iopamidol: clinical use

Prescribing considerations

• Use only under appropriately trained supervision with facilities for managing severe hypersensitivity reactions.
• Correct fluid or electrolyte disturbances and maintain appropriate hydration, particularly in infants and people with severe systemic, cardiac, renal or hepatic disease.
• Assess aspiration risk and confirm nasogastric-tube position before administration.
• For suspected gastrointestinal perforation, use only when the expected diagnostic benefit outweighs the risk.
• Account for ethanol-containing flavours in pregnancy, breastfeeding, children, liver disease, epilepsy or alcohol dependence.

Contraindications and cautions

• Hypersensitivity to iopamidol or any excipient.
• The selected formulation must not be administered parenterally.
• Avoid oral administration in oesophagotracheal fistula because of pulmonary complications from aspiration.

Monitoring

• Observe for immediate hypersensitivity and respiratory complications.
• In severe renal, hepatic or cardiac impairment, consider renal and hepatic function and urine output after the procedure.
• Monitor hydration and haemodynamic status carefully in newborns and infants.
• Check neonatal thyroid function after maternal or neonatal exposure as specified in the product information, particularly in premature neonates.
• Iopamidol can interfere with thyroid-function testing.

Clinical pharmacology

Iopamidol is a hydrophilic, non-ionic iodinated radiopaque agent with lower osmolality than ionic contrast media. Gastrointestinal absorption is poor, at approximately 1–2%; absorbed material is not appreciably metabolised and is principally cleared renally.

Formulation and product differences

• The selected product is an aqueous, colourless to pale-yellow solution for oral or rectal use.
• It contains flavourings and sweeteners; some flavours contain ethanol.
• Do not mix it with other medicines. Use immediately after opening and discard unused solution.
• Discard it if discoloured or if undissolved particles are visible.