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1590 Contrast Media myelography, but was associated with serious adverse iodine) and the dose and strength used vary according to the Omnipaque; Switz.: Accupaque; Omnipaquet; Thai.: Iobrix; effects, including allergy, arachnoiditis, and aseptic mening� procedure and the route. Turk.: Kopaq; Omnipaque; UK: Omnipaque; Ukr. : Omnipaque itis, and has now been superseded by nonionic media. (OMHnnaK); Tomohexol (ToMoreKcon); Unipak (IOmmaK); USA: Residues of iofendylate remaining years after myelography Adverse Effects, Treatment, and Precautions Omnipaque. have been associated with adverse effects. Other former PharmacopoeialPreparations Iohexol and other nonionic iodinated contrast media have uses included ventriculography, and visualisation of the USP 36: Iohexol Injection. fetus in the amniotic sac. similar adverse effects and precautions to ionic media but the effects tend to be less severe and the incidence is Preparat ons generally lower; see under the amidotrizoates, p. 1582.1 lomeproi (BAN, USAN, r/NN) i and p. 1583.1 for details. Pharmacopoeial Preparations Additional neurological adverse effects may occur when iomeprol; lomeprolum; Jo:;rleproi; Jomeprol� !�of,AenpOJI. BP 2014: Iofendylate Injection; nonionic media such as iohexol are used for myelography. 1!/, -N' Bis(2,3-aihydrox-ypropyl)� 2.4,6•triiodl75-{JY:methy.lg1y" USP 36: Iophendylate Injection. These include severe headache, backache, neck stiffness, colafl"lidoH.>ophtbalamide. dizziness, and leg or sciatic-type pain. Convulsions, aseptic G07H221,N,Oe;-'77:71 meningitis, and mild and transitory perceptual aberrations, CAS � such as visual and speech disturbances, and confusion, may 78ft4 9-4 1-9. .{{TC � V0 84BJ O. occur occasionally; rarely, more severe mental disturbances ATCVet ...;.;. QVQ8ABW. have occurred. Urinary retention has also been reported. UN!r� 17ti 1JBP8L Breast feeding. Iohexol is distributed into breast milk in Description. Iorneprol contains about 49% of I. very small quantities1 but no adverse effects have been seen in breast-feeding infants whose mothers were receiv­ Uses and Administration ing iohexol and the American Academy of Pediatrics con­ siders2 that it is therefore usually compatible with breast Iomeprol is a nonionic monomeric iodinated radiographic feeding. contrast medium (p. 1580.1 ). It may be given intravenously, intra-arterially, intrathecally, or by instillation into body 1. Nielsen ST, et a!. Excretion of iohexol apd metrizoate in human breast milk. Acta Radiol 1987; 28: 523-6. cavities, and is used in radiographic procedures including 2. American Academy of Pediatrics. The transfer of drugs and other myelography, angiography, urography, and arthrography. chemicals into human mille Pediatrics 2001; 108: 776-89. [Retired May It is also used to produce contrast enhancement during 20101 Correction. ibid.; 1029. Also available at: http://aappolicy. computed tomography. a appub lications. org/ cgi f content /full/pedia tries% 3 b 1 08/3/776 (accessed 27/03/06) Iomeprol is usually available as solutions containing 30.62 to 81.65% of iomeprol (equivalent to 150 to Effects on the nervous system. Encephalopathy developed 400 mg/mL of iodine) and the dose and strength used vary in a 48-year-old man with sciatica within 9 hours of according to the procedure and the route. iohexol for lumbar myelography but had largely resolved Reviews. 48 hours after the myelogram; complete resolution took 4 1. Dooley M, Jarvis B. Iomeprol: a review of its use as a contrast medium. days.1 However, recovery was slow in a patient who Drngs 2000; 59: 1169-86. developed paraplegia and areflexia in the legs after a simi­ lar procedure. Five months later the patient still com­ Adverse Effects, Treatment, and Precautions plained of paraesthesia in her legs and could not stand As for the amidotrizoates, p. 1582.1 and p. 1583.1. For without support.2 Encephalopathy has also been reported adverse effects relating to the use of nonionic contrast media in association with use of iohexol for coronary angiogra­ such as iomeprol for myelography, see under 1ohexol phy.' (above). L Donaghy M, et at. Encephalopathy after iohexol myelography. Lancet 1985; ii: 887. 2. Noda K. et al. Prolonged paraplegia alter iohexol myelography. Lancet Porphyria. The Drug Database for Acute Porphyria, com­ 1991; 337: 681. piled by the Norwegian Porphyria Centre (NAPOS) and 3. Sawaya RA, et al. Contrast-induced encephalopathy following coronary the Porphyria Centre Sweden, classifies iomeprol as not angioplasty with iohexol. South Med J 2007; 100: 1054-5. porphyrinogenic; it may be used as a drug of first choice and no precautions are needed.1 Porphyria. The Drug Database for Acute Porphyria, com­ I. piled by the Norwegian Porphyria Centre (NAPOS) and The Drug Database for Acute Porphyria. Available at: http://www. drugs-porphyria.org (accessed 18/10/11) the Porphyria Centre Sweden, classifies iohexol as not por­ phyrinogenic; it may be used as a drug of first choice and Profile no precautions are needed.1 Pharmacokinetics Ioglicic acid is an ionic monomeric iodinated radiographic J. The Drug Database for Acute Porphyria. Available at: http:ffwww. After intravascular use, iomeprol is rapidly eliminated contrast medium (p. 1580.1) that has been used, as the drugs-porphyria.org (accessed 18/10/ll) unchanged in the urine, with a terminal elimination half­ meglumine and sodium salts, for diagnostic procedures. life of I.9 hours. It is not significantly bound to plasma Interactions proteins. P epa at ons Antiarrhythmics. A small retrospective study1 found that ............r r..............i ...... .... ................ concurrent use of iohexol and amiodarone resulted in sig­ Proprietary. Preparations (details are given in Volume B) nificant prolongation of the QTc interval compared with iohexol alone. Caution was advised irl the use of iohexol Single-ingredient Preparations. Austral. : Iomeron; Austria: Iomeron; Belg. : Iomeron; China: Iomeron Cz. : lamer­ in patients taking antiarrhythmics that prolong QT inter­ (fl�-iliffi-); on; Denm.: Iomeron; Fin.: Iomeron; Fr.: Iomeron; Ger.: !mer­ val. on; Gr.: Iomeron; Hong Kong: Iomeront; Hung.: Iomeron; Irl. : 1. Goernig M, et at. Iohexol contrast medium induces QT prolongation in Iomeron; Israel: Iomeron; Ital. : Iomeron; Jpn: Iomeron; Neth.: amiodarone patients. Br J Clin Pharmacal 2004; 58: 96-8. Iomeron; Norw.: Iomeron; NZ: Iomeron; Port. : Iomeron; Spain: Iomeron; Swed.: Iomeron; Switz.: Iomeron; Turk.: Pharmacokinetics Iomeron; UK: Iomeron. After intravascular use, 90% or more of a dose of iohexol is Description. Iohexol contains about 46.4% of I. eliminated unchanged in the urine within 24 hours. An Pharmacopoeias. In Eur. (see p. vii), Int., and US. elimination half-life of about 2 hours in patients with lopamidol (BAN, USAN, r!NN) Ph. Eur. 8: (lohexol). A white or greyish-white, hygroscopic normal renal function has been reported. Protein binding in B-l s o; ! pamidoium;·· J a idoti;Jopamf<:J<)Iis powder. Very soluble in water; practically insoluble in blood is reported to be very low. oo o Jopamidoi; ()p m $Q-13-?Q6; MonaMt4i1on. dichloromethane; freely soluble in methyl alcohol. Store in (5)-N,N'.-Bis!2-hydroxy·l.-(hy<_lroxy(f1<;thyi)ethylJ,2,4,(j-tri" airtight containers. Protect from light. Pregnancy. Contrast material was detected1 in the intes­ p USP 36: tines of twin neonates who were born 17 hours after iocjo-5�iactamidoi�o htha!arnid!!. (Iohexol). A white to off-white, hygroscopic, Co·H,,I,NaOtF7V7.1 odourless powder. Very soluble in water and in methyl iohexol was given to their mother for angiography, sug­ C.l\5 60 166c93-0: 6288:1 -0U<S. alcohol; practically insoluble or insoluble in chloroform and gesting that transplacental transfer had taken place. ..:.; in ether. Store at a temperature of 25 degrees, excursions I. Moon AJ, et al. Transplacental passage of iohexol. J Pediatr 2000; 136: AK - \loMB04. 548-9. permitted between 15 degrees and 30 degrees. Protect from AK t'et� •QV08AB04. UNit �Jf/1 3W81H44. light. Preparations ······················ Description. Iopamidol contains about 49% of I. Uses and Administration Proprietary Preparations (details are given in Volume B) Pharmacopoeias. In Eur. (see p. vii), Jpn, and US. Iohexol is a nonionic monomeric iodinated radiographic Single-ingredient Preparations. Arg. : Omnipaque; Austral.: Ph. Eur. 8: (lopamidol). A white or almost white powder. Omnipaque; Austria: Accupaque; Omnipaque; Belg.: Omnipa­ contrast medium (p. 1580.1 ). It may be given intravenously, Freely soluble in water; practically insoluble in alcohol and que; Canad.: Omnipaque; Chile: Omnipaque; China: Omnipa­ in dichloromethane; very slightly soluble in methyl alcohol. intra-arterially, intrathecally, orally, rectally, or by (ilXJ1¥!Kll:); que Ou Su (@:ilf);Shuang Bei ()()(�!:);Cz.: Omnipa­ Protect from light. instillation into body cavities and is used in diagnostic que; Denm.: Omnipaque; Fin.: Omnipaque; Fr.: Omnipaque; procedures including myelography, angiography, urogra­ Ger.: Accupaque; Iohexagita; Omnipaque; Gr.: Accupaque; USP 36: (Iopamidol). A white to off-white, practically phy, arthrography, and visualisation of the gastrointestinal Omnipaque; Hung. : Omnipaque; India: Radiopaque; Irl. : odourless, powder. Very soluble in water; practically tract and body cavities. Iohexol is also used to produce Omnipaque; Israel: Omnipaque; Ital. : Omnipaque; Neth.: insoluble in alcohol and in chloroform; sparingly soluble in contrast enhancement during computed tomography. Omnipaque; Norw.: Omnipaque; NZ:
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