Adult Dosing
Intra-arterial procedures
Intra-arterial digital subtraction angiography (150 mg I/mL)
- Carotid arteries: 6-10 mL
- Vertebral arteries: 4-8 mL
- Aorta: 20-50 mL
- Major branches of the abdominal aorta: 2-20 mL
- Max total dose: 250 mL
Cerebral arteriography (300 mg I/mL)
- Carotid arteries: 3-12 mL
- Vertebral arteries: 4-12 mL
- Aortic arch injection: 20-50 mL
- Max total dose: 150 mL
Peripheral arteriography (300 mg I/mL)
- Subclavian or femoral artery: 5-40 mL
- Aortic bifurcation (distal runoff): 25-50 mL
- Max total dose: 250 mL
Coronary arteriography and left ventriculography (370 mg I/mL)
- Right coronary artery: 3-14 mL
- Left coronary artery: 3-14 mL
- Left ventricle: 30-60 mL
- Max total dose: 225 mL
Aortography and visceral angiography (370 mg I/mL)
- Administer contrast injection proportional to the blood flow and related to the vascular and pathological characteristics of the specific vessels
- Max total dose: 225 mL
Intravenous procedures
Peripheral venography (240 mg I/mL)
- Administer minimum volume necessary to visualize satisfactorily the structures under examination
- Max total dose: 250 mL
Contrast computed tomography (CT) (300 mg I/mL)
- Head: 50-200 mL
- Body: 50-200 mL bolus injection, followed by 100-200 mL rapid infusion
- Max total dose: 200 mL
Contrast computed tomography (370 mg I/mL)
- Head: 41-162 mL
- Body: 41-162 mL bolus injection, followed by 81-162 mL rapid infusion
- Max total dose: 162 mL
Excretory urography (300 mg I/mL)
- 300 mg I/kg
- Max total dose: 100 mL
Pediatric Dosing
- Safety and effectiveness in pediatric patients <2 yrs of age have not been established
Intra-arterial procedures (>2 yrs)
Cardiac chambers and related arteries (370 mg I/mL)
- Inject 1-2 mL/kg; Max total dose: 4 mL/kg
Intravenous (>2 yrs)
Contrast Computerized Tomography or Excretory Urography (300 mg I/mL)
- Inject 1-2 ml/kg; Max total dose: 3 mL/kg
[Outline]
- Life-threatening or fatal, anaphylactoid reactions manifested as respiratory arrest, laryngospasm, bronchospasm, angioedema, and shock, may occur during and after iopromide administration. Emergency facilities and personnel trained in handling medical emergencies should be available for at least 30-60 minutes after iopromide administration
- Patients with a history of previous reaction to a contrast agent, a known sensitivity to iodine and known allergic disorders such as bronchial asthma, hay fever and food allergies or other hypersensitivities are at a higher risk of anaphylactoid reactions. Use cautiously in these patients
- Iopromide can cause acute renal insufficiency or failure, particularly in patients with advanced vascular disease, congestive heart disease, diabetes, multiple myeloma or other paraproteinacious diseases, patients receiving nephrotoxic medications and the elderly patients with age-related renal impairment
- Exercise caution and use the lowest necessary dose in patients with renal insufficiency. Adequately hydrate patients prior to and following iopromide administration; monitor these patients for delayed hemodynamic renal function disturbances several hours following the procedure
- Acute or delayed hemodynamic disturbances have been reported in patients with congestive heart failure, severely impaired renal function, combined renal and hepatic disease, combined renal and cardiac disease, with repetitive or large doses of iopromide, owing to the increase in the circulatory osmotic load. Use cautiously in these patients and monitor for several hours following iopromide administration
- Local and distal organ damage, ischemia, thromboembolism and organ failure including stroke, brachial plexus palsy, chest pain, myocardial infarction, sinus arrest, hepato-renal function abnormalities may occur following angiography. Hence, use meticulous angiographic techniques including close attention to guide wire and catheter manipulation, use of manifold systems and/or three-way stopcocks, frequent catheter flushing with heparinized saline solutions and minimizing the length of the procedure
- Dislodging of plaques, damage or perforation of the vessel wall with resultant pseudoaneurysms, hemorrhage at puncture site, dissection of coronary artery during catheter manipulations and contrast agent injection, increased thrombosis and activation of the complement system have been reported with angiographic procedures. These reactions are influenced by the physicochemical properties of the contrast agent, the dose and the speed of injection. Monitor electrocardiograms and vital signs throughout the procedure. Specialized personnel, adequate equipment and facilities should be readily available for immediate resuscitation and cardioversion
- Because of the risk of inducing thrombosis and embolism, avoid angiography whenever possible in patients with homocystinuria
- Intravascular use of iodinated contrast agents may cause thyroid storm in patients with hyperthyroidism, or with an autonomously functioning thyroid nodule. Evaluate risk/benefit before using iodinated contrast agents in these patients
- Administration of iodinated contrast agents in patients with pheochromocytoma may produce hypertensive crises. Use cautiously in patients with known or suspected pheochromocytoma. Administer the lowest amount required and monitor the blood pressure throughout the procedure and have measures for treatment of a hypertensive crisis readily available
- Iopromide injections may promote sickling in individuals who are homozygous for sickle cell disease
- Tissue necrosis and compartment syndrome may occur following extravasation of iopromide, particularly in patients with severe arterial or venous disease
- Risk and increased radiation exposure is associated with the use of contrast enhancement. Evaluate clinical and other radiological data, and the results of non-contrast CT findings, prior to its use
- Iodinated contrast agents may obscure some lesions which were seen on non-contrast CT scans like the opacification of the inferior vermis resulting in false-positive diagnosis. Also, older infarctions may be obscured by the contrast agent
- Exercise caution when performing venography in patients with suspected thrombosis, phlebitis, local skin infection, severe ischemic disease, venous thrombosis, or a totally obstructed venous system
- Clotting may result when blood remains in contact with syringes containing iodinated contrast agents
Cautions: Use cautiously in
- Preexisting cardiovascular diseases
Pregnancy Category:B
Breastfeeding: It is unknown whether iopromide is excreted in human milk. Because many injectable contrast agents are excreted unchanged in human milk and due to the possibility of potential adverse reaction, caution should be exercised when administering to nursing women, or consideration should be given to temporary discontinuation of nursing.
