ioversol (Rx)

Brand and Other Names:Optiray
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 160mg/mL (34%)
  • 240mg/mL (51%)
  • 300mg/mL (64%)
  • 320mg/mL (68%)
  • 350mg/mL (74%)

Radiographic Body Imaging

Usual: 50-150 mL IV OR 100-250 mL IV of (240 mg/mL)

25-75 mL IV OR 50-150 mL IV infusion; not to exceed 150 mL

For 240 mg/mL: 35-100 mL IV OR 70-200 mL IV infusion; not to exceed 250 mL

Cerebral Arteriography

2-12 mL of 51%, 64%, 68%; may repeat as necessary; not to exceed 200 mL/procedure

20-50 mL aortic arch injection of 51%, 64%, 68% for a simultaneous 4-vessel study; not to exceed 200 mL/procedure

Aortography

45 mL (10-80 mL range) of 68%; may repeat as necessary; not to exceed 250 mL/procedure

Computed Tomography

25-75 mL IV bolus followed by 50-150 mL infusion of 74%; not to exceed 150 mL

25-75 mL IV bolus followed by 50-150 mL infusion of 68%; not to exceed 150 mL

25-75 mL IV bolus followed by 50-150 mL infusion of 64%; not to exceed 150 mL

35-100 mL IV bolus followed by 70-200 mL infusion of 51%; not to exceed 150 mL

Head Imaging

50-150 mL IV of 68% or 64% OR

100-250 mL IV of 51%

Perform scanning immediately following IV administration

Coronary Arteriography

8 mL (2-10 mL) left coronary; 6 mL (1-10 mL) right coronary; may repeat as necessary; not to exceed 250 mL/procedure

IV-DSA

160 mg/mL (34%) recommended

30-50 mL IV, repeat PRN; not to exceed 250 mL/procedure

Administration

  • Carotid arteries: 6-10 mL
  • Subclavian or brachial arteries: 2-10 mL
  • Aorta: 25-50 mL
  • Vertebral arteries: 4-8 mL
  • Major branches of the abdominal aorta

IV Urography

50-75 mL IV of 74%, 68%, or 64% OR

75-100 mL IV of 51%

Higher dosages may be indicated

  • 1.4 mL/kg IV of 350 mg/mL; not to exceed 140 mL, OR
  • 1.5-2 mL/kg IV of 320 mg/mL; not to exceed 150 mL, OR
  • 1.5 mL/kg IV of 300 mg/mL; not to exceed 150 mL, OR
  • 2 mL/kg IV of 240 mg/mL; not to exceed 200 mL

Preparatory dehydration may contribute to ARF

Dosage Forms & Strengths

injectable solution

  • 160mg/mL (34%)
  • 240mg/mL (51%)
  • 300mg/mL (64%)
  • 320mg/mL (68%)
  • 350mg/mL (74%)

Angiocardiography

< 1 month

  • Safety & efficacy not established

> 1 month

  • 1.25 mL/kg (1-1.5 mL/kg) of 68% or 74% as single ventricular injection; not to exceed 5 mL/kg or 250 mL total volume

IV Urography

< 1 month

  • Safety & efficacy not established

> 1 month

  • 0.5-3 mL/kg IV (1-1.5 mL/kg usual); not to exceed 3 mL/kg

Computed Tomography

< 1 month

  • Safety & efficacy not established

> 1 month

  • Body imaging: 2 mL/kg (1-3 mL/kg) of 68%
  • Head imaging: 1-3 mL/kg of 68%
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Interactions

Interaction Checker

and ioversol

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (3)

            • amphotericin B deoxycholate

              amphotericin B deoxycholate and ioversol both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • cidofovir

              cidofovir and ioversol both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            • neomycin PO

              ioversol and neomycin PO both increase nephrotoxicity and/or ototoxicity. Contraindicated.

            Serious - Use Alternative (5)

            • amikacin

              amikacin and ioversol both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • metformin

              ioversol increases levels of metformin by decreasing renal clearance. Contraindicated. Acute renal failure or lactic acidosis may result. D/c metformin 48 hr before and after imaging study.

            • streptozocin

              ioversol and streptozocin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • tacrolimus

              ioversol and tacrolimus both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            • teicoplanin

              ioversol and teicoplanin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

            Monitor Closely (26)

            • acyclovir

              acyclovir and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • adefovir

              adefovir and ioversol both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • aldesleukin

              aldesleukin increases toxicity of ioversol by unknown mechanism. Use Caution/Monitor. Risk of atypical adverse reactions.

            • capreomycin

              capreomycin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • carboplatin

              carboplatin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • cephaloridine

              cephaloridine and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • cisplatin

              cisplatin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • colistin

              colistin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              ioversol and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • foscarnet

              ioversol and foscarnet both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • gentamicin

              ioversol and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • iodixanol

              iodixanol decreases effects of ioversol by unknown mechanism. Use Caution/Monitor. Administration of iodinated contrast agents may interfere with thyroid uptake of radioactive iodine (I-131 and I-123) and decrease therapeutic and diagnostic efficacy in patients with thyroid carcinoma. Decreased efficacy lasts for 6-8 weeks. .

            • metformin

              ioversol increases toxicity of metformin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Administration of intravascular iodinated contrast agents in metformin-treated patients has led to rare cases of acute decrease in renal function and the occurrence of lactic acidosis. The American College of Radiology Guidelines (2018) recommend temporarily stopping metformin in patients with eGFR is <30 mL/min/1.73 m2 or who are undergoing arterial catheter studies that might result in emboli to the renal arteries. Continue to withhold metformin for 48 hr subsequent to the procedure and reinstituted only after renal function has been reevaluated and found to be normal. .

            • methotrexate

              ioversol and methotrexate both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • methoxyflurane

              ioversol and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • oxaliplatin

              ioversol and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • paromomycin

              ioversol and paromomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • pentamidine

              ioversol and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • peramivir

              ioversol increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

            • polymyxin B

              ioversol and polymyxin B both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • rituximab

              ioversol and rituximab both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • rituximab-hyaluronidase

              ioversol and rituximab-hyaluronidase both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • streptomycin

              ioversol and streptomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • tobramycin

              ioversol and tobramycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

            • vancomycin

              ioversol and vancomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

            • voclosporin

              voclosporin, ioversol. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            Minor (0)

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              Adverse Effects

              <1%

              Cardiac disorders: Myocardial infarction, arrhythmia, atrioventricular block complete, atrioventricular block, nodal rhythm, bradycardia, angina pectoris, palpitations

              Ear and labyrinth disorders: Vertigo, tinnitus

              Eye disorders: Vision blurred, periorbital edema, conjunctivitis

              Gastrointestinal disorders: Vomiting, abdominal pain, dysphagia, dry mouth

              General disorders and administration site conditions: Chest pain, pain, hematoma, extravasation, pyrexia, swelling, asthenia, malaise, fatigue, chills, injection site pain, injection site hematoma, extravasation, pyrexia, swelling, asthenia, malaise, fatigue chills

              Infections and infestations: Rhinitis

              Injury, poisoning, and procedural complications: Heart injury, vascular pseudoaneurism

              Metabolism and nutrition disorders: Acidosis

              Musculoskeletal and connective tissue disorders: Muscular weakness, muscle spasms, back pain

              Nervous system disorders: Cerebral infarction, aphasia, tremor, dizziness, presyncope, headache, paraesthesia, dysgeusia

              Psychiatric disorders: Hallucination, visual hallucination, disorientation, anxiety

              Renal and urinary disorders: Urinary retention, renal pain, polyuria

              Respiratory, thoracic, and mediastinal disorders: Laryngeal edema, hypoxia, pulmonary edema, dyspnea, hyperventilation, cough, sneezing, nasal congestion

              Skin and subcutaneous tissue disorders: Urticaria, rash, pruritus, swelling face, hyperhidrosis, erythema

              Vascular disorders: Hypertension, hypotension, arterial spasm, vasospasm, vasodilation, flushing

              Postmarketing Reports

              Endocrine disorders: Hyperthyroidism, hypothyroidism

              Eye disorders and administrative site conditions: Injection site reactions (nerve injury, extravasation, pruritus, induration, bruising, rash, erythema)

              Immune system disorders: Anaphylactoid shock (with multi-organ failure and cardiorespiratory arrest), anaphylactic shock, anaphylactic/hypersensitivity reaction, urticaria

              Renal and urinary disorders: Acute kidney injury

              Skin and subcutaneous tissue disorders: Erythema multiforme, acute generalized exanthematous pustulosis

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              Warnings

              Black Box Warnings

              Administer procedure at facilities where staff is familiar with the recognition and treatment of allergic reactions

              When administering large doses use caution in patients with renal impairment or concurrent renal/hepatic impairment

              Neurologic events including paralysis following cerebral arteriography, arteriography of blood vessels , and spinal arteriography, reported

              Myocardial infarctions and stroke reported with angiographic procedures

              Thyroid storm reported with the use of iodinated contrast media

              Use caution in patients with multiple myeloma and pheochromocytoma

              Serious adverse events reported with inadvertent administration of iodinated contrast media intrathecally

              Inadvertent intrathecal administration may cause death, convulsions, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, seizures, rhabdomyolysis, hyperthermia, and brain edema

              Contraindications

              Not for intrathecal use (may cause death, convulsions, cerebral hemorrhage, coma, paralysis, ARF)

              Symptomatic hyperthyroidism

              Cautions

              Inhibits blood coagulation

              Caution in severe renal impairment, combined renal/hepatic disease, severe thyrotoxicosis, myelomatosis, anuria, pheochromocytoma, sickle cell, CHF, chronic alcoholism, severe arterial/venous disease

              May cause renal failure in patients with advanced vascular disease, diabetes; should be well hydrated before/after procedure; do not use laxatives, diuretics, or preparatory dehydration prior to administering product

              Obtain a history of allergy, hypersensitivity, or prior hypersensitivity reactions to iodinated contrast agents; always have emergency resuscitation equipment and trained personnel available and monitor all patients for hypersensitivity reactions

              Allergies (bronchial asthma, hay fever, food allergies) reported

              Premedication with antihistamines or corticosteroids to avoid or minimize possible allergic reactions should be considered; reports indicate that such pretreatment does not prevent serious life-threatening reactions, but may reduce both their incidence and severity

              General anesthesia may be indicated in the performance of some procedures in selected patients; however, a higher incidence of adverse reactions has been reported in these patients

              In angiographic procedures, the possibility of dislodging plaques or damaging or perforating the vessel wall should be considered during catheter manipulations and contrast medium injection; test injections to ensure proper catheter placement are suggested

              Angiography should be avoided whenever possible in patients with homocystinuria because of risk of inducing thrombosis and embolism

              Patients with congestive heart failure should be observed for several hours following procedure to detect delayed hemodynamic disturbances which may be associated with transitory increase in circulating osmotic load

              Extreme caution during injection of contrast medium is necessary to avoid extravasation; this is especially important in patients with severe arterial or venous disease

              Selective coronary arteriography should be performed only in selected patients and those in whom expected benefits outweigh procedural risk; inherent risks of angiocardiography in patients with chronic pulmonary emphysema must be weighed against necessity for performing this procedure

              Fatal, thromboembolic events causing myocardial infarction and stroke can occur during angiographic procedures; to minimize thromboembolic events use meticulous angiographic technique; avoid blood remaining in contact with syringes containing the product, which increases risk of clotting; avoid angiocardiography in patients with homocystinuria because of risk of inducing thrombosis and embolism

              Contraindicated in patients with symptomatic hyperthyroidism; thyroid storm reported following intravascular use of iodinated radiopaque agents in patients with hyperthyroidism or with autonomously functioning thyroid nodule; evaluate risk in patients before using product

              Hypertensive crisis has occurred after use of iodinated radiopaque contrast agents in patient with pheochromocytoma; closely monitor patients when administering product if pheochromocytoma or catecholamine-secreting paraganglioma is suspected; inject minimum amount of product necessary and have measures for treatment of hypertensive crisis readily available

              Iodinated contrast agents may promote sickling in individuals who are homozygous for sickle cell disease; hydrate patients prior to and following product administration; use product only if necessary imaging information cannot be obtained with alternative imaging modalities, and inject minimum amount necessary

              Severe cutaneous adverse reactions(SCAR), including Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS), may develop from 1 hr to several weeks after intravascular contrast agent administration; reaction severity may increase and time to onset may decrease with repeat administration of contrast agent; prophylactic medications may not prevent or mitigate severe cutaneous adverse reactions; avoid administering product to patients with history of severe cutaneous adverse reaction to product

              FDA MedWatch

              • March 30, 2022: FDA recommended newborns and children aged ≤3 years have follow-up thyroid monitoring within 3 weeks after receiving iodinated contrast media (ICM) for X-rays and other medical imaging procedures
              • Published studies found underactive thyroid and temporary decreases in thyroid hormone levels were uncommon; however, if identified and treated early, future complications may be prevented
              • Appropriately monitor for signs and symptoms of hypothyroidism and decreased thyroid hormone levels following ICM exposure; consider evaluating thyroid function within 3 weeks, especially in term and preterm neonates and children with some underlying conditions
              • If thyroid dysfunction detected, treat and monitor thyroid function as needed to avoid future complications
              • Certain pediatric patients are at increased risk, including newborns or have very low birth weight, prematurity, or presence of cardiac or other conditions (eg, requiring care in neonatal or pediatric ICUs)
              • Patients with cardiac conditions may be at greatest risk since they often require high doses of contrast during invasive cardiac procedures
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              Pregnancy & Lactation

              Pregnancy

              Postmarketing data with product use in pregnant women are insufficient to determine if there is risk of drug-associated adverse developmental outcomes; literature reports show that product crosses placenta and is visualized in digestive tract of exposed infants after birth; product crosses placenta and reaches fetal tissues in small amounts; in animal reproduction studies, no adverse developmental effects were observed following intravenous administration of ioversol to pregnant rats and rabbits at doses 0.35 and 0.71 times, respectively, the maximum recommended human dose

              Lactation

              There is no information about presence of product in human or animal milk, effects of drug on breastfed infant, or effects of drug on milk production; however, iodinated contrast agents are excreted unchanged in human milk in very low amounts with poor absorption from gastrointestinal tract of breastfed infant; the developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for product and any potential adverse effects on breastfed infant from product or from underlying maternal condition; interruption of breastfeeding after exposure to iodinated contrast agents is not necessary because potential exposure of breastfed infant to iodine is small; however, a lactating woman may consider interrupting breastfeeding and pumping and discarding breast milk for 8 hours (approximately 5 elimination half-lives) after product administration in order to minimize drug exposure to breast fed infant

              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.

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              Pharmacology

              Mechanism of Action

              Opacifies vessels in the path of flow of the contrast medium, permitting radiographic visualization of the internal structures until significant hemodilution occurs

              Pharmacokinetics

              Half-life: 2 hr

              Excretion: Urine (>95%)

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              Images

              No images available for this drug.
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              Patient Handout

              Patient Education
              ioversol intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your 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: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              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: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2022 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.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.