Iohexol


Generic Medicine Info
Indications and Dosage
Intra-arterial
Aortography and selective visceral arteriography
Adult: As 300 mg or 350 mg iodine/mL solution: Aorta (aortic arch and ascending aorta): 50-80 mL; Abdominal aorta and its branches (including coeliac and mesenteric arteries): 30-60 mL; Renal artery: 5-15 mL. Doses may be repeated if required. Max total volume: 290 mL (as 300 mg iodine/mL solution); 250 mL (as 350 mg iodine/mL solution). Aortic root and arch study when used alone: As 350 mg iodine/mL solution: 50 mL (dose range: 20-75 mL). Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.
Child: Aortic root or arch, descending aorta: As 350 mg iodine/mL solution: 1 mL/kg, may be repeated as needed. Max: 5 mL/kg, up to total volume of 250 mL. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intra-arterial
Cerebral arteriography
Adult: As 300 mg iodine/mL solution: Common carotid artery: 6-12 mL. Internal carotid artery: 8-10 mL. External carotid artery: 6-9 mL. Vertebral artery: 6-10 mL. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intra-arterial
Peripheral arteriography
Adult: Aortofemoral runoffs: As 300 mg iodine/mL solution: 30-90 mL; As 350 mg iodine/mL solution: 20-70 mL. Selective arteriograms: As 300 mg iodine/mL solution: 10-60 mL; As 350 mg iodine/mL solution: 10-30 mL. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intra-arterial
Digital subtraction angiography
Adult: As 140 mg iodine/mL solution: Aorta: 20-45 mL at 8-20 mL/second. Carotid artery: 5-10 mL at 3-6 mL/second. Femoral artery: 9-20 mL at 3-6 mL/second. Vertebral artery: 4-10 mL at 2-8 mL/second. Renal artery: 6-12 mL at 3-6 mL/second. Other branches of aorta (including subclavian, axillary, innominate and iliac): 8-25 mL at 3-10 mL/second. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.

Intra-arterial
Angiocardiography
Adult: Ventriculography: As 350 mg iodine/mL solution: 40 mL (dose range: 30-60 mL) as a single dose, may be repeated as needed. Max volume with multiple inj: 250 mL. May be combined with selective coronary arteriography. Selective coronary arteriography: As 350 mg iodine/mL solution: 4-8 mL per inj; alternatively, 5 mL (dose range: 3-14 mL) per inj, may be repeated as necessary. Max volume with multiple inj: 250 mL. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.
Child: Ventriculography: As 300 mg iodine/mL solution: 1.75 mL/kg (dose range: 1.5-2 mL/kg), may be repeated as needed. Max dose with multiple inj: 5 mL/kg, up to a total volume of 291 mL. As 350 mg iodine/mL solution: 1.25 mL/kg (dose range: 1-1.5 mL/kg), may be repeated as necessary. Max dose with multiple inj: 5 mL/kg, up to a total volume of 250 mL. Pulmonary angiography: As 300 mg iodine/mL solution: 1 ml/kg. Dosage may vary among countries or individual products. Refer to specific product guidelines.

Intra-articular, Intrasynovial
Arthrography
Adult: Knee joint: As 240 mg or 300 mg iodine/mL solution: 5-15 mL; As 350 mg iodine/mL solution: 5-10 mL. Shoulder joint: As 240 mg iodine/mL solution: 3 mL; As 300 mg iodine/mL solution: 10 mL. Temporomandibular joint: As 300 mg iodine/mL solution: 0.5-1 mL. Higher volumes are recommended for single-contrast examinations; lower volumes are recommended for double-contrast examinations. Use active or passive manipulation to disperse the media throughout the joint space.

Intracavitary
Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic retrograde pancreatography (ERP)
Adult: As 240 mg iodine/mL solution (undiluted): 10-50 mL. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intracavitary, Intraperitoneal, Intrauterine
Hysterosalpingography
Adult: As 240 mg iodine/mL solution (undiluted): 15-50 mL or 15-20 mL. As 300 mg iodine/mL solution (undiluted): 15-25 mL or 15-20 mL. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intracavitary, Intraperitoneal
Herniography
Adult: As 240 mg iodine/mL solution (undiluted): 50 mL. Doses are administered into the body cavity. Dosage may vary based on individual anatomy and/or disease state.

Intracavitary, Urethral
Voiding cystourethrography
Child: As 240 mg, 300 mg or 350 mg iodine/mL solution (diluted with sterile water for inj to prepare 50-100 mg iodine/mL concentration): Usual volume range: 50-300 mL (at 100 mg iodine/mL concentration); 50-600 mL (at 50 mg iodine/mL concentration).

Intracavitary
Sialography
Adult: As 240 mg or 300 mg iodine/mL solution: 0.5-2 mL.

Intrathecal
Myelography
Adult: Lumbar (via lumbar inj): As 180 mg iodine/mL solution: 10-17 mL; As 240 mg iodine/mL solution: 7-12.5 mL. Thoracic (via lumbar or cervical inj): As 240 mg iodine/mL solution: 6-12.5 mL; As 300 mg iodine/mL solution: 6-10 mL. Cervical (via lumbar inj): As 240 mg iodine/mL solution: 6-12.5 mL; As 300 mg iodine/mL solution: 6-10 mL. Cervical (via C1-2 inj): As 180 mg iodine/mL solution: 7-10 mL; As 240 mg iodine/mL solution: 6-12.5 mL; As 300 mg iodine/mL solution: 4-10 mL. Total columnar (via lumbar inj): As 240 mg iodine/mL solution: 6-12.5 mL; As 300 mg iodine/mL solution: 6-10 mL. Doses are given via slow inj over 1-2 minutes. For single myelographic procedure: Max total dose of 3,100 mg iodine or 300 mg iodine/mL concentration. If repeat procedures are needed, wait for at least 48 hours (preferably 5-7 days) before repeating the test. Dosage recommendations, concentrations used, and inj administration may vary among countries or individual products. Refer to specific product guidelines.
Child: Lumbar, thoracic, cervical and/or total columnar (via lumbar puncture): As 180 mg iodine/mL solution. 0-<3 months 2-4 mL; 3-<36 months 4-8 mL; 3-<7 years 5-10 mL; 7-<13 years 5-12 mL; 13-18 years 6-15 mL. For single myelographic procedure: Max total dose of 2,700 mg iodine or 180 mg iodine/mL concentration. If repeat procedures are needed, wait for at least 48 hours (preferably 5-7 days) before repeating the test. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intrathecal
Computed tomographic cisternography
Adult: As 240 mg iodine/mL solution: 4-12 mL via lumbar inj. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.

Intravenous
Contrast-enhanced computerised tomography
Adult: Head imaging via rapid inj: As 300 mg iodine/mL solution: 70-150 mL; As 350 mg iodine/mL solution: 80 mL. Head imaging via infusion: As 240 mg iodine/mL solution: 120-250 mL. Body imaging via rapid inj: As 300 mg iodine/mL solution: 50-200 mL; As 350 mg iodine/mL solution: 60-100 mL. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.
Child: Head imaging: As 240 mg or 300 mg iodine/mL: 1-2 mL/kg. Max dose may be product dependent. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.

Intravenous
Peripheral venography, Phlebography
Adult: As 240 mg iodine/mL solution: 20-150 mL per leg. As 300 mg iodine/mL solution: 40-100 mL per leg. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.

Intravenous
Contrast-enhanced computerised tomography of the abdomen
Adult: In conjunction with orally administered iohexol inj or oral solution: As 300 mg iodine/mL solution (diluted): 100-150 mL. Doses may be given up to 40 minutes after consumption of oral iohexol.
Child: In conjunction with orally administered iohexol inj or oral solution: As 240 mg or 300 mg iodine/mL solution (diluted): 2 mL/kg (dose range: 1-2 mL/kg). Max: 3 mL/kg. Doses may be given up to 60 minutes after consumption of oral iohexol.

Intravenous
Digital subtraction angiography
Adult: As 300 mg or 350 mg iodine/mL solution: 20-60 mL per inj. Alternatively for 350 mg iodine/mL solution, may give usual dose of 30-50 mL via pressure injector at a rate of 7.5-30 mL/second. May require 3 or more inj. Max total dose: 250 mL. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.

Intravenous
Excretory urography
Adult: As 300 mg or 350 mg iodine/mL solution: 40-80 mL, or 0.6-1.2 mL/kg. Dosage recommendations may vary among countries or individual products. Refer to specific product guidelines.
Child: As 240 mg iodine/mL solution: <7 kg: 4 mL/kg; >7 kg: 3 mL/kg. As 300 mg iodine/mL solution: <7 kg: 3 mL/kg; >7 kg: 2 mL/kg. Alternatively for 300 mg iodine/mL solution, may give usual dose of 1-1.5 mL/kg (dose range: 0.5-3 mL/kg). Max total dose: 3 mL/kg. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.

Oral
Contrast-enhanced computerised tomography of the abdomen
Adult: As 9 mg iodine/mL powder for oral solution (Oraltag®): 500-1,000 mL given 20-60 minutes prior to image acquisition. If the patient has difficulty in consuming the required volume, a higher concentration of solution (up to 21 mg iodine/mL solution) may be prepared and administered at a smaller volume. Max total iodine dose: 9 g. In conjunction with IV administration of iohexol: As 240 mg, 300 mg or 350 mg iodine/mL (diluted to 6-12 mg iodine/mL concentration): 500-1,000 mL. Use smaller volumes for higher concentrations. As 9 mg and 12 mg iodine/mL oral solution (Omnipaque®): 500-1,000 mL. Doses may be given all at once or over 45 minutes if with difficulty in consumption.
Child: As 9 mg iodine/mL powder for oral solution (Oraltag®): <3 years 120-300 mL. Max total iodine dose: 4.5 g; 3-18 years 280-750 mL. Max total iodine dose: 9 g. Doses are given 20-60 minutes prior to image acquisition and will vary based on the size of the patient. If the patient has difficulty in consuming the required volume, a higher concentration of solution (up to 21 mg iodine/mL solution) may be prepared and administered at a smaller volume. In conjunction with IV administration of iohexol: As 240 mg, 300 mg or 350 mg iodine/mL (diluted to 9-21 mg iodine/mL concentration): 180-750 mL. Use smaller volumes for higher concentrations. As 9 mg and 12 mg iodine/mL oral solution: 180-750 mL. Max total iodine dose: <3 years 5 g iodine; 3-18 years 10 g iodine. Doses may be given all at once or over 45 minutes if with difficulty in consumption.

Oral
Gastrointestinal tract examination
Adult: As 350 mg iodine/mL solution (undiluted): 50-100 mL.
Child: <3 months As 180 mg iodine/mL solution (undiluted): 5-30 mL; 3 months to 3 years As 180 mg, 240 mg or 300 mg iodine/mL solution (undiluted): Up to 60 mL; 4-10 years As 180 mg, 240 mg or 300 mg iodine/mL solution (undiluted): Up to 80 ml; >10 years As 180 mg, 240 mg or 300 mg iodine/mL solution (undiluted): Up to 100 mL. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.

Oral
Contrast-enhanced computerised tomography of the pelvis
Child: As 9 mg iodine/mL powder for oral solution (Oraltag®): <3 years 120-300 mL. Max total iodine dose: 4.5 g; 3-18 years 280-750 mL. Max total iodine dose: 9 g. Doses are given 20-60 minutes prior to image acquisition and will vary based on the size of the patient. If the patient has difficulty in consuming the required volume, a higher concentration of solution (up to 21 mg iodine/mL solution) may be prepared and administered at a smaller volume.

Rectal
Gastrointestinal tract examination
Child: <3 months As 180 mg iodine/mL solution (undiluted): 5-30 mL; 3 months to 3 years As 180 mg, 240 mg or 300 mg iodine/mL solution (undiluted): Up to 60 mL; 4-10 years As 180 mg, 240 mg or 300 mg iodine/mL solution (undiluted): Up to 80 ml; >10 years As 180 mg, 240 mg or 300 mg iodine/mL solution (undiluted): Up to 100 mL. Larger volumes may be used. Dosage recommendations and concentrations used may vary among countries or individual products. Refer to specific product guidelines.
Reconstitution
As 240 mg, 300 mg or 350 mg iodine/mL inj solution (for oral administration): Dilute with water, carbonated beverage, milk, juice or infant formula to achieve the required concentration. As 9 mg iodine/mL powder for oral solution (Oraltag®): Dilute with water, juice, infant milk, carbonated or sports drink to prepare the desired concentration. Shake well. Refer to local specific product guidelines for the preparation procedure based on final iodine concentration.
Contraindications
Hypersensitivity. Manifest thyrotoxicosis. For 240 and 300 mg iodine/mL solution inj into body cavity indicated for hysterosalpingography: Known or suspected reproductive tract neoplasia, infection signs in any portion of the genital tract (including external genitalia), menstruation or when menstrual period is imminent, within 30 days after conisation or curettage, within 6 months following pregnancy termination. 9 and 12 mg iodine/mL oral solution (Ominipaque®/Oraltag®): parenteral use; 140 and 350 mg iodine/mL solution: intrathecal administration. Known or suspected pregnancy (for 240 and 300 mg iodine/mL solution inj into body cavity used for hysterosalpingography).
Special Precautions
Patient with allergic diathesis, history of known allergies (e.g. bronchial asthma, drug or food allergies); CV disease (e.g. severe coronary heart disease, unstable angina pectoris, valvular disease, prior MI or coronary bypass), pulmonary hypertension, risk factors for nephrotoxicity (e.g. dehydration, diabetes mellitus, CHF, advanced vascular disease, multiple myeloma, hyperuricaemia, paraproteinaemia, concomitant nephrotoxic or diuretic medications), hyper- or hypothyroidism, known or suspected phaeochromocytoma, sickle cell disease; myasthenia gravis, history of epilepsy, acute cerebral infarction, acute intracranial bleeding, cerebral oedema, acute demyelinisation, diseases that cause blood-brain barrier disturbance, advanced cerebral atherosclerosis, previous stroke, frequent TIA, alcohol or drug dependence. Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. Renal and hepatic impairment. Children and elderly. Pregnancy (except for preparations used in hysterosalpingography); lactation.
Adverse Reactions
Significant: Severe cutaneous adverse reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms); hypertensive crisis, acute kidney injury, including renal failure; thyroid storm, hyperthyroidism, transient thyroid suppression or hypothyroidism; exacerbation of myasthenia gravis, seizures, encephalopathy; transient hearing loss (following myelography). Rarely, local pain, oedema, erythema or tissue necrosis (if extravasation occurs).
Cardiac disorders: Arrhythmias.
Eye disorders: Visual disturbances, including photomas.
Gastrointestinal disorders: Diarrhoea, nausea, vomiting, abdominal pain; lower abdominal pain (hysterosalpingography); pancreatitis (ERCP).
General disorders and administration site conditions: Feeling hot; pain (arthrography).
Investigations: Transient respiratory rate changes (intra-arterial/IV); increased blood amylase (ERCP).
Musculoskeletal and connective tissue disorders: Back pain, neck pain or stiffness, lower limb cramp.
Nervous system disorders: Headache, neuralgia, dizziness.
Respiratory, thoracic and mediastinal disorders: Respiratory distress (intra-arterial/IV).
Potentially Fatal: Hypersensitivity reactions, including anaphylaxis. Rarely, CV reactions (e.g. hypotension, shock, cardiac arrest), thromboembolic events resulting in MI or stroke.
Intra-arterial/Intracavitary/IT/IV/Parenteral/PO/Rectal: B
Patient Counseling Information
Ensure adequate hydration before and following administration.
Monitoring Parameters
Closely monitor for signs and symptoms of hypersensitivity and CV reactions. Monitor blood pressure specifically in patients with phaeochromocytoma or catecholamine-secreting paragangliomas.
Overdosage
Symptoms: IV/Intra-arterial: Bradycardia, cyanosis, acidosis, pulmonary haemorrhage, convulsions, coma, and cardiac arrest. Management: Symptomatic and supportive treatment.
Drug Interactions
May lead to transient renal impairment and precipitate lactic acidosis in diabetics who are taking metformin. Increased risk of delayed reactions (e.g. flu-like symptoms, skin reactions, erythema) with interferons and interleukin-2 (<2 weeks treatment). Increased risk of contrast medium-induced seizures with agents that lower seizure threshold (e.g. phenothiazine derivatives, TCAs, certain neuroleptics). May lower the threshold for bronchospasm in asthmatic patients and reduce the responsiveness of treatment with epinephrine when given with β-blockers.
Lab Interference
May interfere with diagnostic tests that use iodine-containing isotopes. High iohexol levels in serum and urine may interfere with bilirubin, proteins or inorganic substances (e.g. Ca, Fe, copper, phosphate) tests.
Action
Description:
Mechanism of Action: Iohexol is a non-ionic, monomeric, triodinated, water-soluble radiographic contrast medium. It allows visualisation of internal body structures by opacifying the path of its flow.
Duration: CNS: Approx 30 minutes (intrathecal); 60 minutes (IV).
Pharmacokinetics:
Absorption: Poorly absorbed (oral). Time to peak plasma iodine concentration: 15-120 seconds (rapid IV inj).
Distribution: Crosses the placenta; enters breast milk (small amounts). Plasma protein binding: <2%.
Metabolism: Not significantly metabolised.
Excretion: Via urine (approx 88-90% as unchanged drug [intravascular, intrathecal]; <1% [oral]).
Chemical Structure

Chemical Structure Image
Iohexol

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3730, Iohexol. https://pubchem.ncbi.nlm.nih.gov/compound/Iohexol. Accessed Nov. 24, 2022.

Storage
Oral solution (Ominipaque®): Store between 0-30°C. Powder for oral solution (Oraltag®): Store between 20-25°C. Protect prepared oral solution from direct sunlight or strong daylight. Solution for inj: Store between 15-30°C. Protect from light. Do not freeze.
MIMS Class
Radiographic & Diagnostic Agents
ATC Classification
V08AB02 - iohexol ; Belongs to the class of watersoluble, nephrotropic, low osmolar preparations used as X-ray contrast media.
References
Anon. Iohexol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/10/2022.

Buckingham R (ed). Iohexol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/10/2022.

GE Healthcare. Omnipaque data sheet 24 April 2020. Medsafe. http://www.medsafe.govt.nz. Accessed 13/10/2022.

Omnipaque Injection (Pharmaforte [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 13/10/2022.

Omnipaque Injection 350 mg I/mL Solution for Injection (GE Healthcare AS). MHRA. https://products.mhra.gov.uk. Accessed 13/10/2022.

Omnipaque Injection, Solution and Oral Solution (GE Healthcare Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 13/10/2022.

Oraltag Solution (Interpharma Praha, A.S.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 13/10/2022.

Disclaimer: This information is independently developed by MIMS based on Iohexol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2024 MIMS. All rights reserved. Powered by MIMS.com
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