Dosing & Uses
Dosage Forms & Strengths
IV solution
- 0.5 mmol/mL (contains 376.9 mg/mL gadoterate meglumine)
MRI Contrast
Gadolinium-based contrast agent for use in MRI of the brain, spine, and associated tissues to detect and visualize areas with disruption of the blood brain barrier and/or abnormal vascularity
0.2 mL/kg (0.1 mmol/kg) IV bolus infused at rate of 2 mL/second
Dosage Forms & Strengths
IV solution
- 0.5 mmol/mL (contains 376.9 mg/mL gadoterate meglumine)
MRI Contrast
Gadolinium-based contrast agent for use in MRI of the brain, spine, and associated tissues in pediatric patients (including term neonates) to detect and visualize areas with disruption of the blood brain barrier and/or abnormal vascularity
0.2 mL/kg (0.1 mmol/kg) IV bolus infused at rate of 1-2 mL/second
Adverse Effects
1-10%
Headache (1.5% pediatric)
<1%
Nausea (0.6%)
Headache (0.5% adult)
Injection site pain (0.4%)
Injection site coldness (0.2%)
Burning sensation (0.2%)
Feeling cold (<0.2%)
Rash (<0.2%)
Somnolence (<0.2%)
Fatigue (<0.2%)
Dizziness (<0.2%)
Vomiting (<0.2%)
Pruritus (<0.2%)
Asthenia
Paraesthesia (<0.2%)
Dysgeusia (<0.2%)
Pain in extremity (<0.2%)
Anxiety (<0.2%)
Hypertension (<0.2%)
Palpitations (<0.2%)
Oropharyngeal discomfort (<0.2%)
Serum creatinine increased (<0.2%)
Injection site reactions, including site inflammation, extravasation, pruritus, and warmth (<0.2%)
Postmarketing Reports
Cardiac disorders: Bradycardia, tachycardia, arrhythmia, hypotension
Nervous system disorders: Coma, convulsion, syncope, presyncope, parosmia, tremor
Musculoskeletal and connective tissue disorders: Muscle contracture, muscle weakness
Gastrointestinal disorders: Diarrhea, salivary hypersecretion
General disorders and administration site conditions: Malaise, fever
Skin and subcutaneous tissue disorders: Nephrogenic systemic fibrosis
Vascular disorders: Superficial phlebitis
Warnings
Black Box Warnings
Gadolinium-based contrast agents (GBCAs) increase risk of nephrogenic systemic fibrosis (NSF) among patients with impaired elimination
Avoid use in these patients unless the diagnostic information is essential and not available with noncontrasted MRI or other modalities
NSF may result in fatal or debilitating fibrosis affecting the skin, muscle and internal organs
Risk of NSF highest with chronic, severe kidney disease (ie, GFR <30 mL/min/1.73 m2) or acute kidney injury
Screen for acute kidney injury and other conditions that may reduce renal function; for patients at risk for chronically reduced renal function (eg, age >60 years, hypertension, diabetes), estimate GFR through laboratory testing
For patients at highest risk for NSF, do not exceed recommended dose and allow sufficient period of time for elimination of the drug before readministration
Contraindications
Hypersensitivity
Cautions
Gadolinium-based contrast agents increase the risk for NSF among patient with impaired elimination (see Black Box Warnings)
Anaphylactic and anaphylactoid reactions reported and may involve cardiovascular, respiratory, and/or cutaneous manifestations, including reports of patients experiencing cardiovascular collapse and death
Acute kidney injury requiring dialysis has occurred in patients with chronically reduced renal function
Gadolinium retention
- Gadolinium is retained for months or years in several organs
- Highest concentrations (nanomoles per gram of tissue) have been identified in the bone, followed by other organs (eg, brain, skin, kidney, liver, and spleen)
- Duration of retention also varies by tissue and is longest in bone
- Patients requiring multiple lifetime doses, pregnant and pediatric patients, and patients with inflammatory conditions are at higher risk of gadolinium retention
Brain deposits
- FDA investigated the risk of brain deposits following repeated use of GBCAs for MRI in 2015
- Publications in the medical literature have reported that deposits of GBCAs remain in the brains of some patients who undergo ≥4 contrast MRI scans, long after the last administration
- As of 2017, the FDA review had not identified adverse health effects from gadolinium retained in the brain after the use of GBCAs MRI; all GBCAs may be associated with some gadolinium retention in the brain and other body tissues
- Early data in rat studies show that linear GBCAs are more prone to dissociation into free gadolinium and demonstrate greater brain deposition than macrocyclic GBCAs, which are less prone to dissociation
Pregnancy & Lactation
Pregnancy
GBCAs cross the placenta and result in fetal exposure and gadolinium retention
Human data on the association between GBCAs and adverse fetal outcomes are limited and inconclusive
Estimated background risk of major birth defects and miscarriage for the indicated population is unknown
All pregnancies have a background risk of birth defect, loss, or other adverse outcomes
Lactation
Estimated infant exposure is 0.001%-0.04% of the maternal dose
Unknown whether the effects of the drug on the breastfed infant or the effects of the drug on milk production
Developmental and health benefits of breastfeeding should be considered together with the mother’s clinical need for the drug and any potential adverse effects on the breastfed infant or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
In MRI, visualization of normal and pathological tissue depends in part on variations in the radiofrequency signal intensity that occurs with differing proton density and longitudinal/transverse relaxation times; gadolinium contrast agents lead to distinct shortening of proton relaxation times in plasma and may improve tissue visualization
Gadoterate does not cross the intact blood-brain barrier (BBB) and, therefore, does not enhance normal brain or lesions that have a normal blood-brain barrier (eg, cysts, mature postoperative scars); however, disruption of the BBB or abnormal vascularity allows distribution of gadoterate in brain lesions such as neoplasms, abscesses, and infarcts
Distribution
Protein bound: None
Vd: 179 mL/kg (females); 211 mL/kg (males)
Metabolism
Not known to be metabolized
Elimination
Half-life: 1.4 hr (females); 2 hr (males); 5.1 hr (moderate renal impairment; 13.9 hr (severe renal impairment)
Renal clearance: 1.27 mL/min/kg (females); 1.74 mL/min/kg (males)
Excretion: urine (72.9-85.5% females; 85.4-92% males)
Administration
IV Incompatibilities
Do not mix with other drugs or parenteral nutrition
IV Preparation
Visually inspect vials/syringes for particulate matter
Do not use if solution contains particulates or container appears damaged
Solution should appear clear, colorless to yellow
When injected using plastic disposable syringes, the contrast medium should be drawn into the syringe and used immediately
Discard unused portion
IV Administration
Ensure catheter and venous patency before injection to avoid tissue extravasation
Adults: Infuse IV bolus at rate of 2 mL/second
Pediatrics (≥2 years): Infuse IV bolus at rate of 1-2 mL/second
To ensure complete injection, follow with saline flush
Contrast MRI can begin immediately following injection
Administer only where trained personnel and therapies are promptly available for hypersensitivity reactions, including resuscitation
Monitoring
- Before administration, assess all patients for history of reaction to contrast media, bronchial asthma, and/or allergic disorders – these patients have an increased risk of hypersensitivity to GBCAs
- During and following administration, observe for signs/symptoms of hypersensitivity
Storage
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F)
Prefilled syringes must not be frozen; frozen syringes should be discarded
Should solidification occur in the vial because of exposure to the cold, bring to room temperature before use
If vial allowed to stand at room temperature for a minimum of 90 minutes, gadoterate meglumine should return to a clear, colorless to yellow solution; if solids persist, discard vial
Images
BRAND | FORM. | UNIT PRICE | PILL IMAGE |
---|---|---|---|
Dotarem intravenous - | 0.5 mmol/mL (376.9 mg/mL) vial | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL solution | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL (376.9 mg/mL) vial | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL solution | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL solution | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL solution | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL (376.9 mg/mL) vial | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL (376.9 mg/mL) vial | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL (376.9 mg/mL) vial | ![]() | |
Dotarem intravenous - | 0.5 mmol/mL (376.9 mg/mL) vial | ![]() |
Copyright © 2010 First DataBank, Inc.
Patient Handout
gadoterate meglumine intravenous
GADOLINIUM-BASED CONTRAST AGENT - INJECTION
COMMON BRAND NAME(S): Clariscan, Dotarem, Elucirem, Eovist, Gadavist, Multihance, Prohance, Vueway
WARNING: This medication may rarely cause kidney damage. The risk of kidney damage is greater if you already have kidney problems, if you are elderly, or if you have high blood pressure or diabetes.Your doctor should check how well your kidneys are working before you receive this medication.See also Side Effects section.
USES: This medication is used before a magnetic resonance imaging (MRI) scan. It belongs to a class of drugs known as gadolinium-based contrast agents (GBCAs). This medication helps the MRI scan make clearer images, so your doctor can more easily diagnose your condition.
HOW TO USE: Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start this medication. If you have any questions, ask your health care professional.This medication is given by injection into a vein by a health care provider. The injection is given as directed by your doctor. The dosage is based on your medical condition and weight.
SIDE EFFECTS: Nausea, unpleasant taste, or headache may occur. If any of these effects last or get worse, tell your health care professional.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: kidney problems (such as change in the amount of urine), pain/swelling/redness at the injection site, swelling ankles/feet.Get medical help right away if you have any very serious side effects, including: dark patches on the skin, hardening/tightening of the skin, joint stiffness, hip/rib pain, muscle weakness, trouble moving.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using this medication, tell your health care professional if you are allergic to it; or to other gadolinium-based contrast agents (such as gadoterate meglumine, gadoteridol, gadoxetate disodium, gadobenate dimeglumine, gadobutrol, or gadopiclenol); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease (including being on dialysis), diabetes, high blood pressure.Gadolinium can stay in your body for months or years after getting this medication. Studies have not found harmful effects from gadolinium if your kidneys work normally. For more details talk to your doctor.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication may pass into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as kidney function) may be done before you use this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: Not applicable. This medication is given once before your imaging test.
STORAGE: Not applicable. This medication is given in a hospital or clinic and will not be stored at home.
Information last revised September 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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