Most Commonly Used Gadolinium-Based Contrast Agent in India
I cannot definitively identify the single most commonly used GBCA specifically in India from the provided evidence, as none of the guidelines or research directly addresses Indian market data or prescribing patterns.
Global Market Context (Potentially Applicable to India)
Macrocyclic agents dominate the global market, representing more than 80% of European usage, with Bayer holding the largest overall market share among major manufacturers worldwide. 1, 2
Leading Agents by Manufacturer and Market Share:
Gadobutrol (Gadavist, Bayer) - Bayer maintains the largest global market share, with gadobutrol being their primary macrocyclic agent that replaced their linear agent gadopentetate dimeglumine 1
Gadoterate meglumine (Dotarem, Guerbet) - Guerbet dominates the European market specifically, though has smaller U.S. market share 1, 2
Gadoteridol (ProHance, Bracco) - Holds approximately 5% of U.S. market with rising utilization 1, 2
Gadobenate dimeglumine (MultiHance, Bracco) - Has risen substantially in U.S. market share in recent years 1, 2
Clinical Recommendation Based on Safety Profile
Regardless of local market availability, macrocyclic GBCAs should be preferentially used over linear agents due to their markedly superior stability and significantly reduced risk of nephrogenic systemic fibrosis and brain gadolinium deposition. 1, 2
Safety-Based Agent Classification:
Group II agents (lowest NSF risk): All macrocyclic agents including gadoterate meglumine, gadobutrol, and gadoteridol demonstrate 0% NSF risk in 4,931 administrations to patients with severe CKD 1
Linear agents: Four linear GBCAs (gadodiamide, gadoversetamide, gadopentetate dimeglumine, and gadobenate dimeglumine) had marketing authorizations suspended by the European Medicines Agency in 2017 due to brain gadolinium deposition concerns 1, 2
Common Pitfall to Avoid:
Do not assume that availability or cost considerations should override safety concerns—the approximately 190-fold increased rate of NSF with Group I linear agents compared to Group II macrocyclic agents (1.52 vs 0.008 per million exposures) represents a clinically significant safety difference. 1