From the Guidelines
Iopamidol is a suitable contrast agent for diagnostic imaging procedures, including CT scans, angiography, and urography, with a comparable risk of contrast-induced nephropathy to isosmolar agents like iodixanol, as shown in the CARE study 1. The typical adult dose ranges from 50-400 mL depending on the procedure, with concentrations varying from 200-370 mg iodine/mL. Before administration, patients should be screened for risk factors including:
- Previous contrast reactions
- Renal impairment (eGFR <30 mL/min/1.73m²)
- Diabetes
- Dehydration
- Use of nephrotoxic medications Adequate hydration before and after the procedure is essential to reduce the risk of contrast-induced nephropathy, as emphasized in the 2012 ACCF/AHA focused update 1. Patients should fast for 4-6 hours before the procedure but continue to drink clear fluids. Iopamidol is contraindicated in patients with severe hypersensitivity to iodinated contrast media. For patients with mild to moderate renal impairment, dose reduction and hydration protocols should be implemented, as recommended in the guidelines 1. Potential adverse reactions include:
- Allergic-like reactions (ranging from mild rash to severe anaphylaxis)
- Contrast-induced nephropathy
- Extravasation injuries Healthcare providers should have emergency medications and equipment readily available during administration, as advised in the guidelines 1. Iopamidol works by temporarily increasing the density of tissues and blood vessels where it flows, creating contrast differences that enhance visualization of anatomical structures during imaging procedures. The choice of contrast agent should be based on individual patient characteristics, including renal function and other clinical characteristics, rather than solely on the type of contrast agent, as recommended in the 2012 ACCF/AHA focused update 1. In patients with chronic kidney disease, the risk of contrast-induced nephropathy can be minimized by using a low-osmolar contrast agent like iopamidol and implementing adequate hydration protocols, as shown in the studies 1. Overall, iopamidol is a safe and effective contrast agent for diagnostic imaging procedures when used appropriately and with proper patient preparation and monitoring, as supported by the evidence from the studies 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION In adultsa solution that is approximately isotonic (Iopamidol Injection, 41%) is recommended for examination of the lumbar region. For movement of the contrast medium to distant target areas the more concentrated Iopamidol Injection, 61% preparation should be used to compensate for dilution of Iopamidol Injection with cerebrospinal fluid The usual recommended adult dose range for iopamidol is 2000-3000 mg iodine. The minimum dose needed to perform a procedure should always be used. In pediatric patients, a solution that is approximately isotonic (Iopamidol Injection, 41%) is recommended for all intrathecal procedures In children, loss of contrast due to mixing on movement of the medium is less apt to occur because of their shorter spinal cord. The usual recommended pediatric dose range for iopamidol is 1400-2400 mg iodine. Iopamidol formulated to contain more than 200 mgI/mL should not be used intrathecally in children. The minimum dose needed to perform a procedure should always be used See pediatric dosage table for recommended dosage.
The guidelines for using iopamidol in diagnostic imaging procedures are as follows:
- Use the minimum dose needed to perform a procedure.
- For adults, the recommended dose range is 2000-3000 mg iodine.
- For pediatric patients, the recommended dose range is 1400-2400 mg iodine.
- Use a solution that is approximately isotonic (Iopamidol Injection, 41%) for examination of the lumbar region in adults and for all intrathecal procedures in children.
- Iopamidol Injection, 61% preparation should be used for movement of the contrast medium to distant target areas.
- Injection must be made slowly over one to two minutes to avoid excessive mixing with cerebrospinal fluid.
- An interval of at least 48 hours should be allowed before repeat examination.
- Patients should be well hydrated prior to and following Iopamidol Injection administration 2.
- Iopamidol Injection is indicated for intrathecal administration in adult neuroradiology including myelography (lumbar, thoracic, cervical, total columnar), and for contrast enhancement of computed tomographic (CECT) cisternography and ventriculography 2.
From the Research
Guidelines for Using Iopamidol in Diagnostic Imaging Procedures
- Iopamidol is a clinically approved X-Ray contrast agent used for various diagnostic applications, with a good clinical acceptance 3.
- When using iopamidol, it is essential to identify patients at risk of contrast-induced nephropathy (CIN) to implement preventative strategies, such as minimizing the amount of contrast administered and providing adequate hydration 4.
- The risk of CIN from contrast-enhanced MDCT in patients with renal insufficiency appears to be low, with an incidence of 6.1% 5.
- Special care should still be taken in patients with renal insufficiency, and new criteria can be used to diagnose clinically significant renal injury related to contrast media exposure 6.
- Recent evidence suggests that most cases of acute kidney injury (AKI) caused by iodinated contrast material (ICM) were instead due to contrast-independent causes of AKI or normal variation in renal function 7.
Preventative Strategies
- Minimizing the amount of contrast administered is a cornerstone of an effective preventative approach for CIN 4.
- Providing adequate hydration is also crucial in preventing CIN 4.
- Novel modalities, including pharmacological and non-pharmacological strategies, can be used to prevent contrast-induced nephropathy 6.