X-ray contrast media. Watersoluble nephrotropic low-osmolar iodinated agents
ATC code: V08AB05 (Iopromide)
Brand names
Ultravist, Ultravist 300, Ultravist 370
A non-ionic, water-soluble iodinated contrast medium. Iodine in the molecule absorbs X-rays and produces contrast of vessels, parenchymal organs and pathological foci on CT and angiography. Low osmolarity (around 600 mOsm/kg) reduces adverse effects compared with ionic high-osmolar agents. The drug is not metabolized and is excreted unchanged by the kidneys within 24 hours.
First line
Iopromide is a standard contrast medium for contrast-enhanced CT: thoracic, abdominal, pelvic CT, CT angiography and CT perfusion. The concentration of 300–370 mg I/mL is matched to the task: 300 for routine CT, 370 for CT angiography and tumor vascularity assessment. Dose is calculated by body weight and study protocol (typically 1–2 mL/kg).
First line
In diagnostic and interventional angiography (coronary, peripheral, cerebral), iopromide is a primary contrast agent. Low osmolarity is important to reduce pain during arterial injection and the risk of adverse reactions. The 370 mg I/mL concentration provides optimal arterial enhancement.
Not recommended
In patients with eGFR < 30 mL/min/1.73 m², decompensated heart failure, dehydration or concurrent nephrotoxic drugs, intravenous iodinated contrast without strict indication or preparation is in the unjustified-risk category per 2021. Rational practice: assess alternatives (non-gadolinium MRI, ultrasound); when contrast is unavoidable, prepare the patient (hydration, creatinine control, withdrawal of nephrotoxic drugs).
Not recommended
2021 and recommend temporary metformin withdrawal for 48 hours before and after contrast in patients with eGFR < 30 mL/min/1.73 m² or signs of acute kidney injury. In patients with stable eGFR ≥ 30 mL/min/1.73 m², withdrawal is not required. Contrast administration during metformin therapy in renally impaired patients without withdrawal raises the risk of lactic acidosis.
1 pair found. Sorted from critical to minor.
Mechanism
Внутривенные йодсодержащие контрастные вещества могут привести к острому ухудшению почечной функции и накоплению метформина, что повышает риск лактацидоза.
Management
Отменить метформин в день введения контраста при < 60 мл/мин/1.73 м²; возобновить через 48 часов при подтвержденной сохранности функции почек.
FDA category B. Performed for acute indications when MRI or ultrasound substitution is not feasible. Possible neonatal thyroid suppression – neonatal TSH is monitored in the first weeks after delivery.
Transfers into breast milk in minimal amounts (less than 0.01% of dose). Interruption of breastfeeding is not required by most international guidelines (ACR 2021), although a 24-hour interruption is sometimes practiced.
Iopromide is evaluated for the following indications with varying evidence strength: CT contrast enhancement (evidence tier A), Diagnostic angiography (evidence tier A), Iodinated contrast use during metformin therapy (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Iopromide (≥ 1 in 100): Warmth sensation, facial flushing, Nausea, Metallic taste, Transient dizziness. See the Safety section for uncommon and serious reactions.
FDA category B. FDA category B. Performed for acute indications when MRI or ultrasound substitution is not feasible. Possible neonatal thyroid suppression – neonatal TSH is monitored in the first weeks after delivery.
Transfers into breast milk in minimal amounts (less than 0.01% of dose). Interruption of breastfeeding is not required by most international guidelines (ACR 2021), although a 24-hour interruption is sometimes practiced.
Iopromide is contraindicated in: Overt hyperthyroidism; History of severe allergic reactions to iodinated contrast; Concomitant interleukin-2; Severe decompensated heart failure; Uncorrected bleeding diathesis. Full list in the Safety section.
allergy to elemental iodine is rare; reactions to contrast are hypersensitivity to the molecule and osmolarity. Seafood allergy does not increase contrast reaction risk.
hydration matters before and after the study, but «more is better» is not true – excessive hydration is harmful in heart failure.
in acute life-threatening states (trauma, pulmonary embolism, aortic dissection), contrast CT is performed when alternatives are not feasible.