Visipaque 270mg/ml Inj, 150ml
WARNING: This drug is given as a shot into a vein or artery only.This drug must not be given into the spine.Very bad health problems, paralysis, and death have happened when contrast has been given into blood vessels in the spinal cord. Talk with the doctor. @ COMMON USES: It is used before a CT scan or other test.
Drug Class
Diagnostic Agent
Pharmacologic Class
Iodinated Contrast Media, Non-ionic, Iso-osmolar
Pregnancy Category
Not available
FDA Approved
May 1996
DEA Schedule
Not Controlled
Overview
What is this medicine?
Visipaque is a special dye, called a contrast agent, that doctors inject into your body, usually into a vein. It helps make certain parts of your body, like blood vessels or organs, show up more clearly on X-ray images, such as CT scans. This helps doctors find problems or see how well your body is working.
How to Use This Medicine
Taking Your Medication
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. This medication is administered as an intravenous or intra-arterial injection only. Before receiving the injection, it is essential to ensure you are not dehydrated. Consult your doctor to determine if you need to drink extra fluids before the procedure.
After receiving the injection, drink plenty of non-caffeinated liquids unless your doctor advises you to limit your fluid intake. In some cases, other medications may be given before this medication to help minimize side effects.
Storing and Disposing of Your Medication
This injection will be administered in a healthcare setting, and you will not need to store it at home.
Missing a Dose
Since this medication is given in a healthcare setting, you will not need to worry about missing a dose. The healthcare professionals will administer the medication as scheduled.
To use this medication safely and effectively, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. This medication is administered as an intravenous or intra-arterial injection only. Before receiving the injection, it is essential to ensure you are not dehydrated. Consult your doctor to determine if you need to drink extra fluids before the procedure.
After receiving the injection, drink plenty of non-caffeinated liquids unless your doctor advises you to limit your fluid intake. In some cases, other medications may be given before this medication to help minimize side effects.
Storing and Disposing of Your Medication
This injection will be administered in a healthcare setting, and you will not need to store it at home.
Missing a Dose
Since this medication is given in a healthcare setting, you will not need to worry about missing a dose. The healthcare professionals will administer the medication as scheduled.
Lifestyle & Tips
- Drink plenty of fluids before and after the procedure, especially if you have kidney problems, to help your kidneys flush out the dye.
- Inform your doctor about all your medications, especially for diabetes (like metformin) or kidney conditions.
- Report any allergies, especially to iodine or previous contrast dyes.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Highly variable, depends on procedure and patient weight. E.g., for CT angiography: 50-150 mL (270 mgI/mL or 320 mgI/mL) administered intravenously.
Dose Range:
20 - 200 mg
Condition-Specific Dosing:
CT_Head:
50-150 mL (270 mgI/mL or 320 mgI/mL) IV
CT_Body:
50-150 mL (270 mgI/mL or 320 mgI/mL) IV
Angiography_Peripheral:
20-150 mL (270 mgI/mL or 320 mgI/mL) IV/IA
Angiography_Coronary:
30-150 mL (320 mgI/mL) IA
Pediatric Dosing
Neonatal:
Dosing is weight-based and procedure-specific. Typically 1-3 mL/kg, not to exceed 4 mL/kg or 150 mL total.
Infant:
Dosing is weight-based and procedure-specific. Typically 1-3 mL/kg, not to exceed 4 mL/kg or 150 mL total.
Child:
Dosing is weight-based and procedure-specific. Typically 1-3 mL/kg, not to exceed 4 mL/kg or 150 mL total.
Adolescent:
Dosing is weight-based and procedure-specific. Typically 1-3 mL/kg, not to exceed 4 mL/kg or 150 mL total.
Dose Adjustments
Renal Impairment:
Mild:
No specific dose adjustment required, but adequate hydration is crucial.
Moderate:
No specific dose adjustment required, but adequate hydration is crucial. Monitor renal function closely.
Severe:
Use with caution. Adequate hydration is crucial. Consider alternative imaging if possible. Monitor renal function closely.
Dialysis:
Can be used in patients on dialysis. Contrast media is dialyzable. If possible, administer immediately prior to dialysis session.
Hepatic Impairment:
Mild:
No adjustment
Moderate:
No adjustment
Severe:
No adjustment
Pharmacology
Mechanism of Action
Iodixanol is a non-ionic, iso-osmolar dimeric iodinated contrast medium. It enhances the visibility of structures or fluids within the body by absorbing X-rays. The iodine atoms in the molecule absorb X-rays, creating a contrast between the structures containing the contrast medium and the surrounding tissues. Its iso-osmolality to blood may contribute to a lower incidence of adverse events, particularly cardiovascular effects and pain/heat sensation upon injection, compared to hyperosmolar contrast agents.
Pharmacokinetics
Absorption:
Bioavailability:
100%
Tmax:
Immediately after IV injection
FoodEffect:
Not applicable (IV administration)
Distribution:
Vd:
Approximately 0.26 L/kg (similar to extracellular fluid volume)
ProteinBinding:
< 2%
CnssPenetration:
Limited (does not cross intact blood-brain barrier)
Elimination:
HalfLife:
Approximately 2 hours
Clearance:
Approximately 110 mL/min (renal clearance)
ExcretionRoute:
Primarily renal (glomerular filtration)
Unchanged:
> 97%
Pharmacodynamics
OnsetOfAction:
Immediate (upon injection)
PeakEffect:
Immediate (upon injection, then distribution)
DurationOfAction:
Brief (as long as it is present in the vascular system or target organ, then rapidly excreted)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Signs of thyroid problems, such as:
+ Weight changes
+ Feeling nervous, excitable, restless, or weak
+ Hair thinning
+ Depression
+ Eye or neck swelling
+ Difficulty focusing
+ Sensitivity to heat or cold
+ Menstrual changes
+ Shakiness
+ Sweating
Chest pain or pressure
Fast or abnormal heartbeat
Severe dizziness or fainting
Swelling, warmth, numbness, color changes, or pain in a leg or arm
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred vision
Tissue damage at the injection site, characterized by redness, burning, pain, swelling, blisters, skin sores, or fluid leakage
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious reactions, which can occur within 1 hour to several weeks after administration and may affect internal organs
+ Signs of severe skin reactions include:
- Red, swollen, blistered, or peeling skin
- Red or irritated eyes
- Sores in the mouth, throat, nose, eyes, genitals, or skin
- Fever
- Chills
- Body aches
- Shortness of breath
- Swollen glands
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it is essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Feeling of warmth
Irritation at the injection site
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek medical attention immediately:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Signs of thyroid problems, such as:
+ Weight changes
+ Feeling nervous, excitable, restless, or weak
+ Hair thinning
+ Depression
+ Eye or neck swelling
+ Difficulty focusing
+ Sensitivity to heat or cold
+ Menstrual changes
+ Shakiness
+ Sweating
Chest pain or pressure
Fast or abnormal heartbeat
Severe dizziness or fainting
Swelling, warmth, numbness, color changes, or pain in a leg or arm
Weakness on one side of the body
Trouble speaking or thinking
Changes in balance
Drooping on one side of the face
Blurred vision
Tissue damage at the injection site, characterized by redness, burning, pain, swelling, blisters, skin sores, or fluid leakage
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other serious reactions, which can occur within 1 hour to several weeks after administration and may affect internal organs
+ Signs of severe skin reactions include:
- Red, swollen, blistered, or peeling skin
- Red or irritated eyes
- Sores in the mouth, throat, nose, eyes, genitals, or skin
- Fever
- Chills
- Body aches
- Shortness of breath
- Swollen glands
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it is essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Feeling of warmth
Irritation at the injection site
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Difficulty breathing, wheezing, or shortness of breath
- Hives, rash, or severe itching
- Swelling of your face, lips, tongue, or throat
- Dizziness or feeling faint
- Chest pain or discomfort
- Unusual weakness or tiredness
- Decreased urination or swelling in your legs/feet (signs of kidney problems)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you are currently dehydrated, have a poor diet, or have recently used a laxative or diuretic (water pill).
If you have experienced a skin reaction to this medication or a similar medication in the past.
If you are taking metformin or any other medications that may interact with this drug.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your existing health conditions and medications. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you are currently dehydrated, have a poor diet, or have recently used a laxative or diuretic (water pill).
If you have experienced a skin reaction to this medication or a similar medication in the past.
If you are taking metformin or any other medications that may interact with this drug.
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your existing health conditions and medications. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
Important Warnings and Cautions for Patients Taking This Medication
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor may need to monitor your blood work while you are on this medication, so be sure to discuss this with them.
Although rare, this medication can cause life-threatening or fatal heart problems, including low blood pressure and heart attack. It is crucial to talk to your doctor about these potential risks. Additionally, when used in conjunction with certain procedures, this medication can increase the risk of blood clots, which may lead to heart attack and stroke, potentially resulting in death. If you have any questions or concerns, consult with your doctor.
This medication may interfere with certain laboratory tests, so it is vital to inform all your child's healthcare providers and laboratory personnel that they are taking this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the benefits and risks of this medication with their doctor, as it may affect the baby.
Special Considerations for Children
When administering this medication to children, use caution, as the risk of side effects may be higher in some pediatric patients. In children under 3 years of age, the use of medications like this one has been associated with low thyroid function, which can impact child development. Your child's doctor may recommend monitoring their thyroid function for a period after receiving the injection. If you have any questions or concerns, consult with your child's doctor.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor may need to monitor your blood work while you are on this medication, so be sure to discuss this with them.
Although rare, this medication can cause life-threatening or fatal heart problems, including low blood pressure and heart attack. It is crucial to talk to your doctor about these potential risks. Additionally, when used in conjunction with certain procedures, this medication can increase the risk of blood clots, which may lead to heart attack and stroke, potentially resulting in death. If you have any questions or concerns, consult with your doctor.
This medication may interfere with certain laboratory tests, so it is vital to inform all your child's healthcare providers and laboratory personnel that they are taking this medication.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the benefits and risks of this medication with their doctor, as it may affect the baby.
Special Considerations for Children
When administering this medication to children, use caution, as the risk of side effects may be higher in some pediatric patients. In children under 3 years of age, the use of medications like this one has been associated with low thyroid function, which can impact child development. Your child's doctor may recommend monitoring their thyroid function for a period after receiving the injection. If you have any questions or concerns, consult with your child's doctor.
Overdose Information
Overdose Symptoms:
- Fluid overload (pulmonary edema, heart failure)
- Electrolyte disturbances
- Acute renal failure
What to Do:
Treatment is symptomatic and supportive. Monitor fluid and electrolyte balance. Hemodialysis can be used to remove iodixanol from the body. Call 1-800-222-1222 (Poison Control) or seek immediate medical attention.
Drug Interactions
Major Interactions
- Metformin (in patients with renal impairment or acute kidney injury risk)
- Interleukin-2 (IL-2) (increased risk of delayed adverse reactions)
Moderate Interactions
- Beta-blockers (increased risk of anaphylactoid reactions, may blunt response to epinephrine)
- Diuretics (increased risk of dehydration and acute kidney injury)
- Nephrotoxic drugs (e.g., NSAIDs, aminoglycosides) (increased risk of acute kidney injury)
Monitoring
Baseline Monitoring
Renal function (serum creatinine, eGFR)
Rationale: To assess baseline kidney function and risk of contrast-induced nephropathy (CIN).
Timing: Prior to contrast administration (within 30 days, ideally within 7 days for high-risk patients).
Allergy history (especially to iodine or contrast media)
Rationale: To identify patients at increased risk for hypersensitivity reactions.
Timing: Prior to contrast administration.
Hydration status
Rationale: Adequate hydration is critical to prevent CIN.
Timing: Prior to contrast administration.
Thyroid function (TSH, T4)
Rationale: Iodinated contrast can induce hyperthyroidism or hypothyroidism in susceptible individuals.
Timing: Consider in patients with known or suspected thyroid disease.
Routine Monitoring
Vital signs (BP, HR, RR, O2 Sat)
Frequency: During and immediately after injection, then as clinically indicated.
Target: Within patient's normal range.
Action Threshold: Significant deviations, signs of hypersensitivity.
Signs/symptoms of hypersensitivity reaction (e.g., rash, urticaria, dyspnea, hypotension)
Frequency: Continuously during and for at least 30 minutes post-injection.
Target: Absence of symptoms.
Action Threshold: Any sign of reaction requires immediate intervention.
Renal function (serum creatinine)
Frequency: 24-72 hours post-contrast in high-risk patients (e.g., pre-existing renal impairment, diabetes, dehydration).
Target: Return to baseline or stable.
Action Threshold: Increase in serum creatinine by ≥0.3 mg/dL or ≥50% from baseline within 48-72 hours.
Symptom Monitoring
- Rash
- Hives (urticaria)
- Itching (pruritus)
- Swelling of face, lips, tongue, or throat (angioedema)
- Difficulty breathing (dyspnea)
- Wheezing
- Cough
- Chest tightness
- Dizziness
- Lightheadedness
- Nausea
- Vomiting
- Flushing
- Headache
- Pain or warmth at injection site
- Signs of acute kidney injury (decreased urine output, swelling)
Special Patient Groups
Pregnancy
Use during pregnancy only if clearly needed and the potential benefits outweigh the potential risks. Animal studies have not shown evidence of fetal harm, but human data are limited. Iodinated contrast media cross the placenta.
Trimester-Specific Risks:
First Trimester:
Limited data, theoretical risk of fetal thyroid dysfunction.
Second Trimester:
Limited data, theoretical risk of fetal thyroid dysfunction.
Third Trimester:
Limited data, theoretical risk of fetal thyroid dysfunction. Neonatal thyroid function monitoring may be considered if exposure occurred in the third trimester.
Lactation
Considered safe. Iodixanol is minimally excreted into breast milk and poorly absorbed by the infant's gastrointestinal tract. A temporary interruption of breastfeeding (e.g., for 24 hours) is generally not necessary but can be considered if there are concerns.
Infant Risk:
Low
Pediatric Use
Dosing is weight-based and procedure-specific. Children, especially neonates and infants, are more susceptible to fluid shifts and electrolyte imbalances. Adequate hydration is crucial. Risk of thyroid dysfunction in neonates/infants should be considered.
Geriatric Use
Increased risk of contrast-induced nephropathy due to age-related decline in renal function. Careful assessment of renal function and hydration status is essential. Use the lowest effective dose.
Clinical Information
Clinical Pearls
- Iodixanol (Visipaque) is the only iso-osmolar iodinated contrast medium available, meaning its osmolality is similar to that of human blood. This property may lead to a lower incidence of pain/warmth sensation upon injection and potentially fewer cardiovascular adverse events compared to hyperosmolar or low-osmolar agents.
- Despite being iso-osmolar, the risk of contrast-induced nephropathy (CIN) still exists, especially in patients with pre-existing renal impairment, diabetes, or dehydration. Aggressive hydration is the cornerstone of CIN prevention.
- Always assess patient's renal function (eGFR) before administering iodinated contrast.
- Patients on metformin should have their renal function assessed. If eGFR is <30 mL/min/1.73m² or if acute kidney injury is anticipated, metformin should be withheld at the time of or prior to the procedure and for 48 hours afterward, and reinstituted only after renal function has been re-evaluated and found to be stable.
- Be prepared for hypersensitivity reactions, ranging from mild urticaria to severe anaphylaxis. Have resuscitation equipment and medications (e.g., epinephrine, antihistamines, corticosteroids) readily available.
Alternative Therapies
- Iohexol (Omnipaque)
- Iopamidol (Isovue)
- Ioversol (Optiray)
- Ioxaglate (Hexabrix - ionic, high osmolar)
- Gadolinium-based contrast agents (for MRI, different mechanism)
Cost & Coverage
Average Cost:
Varies widely by institution, contract, and volume. Typically ranges from $50-$200+ per 150mL vial. per 150 mL vial
Insurance Coverage:
Generally covered by medical insurance for diagnostic imaging procedures.
General Drug Facts
If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure safe use, never share your prescription medications with others, and do not take medications that have been prescribed to someone else.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. Properly dispose of any unused or expired medications. Unless specifically instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the best method for disposing of medications, consult with your pharmacist, as they can provide guidance on safe disposal practices and inform you about potential drug take-back programs in your area.
Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist to see if this is the case. If you have any questions or concerns about your medication, do not hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider for clarification and support.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide detailed information about the medication involved, including the amount taken and the time it was taken, to ensure prompt and effective treatment.
Store all medications in a secure location, out of the reach of children and pets, to prevent accidental ingestion. Properly dispose of any unused or expired medications. Unless specifically instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the best method for disposing of medications, consult with your pharmacist, as they can provide guidance on safe disposal practices and inform you about potential drug take-back programs in your area.
Some medications may come with an additional patient information leaflet, so it is a good idea to check with your pharmacist to see if this is the case. If you have any questions or concerns about your medication, do not hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider for clarification and support.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. When reporting the incident, be prepared to provide detailed information about the medication involved, including the amount taken and the time it was taken, to ensure prompt and effective treatment.