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Iohexol
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| Clinical data | |
|---|---|
| Trade names | Iodaque, Hexopaque, Oraltag, others |
| Other names | 5-[N-(2,3-Dihydroxypropyl)acetamido]-2,4,6-triiodo-N,N'-bis(2,3-dihydroxypropyl)isophthalamide |
| AHFS/Drugs.com | Micromedex Detailed Consumer Information |
| License data | |
| Routes of administration | Intrathecal, intravascular, by mouth, intracavital, rectal |
| ATC code | |
| Legal status | |
| Legal status | |
| Pharmacokinetic data | |
| Protein binding | Low |
| Metabolism | Nil |
| Elimination half-life | Variable |
| Excretion | Kidney, unchanged |
| Identifiers | |
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| CAS Number | |
| PubChem CID | |
| DrugBank | |
| ChemSpider | |
| UNII | |
| KEGG | |
| ChEBI | |
| ChEMBL | |
| CompTox Dashboard (EPA) | |
| ECHA InfoCard | 100.060.130 |
| Chemical and physical data | |
| Formula | C19H26I3N3O9 |
| Molar mass | 821.142 g·mol−1 |
| 3D model (JSmol) | |
| Melting point | 174 to 180 °C (345 to 356 °F) |
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Iohexol, sold under the trade names Omnipaque and Iodaque among others, is a contrast agent used for X-ray imaging.[3] This includes when visualizing arteries, veins, ventricles of the brain, the urinary system, and joints, as well as during computed tomography (CT scan).[3] It is given by mouth, injection into a vein, or into a body cavity.[4]
Side effects include vomiting, skin flushing, headache, itchiness, kidney problems, and low blood pressure.[3] Less commonly allergic reactions or seizures may occur.[3] Allergies to povidone-iodine or shellfish do not affect the risk of side effects more than other allergies.[5] Use in the later part of pregnancy may cause hypothyroidism in the baby.[6] Iohexol is an iodinated non-ionic radiocontrast agent.[3] It is in the low osmolar family.[7]
Iohexol was approved for medical use in 1985.[8] It is on the World Health Organization's List of Essential Medicines.[9][4]
Chemistry
[edit]The osmolality of iohexol ranges from 322 mOsm/kg—approximately 1.1 times that of blood plasma—to 844 mOsm/kg, almost three times that of blood.[10] Despite this difference, iohexol is still considered a low-osmolality contrast agent; the osmolality of older agents, such as diatrizoate, may be more than twice as high.[11]
Adverse effects
[edit]The most common side effects after intravenous injections are: pain at the site of injection (3%), blurring of vision (2%), nausea (2%), arrhythmia (2%), taste perversion (1%), hypotension (0.7%), and vomiting (0.7%).[12]
Society and culture
[edit]Naming
[edit]It is sold under the brand name Omnipaque.[13] It is also sold as a density gradient medium under the names Accudenz, Histodenz, and Nycodenz.[14][15]
Available forms
[edit]It is available in various concentrations, from 140[12] to 350[16] milligrams of iodine per milliliter.[12] Iohexol can given as intrathecal, intravascular, oral, rectal, intraarticular, or into the body cavity.[12]
References
[edit]- ^ "Product monograph brand safety updates". Health Canada. February 2024. Retrieved 24 March 2024.
- ^ "Regulatory Decision Summary for Omnipaque". Drug and Health Products Portal. 29 December 2023. Retrieved 2 April 2024.
- ^ a b c d e World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. pp. 317–8. hdl:10665/44053. ISBN 9789241547659.
- ^ a b Hamilton R (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 171. ISBN 9781284057560.
- ^ ACR Manual on Contrast Media v10.3. 2017 (PDF). American College of Radiology. 2017. p. 6. ISBN 9781559030120. Archived (PDF) from the original on 1 January 2018. Retrieved 1 January 2018.
- ^ Briggs GG, Freeman RK, Yaffe SJ (2011). Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. Lippincott Williams & Wilkins. p. 761. ISBN 9781608317080. Archived from the original on 1 January 2017.
- ^ Sutton D, Young JW (2012). A Short Textbook of Clinical Imaging. Springer Science & Business Media. p. 235. ISBN 9781447117551. Archived from the original on 1 January 2017.
- ^ Broe ME, Porter GA, Bennett WM, Verpooten GA (2013). Clinical Nephrotoxins: Renal Injury from Drugs and Chemicals. Springer Science & Business Media. p. 325. ISBN 9789401590884. Archived from the original on 1 January 2017.
- ^ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
- ^ GE Healthcare (May 2006). "Omnipaque (Iohexol) injection. Product label". DailyMed. U.S. National Library of Medicine. Archived from the original on 7 July 2012. Retrieved 28 March 2007.
- ^ Amersham Health (April 2006). "Hypaque (Diatrizoate Meglumine and Diatrizoate Sodium) injection, solution. Product label". DailyMed. U.S. National Library of Medicine. Archived from the original on 23 May 2011. Retrieved 29 March 2007.
- ^ a b c d "Highlights of prescribing information for Omnipaque" (PDF). US Food and Drug Administration. Archived from the original (PDF) on 20 June 2022. Retrieved 13 December 2022.
- ^ "Omnipaque". Ireland: Health Products Regulatory Authority. January 2018. Archived from the original (PDF) on 28 August 2021. Retrieved 31 July 2020.
- ^ "HistoDenz" (PDF). Product information sheet. Sigma-Aldrich. D2158. Archived from the original (PDF) on 20 November 2015. Retrieved 19 November 2015.
- ^ "Nycodenz®: A universal density gradient medium" (PDF). Axis-Shield Density Gradient Media. Archived from the original (PDF) on 26 February 2015. Retrieved 19 November 2015.
- ^ Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Omnipaque 350 mg J/ml Infusionsflasche.
Iohexol
View on GrokipediaMedical uses
Indications
Iohexol is a non-ionic iodinated contrast medium primarily used to enhance visibility of internal structures in X-ray-based diagnostic imaging procedures.[2] It works by providing radiopacity through its iodine content, allowing for clearer delineation of anatomical features during various radiological examinations.[5] For intravascular administration, iohexol is indicated in angiography of arteries and veins, including cerebral arteriography, peripheral arteriography, aortography, selective coronary arteriography, pulmonary angiography in pediatric patients, and intra-arterial digital subtraction angiography, as well as for intravenous contrast enhancement in computed tomography (CT) scans of the head, body, and extremities, excretory urography, peripheral venography, and intravenous digital subtraction angiography.[5] Intrathecal use is approved for myelography and CT myelography (lumbar, thoracic, cervical, total columnar) and CT cisternography to visualize the brain ventricles and spinal subarachnoid spaces.[5] Oral or rectal administration supports gastrointestinal tract opacification for radiographic examination and CT of the abdomen and pelvis.[5] Intra-articular injection is indicated for arthrography to assess joint structures.[5] In body cavity procedures, iohexol is used for hysterosalpingography (in non-pregnant adults), endoscopic retrograde cholangiopancreatography, herniography, and voiding cystourethrography to evaluate the urinary tract and other cavities.[5] These applications enable detailed visualization of blood vessels, the urinary tract, brain ventricles, and joints, facilitating accurate diagnosis in diverse clinical scenarios.[5] Due to its essential role in these diagnostic imaging techniques, iohexol is included on the World Health Organization's Model List of Essential Medicines under radiocontrast media.[6]Administration and dosage
Iohexol is administered via multiple routes depending on the imaging procedure, including intravenous (IV) for computed tomography (CT) and angiography, intrathecal for myelography, oral for gastrointestinal (GI) tract visualization, rectal for lower GI studies, intra-articular for joint imaging, and direct injection into body cavities such as during endoscopic retrograde pancreatography (ERP) or hysterosalpingography.[7] The choice of route is guided by the specific diagnostic indication, with IV being the most common for systemic contrast enhancement in CT scans.[8] Dosage is determined by the iodine concentration of the formulation, ranging from 140 to 350 mgI/mL for injectable forms, and tailored to patient weight, age, and procedure type. For IV administration in adult CT head imaging, typical doses are 70-150 mL of 300 mgI/mL or 80 mL of 350 mgI/mL, administered as a bolus or infusion; for body CT, 50-200 mL of 300 mgI/mL is used.[9] In intrathecal myelography, adults receive 6-17 mL of 180-300 mgI/mL (total iodine 1.2-3.06 gI), injected slowly over 1-2 minutes, while pediatric doses are lower at 2-15 mL of 180 mgI/mL (total up to 2.7 gI), adjusted by age and weight.[8] For CT of the abdomen and pelvis, oral administration involves 500-1000 mL diluted to 6-12 mgI/mL, often combined with IV dosing; for radiographic examination of the GI tract, 50-100 mL of undiluted 350 mgI/mL may be used. Rectal doses for lower GI studies are similar in volume but delivered via enema.[7] Intra-articular injections for arthrography use 5-20 mL of 240-350 mgI/mL, and body cavity injections vary from 10-100 mL based on the site.[9] Maximum total iodine doses are limited, such as 250-290 mL (up to 87.5-101.5 gI) for IV/IA procedures and under 3.06 gI for intrathecal use to minimize risks.[8] Preparation involves using sterile technique for all injections, inspecting solutions for particulates or discoloration, and administering at body temperature (37°C) or room temperature (20-25°C); oral solutions may be diluted with water, juice, or milk just prior to use.[7] Single-use vials should be discarded after partial withdrawal to prevent contamination. Hydration protocols are essential, with patients encouraged to drink fluids before and after parenteral administration to reduce the risk of contrast-induced nephropathy.[9] Special considerations include dose reductions for pediatric patients (e.g., 1-3 mL/kg IV for CT) and those with renal impairment, where the minimum effective dose is used; for allergy-prone individuals, premedication may be employed, though routine test doses are not recommended—instead, emergency resuscitation equipment must be available.[8] Dosing intervals, such as 48 hours between intrathecal exams, help prevent cumulative toxicity.[7]| Route | Example Adult Dosage | Concentration (mgI/mL) | Notes |
|---|---|---|---|
| Intravenous (CT) | 70-150 mL bolus | 300 | Adjust for weight; max 150 mL |
| Intrathecal (Myelography) | 6-17 mL | 180-300 | Slow injection; max 3.06 gI |
| Oral (GI CT) | 500-1000 mL diluted | 6-12 | 20-60 min pre-IV; pediatric max 5 gI (<3 years) to 10 gI (3-18 years) |
| Intra-articular | 5-20 mL | 240-350 | For joint imaging only |