gadoxetic acid, disodium: clinical use

Prescribing considerations

• Use only when essential diagnostic information is unavailable from unenhanced MRI and delayed-phase imaging is required.
• Screen for renal dysfunction, particularly in older adults.
• Avoid where possible in severe renal impairment and during the perioperative liver-transplantation period because of possible nephrogenic systemic fibrosis risk.
• Assess carefully with severe cardiovascular disease, previous contrast reactions, asthma or allergic disorders.
• Do not use with uncorrected hypokalaemia; use particular care with congenital long-QT syndrome, relevant arrhythmia history or QT-prolonging medicines.
• Safety and efficacy are not established in patients younger than 18 years.

Contraindications and cautions

• Hypersensitivity to gadoxetic acid, disodium or any excipient.

Monitoring

• Check renal function before administration.
• Ensure immediate access to hypersensitivity treatment and observe for at least 30 minutes afterwards.
• Monitor the injection site for extravasation.
• Record the product name, batch and administered amount.
• Elevated bilirubin or ferritin may reduce hepatic contrast; some serum iron methods can give false results for up to 24 hours.

Clinical pharmacology

A linear, ionic gadolinium chelate with extracellular distribution followed by selective hepatocyte uptake through organic-anion transport pathways. It is not metabolised and is eliminated through renal and hepatobiliary routes.

Formulation and product differences

• Ready-to-use, undiluted solution in glass or plastic prefilled syringes.
• The solution should be clear and colourless to pale yellow; do not use if markedly discoloured, particulate or in a defective container.
• Contains sodium and must not be mixed with other medicines because compatibility studies are unavailable.