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Uro-Angiographic Contrast Agents—The Holy Grail
Published in Christoph de Haën, X-Ray Contrast Agent Technology, 2019
In some companies with persisting research on monomeric uro-angiographic contrast agents, attention shifted from novel iodinated moieties to the choice of counter ions. In the late 1950s, the availability of diatrizoic acid formulated with various cations had led to the insight that not only the anionic triiodinated portion of monomeric ionic molecules played a role in intravascular tolerability and pain sensation but also the single cation or cation mixture used for its neutralization (Massell, Greenstone, and Heringman 1957; Sjögren 1957; Fischer and Eckstein 1961). Diatrizoate sodium/meglumine [UROGRAFIN, Schering, RENOGRAFIN, Squibb] was better tolerated and caused less pain than diatrizoate sodium [HYPAQUE, Winthrop]. In the early 1960s, this caused HYPAQUE to significantly lose market share, most strongly in the United States. Therefore, eventually Winthrop Laboratories too formulated its compound with some meglumine as counter ion, giving it the name HYPAQUE M™.
Cumulative administrations of gadolinium-based contrast agents: risks of accumulation and toxicity of linear vs macrocyclic agents
Published in Critical Reviews in Toxicology, 2019
Lara Chehabeddine, Tala Al Saleh, Marwa Baalbaki, Eman Saleh, Samia J. Khoury, Salem Hannoun
Nonionic contrasts usually have a lower osmolality than ionic ones due to the additional contribution of Na+ and meglumine. Runge et al. performed an experimental study in which they tested the effects of a single high dose GBCA injection of different osmolalities (case of extravasation) compared to saline and an X-ray contrast control (Runge et al. 2002). The tested GBCAs were gadopentetate dimeglumine (1960 mOsm/kg; LD50 = 6–7 mmol/kg), gadodiamide (789 mOsm/kg; LD50 = 14.8 mmol/kg), gadoversetamide (1110 mOsm/kg; LD50 = 30.3 mmol/kg) and gadoteridol (630 mOsm/kg; LD50 = 12 mmol/kg) (Bousquet et al. 1988; Oksendal and Hals 1993). They showed that the extravasation of high osmolality GBCAs can lead to inflammation, edema and cell necrosis. Indeed, the agent with the highest osmolality had the worse consequences; gadopentetate dimeglumine had similar effects to meglumine diatrizoate, a high osmolality and high viscosity iodinated X-ray contrast agent. Gadoversetamide had similar effects to gadopentetate dimeglumine in terms of necrosis and edema but the inflammatory response was less intense. In contrast, agents with the lowest osmolality (i.e. gadodiamide and gadoteridol) caused significantly less cell necrosis and inflammation and were no different than physiological saline. Low osmolality (nonionic) contrast agents therefore have an advantage when the dose needs to be injected fast (using for example a power injector).
An analysis of fatal iatrogenic therapeutic errors reported to United States poison centers
Published in Clinical Toxicology, 2021
James B. Leonard, Faisal S. Minhaj, Wendy Klein-Schwartz
Intrathecal administration of chemotherapy is a well-described potentially fatal medication error. In a systematic review published in 2014, Gilbar identified 32 cases of intrathecal vincristine administration, 25 of which resulted in death [4]. The risk of intrathecal vincristine administration has been described since 1968, but cases continue to occur with the cases in this series in 2002, 2008, and 2009 [18]. Importantly, in our series, other agents involved in intrathecal errors included imaging agents (diatrizoate meglumine and gadolinium), baclofen, and morphine. While baclofen and morphine are frequently used intrathecally, overdose has been described as complications with both, and these procedures are not without risk [19,20].
Delayed hypersensitivity reaction after oral intake of non-ionic iodinated contrast medium
Published in Acta Clinica Belgica, 2022
Alan A. Peters, Johannes T. Heverhagen, Ingrid B. Boehm
Iodinated contrast medium intake via the gastrointestinal route is able to induce various immediate adverse reactions of different severity grades [1,2]. Delayed reactions following intravascular injection of the contrast agent are well known [3], and seem to occur more often than immediate reactions. Non-immediate allergic reactions following oral CM-applications are less common, and have been only once reported in the context of an ionic iodinated contrast materials (diatrizoate sodium solution, diatrizoate meglumine [Gastrografin®]) [4].