Adult Dosing
Angiocardiography: Ventriculography, aortic root injections, and selective coronary arteriography
Ventriculography
- Usual volume: 40 mL/injection with a range of 30-60 mL; may be repeated PRN (Omnipaque 350)
- With selective coronary arteriography, maximum total volume is 250 mL (87.5 gI) (Omnipaque 350)
Selective coronary arteriography
- Usual volume: 5 mL per injection with a range of 3-14 mL
Aortic root and arch study when used alone
- Usual volume: 50 mL; range: 20-75 mL
Combined angiocardiographic procedures
- Multiple Procedures
- Maximum total volume: 250 mL (87.5 gI) (Omnipaque 350)
Aortography and selective visceral arteriography (Omnipaque 300, Omnipaque 350)
- Usual single injection volume: 50-80 mL for the aorta, 30-60 mL for major branches including celiac and mesenteric arteries, and 5-15 mL for renal arteries
- May repeat injections PRN, but the total volume should not exceed 291 mL of Omnipaque 300 or 250 mL of Omnipaque 350
Cerebral arteriography
Omnipaque 300
- Common carotid artery: 6-12 mL
- Internal carotid artery: 8-10 mL
- External carotid artery: 6-9 mL
- Vertebral artery: 6-10 mL
CT scanning of the head and body
- Head imaging via injection: 70-150 mL (21-45 gI) (Omnipaque 300); 80 mL (28 gI) (Omnipaque 350)
- Head imaging via infusion: 120-250 mL (29-60 gI) (Omnipaque 240)
- Body imaging via injection: 50-200 mL (15-60 gI) (Omnipaque 300); 60-100 mL (21 gI to 35 gI) (Omnipaque 350)
Digital subtraction angiography
- Usual volume: 30-50 mL (Omnipaque 350)
- Administer as bolus at 7.5-30 mL/sec using pressure injector
- Three or more injections may be required, up to a total volume not to exceed 250 mL
Intra-arterial (Omnipaque 140)
- Administer one or more bolus via intra-arterial injections
- Aorta: 20-45 mL at 8-20 mL/sec
- Carotid: 5-10 mL at 3-6 mL/sec
- Femoral: 9-20 mL at 3-6 mL/sec
- Vertebral: 4-10 mL at 2-8 mL/sec
- Renal: 6-12 mL at 3-6 mL/sec
- Other branches of the aorta: 8-25 mL at 3-10 mL/sec
Peripheral angiography
- Aortofemoral runoffs: 20-70 mL (Omnipaque 350); 30-90 mL (Omnipaque 300)
- Selective arteriograms (femoral/iliac): 10-30 mL (Omnipaque 350); 10-60 mL (Omnipaque 300)
- Venography (per leg): 20-150 mL (Omnipaque 240); 40-100 mL (Omnipaque 300)
Excretory urography
Omnipaque 300/350
- 200-350 mgI/kg body weight may produce diagnostic opacification of the excretory system in patients with normal renal function
Pediatric Dosing
Angiocardiography: Ventriculography, pulmonary arteriography, venography and studies of the collateral arteries
Ventriculography
- Usual dose: 1.25 mL/kg with a range of 1-1.5 mL/kg; NMT 5 mL/kg or a total volume of 250 mL (Omnipaque 350)
- Usual dose: 1.75 mL/kg with a range of 1.5-2 mL/kg; NMT 5 mL/kg or a total volume of 291 mL (Omnipaque 300)
Pulmonary angiography
- Usual dose: 1 mL/kg (Omnipaque 350) per injection
Combined angiographic procedures
- Multiple Procedures
- Maximum total volume should not exceed 5 mL/kg up to a total volume of 250 mL (Omnipaque 350)
- Maximum total volume should not exceed 6 mL/kg up to a total volume of 291 mL (Omnipaque 300)
Aortography and selective visceral arteriography (Omnipaque 300, Omnipaque 350)
- Usual single injection dose is 1 mL/kg and should not exceed 5 mL/kg up to a total volume of 250 mL (Omnipaque 350)
CT scanning of the head and body
- Head Imaging: 1-2 mL/kg (Omnipaque 240 or Omnipaque 300)
- Do not exceed a maximum dose of 28 gI with Omnipaque 240 or 35 gI with Omnipaque 300
Excretory urography
Omnipaque 300
- 0.5-3 mL/kg of body weight may produce diagnostic opacification of the excretory tract
- Usual dose: 1-1.5 mL/kg; Max: 3 mL/kg
Note:
- Dosage for infants and children should be administered in proportion to age and body weight
[Outline]
See Supplemental Patient Information
- Clotting has been reported when blood remains in contact with syringes containing nonionic contrast media
- Life-threatening thromboembolic events causing MI and stroke have been occasionally reported during angiographic procedures with ionic and nonionic contrast media. This event can be minimized by meticulous intravascular administration technique during angiographic procedures
- Exercise caution in patients with severe functional disturbances of the liver and kidneys, severe thyrotoxicosis, or myelomatosis. Iohexol is not recommended for use in patients with anuria
- Radiopaque contrast agents are potentially hazardous in patients with multiple myeloma or other paraproteinemia, particularly in those with therapeutically resistant anuria. Partial dehydration in the preparation of these patients prior to injection is not recommended since this may predispose the patient to precipitation of the myeloma protein in the renal tubules. No form of therapy, including dialysis, has been successful in reversing this effect
- Intravenous or intra-arterial administration of ionic contrast media may promote sickling in individuals who are homozygous for sickle cell disease
- Radiopaque materials should be administered cautiously to patients known or suspected of having pheochromocytoma. Blood pressure should be assessed throughout the procedure and measures for the treatment of hypertensive crisis should be readily available
- Thyroid storm has been reported with the use of iodinated, ionic radiopaque contrast media in patients with hyperthyroidism or with an autonomously functioning thyroid nodule; consider evaluating this additional risk in such patients before use of any contrast medium
- Perform urography cautiously in patients with severely impaired renal function and those with combined renal and hepatic disease
- 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, infants and small children. Dehydration in these patients is enhanced by the osmotic diuretic action of contrast agents
- Acute renal failure may occur in diabetic patients with diabetic nephropathy and in susceptible non-diabetic patients following excretory urography. Carefully consider the potential risks before performing radiographic procedure in such patients
- Before initiating therapy, consider the possibility of a serious, life-threatening, fatal, anaphylactoid, or cardiovascular 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 may require general anesthesia in selected adult patients; however, a higher incidence of adverse reactions has been reported in such patients
- Avoid angiography whenever possible in patients with homocystinuria due to the risk of inducing thrombosis and embolism. During angiographic procedures, the possibility of dislodging plaques or damaging or perforating the vessel wall should be borne in mind during the catheter manipulations and contrast medium injection
- Continuous monitoring of vital signs is recommended during administration of large doses of Omnipaque 350. Large volumes of solution should be administered cautiously in patients with incipient heart failure because of the possibility of aggravating the preexisting condition. Hypotension should be corrected as it may induce serious arrhythmias
- Undertake special care regarding dosage in patients with right ventricular failure, pulmonary hypertension, or stenotic pulmonary vascular beds because of the hemodynamic changes which may occur after injection into the right heart outflow tract
- During contrast medium administration, pediatric patients may be at a higher risk of developing adverse events, particularly those having asthma, a sensitivity to medication and/or allergens, CHF, a serum creatinine >1.5 mg/dL or those <12 months of age
- Entry of a large aortic dose into the renal artery may cause albuminuria, hematuria, and elevated creatinine and urea nitrogen
- High pressure intra-arterial injections may cause rupture of small peripheral arteries
- Pulsation should be present in the artery to be injected. Angiography should be performed with extreme caution, if at all, in thromboangiitis obliterans, or ascending infection associated with severe ischemia
- Because there is a possibility of temporary suppression of urine formation, it is recommended that a suitable interval elapse before excretory urography is repeated, particularly in patients with unilateral or bilateral reduction in renal function
- 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
- CHF
- Renal transplant recipients
- Myelomatous patients
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
