Ioversol 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.

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.

Iodinated contrast media such as ioversol, can cause life-threatening or fatal hypersensitivity reactions including anaphylaxis and anaphylactic shock. Manifestations include respiratory arrest, laryngospasm, bronchospasm, angioedema, and shock. Most severe reactions develop shortly after the start of the injection (e.g. within 1 to 3 minutes), but delayed reactions may occur. There is an increased risk in patients with a history of a previous reaction to contrast agent, and known allergies (i.e., bronchial asthma, drug, or food allergies), and other hypersensitivities. Caution is advised on these patients. Premedication with antihistamines or corticosteroids to avoid or minimize possible allergic reactions may reduce both their incidence and severity.

Acute kidney injury, including renal failure, may occur after ioversol administration. Risk factors include preexisting renal impairment, dehydration, diabetes, congestive heart failure, advanced vascular disease, multiple myeloma, elderly age, and concomitant use of nephrotoxic or diuretic medications. The lowest dose of ioversol should be used in patients with renal impairment and other risk factors.

Life-threatening or fatal cardiovascular reactions have occurred with the use of ioversol, including cardiac arrest, hypotensive collapse and shock. Most deaths have occurred following 10 minutes of the injection, and cardiovascular disease has been identified as the main underlying factor. Additionally, ioversol increases the circulatory osmotic load and may induce acute or delayed hemodynamic disturbances in patients with congestive heart failure, and severely impaired renal function with or without hepatic disease. Caution should be used when using ioversol in these patients and the lowest dose possible should be used.