REACTIONS TO CONTRAST MATERIAL
- Allergic Reactions-It is impossible to predict which
patients will have an adverse reaction to IV administration of
contrast material. If an patient has a history of a previous adverse
reaction, is hypotensive, in congestive heart failure,
pheochromocytoma, multiple myeloma, diabetes mellitus, or has severe
renal disease, then contrast material should not be administered. If
it is necessary to do so, then it is best to use a non-ionic,
iodinated contrast material. It may be beneficial to
prophyllactically treat the patient with antihistamines. And, these
patients should be closely monitored. In humans, signs may be mild
consistenting of nausea, metallic taste sensation, burning sensation
in the arm during injection. In these cases, no treatment is
generally needed besides monitoring for progression of signs. Signs
may progress to flushing of the skin and urticaria. Treatment with
antihistamines may be warranted. In moderately severe cases,
breathing may become difficult and treatment with steroids may be
warranted. In severe cases of anaphylaxis, full CPR may be
- Acute Renal Failure - Occasionally, acute renal failure may
result following IV administration of iodinated contrast material.
Aggressive treatment with fluids, dopamine, lasix, and mannitol may
- Aspiration - Aspiration of small volumes of barium sulfate
suspension is usually incidental. The barium is eliminated by
coughing and the mucocilliary apparatus. The remainder of the barium
is removed by macrophages and will accumulate in the
tracheobronchial lymph nodes which will then appear opaque for
years. Aspiration of large volumes of barium can cause suffocation
and suction may be necessary to remove the barium. If gastric
contents or other material is aspirated, then pneumonia may result.
Often, this is treatable with antibiotics. Aspiration of nonionic,
iodinated contrast material may lead to pulmonary edema.
- Pulmonary Edema - Life threatening pulmonary edema may
develop if iodinated (especially ionic) contrast material is
administered into the lungs. Aggressive treatment including oxygen,
lasix, and steroids may be necessary.
- Seizure - One of the most common adverse reaction to
myelography is seizures, especially after cervical injections. These
typically occur during recovery from anesthesia or within the next
24 hours. They typically are self-limiting and can be managed with
valium or anesthesia. Injection of ionic contrast material
during myleography typically results in severe seizures and death.
- Peritonitis - Barium will induce granulomas when
administered within the peritoneal cavity. This may have mild,
inconsequential effects or result in severe abdominal adhesions,
abdominal pain, and possible decompensation of the patient. Barium
has been injected into the mediastinum of cats with minimal
Classification of reactions to contrast agent reactions
|Nausea - retching
Chest / abdominal pain
More information extracts
Diabetic nephropathy may predispose to renal impairment following
intravascular contrast medium administration. This may
precipitate lactic acidosis in patients who are taking biguanides.
As a precaution, biguanides should be stopped 48 hours prior to
the contrast medium examination.
reactions can be aggravated in patients on beta-blockers, and
these patients may be refractory to standard treatment with beta
The prevalence of
delayed reactions (e.g. fever, rash, flulike symptoms, joint pain
and pruritus) to iodinated contrast media is higher in patients
who have received interleukin, as long as several months prior to
the administration of iodinated contrast medium.
Renal toxicity has
been reported in a few patients with liver dysfunction who were
given an oral cholecystographic agent followed by
intravascular contrast agents. Administration of any
intravascular contrast agent should therefore be postponed in
patients who have recently received a cholecystographic contrast
The following table of incidence of reactions is based upon
controlled clinical trials in which ULTRAVIST®
Injection was compared with nonionic contrast agents (iohexol, iopamidol,
ioversol) in 1367 patients. This listing includes all
reported adverse reactions regardless of attribution.
Adverse reactions are listed by body system and in decreasing
order of occurrence greater than 0.5% in the iopromide group.
One or more adverse reactions were recorded in 229 of 708 (32%)
patients during the clinical trials, coincidental with the
administration of ULTRAVIST® Injection or within the
defined duration of the study follow-up period (24-72 hours). The
incidence and type of adverse reactions were similar to those of
the studied nonionic comparators (iohexol, iopamidol, ioversol)
used in the clinical trials. Also, as with other contrast agents,
ULTRAVIST® Injection is often associated with
sensations of warmth and/or pain. The incidence is similar to the
other nonionic contrast comparators.
Serious, life-threatening and fatal reactions have been
associated with the administration of iodine-containing contrast
media, including ULTRAVIST® Injection. In clinical
trials 7/708 patients given ULTRAVIST® Injection and
4/659 given a comparator died 5 days or later after drug
administration. Also, 8/708 patients given ULTRAVIST®
Injection and 4/659 given a comparator had serious adverse events.
Rare reports of death due to anaphylaxis and thrombosis have been
documented during foreign postmarketing surveillance.
The following adverse reactions were observed in less than or
equal to 0.5% of the subjects receiving ULTRAVIST®
BODY: abdominal pain, asthenia, chills, dry mouth, edema of the
face, fever, malaise, neck pain; CARDIOVASCULAR: AV block (complete),
bradycardia, coronary thrombosis, hypoxia, peripheral vascular
disorder, pulmonary hypertension, sweating increase, syncope,
vascular anomaly, ventricular extrasystoles; DIGESTIVE:
constipation, diarrhea, dyspepsia, salivation increase, sore
throat; INJECTION SITE REACTIONS: edema, erythema, rash;
METABOLIC: excessive thirst; MUSCULOSKELETAL: arthralgia,
myasthenia; NERVOUS SYSTEM: agitation, anxiety; convulsion,
depression, emotional lability, hypertonia, hypesthesia, incoordination, insomnia, neuropathy, speech disorder, tremor;
RESPIRATORY: apnea, asthma, cough increased, pharyngitis,
respiratory disorder (unspecified); SKIN AND APPENDAGES: pruritus,
rash; SPECIAL SENSES: visual field defect; UROGENITAL: dysmenorrhea, kidney pain.
Additional adverse events reported in foreign postmarketing
surveillance and other trials with the use of ULTRAVIST®
Injection include: apparent hypersensitivity reactions,
congestive heart failure, tachycardia, ventricular fibrillation, hemopericardium, aphasia, tongue paralysis, amnesia,
hypotonia, mydriasis, lacrimation disorder, hematuria, renal failure, and
The overall character, quality, and severity of adverse reactions
in pediatric patients is similar to that reported in adult
populations from domestic and foreign postmarketing surveillance
and other information. Additional adverse reactions reported in
pediatric patients from foreign marketing surveillance or other
information are: epistaxis, angioedema, migraine, joint disorder
(effusion), muscle cramps, mucous membrane disorder (mucosal
swelling), conjunctivitis, hypoxia, fixed eruptions, vertigo,
diabetes insipidus, and brain edema.
The adverse effects of overdosage are life-threatening and affect
mainly the pulmonary and cardiovascular systems. Treatment of an
overdosage is directed toward the support of all vital functions,
and prompt institution of symptomatic therapy.
ULTRAVIST® Injection binds negligibly to plasma or
serum protein and can, therefore, be dialyzed.
with Regard to Metformin-Induced Lactic Acidosis and X-ray Contrast Medium