Adult Dosing
Oral pass-thru examination of the gastrointestinal tract
Omnipaque 350
- Usual dose: 50-100 mL depending on nature of examination and patient size
Contrast enhanced CT of the abdomen
Omnipaque 300
- Dilute PO dose to concentrations of 6-9 mgI/mL and administer in combination with IV dose
- Recommended PO dose: 500-1000 mL; administer dose 20-40 min prior to IV dose and image acquisition
- Recommended IV dose: 100-150 mL
Arthrography
- Radiography of the knee joint
- 5-15 mL (Omnipaque 240/300)
- 5-10 mL (Omnipaque 350)
- Radiography of the shoulder joint
- 3 mL (Omnipaque 240)
- 10 mL (Omnipaque 300)
- Radiography of the temporomandibular joint
Notes:- Amount injected is dependent on the size of the joint to be examined and the technique employed. Lower volumes of contrast medium are recommended for double-contrast examinations; higher volumes recommended for single-contrast examinations
Endoscopic retrograde pancreatography (ERP)/Endoscopic retrograde cholangiopancreatography (ERCP)
- Recommended dose: 10-50 mL depending on individual anatomy and/or disease state (Omnipaque 240)
Hysterosalpingography
- Recommended dose: 15-20 mL depending on individual anatomy and/or disease state (Omnipaque 240, 300)
Herniography
- Recommended dose: 50 mL depending on individual anatomy and/or disease state (Omnipaque 240)
Pediatric Dosing
Oral pass-thru examination of the GI tract (depending on nature of examination and patient size)
- <3 months: 5-30 mL (Omnipaque 180)
- 3 months-3 years: Up to 60 mL (Omnipaque 180/240/300)
- 4-10 years: Up to 80 mL (Omnipaque 180/240/300)
- >10 years: Up to 100 mL (Omnipaque 180/240/300)
- Larger volumes may be used when given rectally
Contrast enhanced CT of the abdomen
Omnipaque 240, 300
- Dilute PO dose to concentrations of 9-21 mgI/mL and administer in combination with IV dose
- Recommended PO dose: 180-750 mL; administer dose 30-60 min prior to IV dose and image acquisition
- Recommended IV dose: 2 mL/kg (range 1-2 mL/kg); Max: 3 mL/kg
- <3 years: Total PO dose in grams of iodine should not exceed 5 gI
- 3-18 years: Total PO dose in grams of iodine should not exceed 10 gI
- Administer total oral dose all at once or over 30-45 min if there is difficulty consuming the required volume
Voiding cystourethrography (VCU)
- 50-300 mL of Omnipaque at a concentration of 100 mgI/mL
- 50-600 mL of Omnipaque at a concentration of 50 mgI/mL
[Outline]
- Hypovolemia has been reported following oral administration of hypertonic contrast media. The occurrence of diarrhea may result in hypovolemia in infants and young children. Plasma fluid loss may cause a shock-like state that could be dangerous if untreated, particularly in the elderly/cachectic patients as well as infants and small children
- Clotting has been reported when blood remains in contact with syringes containing nonionic contrast media
- Serious thromboembolic events causing MI and stroke have been reported during angiographic procedures with ionic and nonionic contrast media. Factors contributing to the development of thromboembolic events include length of procedure, underlying disease state, catheter and syringe material, and concomitant medications
- Use cautiously in patients with severe functional disturbances of the liver and kidneys, severe thyrotoxicosis, or myelomatosis. Therapy is not recommended for use in patients with anuria
- Radiopaque contrast media are potentially hazardous in patients with multiple myeloma, especially in those with therapeutically resistant anuria
- Administer radiopaque materials cautiously in 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
- There have been reports of thyroid storm following the use of iodinated, ionic radiopaque contrast media in patients with hyperthyroidism or with an autonomously functioning thyroid nodule
- Perform urography cautiously in patients with severely impaired renal function and patients 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, and appropriate medical facilities 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 urographic agents
- Acute renal failure may occur in diabetic patients with diabetic nephropathy and in susceptible non-diabetic patients following excretory urography. Adequate care should be taken before performing radiographic procedure in these patients
- Before initiating therapy, consider the possibility of 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: 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
- Because the VCU procedure requires instrumentation, extreme caution should be exercised in patients with acute urinary tract infection. Bladder filling should be done at a steady rate, with care to avoid excessive pressure
- Performance of certain procedures may require general anesthesia in certain adult patients; however, this may be accompanied by a higher incidence of adverse reactions in such patients
- Exercise caution to avoid possible spreading of the lesion by the procedure in patients with carcinoma or in those in whom the condition is suspected
- Avoid angiography, whenever possible, in patients with homocystinuria because of the risk of inducing thrombosis and embolism. During angiographic procedures, the possibility of dislodging plaques or damaging/perforating the vessel wall should be borne in mind during the catheter manipulations and contrast medium injection
Cautions: Use cautiously in:
- Renal impairment
- Hepatic impairment
- Pheochromocytoma
- Renal transplant recipients
Pregnancy Category:B
Breastfeeding: Safety unknown. Limited information indicates that maternal doses of iohexol up to 45.3 grams (containing 21 grams of iodine) produce low levels in milk. Because, iohexol is poorly absorbed orally, it is not likely to reach the bloodstream of the infant or cause any adverse effects in breastfed infants. 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 12 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.
