dose
Gastrointestinal tract radiographic examination
Oral, 30 to 75 mL of a solution containing the equivalent of 125 mg to 250 mg of iodine per mL. {51}

Rectal, 100 to 500 mL of a solution containing the equivalent of 62 mg to 93 mg of iodine per mL. {105}


Usual geriatric dose
See Usual adult and adolescent dose

Note: Geriatric patients may be more sensitive to the effects of the usual adult dose.


Strength(s) usually available
U.S.—


41.66% (416.7 mg per mL) of diatrizoate sodium with 24.9% (249 mg per mL) of iodine (Rx) [Hypaque Sodium Oral Solution (polysorbate 80)]

Canada—


41.66% (416.7 mg per mL) of diatrizoate sodium with 24.9% (249 mg per mL) of iodine (Rx) [Hypaque Oral (polysorbate 80)]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container. Protect from freezing. {06}

Preparation of dosage form:
{97}{105}

Diatrizoate Sodium
solution (%)*
Dilution required
Iodine content of
diluted solution
(mgI/mL)
10
Dilute each 25 mL to 100 mL
62
15
Dilute each 40 mL to 100 mL
93
20
Dilute each 50 mL to 100 mL
125
25
Dilute each 60 mL to 100 mL
155
40
Use undiluted
250
* Approximate values.
 Oral solutions of different strengths may be prepared by using water, milk, or a carbonated beverage as diluents.

Stability:
Solution should be used upon preparation; do not store for future use. {01}

Note: For oral or rectal use only.



DIATRIZOATE SODIUM (FOR SOLUTION) USP

Usual adult and adolescent dose
Gastrointestinal tract radiographic examination
Oral, 90 to 180 mL of a solution containing the equivalent of 155 mg to 250 mg of iodine per mL. {01} {02} {03} {98}

Rectal, 500 to 1000 mL of a solution containing the equivalent of 93 mg to 155 mg of iodine per mL. {98}


Usual pediatric dose
Gastrointestinal tract radiographic examination
Oral, 30 to 75 mL of a solution containing the equivalent of 125 mg to 250 mg of iodine per mL. {98}

Rectal, 100 to 500 mL of a solution containing the equivalent of 62 mg to 93 mg of iodine per mL. {98}


Usual geriatric dose
See Usual adult and adolescent dose

Note: Geriatric patients may be more sensitive to the effects of the usual adult dose.


Size(s) usually available:
U.S.—


250-gram size can containing 59.87% of iodine (approximately 600 mg of iodine per gram) (Rx) [Hypaque Sodium Oral Powder (polysorbate 80){98}]

Canada—


250-gram size can containing 59.87% of iodine (approximately 600 mg of iodine per gram) (Rx) [Hypaque Oral (polysorbate 80)]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.

Preparation of dosage form:
{98}

Diatrizoate Sodium
solution (%)
Measuring spoons*
of powder
per 100 mL
of diluent
Iodine content of
prepared solution
(mgI/mL)
10
1
62
15
11/2
93
20
2
125
25
21/2
155
40
4
250
* One level measuring spoon equals approximately 10 grams of powder.
 Oral solutions may be sweetened or flavored (e.g., with vanilla, lemon, chocolate). The diluent may be water, milk, or a carbonated drink.

Stability:
Solution should be used upon preparation; do not store for future use. {01}

Note: Solution for oral or rectal use only.




Parenteral Dosage Forms

DIATRIZOATE MEGLUMINE INJECTION USP

Usual adult and adolescent dose
Intravascular


Angiography, cerebral:
For visualization of cerebral vessels—Percutaneous or catheter, 8 to 12 mL of a solution containing the equivalent of 282 mg of iodine per mL, injected into the common carotid artery; repeated as needed. {60} {100} {110}

For visualization of vessels in the posterior fossa or the occipital lobes—Percutaneous or operative method, 6 to 10 mL of a solution containing the equivalent of 282 mg of iodine per mL, injected into the vertebral artery; repeated as needed. {106} {110}

For visualization of vessels in the posterior fossa and/or right cerebral hemisphere (retrograde brachial)—Retrograde catheter, 35 to 50 mL of a solution containing the equivalent of 282 mg of iodine per mL by rapid administration. {60} {61} {106}



Aortography:
Translumbar or retrograde catheter method, 15 to 40 mL of a solution containing the equivalent of 282 mg or 358 mg of iodine per mL administered rapidly into the aorta, as a single dose; may be repeated as needed. {106}



Arteriography:
Peripheral arteriography—Percutaneous or operative methods, 20 to 40 mL of either a solution containing the equivalent of 282 mg or 358 mg of iodine per mL administered into the larger peripheral arteries. {28} {103} {110}

Renal arteriography (selective)—Via catheter, 5 to 8 mL of a diatrizoate meglumine solution containing the equivalent of 282 mg of iodine per mL, administered into the renal artery; may be repeated as needed. {103}



Venography, peripheral:
Upper extremity—Percutaneous, 10 to 20 mL of a solution containing the equivalent of 282 mg of iodine per mL per extremity administered rapidly into a superficial vein of the forearm or hand. {02} {28}

Lower extremity—Intravenous (rapid) or intravenous infusion, 50 to 100 mL of a solution containing the equivalent of 141 mg of iodine per mL, or percutaneous, 20 to 40 mL of a solution (containing the equivalent of 282 mg of iodine per mL) per extremity administered rapidly into a superficial vein on the lateral side of the foot. {02} {28} {109}

Note: To minimize the incidence of pain and phlebitis in the lower extremity, it is recommended that the 60% solution (containing the equivalent of 282 mg of iodine per mL) be diluted to a 45% solution (containing the equivalent of 211.5 mg of iodine per mL) with 5% dextrose injection. {02} {106}




Cholangiography:
Direct cholangiography—Intraductal injection or instillation, 10 to 15 mL of either a solution containing the equivalent of 141 mg or 282 mg of iodine per mL into the cystic duct or common bile duct. {01} {02} {28} {100}

Patients with obstructive jaundice—Intraductal, 40 to 50 mL of a solution containing the equivalent of 282 mg of iodine per mL injected directly after the contents of the gallbladder are aspirated during surgery. {01} {02} {100}

Patients with acute pancreatitis—Intraductal, 5 to 10 mL of a solution containing the equivalent of 282 mg of iodine per mL injected directly. {02}

Percutaneous transhepatic cholangiography1—20 to 40 mL (range, 10 to 60 mL, depending on degree of biliary duct dilatation) of either a solution containing the equivalent of 141 mg or 282 mg of iodine per mL administered slowly into the biliary duct. {01} {02} {03} {15} {100} {110}

Note: A 30% solution (containing the equivalent of 141 mg of iodine per mL) may be prepared from a 60% solution (containing the equivalent of 282 mg of iodine per mL) by dilution with 0.9% sodium chloride injection. {02} {106}




CT of the brain:
Intravenous infusion, 1 to 4.4 mL per kg of body weight of a solution containing the equivalent of 141 mg of iodine per mL administered over a period of ten to twenty minutes or longer; or 50 to 150 mL of a solution containing the equivalent of 282 mg of iodine per mL. {01} {02} {100} {102} {109}



CT of the body:
Intravenous infusion, 300 mL of a solution containing the equivalent of 141 mg of iodine per mL administered over a period of approximately twenty minutes. {03} {28} {109}



Splenoportography:
Percutaneous, 20 to 25 mL of a solution containing the equivalent of 282 mg of iodine per mL administered rapidly after a preliminary small dose has been injected to confirm splenic entry. {01} {02} {03} {100} {110}



Urography:


Excretory urography—
Intravenous infusion, 4.4 mL of a solution containing the equivalent of 141 mg of iodine per mL per kg of body weight administered at a rate not to exceed 40 mL per minute. A minimum of 250 mL may be needed for optimum visualization. {01} {02} {102} {110}

Note: Patients with cardiac disease may require a slower infusion rate. {02} {109}


Intravenous, 20 to 60 mL of a solution containing the equivalent of 282 mg of iodine per mL or 20 mL of a solution containing the equivalent of 358 mg of iodine per mL administered over a one- to three-minute period. {100} {110}

Intramuscular, 25 mL of a solution containing the equivalent of 282 mg of iodine per mL. {106}

Note: Intramuscular administration may be very irritating to the tissues. {106}




Retrograde urography (unilateral)1
Via catheter, 15 mL of a solution containing the equivalent of 141 mg of iodine per mL instilled slowly into the ureter and renal pelvis. {02} {59}

Note: The 30% solution (containing the equivalent of 141 mg of iodine per mL) may be diluted with sterile distilled water if less contrast is desired. {02}



Note: In patients with reduced renal function, repeat urography is not recommended for at least forty-eight hours because of the possibility of temporary oliguria or anuria.



Intrasynovial—Arthrography: Intrasynovial, as a solution containing the equivalent of 282 mg of iodine per mL {28} {100} {110}
Knee, shoulder, or hip joint: 5 to 15 mL.

Temporomandibular joint: 0.5 mL.

Other joints: 1 to 4 mL.

Intradiskal—Diskography: As a solution containing the equivalent of 282 mg of iodine per mL injected slowly {100} {110}
Cervical disk: Up to 0.5 mL.

Lumbar disk: 1 to 2 mL, not to exceed 2 mL.

Ruptured or abnormal disk: 1 to 2 mL, not to exceed 2 mL.


Usual pediatric dose
Intravascular


Angiocardiography:


Children up to 5 years of age—
Intravenous, 10 to 20 mL of a solution containing the equivalent of 358 mg of iodine per mL administered as a single dose. {106}



Children 5 to 10 years of age—
Intravenous, 20 to 30 mL of a solution containing the equivalent of 358 mg of iodine per mL. {106}

Note: In infants weighing less than 7 kg, especially in those with right-heart strain or failure and with decreased or nonfunctional pulmonary vascular beds, a dose of 10 to 20 mL may be dangerous. {02} {106}





Angiography, cerebral:
Dosage must be individualized by physician in proportion to body weight. {100}



Aortography:
Translumbar or retrograde catheter method, 1 mL per kg of body weight, or 15 to 40 mL as a single injection, of a solution containing the equivalent of 358 mg of iodine per mL. {106}



Arteriography:
Peripheral arteriography—Use is not recommended. {15}

Renal arteriography (selective): Dosage must be individualized by physician in proportion to body weight. {15} {60}



Venography, peripheral:
Dosage must be individualized by physician in proportion to body weight. {60} {109}



Cholangiography, direct:
Dosage must be individualized by physician in proportion to body weight. {60}



Cholangiography, percutaneous transhepatic1:
Dosage must be individualized by physician in proportion to body weight. {60}



CT of the brain:
Dosage must be individualized by physician in proportion to body weight. {60}



Splenoportography:
Dosage must be individualized by physician in proportion to body weight. {60}



Urography:


Excretory urography—
Intravenous infusion: Dosage must be individualized by physician in proportion to body weight.

Intravenous, as a solution containing the equivalent of 282 mg of iodine per mL: {100} {106}

Children weighing up to 4.5 kg—5 to 10 mL (or 8 mL of a solution containing the equivalent of 358 mg of iodine per mL).

Children weighing 4.5 to 13.6 kg—10 to 15 mL.

Children weighing 13.6 to 27.3 kg—15 to 30 mL.

Children weighing 27.3 kg and over—30 mL.




Retrograde urography1
Dosage must be individualized by physician in proportion to body weight. {60}



Intrasynovial
Arthrography: Dosage must be individualized by physician in proportion to body weight. {60}

Intradiskal
Diskography: Dosage must be individualized by physician in proportion to body weight. {60}


Usual geriatric dose
See Usual adult and adolescent dose

Note: Geriatric patients may be more sensitive to the effects of the usual adult dose. {01}


Strength(s) usually available
U.S.—


30% (300 mg per mL) of diatrizoate meglumine with 14.1% (141 mg per mL) of iodine (Rx) [Hypaque Meglumine 30%] [Reno-Dip] [Urovist Meglumine DIU/CT]


60% (600 mg per mL) of diatrizoate meglumine with 28.2% (282 mg per mL) of iodine (Rx) [Angiovist 282] [Hypaque Meglumine 60%] [Reno-M-60]


76% (760 mg per mL) of diatrizoate meglumine with 35.8% (358 mg per mL) of iodine (Rx)[Generic]

Canada—


18% (180 mg per mL) of diatrizoate meglumine with 8.5% (85 mg per mL) of iodine (Rx) [Hypaque-M 18%]


30% (300 mg per mL) of diatrizoate meglumine with 14.1% (141 mg per mL) of iodine (Rx) [Hypaque-M 30%]


60% (600 mg per mL) of diatrizoate meglumine with 28.3% (283 mg per mL) of iodine (Rx) [Hypaque-M 60%]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. Protect from freezing. {06} {100}

Stability:
If for intravascular use, any unused portion remaining in the container should be discarded after 6 hours. {06}

Crystals may form in the solution but are readily redissolved by immersing the container in hot water and gently shaking it. {106}

Incompatibilities:
Diatrizoate meglumine injection is physically incompatible with diphenhydramine hydrochloride injection or promethazine hydrochloride injection. {02} {59} {100} {102}


DIATRIZOATE MEGLUMINE AND DIATRIZOATE SODIUM INJECTION USP

Usual adult and adolescent dose
Intravascular—


Angiocardiography {103} {106} {111}:
Via catheter, administered rapidly within one to two seconds into a large peripheral vein or into the chambers of the heart or associated blood vessels—

Iodine content
of contrast solution
(mg I/mL)
mL
310
50
370
40–50
385
35–50
462
35–50


Intravenous digital subtraction, 30 to 60 mL, with a range of 0.5 to 1 mL per kg of body weight, of a solution containing the equivalent of 370 mg of iodine per mL, administered at a bolus rate of 7.5 to 30 mL per second using a pressure injector. {103}

Left ventriculography—Via catheter, 40 to 50 mL of a solution containing the equivalent of 370 mg of iodine per mL injected rapidly within one to two seconds into the left ventricle of the heart. {103} {106}

Pulmonary angiography—Via catheter, 10 to 56 mL of a solution containing the equivalent of 370 mg of iodine per mL administered rapidly within one to two seconds into the pulmonary artery. {02} {103}

Note: When angiocardiography is combined with other angiographic procedures, the dosage should not exceed 225 mL of a solution containing the equivalent of 370 mg of iodine per mL. {01} {02} {103}



Angiography, cerebral—
For visualization of cerebral vessels—Percutaneous or catheter, 10 mL of a solution containing the equivalent of 290 mg of iodine per mL administered into the common carotid artery. {60} {106}

For visualization of vessels in the posterior fossa or the occipital lobes—Percutaneous or operative method, 6 to 10 mL of a solution containing the equivalent of 290 mg of iodine per mL administered into the vertebral artery. {106}



Aortography—
Translumbar or retrograde catheter method, 20 to 30 mL (some clinicians recommend doses up to 80 mL) of a solution containing the equivalent of 310 mg of iodine per mL; or 15 to 50 mL of a solution containing the equivalent of 370 mg of iodine per mL solution, as a single dose; may be repeated if necessary. {02} {103} {111}


Abdominal aortography—
As a solution containing either the equivalent of 385 mg or 462 mg of iodine per mL: {02} {106}

Translumbar—10 to 15 mL.

Retrograde catheter—15 to 25 mL.

Cannula—35 to 40 mL.




Arteriography—


Coronary arteriography—
Via catheter, 50 mL, administered into the root of the aorta for simultaneous bilateral angiograms, or 15 to 25 mL administered at the sinus of Valsalva on either side, of either a solution containing the equivalent of 385 mg or 462 mg of iodine per mL. {01} {03}



Selective coronary arteriography—
Via catheter, 3 to 5 mL of either a solution containing the equivalent of 385 mg or 462 mg of iodine per mL; or 4 to 10 mL of a solution containing the equivalent of 370 mg of iodine per mL, administered into either coronary artery; may be repeated as needed. {03} {106}



Selective coronary arteriography combined with left ventriculography —
Via catheter, 35 to 50 mL of a solution containing the equivalent of 370 mg of iodine per mL. {28}

Note: Some clinicians recommend that the 60% diatrizoate meglumine and 30% diatrizoate sodium solution (containing the equivalent of 462 mg of iodine per mL) not be used since the risk of ventricular fibrillation may be increased.




Peripheral arteriography—
Entire extremity: Percutaneous or operative method, 20 to 40 mL of a solution containing the equivalent of 290 mg or 370 mg of iodine per mL; or 10 to 25 mL of either a solution containing the equivalent of 385 mg or 462 mg of iodine per mL; or 30 to 50 mL of a solution containing the equivalent of 310 mg of iodine per mL; as a single dose administered into the femoral or subclavian artery. {02} {03} {28} {103} {111}

Upper or lower extremity: Percutaneous or operative method, 10 to 20 mL of a solution containing the equivalent of 290 mg or 370 mg of iodine per mL; as a single dose. {01} {02} {03} {28} {111}



Renal arteriography (selective)—
Via catheter, 5 to 8 mL of a solution containing the equivalent of 385 mg of iodine per mL; or 5 to 10 mL of a solution containing the equivalent of 370 mg of iodine per mL, administered into either or both renal arteries; may be repeated as needed. {02} {03} {103}



Visceral arteriography (selective)—
Via catheter, of a solution containing the equivalent of 370 mg of iodine per mL, administered into the appropriate visceral artery {103} {112}

Superior mesenteric artery—20 to 40 mL.

Inferior mesenteric artery—20 to 40 mL.

Celiac artery—30 to 50 mL.

Hepatic artery—15 to 30 mL.

Splenic artery—20 to 50 mL.




Venography1


Central venography1
Inferior or superior venacavography: Percutaneous, 30 to 60 mL of a solution containing the equivalent of 310 mg; or 40 to 50 mL of a solution containing the equivalent of 370 mg of iodine per mL, administered directly or via catheter into the saphenous, femoral, or iliac vein; dose may be repeated if necessary for an additional radiograph. {60} {103} {106} {111} {112}



Renal venography1
Percutaneous, 20 to 40 mL of a solution containing the equivalent of 370 mg of iodine per mL administered via catheter into the vena cava or the renal vein. {103}



Peripheral venography1 {103} {111}
Upper extremity: Percutaneous, 20 to 50 mL of either a solution containing the equivalent of 310 mg or 370 mg of iodine per mL; or 10 mL of a solution containing the equivalent of 290 mg of iodine per mL, per extremity, administered rapidly into a superficial vein of the forearm or hand.

Lower extremity: Percutaneous, 20 to 50 mL of a solution containing the equivalent of 290 mg, 310 mg, or 370 mg of iodine per mL, per extremity, administered rapidly into a superficial vein on the lateral side of the foot.

Note: Larger doses than those stated above have been safely used for visualization of veins in the lower extremities. {106}
To minimize the incidence of pain and phlebitis in the lower extremity, it is recommended that 3 parts of a 52% diatrizoate meglumine and 8% diatrizoate sodium injection (containing the equivalent of 290 mg per mL of iodine) be diluted with 1 part of 5% dextrose injection. {02} {106}





Cholangiography1


Direct cholangiography—
Intraductal, 10 mL of a solution containing the equivalent of 290 mg of iodine per mL, diluted or undiluted, injected or instilled into the cystic duct or common bile duct. {02} {03} {28} {106}
In patients with acute pancreatitis: 5 to 10 mL of a solution containing the equivalent of 290 mg of iodine per mL, undiluted. {02} {03} {106}




Transhepatic cholangiography1
Percutaneous, 20 to 40 mL, depending on the degree of biliary duct dilation, of a solution containing the equivalent of 290 mg of iodine per mL, diluted or undiluted, administered slowly into the biliary duct. {02} {03} {106}




CT of the brain—
Intravenous, 2 to 4 mL per kg of body weight of a solution containing the equivalent of 150 mg of iodine per mL; or 50 to 150 mL of a solution containing the equivalent of 290 mg of iodine per mL; or 50 to 125 mL of a solution containing the equivalent of 370 mg of iodine per mL, by rapid administration. {02} {103}



CT of the body—
Intravenous, 50 to 125 mL of a solution containing the equivalent of 370 mg of iodine per mL; or 100 mL of a solution containing the equivalent of 290 mg of iodine per mL. {103}

Note: For vascular opacification, 25 to 50 mL of a solution containing the equivalent of 370 mg of iodine per mL administered as a bolus and repeated if needed. {106}
For prolonged arterial or venous phase enhancement or enhancement of specific lesion, 100 mL of a solution containing the equivalent of 370 mg of iodine per mL by rapid infusion. {03} {106}




Splenoportography—
Percutaneous, 20 to 25 mL of a solution containing the equivalent of 290 mg of iodine per mL administered rapidly after a preliminary small dose has been injected to confirm splenic entry. {02} {03} {106}



Urography, excretory—
Intravenous, 30 mL of a solution containing the equivalent of 310 mg of iodine per mL; or 20 to 50 mL of a solution containing the equivalent of 370 mg of iodine per mL; or 25 mL of a solution containing the equivalent of 290 mg of iodine per mL; or 50 mL of a solution containing the equivalent of 385 mg or 462 mg of iodine per mL, by rapid administration. {01} {02} {03} {28} {103}

Note: In patients with reduced renal function, repeat urography is not recommended for at least 48 hours because of the possibility of temporary oliguria or anuria. {02} {103}




Nephrotomography—
Intravenous, 100 mL of a solution containing the equivalent of 370 mg of iodine per mL, administered rapidly. {01} {28}



Usual pediatric dose


Intravascular:


Angiocardiography—
Via catheter, 0.5 to 1 mL per kg of body weight of a solution containing the equivalent of 385 mg of iodine per mL or 0.2 to 0.3 mL per kg of body weight of a solution containing the equivalent of 370 mg of iodine per mL, administered rapidly within one to two seconds into a large peripheral vein or into the chambers of the heart or associated blood vessels. {02} {28} {106} {111}
Or, as a solution containing the equivalent of 310 mg of iodine per mL—

Children up to 2 years of age and weighing 7 kg or more: 10 to 20 mL.

Children 2 to 4 years of age: 20 to 30 mL.

Children 4 to 10 years of age: 30 to 40 mL.

Or, as a solution containing the equivalent of 370 mg of iodine per mL {03} {111}

Children up to 2 years of age and weighing 7 kg or more: 10 to 15 mL.

Children 2 to 4 years of age: 15 to 20 mL.

Children 4 to 10 years of age: 20 to 30 mL. {03}

Note: In patients with stenotic lesions of the aorta, 0.5 mL per kg of body weight of a solution containing the equivalent of 385 mg of iodine per mL is recommended. {01}




Pulmonary angiography—
Via catheter, 0.3 to 0.9 mL per kg of body weight, not to exceed 1 mL per kg of body weight, of a solution containing the equivalent of 370 mg of iodine per mL administered rapidly within one to two seconds into the pulmonary artery. {01} {02} {103}



Left ventriculography—
Via catheter, 0.2 to 0.3 mL (some clinicians recommend 0.5 to 1.5 mL) per kg of body weight of a solution containing the equivalent of 370 mg of iodine per mL administered rapidly within one to two seconds into the left ventricle of the heart; not to exceed 50 mL. {01} {02}

Note: When angiocardiography is combined with other angiographic procedures, the dosage should not exceed 4 mL per kg of body weight of a solution containing the equivalent of 370 mg of iodine per mL. In young infants the dosage of this solution should not exceed 3 mL per kg of body weight. {01} {02} {103}





Angiography, cerebral—
Dosage must be individualized by physician in proportion to body weight. {01}



Aortography—
Translumbar or retrograde catheter method, 0.3 to 0.9 mL per kg of body weight, not to exceed 1 mL per kg of body weight, of a solution containing the equivalent of 370 mg of iodine per mL. {02} {103}



Arteriography—
Peripheral arteriography—Use is not recommended.

Renal arteriography (selective): Dosage must be individualized by physician in proportion to body weight.



Cholangiography1
Dosage must be individualized by physician in proportion to body weight.



CT of the brain—
Dosage must be individualized by physician in proportion to body weight. {103}



CT of the body—
Dosage must be individualized by physician in proportion to body weight. {103}



Splenoportography—
Dosage must be individualized by physician in proportion to body weight.



Urography, excretory—
Intravenous, 0.5 to 1 mL per kg of body weight, not to exceed 50 mL, of a solution containing the equivalent of 385 mg of iodine per mL; or of a solution containing the equivalent of {28} {103} {106}

Children
290
mgI/mL
(mL)
310
mgI/mL
(mL)
370
mgI/mL
(mL)
Up to 6 months
5
6
4–5
6 to 12 months
8
10
6–8
1 to 2 years
10
12
8–10
2 to 5 years
12
15
10–12
5 to 7 years
15
18
12–15
7 to 10 years
18
22
14–18
10 to 15 years
20
24
16–20




Nephrotomography—
Dosage must be individualized by physician in proportion to body weight. {28}



Venography, peripheral1
Dosage must be individualized by physician in proportion to body weight.



Usual geriatric dose
See Usual adult and adolescent dose

Note: Geriatric patients may be more sensitive to the effects of the usual adult dose.


Strength(s) usually available
U.S.—


28.5% (285 mg per mL) of diatrizoate meglumine and 29.1% (291 mg per mL) of diatrizoate sodium with 31% (310 mg per mL) of iodine (Rx) [Renovist II]


34.3% (343 mg per mL) of diatrizoate meglumine and 35% (350 mg per mL) of diatrizoate sodium with 37% (370 mg per mL) of iodine (Rx) [Renovist]


52% (520 mg per mL) of diatrizoate meglumine and 8% (80 mg per mL) of diatrizoate sodium with 29% (290 mg per mL) of iodine (Rx) [Angiovist 292] [Renografin-60]


66% (660 mg per mL) of diatrizoate meglumine and 10% (100 mg per mL) of diatrizoate sodium with 37% (370 mg per mL) of iodine (Rx) [Angiovist 370] [Hypaque-76] [MD-76] [Renografin-76]

Canada—


50% (500 mg per mL) of diatrizoate meglumine and 25% (250 mg per mL) of diatrizoate sodium with 38.5% (385 mg per mL) of iodine (Rx) [Hypaque-M 75%]


66% (660 mg per mL) of diatrizoate meglumine and 10% (100 mg per mL) of diatrizoate sodium with 37% (370 mg per mL) of iodine (Rx) [Hypaque-M 76%] [MD-76]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. Protect from freezing. {06} {111}

Stability:
If for intravascular use, any unused portion remaining in the container should be discarded after 6 hours. {06}

Crystals may form in the solution but are readily redissolved by immersing the container in hot water and gently shaking it. {106}

Incompatibilities:
Diatrizoate meglumine and diatrizoate sodium injection is physically incompatible with protamine sulfate solutions or promethazine hydrochloride injection. {01} {103}


DIATRIZOATE SODIUM INJECTION USP

Usual adult and adolescent dose
Intravascular


Angiography1:


Cerebral angiography—
For visualization of cerebral vessels: Direct injection, 8 to 12 mL of a solution containing the equivalent of 300 mg of iodine per mL administered into the common carotid artery. {104}

For visualization of posterior fossa or occipital lobe vessels: Direct injection, 6 to 10 mL of a solution containing the equivalent of 300 mg of iodine per mL administered into the vertebral artery. {106}

For visualization of vessels in the posterior fossa and/or right cerebral hemisphere (retrograde brachial): Retrograde catheter, 35 to 50 mL of a solution containing the equivalent of 300 mg of iodine per mL by rapid administration. {104}

Note: Many clinicians feel the use of pure diatrizoate sodium preparations for cerebral or peripheral angiography is no longer warranted; they recommend diatrizoate meglumine as the salt of choice for these uses. {15}





Aortography1:
As a solution containing the equivalent of 300 mg of iodine per mL— {01} {03} {104}

Intravenous, 1 mL per kg of body weight.

Retrograde (catheter), 0.5 to 1 mL per kg of body weight.

Translumbar, 10 to 30 mL.




Arteriography1:


Peripheral arteriography—
Percutaneous or operative method, 25 to 35 mL of a solution containing the equivalent of 300 mg of iodine per mL administered into the brachial or femoral artery. {01} {106}

Note: Many clinicians feel the use of pure diatrizoate sodium preparations for peripheral arteriography is no longer warranted, since their use would result in extreme pain. {15}




Renal arteriography (selective)—
Via catheter, 5 to 8 mL of a solution containing the equivalent of 300 mg of iodine per mL administered into the renal artery, repeated as needed. {01} {03} {106}




Cholangiography {01}:


Operative—
10 to 15 mL of either a solution containing the equivalent of 150 mg or 300 mg of iodine per mL injected or instilled into the cystic duct or common bile duct. {104}

In patients with obstructive jaundice: Intravesical instillation, 40 to 50 mL of a solution containing the equivalent of 300 mg of iodine per mL administered directly into the gallbladder after aspiration of its contents. {104}

In patients with acute pancreatitis: Intravesical instillation, 5 to 10 mL of a solution containing the equivalent of 300 mg of iodine per mL. {106}



Postoperative T-tube—
See Operative cholangiography.



Transhepatic cholangiography1
Percutaneous, 20 to 40 mL (range, 10 to 60 mL, depending on degree of biliary duct dilation) of a solution containing the equivalent of 150 mg or 300 mg of iodine per mL administered slowly into the biliary duct. {104}

Note: A 25% injection (containing the equivalent of 150 mg of iodine per mL) may be prepared from a 50% injection (containing the equivalent of 300 mg of iodine per mL) by dilution with 0.9% sodium chloride injection. {106}





CT of the brain:
Intravenous infusion, 300 mL of a solution containing the equivalent of 150 mg of iodine per mL administered over a ten- to twenty-minute period; or 50 to 150 mL of a solution containing the equivalent of 300 mg of iodine per mL. {01} {28} {99}



Splenoportography1:
Percutaneous, 20 to 25 mL of a solution containing the equivalent of 300 mg of iodine per mL administered rapidly after a small preliminary dose has been injected to confirm splenic entry. {01} {104}



Urography:


Excretory urography—
Intravenous infusion, 4.4 mL of a solution containing the equivalent of 150 mg of iodine per mL per kg of body weight, not to exceed 400 mL, administered over a three- to ten-minute period. A minimum of 250 mL may be needed for optimum visualization. {01} {99}

Intravenous, 50 to 60 mL of a solution containing the equivalent of 300 mg of iodine per mL. {104}



Retrograde urography (unilateral)1
Via catheter, 6 to 10 mL of a solution containing the equivalent of 120 mg of iodine per mL instilled slowly into the ureter and renal pelvis. {28}

Note: The above dose is doubled for bilateral examination.



Note: In patients with reduced renal function, repeat urography is not recommended for at least forty-eight hours because of the possibility of temporary oliguria or anuria. {01} {03} {28}




Venography:


Peripheral venography1
Percutaneous, 15 to 40 mL of a solution containing the equivalent of 300 mg of iodine per mL. {01} {106}



Intraosseous venography—
Intraosseous, 10 to 20 mL of a solution containing the equivalent of 300 mg of iodine per mL, administered after aspiration of 4 mL of bone marrow. {104}

Pterygoid venous plexus: Intraosseous, 5 to 8 mL of a solution containing the equivalent of 300 mg of iodine per mL administered into the medullary cavity of the mandible. {104}

Note: Many clinicians feel the use of pure diatrizoate sodium preparations for venography is no longer warranted; they recommend diatrizoate meglumine as the salt of choice for this use. {15}





Usual pediatric dose
Intravascular


Angiography1:
Dosage must be individualized by physician in proportion to body weight. {104}


Aortography1
Intravenous—See Usual adult and adolescent dose.

Retrograde (catheter)—See Usual adult and adolescent dose.

Translumbar—Dosage must be individualized by physician in proportion to body weight.




Arteriography:


Abdominal arteriography—
Translumbar or retrograde catheter method, 1 mL per kg of body weight of a solution containing the equivalent of 300 mg of iodine per mL. {01}



Peripheral arteriography1
Dosage must be individualized by physician in proportion to body weight. {01}



Renal arteriography (selective)1
Dosage must be individualized by physician in proportion to body weight. {106}




Cholangiography:
Dosage must be individualized by physician in proportion to body weight. {104}



CT of the brain:
Dosage must be individualized by physician in proportion to body weight.



Splenoportography1:
Dosage must be individualized by physician in proportion to body weight. {104}



Urography:


Excretory urography {01} {104}
Intravenous, as a solution containing the equivalent of 300 mg of iodine per mL administered rapidly:

Children up to 6 months of age—5 mL.

Children 6 to 12 months of age—6 to 8 mL.

Children 1 to 2 years of age—8 to 10 mL.

Children 2 to 5 years of age—10 to 12 mL.

Children 5 to 7 years of age—12 to 15 mL.

Children 7 to 11 years of age—15 to 18 mL.

Children 11 to 15 years of age—18 to 20 mL.

Note: Some clinicians recommend intravenous administration of 1 to 2 mL per kg of body weight of the solution containing the equivalent of 300 mg of iodine per mL.





Retrograde urography (unilateral)1
Via catheter, as a solution containing the equivalent of 120 mg of iodine per mL {106}:

Children up to 1 year of age—Up to 1.5 mL.

Children 1 to 5 years of age—1.5 to 3 mL.

Children 5 years of age and over—4 to 5 mL.

Note: The above doses are doubled for bilateral examination.






Venography1:
Dosage must be individualized by physician in proportion to body weight.



Usual geriatric dose
See Usual adult and adolescent dose

Note: Geriatric patients may be more sensitive to the effects of the usual adult dose.


Strength(s) usually available
U.S.—


25% (250 mg per mL) of diatrizoate sodium with 15% (150 mg per mL) of iodine (Rx) [Hypaque Sodium 25%{99}]


50% (500 mg per mL) of diatrizoate sodium with 30% (300 mg per mL) of iodine (Rx) [Hypaque Sodium 50%] [Urovist Sodium 300{104}]

Canada—


50% (500 mg per mL) of diatrizoate sodium with 30% (300 mg per mL) of iodine (Rx) [Hypaque Sodium 50%{28}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. Protect from freezing. {01}

Stability:
If for intravascular use, any unused portion remaining in the container should be discarded.

Crystals may form in the solution but are readily redissolved by immersing the container in hot water and gently shaking it. {104}

Incompatibilities:
Diatrizoate sodium injection is physically incompatible with diphenhydramine hydrochloride injection. {01} {02} {104}



Revised: 05/11/1995



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