Iohexol Dosage

Usual Adult Dose for Myelography

Intrathecal:
The volume and concentration of iohexol 180, iohexol 240, or iohexol 300 to be administered will depend on the degree and extent of contrast required in the area(s) under examination and on the equipment and technique employed.

Iohexol 180 at a concentration of 180 mgI/mL, iohexol 240 at a concentration of 240 mgI/mL, or iohexol 300 at a concentration of 300 mgI/mL is recommended for the examination of the lumbar, thoracic, and cervical regions in adults by lumbar or direct cervical injection.

A total dose of 3060 mg iodine or a concentration of 300 mgI/mL should not be exceeded in adults in a single myelographic examination. This is based on clinical trial evaluation to date. As in all diagnostic procedures, the minimum volume and dose to produce adequate visualization should be used. Most procedures do not require either maximum dose or concentration.

Anesthesia is not necessary. Premedication sedatives or tranquilizers are usually not needed. Patients should be well hydrated prior to and following contrast administration.

Seizure-prone patients should be maintained on anticonvulsant medication.

Many radiopaque contrast agents are incompatible in vitro with some antihistamines and many other drugs; therefore, concurrent drugs should not be physically admixed with contrast agents.

Rate of Injection: To avoid excessive mixing with CSF and consequent dilution of contrast, injection should be made slowly over 1 to 2 minutes.

Depending on the estimated volume of contrast medium which may be required for the procedure a small amount of CSF may be removed to minimize distention of the subarachnoid spaces.

The lumbar or cervical puncture needle may be removed immediately following injection since it is not necessary to remove iohexol after injection into the subarachnoid space.

The usual recommended total doses for use in lumbar, thoracic, cervical, and total columnar myelography in adults are 1.2 gI to 3.06 gI.

If in the clinical judgment of the physician sequential or repeat examinations are required, a suitable interval of time between administrations should be observed to allow for normal Iohexol clearance of the drug from the body. An interval of at least 48 hours should be allowed before repeat examination; however, whenever possible, 5 to 7 days is recommended.

Usual Adult Dose for Angiocardiography

The individual dose or volume is determined by the size of the structure to be visualized, the anticipated degree of hemodilution, and valvular competence. Weight is a minor consideration in adults. The volume of each individual injection is a more important consideration than the total dosage used. When large individual volumes are administered, as in ventriculography and aortography, it has been suggested that several minutes be permitted to elapse between each injection to allow for subsidence of possible hemodynamic disturbances.

The recommended single injection volume of iohexol 350 for angiocardiographic procedures in adults are as follows:

Ventriculography:
The usual adult volume for a single injection is 40 mL with a range of 30 mL to 60 mL. This may be repeated as necessary. When combined with selective coronary arteriography, the total administered volume should not exceed 250 mL (87.5 gI).

Selective Coronary Arteriography:
The usual volume for right or left coronary arteriography is 5 mL (range 3 mL to 14 mL) per injection.

Aortic Root and Arch Study When Used Alone:
The usual single injection volume is 50 mL, with a range of 20 mL to 75 mL.

Combined Angiocardiographic Procedures:
Multiple Procedures:
The visualization of multiple vascular systems and target organs is possible during a single radiographic examination of the patient. Large doses of iohexol 350 have been well tolerated in angiographic procedures requiring multiple injections. The maximum total volume for multiple procedures should not exceed 250 mL of 350 mgI/mL (87.5 gI).

Usual Adult Dose for Visceral Arteriography

Iohexol 300 at a concentration of 300 mgI/mL and iohexol 350 at a concentration of 350 mgI/mL are indicated in adults for use in aortography and selective visceral arteriography including studies of the aortic arch, ascending aorta, and abdominal aorta and its branches (celiac, mesenteric, renal, hepatic and splenic arteries).

The usual volume as a single injection is 50 mL to 80 mL for the aorta, 30 mL to 60 mL for major branches including celiac and mesenteric arteries, and 5 mL to 15 mL for renal arteries. Repeated injections may be performed if indicated, but the total volume should not exceed 291 mL of iohexol 300 or 250 mL of iohexol 350 (87.5 gI).

Usual Adult Dose for Aortography

Iohexol 300 at a concentration of 300 mgI/mL and iohexol 350 at a concentration of 350 mgI/mL are indicated in adults for use in aortography and selective visceral arteriography including studies of the aortic arch, ascending aorta, and abdominal aorta and its branches (celiac, mesenteric, renal, hepatic and splenic arteries).

The usual volume as a single injection is 50 mL to 80 mL for the aorta, 30 mL to 60 mL for major branches including celiac and mesenteric arteries, and 5 mL to 15 mL for renal arteries. Repeated injections may be performed if indicated, but the total volume should not exceed 291 mL of iohexol 300 or 250 mL of iohexol 350 (87.5 gI).

Usual Adult Dose for Cerebral Arteriography

Iohexol 300 at a concentration of 300 mgI/mL is indicated in adults for use in cerebral arteriography.

Iohexol 300 is recommended for cerebral arteriography at the following volumes: common carotid artery (6 mL to 12 mL), internal carotid artery (8 mL to 10 mL), external carotid artery (6 mL to 9 mL), and vertebral artery (6 mL to 10 mL).

The degree of pain and flushing as the result of the use of iohexol 300 in cerebral arteriography is less than that seen with comparable injections of many contrast media. In cerebral arteriography, patients should be appropriately prepared consistent with existing or suspected disease states.

Usual Adult Dose for Head Imaging

Head Imaging by Injection: 70 mL to 150 mL (21 gI to 45 gI) of iohexol 300 (300 mgI/mL) or 80 mL (28 gI) of iohexol 350 (350 mgI/mL)

Head Imaging by Infusion: 120 mL to 250 mL (29 gI to 60 gI) of iohexol 240 (240 mgI/mL)

Iohexol may be used to redefine diagnostic precision in areas of the brain which may not otherwise have been satisfactorily visualized.

Tumors:
Iohexol may be useful to investigate the presence and extent of certain malignancies such as: gliomas including malignant gliomas, glioblastomas, astrocytomas, oligodendrogliomas and gangliomas, ependymomas, medulloblastomas, meningiomas, neuromas, pinealomas, pituitary adenomas, craniopharyngiomas, germinomas, and metastatic lesions. The usefulness of contrast enhancement for the investigation of the retrobulbar space and in cases of low grade or infiltrative glioma has not been demonstrated. In calcified lesions, there is less likelihood of enhancement. Following therapy, tumors may show decreased or no enhancement. The opacification of the inferior vermis following iohexol injection contrast media administration has resulted in false-positive diagnosis in a number of otherwise normal studies.

Non-neoplastic Conditions:
Iohexol may be beneficial in the image enhancement of nonneoplastic lesions. Cerebral infarctions of recent onset may be better visualized with contrast enhancement, while some infarctions are obscured if contrast medium is used. The use of iodinated contrast media results in enhancement in about 60 percent of cerebral infarctions studied from one to four weeks from the onset of symptoms.

Sites of active infection may also be enhanced following contrast medium administration.

Arteriovenous malformations and aneurysms will show contrast enhancement. For these vascular lesions the enhancement is probably dependent on the iodine content of the circulating blood pool.

Hematomas and intraparenchymal bleeders seldom demonstrate contrast enhancement. However, in cases of intraparenchymal clot, for which there is no obvious clinical explanation, contrast media administration may be helpful in ruling out the possibility of associated arteriovenous malformation.

Usual Adult Dose for Digital Subtraction Angiography

Intravenous Administration:
Iohexol 350 at a concentration of 350 mgI/mL is indicated in adults for use in intravenous digital subtraction angiography (I.V.DSA) of the vessels of the head, neck, and abdominal, renal and peripheral vessels. Iohexol 350 can be injected intravenously as a rapid bolus to provide arterial visualization using digital subtraction radiography. Preprocedural medications are not considered necessary.

The usual injection volume of iohexol 350 for the intravenous digital technique is 30 mL to 50 mL of a 350 mgI/mL solution. This is administered as a bolus at 7.5 to 30 mL/second using a pressure injector. The volume and rate of injection will depend primarily on the type of equipment and technique used. Frequently three or more injections may be required, up to a total volume not to exceed 250 mL (87.5 gI).

Arteriograms of diagnostic quality can be obtained following the intravenous administration of contrast media employing digital subtraction and computer imaging enhancement techniques. The intravenous route of administration using these techniques has the advantage of being less invasive than the corresponding selective catheter placement of medium. The dose is administered into a peripheral vein, the superior vena cava or right atrium, usually by mechanical injection although sometimes by rapid manual injection. The technique has been used to visualize the ventricles, aorta and most of its larger branches, including the carotids, cerebrals, vertebrals, renal, celiac, mesenteric, and the major peripheral vessels of the limbs. Radiographic visualization of these structures is possible until significant hemodilution occurs.

Iohexol 350 has provided diagnostic arterial radiographs in about 95% of patients. In some cases, poor arterial visualization has been attributed to patient movement. Iohexol 350 is very well tolerated in the vascular system. Patient discomfort (general sensation of heat and/or pain) following injection is less than with various other contrast media.

Intra-arterial Administration:
Iohexol 140 at a concentration of 140 mgI/mL is indicated for use in intra-arterial digital subtraction angiography of head, neck, abdominal, renal and peripheral vessels. The intra-arterial route of administration has the advantages of allowing a lower total dose of contrast agent since there is less hemodilution than with the intravenous route of administration. Patients with poor cardiac output would be expected to have better contrast enhancement following intra-arterial administration as compared with intravenous administration. A higher concentration of contrast agent may be needed to facilitate catheter placement under fluoroscopic control.

Mechanical or hand injection can be used to administer one or more bolus intra-arterial injections of iohexol 140. The volume and rate of injection will depend on the type of equipment, technique used, and the vascular area to be visualized.

Usual Adult Dose for Peripheral Angiography

Iohexol 300 at a concentration of 300 mgI/mL or iohexol 350 at a concentration of 350 mgI/mL is indicated in adults for use in peripheral arteriography. Iohexol 240 at a concentration of 240 mgI/mL or iohexol 300 at a concentration of 300 mgI/mL is indicated in adults for use in peripheral venography.

The volume required will depend on the size, flow rate, and disease state of the injected vessel and on the size and condition of the patient, as well as the imaging technique used.

Recommended dosage for use in peripheral angiography:
Aortofemoral runoffs: 20 mL to 70 mL of iohexol 350 (350 mgI/mL) 30 mL to 90 mL of iohexol 300 (300 mgI/mL)
Selective arteriograms: 10 mL to 30 mL of iohexol 350 (350 mgI/mL) (femoral/iliac) 10 mL to 60 mL of iohexol 300 (300 mgI/mL)
Venography (per leg): 20 mL to 150 mL of iohexol 240 (240 mgI/mL) 40 mL to 100 mL of iohexol 300 (300 mgI/mL)

Sedative medication may be employed prior to use. Anesthesia is not considered necessary. Patient discomfort during and immediately following injection is substantially less than that following injection of various other contrast media. Moderate to severe discomfort is very unusual.

Usual Adult Dose for Urography

Excretory Urography:
Iohexol 300 at a concentration of 300 mgI/mL or iohexol 350 at a concentration of 350 mgI/mL is indicated for use in excretory urography to provide diagnostic contrast of the urinary tract.

Iohexol 300 and iohexol 350 at dosages from 200 mgI/kg body weight to 350 mgI/kg body weight have produced diagnostic opacification of the excretory system in patients with normal renal function.

Usual Adult Dose for Gastrointestinal Tract Examination

Oral Pass-thru Examination of the Gastrointestinal Tract:
The recommended dosage of undiluted iohexol 350 at a concentration of 350 mgI/mL for oral pass-thru examination of the gastrointestinal tract in adults is 50 mL to 100 mL depending on the nature of the examination and the size of the patient.

The recommended oral dosage of iohexol diluted to concentrations of 6 mgI/mL to 9 mgI/mL for contrast enhanced computed tomography of the abdomen in adults is 500 mL to 1000 mL. Smaller administered volumes are needed as the concentration of the final solution is increased. In conjunction with dilute oral administration, the recommended dosage of iohexol 300 administered intravenously is 100 mL to 150 mL. The oral dose is administered about 20 to 40 minutes prior to the intravenous dose and image acquisition.

Iohexol may be diluted with water or beverage.

Dilutions of iohexol should be prepared just prior to use and any unused portion discarded after the procedure.

Endoscopic Retrograde Pancreatography (ERP)/Endoscopic Retrograde Cholangiopancreatography (ERCP):
Lower volumes are recommended for double-contrast examinations and higher volumes are recommended for single-contrast examinations.

Attention should be paid to the injection pressure and total volume injected to minimize disruptive distention of the ducts examined.

Recommended dose of iohexol 240 at a concentration of 240 mgI/mL:
10 mL to 50 mL but may vary depending on individual anatomy and/or disease state.

Herniography:
Recommended dosage of iohexol 240: 50 mL but may vary depending on individual anatomy and/or disease state.

Usual Adult Dose for Body Imaging

CT Scanning of the Body:
Iohexol may be useful for enhancement of computed tomographic images for detection and evaluation of lesions in the liver, pancreas, kidneys, aorta, mediastinum, pelvis, abdominal cavity, and retroperitoneal space.

Enhancement of computed tomography with iohexol may be of benefit in establishing diagnoses of certain lesions in these sites with greater assurance than is possible with CT alone. In other cases, the contrast agent may allow visualization of lesions not seen with CT alone or may help to define suspicious lesions seen with unenhanced CT.

The concentration and volume required will depend on the equipment and imaging technique used.

Recommended dosage for contrast enhanced computed tomography:
Body Imaging by Injection: 50 mL to 200 mL (15 gI to 60 gI) of iohexol 300 (300 mgI/mL) 60 mL to 100 mL (21 gI to 35 gI) of iohexol 350 (350 mgI/mL)

Usual Adult Dose for Arthrography

Arthrography:
Iohexol 240 at a concentration of 240 mgI/mL or iohexol 300 at a concentration of 300 mgI/mL or iohexol 350 at a concentration of 350 mgI/mL is indicated in radiography of the knee joint in adults, and iohexol 240 at a concentration of 240 mgI/mL or iohexol 300 at a concentration of 300 mgI/mL is indicated in radiography of the shoulder joint in adults, and iohexol 300 at a concentration of 300 mgI/mL is indicated in radiography of the temporomandibular joint in adults. Arthrography may be helpful in the diagnosis of posttraumatic or degenerative joint diseases, synovial rupture, the visualization of communicating bursae or cysts, and in meniscography.

Strict aseptic technique is required to prevent infection. Fluoroscopic control should be used to ensure proper needle placement, prevent extracapsular injection, and prevent dilution of contrast medium.

Undue pressure should not be exerted during injection.

Recommended dosage:
Arthrography is usually performed under local anesthesia. The amount of iohexol injected is dependent on the size of the joint to be examined and the technique employed. Lower volumes of contrast medium are usually injected for knee and shoulder arthrography when double-contrast examinations using 15 mL to 100 mL of air are performed.

The following concentrations and volumes are recommended for normal adult knee, shoulder, and temporomandibular joints but should serve as guidelines since joints may require more or less contrast medium for optimal visualization.

Knee:
iohexol 240 5 mL to 15 mL
iohexol 300 5 mL to 15 mL
iohexol 350 5 mL to 10 mL

Shoulder:
iohexol 300 10 mL
iohexol 240 3 mL

Temporomandibular:
iohexol 300 0.5 mL to 1.0 mL

Passive or active manipulation is used to disperse the medium throughout the joint space.

Usual Adult Dose for Hysterosalpingography

Hysterosalpingography:
Iohexol 240 at a concentration of 240 mgI/mL or iohexol 300 at a concentration of 300 mgI/mL is indicated in radiography of the internal group of adult female reproductive organs: ovaries, fallopian tubes, uterus, and vagina. Hysterosalpingography is utilized as a diagnostic and therapeutic modality in the treatment of infertility and other abnormal gynecological conditions.

The procedure should not be performed during the menstrual period or when menstrual flow is imminent, nor should it be performed when infection is present in any portion of the genital tract, including the external genitalia. The procedure is also contraindicated for pregnant women or for those in whom pregnancy is suspected. Its use is not advised for 6 months after termination of pregnancy or 30 days after conization or curettage.

Recommended dosage of iohexol 240: 15 mL to 20 mL and of iohexol 300 is 15 mL to 20 mL but will vary depending on individual anatomy and/or disease state.

Usual Pediatric Dose for Myelography

Intrathecal:
The volume and concentration of iohexol 180 to be administered will depend on the degree and extent of contrast required in the area(s) under examination and on the equipment and technique employed.

Iohexol 180 at a concentration of 180 mgI/mL is recommended for the examination of the lumbar, thoracic, and cervical regions in children by lumbar injection and is slightly hypertonic to CSF.

A total dose of 2700 mg iodine or a concentration of 180 mgI/mL should not be exceeded in children in a single myelographic examination. This is based on clinical trial evaluation to date. As in all diagnostic procedures, the minimum volume and dose to produce adequate visualization should be used. Most procedures do not require either maximum dose or concentration.

Anesthesia is not necessary. Premedication sedatives or tranquilizers are usually not needed. Patients should be well hydrated prior to and following contrast administration.

Seizure-prone patients should be maintained on anticonvulsant medication.

Many radiopaque contrast agents are incompatible in vitro with some antihistamines and many other drugs; therefore, concurrent drugs should not be physically admixed with contrast agents.

Rate of Injection: To avoid excessive mixing with CSF and consequent dilution of contrast, injection should be made slowly over 1 to 2 minutes.

Depending on the estimated volume of contrast medium which may be required for the procedure a small amount of CSF may be removed to minimize distention of the subarachnoid spaces.

The lumbar or cervical puncture needle may be removed immediately following injection since it is not necessary to remove iohexol after injection into the subarachnoid space.

The usual recommended total doses for lumbar, thoracic, cervical, and/or total columnar myelography by lumbar puncture in children are 0.36 gI to 2.7 gI. Actual volumes administered depend largely on patient age.

If in the clinical judgment of the physician sequential or repeat examinations are required, a suitable interval of time between administrations should be observed to allow for normal Iohexol clearance of the drug from the body. An interval of at least 48 hours should be allowed before repeat examination; however, whenever possible, 5 to 7 days is recommended.

Usual Pediatric Dose for Angiocardiography

The individual dose or volume is determined by the size of the structure to be visualized, the anticipated degree of hemodilution, and valvular competence. Weight must be considered in infants and young children. The volume of each individual injection is a more important consideration than the total dosage used. When large individual volumes are administered, as in ventriculography and aortography, it has been suggested that several minutes be permitted to elapse between each injection to allow for subsidence of possible hemodynamic disturbances.

The recommended single injection volume of iohexol 350 and iohexol 300 for angiographic procedures in children are as follows:

Ventriculography:
The usual single injection dose of iohexol 350 is 1.25 mL/kg of body weight with a range of 1.0 mL/kg to 1.5 mL/kg. For iohexol 300 the usual single injection dose is 1.75 mL/kg with a range of 1.5 mL/kg to 2.0 mL/kg. When multiple injections are given, the total administered dose should not exceed 5 mL/kg up to a total volume of 250 mL of iohexol 350 or up to a total volume of 291 mL of iohexol 300.

Pulmonary Angiography:
The usual single injection dose is 1.0 mL/kg of iohexol 350.

Combined Angiocardiographic Procedures:
Multiple Procedures:
Visualization of multiple vascular systems and target organs is possible during a single radiographic examination of the patient. The maximum total dose for multiple injection procedures should not exceed 5.0 mL/kg up to a total volume of 250 mL of iohexol 350 or 6.0 mL/kg up to a total volume of 291 mL of iohexol 300.

Usual Pediatric Dose for Visceral Arteriography

Iohexol 350 at a concentration of 350 mgI/mL is indicated in children for use in aortography including studies of the aortic root, aortic arch, ascending and descending aorta.

The usual single injection dose is 1.0 mL/kg of iohexol 350 and should not exceed 5.0 mL/kg up to a total volume of 250 mL of iohexol 350.

Usual Pediatric Dose for Aortography

Iohexol 350 at a concentration of 350 mgI/mL is indicated in children for use in aortography including studies of the aortic root, aortic arch, ascending and descending aorta.

The usual single injection dose is 1.0 mL/kg of iohexol 350 and should not exceed 5.0 mL/kg up to a total volume of 250 mL of iohexol 350.

Usual Pediatric Dose for Head Imaging

For contrast enhanced computed tomographic head imaging: 1.0 mL/kg to 2.0 mL/kg for iohexol 240 or iohexol 300. It should not be necessary to exceed a maximum dose of 28 gI with iohexol 240 or 35 gI with iohexol 300.

Iohexol may be used to redefine diagnostic precision in areas of the brain which may not otherwise have been satisfactorily visualized.

Tumors:
Iohexol may be useful to investigate the presence and extent of certain malignancies such as: gliomas including malignant gliomas, glioblastomas, astrocytomas, oligodendrogliomas and gangliomas, ependymomas, medulloblastomas, meningiomas, neuromas, pinealomas, pituitary adenomas, craniopharyngiomas, germinomas, and metastatic lesions. The usefulness of contrast enhancement for the investigation of the retrobulbar space and in cases of low grade or infiltrative glioma has not been demonstrated. In calcified lesions, there is less likelihood of enhancement. Following therapy, tumors may show decreased or no enhancement. The opacification of the inferior vermis following iohexol injection contrast media administration has resulted in false-positive diagnosis in a number of otherwise normal studies.

Non-neoplastic Conditions:
Iohexol may be beneficial in the image enhancement of nonneoplastic lesions. Cerebral infarctions of recent onset may be better visualized with contrast enhancement, while some infarctions are obscured if contrast medium is used. The use of iodinated contrast media results in enhancement in about 60 percent of cerebral infarctions studied from one to four weeks from the onset of symptoms.

Sites of active infection may also be enhanced following contrast medium administration.

Arteriovenous malformations and aneurysms will show contrast enhancement. For these vascular lesions the enhancement is probably dependent on the iodine content of the circulating blood pool.

Hematomas and intraparenchymal bleeders seldom demonstrate contrast enhancement. However, in cases of intraparenchymal clot, for which there is no obvious clinical explanation, contrast media administration may be helpful in ruling out the possibility of associated arteriovenous malformation.

Usual Pediatric Dose for Cystourethrography

Voiding cystourethrography is often performed in conjunction with excretory urography.

Excretory Urography:
Iohexol 300 at a concentration of 300 mgI/mL is indicated for excretory urography.

Iohexol 300 at doses of 0.5 mL/kg to 3.0 mL/kg of body weight has produced diagnostic opacification of the excretory tract. The usual dose for children is 1.0 mL/kg to 1.5 mL/kg. Dosage for infants and children should be administered in proportion to age and body weight. The total administered dose should not exceed 3 mL/kg.

Voiding Cystourethrography (VCU):
Iohexol may be diluted to a concentration of 50 mgI/mL to 100 mgI/mL for voiding cystourethrography. The concentration may vary depending upon the patient's size and age and also with the technique and equipment used. Sufficient volume of contrast medium should be administered to adequately fill the bladder. The usual volume ranges from 50 mL to 300 mL of iohexol at a concentration of 100 mgI/mL and 50 mL to 600 mL of iohexol at a concentration of 50 mgI/mL.

Dilutions of iohexol should be prepared just prior to use and any unused portion discarded after the procedure.

Usual Pediatric Dose for Gastrointestinal Tract Examination

Oral Pass-thru Examination of the Gastrointestinal Tract:
The dosage of undiluted iohexol 300 at a concentration of 300 mgI/mL, iohexol 240 at a concentration of 240 mgI/mL or iohexol 180 at a concentration of 180 mgI/mL for oral pass-thru examination of the gastrointestinal tract in children is dependent on the nature of the examination and the size of the patient. Based on clinical experience, it is recommended that iohexol 180 be used in children less than 3 months of age. Iohexol 180, iohexol 240 or iohexol 300 may be used in children 3 months of age and older.

The following dosage guidelines are recommended:
Age/Volume of iohexol:
Less than 3 months: 5 to 30 mL
Three months to 3 years: Up to 60 mL
Four years to 10 years: Up to 80 mL
Greater than 10 years: Up to 100 mL
When given rectally, larger volumes may be used.

The recommended oral dosage of iohexol diluted to concentrations of 9 mgI/mL to 21 mgI/mL for contrast enhanced computed tomography of the abdomen in children is 180 mL to 750 mL. Smaller administered volumes are needed as the concentration of the final solution is increased. The total oral dose in grams of iodine should generally not exceed 5 gI for children less than 3 years of age and 10 gI for children from 3 to 18 years of age. The oral dosage may be given all at once or over a period of 30 to 45 minutes if there is difficulty in consuming the required volume.

In conjunction with dilute oral administration the recommended dosage of iohexol 240 and iohexol 300 is 2.0 mL/kg when administered intravenously with a range of 1.0 mL/kg to 2.0 mL/kg. Dosage for infants and children should be administered in proportion to age and body weight. The total intravenously administered dose should not exceed 3 mL/kg. The oral dose is administered about 30 to 60 minutes prior to the intravenous dose and image acquisition.

Iohexol may be diluted with water or beverage.

Dilutions of iohexol should be prepared just prior to use and any unused portion discarded after the procedure.

Herniography:
Recommended dosage of iohexol 240: 50 mL but may vary depending on individual anatomy and/or disease state.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

The lowest dose of iohexol necessary to obtain adequate visualization should be used. A lower dose may reduce the possibility of an adverse reaction. Most procedures do not require use of either the maximum volume or the highest concentration of iohexol. The combination of volume and concentration of iohexol to be used should be carefully individualized accounting for factors such as age, body weight, size of the vessel and the rate of blood flow within the vessel. Other factors such as anticipated pathology, degree and extent of opacification required, structure(s) or area to be examined, disease processes affecting the patient, and equipment and technique to be employed should be considered.

Precautions

CONTRAINDICATIONS:

• Hysterosalpingography (240 mg and 300 mg body cavity formulations) is contraindicated during pregnancy or suspected pregnancy, menstruation or when menstrual flow is imminent, within 6 months after termination of pregnancy, within 30 days after conization or curettage, when signs of infection are present in any portion of the genital tract including the external genitalia, and when reproductive tract neoplasia is known or suspected because of the risk of peritoneal spread of neoplasm.
• Injection formulations of 140 mg and 350 mg are contraindicated for intrathecal use.
• Oral solutions of 9 mg and 12 mg are contraindicated for parenteral administration.

US BOXED WARNING:

• INADVERTENT INTRATHECAL USE: Inadvertent intrathecal administration may cause death, convulsions, seizures, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, rhabdomyolysis, hyperthermia, and brain edema. Iohexol 140 and 350 are not for intrathecal use.

• Safety and effectiveness of this drug have not been established in pediatric patients for intra-arterial digital subtraction angiography, intravenous digital subtraction angiography, cerebral arteriography, peripheral arteriography, venography, arthrography, ERCP, herniography, or hysterosalpingography.
• Safety and efficacy of iohexol 180 have not been established for intrathecal use in pediatric patients younger than 2 weeks.
• Safety and effectiveness of iohexol 240 and 300 have not been established in pediatric patients for myelography (lumbar, thoracic, cervical, total columnar) and for CT (myelography, cisternography, or ventriculography).
• Safety and effectiveness of iohexol 300 have not been established in pediatric patients for aortography.
• Safety and effectiveness of iohexol 350 have not been established in pediatric patients for CT imaging of the head and body.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

It may be desirable that solutions of radiopaque diagnostic agents be used at body temperature when injected.

Under conditions of slowed aortic circulation there is an increased likelihood for aortography to cause muscle spasm. Occasional serious neurologic complications, including paraplegia, have also been reported in patients with aortoiliac obstruction, femoral artery obstruction, abdominal compression, hypotension, hypertension, spinal anesthesia, and injection of vasopressors to increase contrast. In these patients the concentration, volume and number of repeat injections of the medium should be maintained at a minimum with appropriate intervals between injections. The position of the patient and catheter tip should be carefully monitored. Entry of a large aortic dose into the renal artery may cause, even in the absence of symptoms, albuminuria, hematuria, and an elevated creatinine and urea nitrogen. Rapid and complete return of function usually follows.

Cerebral arteriography should be undertaken with extreme care with special caution in elderly patients, patients in poor clinical condition, advanced arteriosclerosis, severe arterial hypertension, recent cerebral embolism or thrombosis, and cardiac decompensation. Since the contrast medium is given by rapid injection, the patient should be monitored for possible reactions.

Digital Subtraction Angiography via Intravenous Administration: Since the contrast medium is usually administered mechanically under high pressure, rupture of smaller peripheral veins can occur. It has been suggested that this can be avoided by using an intravenous catheter threaded proximally beyond larger tributaries or, in the case of the antecubital vein, into the superior vena cava. Sometimes the femoral vein is used.

High pressure intra-arterial injections may also cause the rupture of smaller peripheral arteries.

Peripheral Angiography: Pulsation should be present in the artery to be injected. In thromboangiitis obliterans, or ascending infection associated with severe ischemia, angiography should be performed with extreme caution, if at all.

Excretory Urography via Intravascular Administration: Preparatory dehydration is not recommended in the elderly, infants, young children, diabetic, or azotemic patients, or in patients with suspected myelomatosis. Pediatric patients at higher risk of experiencing adverse events during contrast medium administration may include those having asthma, sensitivity to medication and/or allergens, congestive heart failure, a serum creatinine greater than 1.5 mg/dL or those less than 12 months of age. Since there is a possibility of temporary suppression of urine formation, it is recommended that a suitable interval elapse before excretory urography is repeated, especially in patients with unilateral or bilateral reduction in renal function.

Because the voiding cystourethrography procedure requires instrumentation, special precautions should be observed in those patients known to have an acute urinary tract infection. Filling of the bladder should be done at a steady rate, exercising caution to avoid excessive pressure. Sterile procedures are essential.

In patients with carcinoma or in those in whom the condition is suspected, caution should be exercised to avoid possible spreading of the lesion by hysterosalpingography. Injection of iohexol in hysterosalpingography has been associated with immediate but transient pain. The cause of the pain may be due as much to the procedure itself as to the contrast medium injected, therefore attention should be paid to the injection pressure and volume instilled to avoid disruptive distention of the uterus and fallopian tubes. Fluoroscopic monitoring is recommended.

Sterile technique must be used in all vascular injections involving contrast media.

Withdrawal of contrast agents from their containers should be accomplished under aseptic conditions with sterile equipment.

Sterile techniques must be used with any invasive procedure.

If nondisposable equipment is used, scrupulous care should be taken to prevent residual contamination with traces of cleansing agents.

Further information

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