Iodixanol (Visipaque) is an iodinated intravenous (IV) contrast agent which is iso-osmolar with plasma. Unlike the non-ionic monomer iohexol (Omnipaque), Visipaque is a non-ionic dimer; however, both agents are routinely utilized for angiography, venography, contrast-enhanced CT scans, and other diagnostic/interventional procedures. Tissue extravasation can result in localized necrosis, and certain formulations should not be used intrathecally!

Contrast-induced nephropathy (CIN) is thought to be due to direct tubular epithelium cytotoxicity, renal hypoxemia from dysregulated renal blood flow, and the production of reactive oxygen species. Although CIN is typically transient, it is a common cause of hospital-acquired acute kidney injury and can increase morbidity and mortality in vulnerable populations (e.g., the elderly with multiple comorbidities). Many hospitals have protocols related to preventing CIN, including hydration, N-acetylcysteine, bicarbonate, etc. However, depending on what one reads, the data tends to be all over the place regarding which options are effective in preventing CIN due to variable sample sizes, study quality, and confounders like the amount/concentration of contrast.

Based on the data (search PubMed for countless articles), shellfish allergies do not increase the risk of an allergic reaction to IV contrast more than other allergies. This dogma needs to be dissolved!

Due to shutdowns in China, the global supply of iodinated contrast has significantly decreased (down by 85% by some estimates!) at the time of this writing. This has forced many hospitals to ration contrast and, in many instances, cancel elective imaging/procedures dependent on iodinated IV contrast.

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  1. Hi, I am a Pain Medicine fellow and we commonly administer Omnipaque in the intrathecal space. I believe there are formulations which can be administered intrathecally for myelography. By the way, love your content. You are the man!


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