Iodixanol Disease Interactions

Reports of thyroid storm following the use of iodinated diagnostic agents in patients with hyperthyroidism or with an autonomously functioning thyroid nodule suggest that this additional risk be evaluated in such patients before the use of any contrast medium. Some agents such as ioversol are contraindicated in symptomatic hyperthyroidism.

Administration of radiopaque materials to patients known or suspected of having pheochromocytoma should be performed with extreme caution. If, in the opinion of the physician, the possible benefits of such procedures outweigh the considered risk, the procedures should be performed with the absolute minimum amount of injected radiopaque medium. The blood pressure should be assessed throughout the procedure and measures for treatment of a hypertensive crisis should be available.

Some contrast agents have shown to promote the phenomenon of sickling (blood cell rupture) in individuals who are homozygous for sickle cell disease when administered intravenously or intra- arterially. Caution is advised.

A definite risk exists in the use of intravascular contrast agents in patients who are known to have multiple myeloma. In such cases, anuria has developed resulting in progressive uremia, renal failure and eventually death. Although neither the contrast agent nor dehydration has separately proved to be the cause of anuria in myeloma, it has been speculated that the combination of both may be causative factors. The risk in patients with myeloma is not a contraindication to the procedure; however, partial dehydration in the preparation of these patients for the examination is not recommended since this may predispose to precipitation of myeloma protein in the renal tubules. Myeloma, which occurs most commonly in persons over 40, should be considered before instituting intravascular administration of contrast agents.

The administration of iodinated contrast media may aggravate the symptoms of myasthenia gravis. Caution is advised when using these agents in patients with this condition.

In patients with advanced renal disease, iodinated contrast media should be used with caution, and only when the need for the examination dictates, since the excretion of the medium may be impaired. Patients with combined renal and hepatic disease, severe hypertension or congestive heart failure, and those with recent renal transplant may present an additional risk.

Iodixanol can cause life-threatening or fatal hypersensitivity reactions including anaphylaxis. Manifestations include respiratory arrest, laryngospasm, bronchospasm, angioedema, and shock. Most severe reactions develop shortly after the start of the injection (within 3 minutes), but reactions can occur up to hours later. There is an increased risk in patients with a history of a previous reaction to a contrast agent, and known allergies (i.e., bronchial asthma, drug, or food allergies) or other hypersensitivities. Premedication with antihistamines or corticosteroids does not prevent serious life-threatening reactions, but may reduce both their incidence and severity. Obtain a history of allergy, hypersensitivity, or hypersensitivity reactions to iodinated contrast agents and always have emergency resuscitation equipment and trained personnel available prior to iodixanol administration. Monitor all patients for hypersensitivity reactions.