Adult Dosing
Lumbar, thoracic, cervical, and total columnar myelography
Omnipaque 180 (180 mgI/mL)
- Lumbar myelography, via lumbar injection 10-17 mL (1.8-3.06 gI)
- Cervical myelography, via C1-C2 injection: 7-10 mL (1.3-1.8 gI)
Omnipaque 240 (240 mgI/mL)
- Lumbar myelography, via lumbar injection: 7-12.5 mL (1.7-3.0 gI)
- Thoracic myelography, via lumbar/cervical injection: 6-12.5 mL (1.7-3.0 gI)
- Cervical myelography, via lumbar/C1-C2 injection: 6-12.5 mL (1.4-3.0 gI)
- Total columnar myelography, via lumbar injection: 6-12.5 mL (1.4-3.0 gI)
Omnipaque 300 (300 mgI/mL)
- Thoracic myelography, via lumbar/cervical injection: 6-10 mL (1.8-3.0 gI)
- Cervical myelography, via lumbar injection: 6-10 mL (1.8-3.0 gI); via C1-C2 injection: 4-10 mL (1.2-3.0 gI)
- Total columnar myelography, via lumbar injection: 6-10 mL (1.8-3.0 gI)
Notes:- Injection should be administered slowly over 1-2 minutes to avoid excessive mixing with CSF
- Max: 300 mgI/mL or 3060 mg iodine per single myelographic examination
- Patients should be well hydrated prior to and following contrast administration; maintain seizure-prone patients on anticonvulsant medication
Pediatric Dosing
Lumbar, thoracic, cervical, and total columnar myelography
Omnipaque 180 (180 mgI/mL)
- 0 - <3 months: 2-4 mL (0.36-0.72 gI)
- 3 - <36 months: 4-8 mL (0.72-1.44 gI)
- 3 - <7 years: 5-10 mL (0.9-1.8 gI)
- 7 - <13 years: 5-12 mL (0.9-2.16 gI)
- 13-18 years: 6-15 mL (1.08-2.7 gI)
Notes:- Injection should be administered slowly over 1-2 minutes to avoid excessive mixing with CSF
- Max: 180 mgI/mL or 2700 mg iodine per single myelographic examination
- Patients should be well hydrated prior to and following contrast administration; maintain seizure-prone patients on anticonvulsant medication
[Outline]
See Supplemental Patient Information
- Serious adverse reactions including death, convulsions, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, seizures, rhabdomyolysis, hyperthermia, and brain edema have been reported due to the inadvertent intrathecal administration of iodinated contrast media that are not recommended for intrathecal use. Exercise extreme caution not to administer Omnipaque 140 and 350 intrathecally
- If grossly bloody CSF is encountered during the procedure, consider the possible benefits of a myelographic procedure in terms of the risk to the patient
- Elderly patients are at greater risk following myelography and should be evaluated carefully. Special attention should be given to dose and concentration of the medium, hydration, and technique used
- Patients receiving anticonvulsants should be maintained on this therapy. If a seizure occurs, intravenous diazepam or phenobarbital sodium is recommended. Premedication with barbiturates is recommended in patients with a history of seizure activity who are not on anticonvulsant therapy
- Consider prophylactic anticonvulsant treatment with barbiturates in patients with evidence of inadvertent intracranial entry of a large or concentrated bolus of the contrast medium as there may be an increased risk of seizure
- Concomitant use of phenothiazine derivatives, including those used for their antihistamine properties, MAO inhibitors, tricyclic antidepressants, CNS stimulants, and psychoactive drugs such as analeptics, major tranquilizers, or antipsychotic drugs are not recommended
- Exercise caution to prevent inadvertent intracranial entry of a large dose or concentrated bolus of the medium. Utmost care should also be taken to avoid rapid dispersion of the medium causing inadvertent rise to intracranial levels. Direct intracisternal or ventricular administration for standard radiography (not CT) is not indicated
- Diagnostic procedures involving the use of radiopaque diagnostic agents should be performed under the direction of personnel with the prerequisite training and knowledge of the particular procedure to be performed. Appropriate medical facilities and emergency treatment of severe reactions to the contrast agent should be readily available for coping with any complications of the procedure
- Patients should be well hydrated prior to and following administration of iohexol, as preparatory dehydration may contribute to acute renal failure in patients with advanced vascular disease, diabetic patients, and in susceptible nondiabetic patients. Dehydration in these patients is enhanced by the osmotic diuretic action of contrast agents
- Before initiating therapy, consider the possibility of a serious, life-threatening, fatal, anaphylactoid, cardiovascular or CNS reactions. Consider the possibility of an idiosyncratic reaction in susceptible patients, particularly those with a history of a previous reaction to contrast media, patients with a known sensitivity to iodine per se, and patients with a known clinical hypersensitivity including bronchial asthma, hay fever, and food allergies
- Prior to administration of any contrast media, a thorough medical history with emphasis on allergy and hypersensitivity is recommended
- Exercise caution in patients with a positive history of allergies or hypersensitivity. Consider pre-medication with antihistamines or corticosteroids to reduce the incidence and severity of possible allergic reactions in such patients
- Administration of contrast media should be performed cautiously in patients with severely impaired renal function and those with combined renal and hepatic disease
- If the contrast media is to be injected using plastic disposable syringes, it should be drawn into the syringe and used immediately
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Pheochromocytoma
- Renal transplant recipients
- History of epilepsy
- Severe cardiovascular disease
- Chronic alcoholism
- Multiple sclerosis
Supplemental Patient Information
- Advise patients to keep their physicians informed if they are diabetic or if they have multiple myeloma, known thyroid disorder, pheochromocytoma, or homozygous sickle cell disease
Pregnancy Category:B
Breastfeeding: Safety unknown. Limited information indicates that maternal doses of iohexol up to 45.3 g (containing 21 g of iodine) produce low levels in milk. Guidelines developed by several professional organizations state that breastfeeding need not be disrupted after a nursing mother receives an iodine-containing contrast medium. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 8 December 2011). It is not known to what extent iohexol is excreted in breast milk. Because many injectable contrast agents are excreted unchanged in human milk, manufacturer advises caution. Bottle feedings may be substituted for breast feedings for 24 hrs following product administration
