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Iodixanol

A Review of its Pharmacodynamic and Pharmacokinetic Properties and Diagnostic Use as an x-Ray Contrast Medium

  • Drug Evaluation
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Abstract

Synopsis

Iodixanol is an iso-osmolal nonionic dimeric hydrophilic contrast agent. It has similar diagnostic efficacy to that of other iodinated contrast media. Because of its physical properties, iodixanol would be expected to produce a lower incidence of adverse events than other nondimeric contrast media. Indeed, pharmacodynamic studies indicate that iodixanol has fewer cardiovascular effects, causes less renal damage and is associated with similar or smaller changes to the blood-brain barrier and neurological function when compared with nondimeric nonionic contrast media.

In clinical trials, iodixanol had a similar tolerability profile to other nonionic contrast media but induced fewer adverse events than ioxaglate. Iodixanol appears to have an advantage over other contrast media in that it generally causes less frequent and less intense discomfort on injection. However, in common with other newer, and usually nonionic, contrast media, iodixanol is expensive. Studies investigating other nonionic contrast media (but not iodixanol) have shown that it is not cost-effective in all patients to replace older, usually ionic, contrast media with the more costly newer alternatives.

Nonetheless, in selected patients who are considered at increased risk of contrast medium-associated adverse events, nonionic agents should be used. Iodixanol, with its lower intensity (and possibly frequency) of discomfort, may be a preferred option in these patients.

Physical Properties

In addition to chemotoxicity, adverse events associated with contrast media are related to increases in osmolality and ionicity. Iodixanol is a dimeric nonionic contrast medium with lower osmolality and a higher iodine ratio than other nondimeric contrast media. Iodixanol has 9 hydroxyl groups and no carboxyl groups; presence of these groups is associated with reduced and increased toxicity, respectively.

Pharmacodynamic Properties

Iodixanol produced similar angiographic attenuation, indicating similar diagnostic efficacy, to ioxaglate and iohexol in animals or an experimental circulation model.

Contrast media have been associated with several adverse events affecting the cardiovascular system. However, injection of iodixanol into the coronary arteries of dogs with or without left ventricular failure does not cause depression of myocardial function. Transient alteration in cardiac parameters and ventricular tachycardia or fibrillation occur at a lower frequency and/or intensity than similar effects produced by iohexol, iotrolan (another hexaiodinated iso-osmolar contrast medium), ioxaglate or iopamidol. Iodixanol and iotrolan produce similar haemo-dynamic changes in pigs.

Although intra-arterial injection of iodixanol 320 mgI/ml causes undesirable peripheral vasodilation in patients undergoing femoral arteriography, studies conducted in dogs or rabbits showed that iodixanol induced significantly smaller changes in blood flow than the same iodine concentrations of iohexol, iopentol, iopromide or metrizoate.

Iodixanol, iopamidol, iopentol and iohexol all reduced erythrocyte aggregation in vitro by a similar extensive amount, but diatrizoate induced significantly more erythrocyte rigidification. The nonionic contrast media also induced morphological changes in erythrocytes with stomatocyte and echinocyte deformation occurring. However, iodixanol was the only agent that did not produce desiccocytes. Leucocyte phagocytosis, adherence and degranulation were also inhibited by contrast media, with iodixanol having the least effect.

In healthy volunteers, iodixanol acts as an osmodiuretic and produces a dose-dependent increase in urine volume. Iodixanol 1.2 gI/kg increased osmolar clearance and urinary sodium, N-acetyl-/gb-glucosamidase and β2-microglobulin excretion to a smaller extent, but induced a more prolonged increase in urinary alkaline phosphatase excretion and greater delayed corticomedullary attenuation than iopamidol or iopentol (at the same iodine dose). However, iodixanol caused less formation of large cytoplasmic vacuoles than iohexol, iopentol, iopromide, ioxaglate or metrizoate in renal epithelial cell lines from proximal and distal tubules. Glomerular filtration rate is not affected by nonionic contrast media.

In rabbits, experimental carotid angiography with iohexol, iodixanol, ioversoi or iotrolan all had similar disruptive effects on the blood-brain barrier that tended to correlate with hydrophilicity of the contrast media rather than with osmolality. Subarachnoid injection of iodixanol induced a lower excitatory response in rabbits than iotrolan, but more excitation than iohexol. In general, few adverse neural effects of iodixanol were noted in studies conducted in mice or dogs.

Pharmacokinetic Properties

Iodixanol has a pharmacokinetic profile similar to that of many other nonionic contrast media. After intravenous injection of iodixanol in healthy volunteers, peak serum iodixanol concentrations are rapidly achieved. Serum concentrations then decrease biexponentially: little drug is detected 24 hours after administration. Iodixanol distributes only in the extracellular fluid. Distribution half-life (t½α), elimination half-life (t½β) and apparent volume of distribution are not dose-dependent, with mean values of 0.43 and 2.18 hours and 0.275 L/kg, respectively, for iodixanol 0.3 to 1.2 gl/kg.

Iodixanol is not metabolised and is predominantly excreted in the urine by glomerular filtration. At least 97% of an injected dose is excreted unchanged in the urine within 24 hours and 1.2% is excreted unchanged in the faeces within 72 hours.

The pharmacokinetic profile of iodixanol in elderly patients appears to be affected more by renal function than age. Iodixanol has similar distribution pharmacokinetics in patients with stable but severely impaired renal function (serum creatinine level >400 μmol/L or creatinine clearance <20 ml/min) to that observed in healthy volunteers. However, elimination is slower: mean t½β of the drug is prolonged and renal clearance is reduced. Over 5 days, 76.1% of the administered iodixanol dose is excreted renally (via glomerular filtration) and 8.2% is recovered in the faeces of patients with renal impairment.

Diagnostic Efficacy

Iodixanol has been evaluated for use in endoscopic retrograde cholangiopancreatography, cardioangiography, cerebral angiography, urography and aorto-femoral angiography. It has also been investigated for use in patients undergoing computed tomography. In general, diagnostic efficacy is achieved in almost all patients given iodixanol at concentrations of 270 or 320 mgI/ml. In most clinical trials, contrast media were preheated to 37°C before injection.

At similar iodine concentrations, iodixanol, iohexol and ioxaglate have equivalent efficacy in cardioangiography. The diagnostic utility of iodixanol is also equivalent to that of iopamidol, iohexol or iopromide when administered by the percutaneous femoral catheterisation technique for aortofemoral, femoral or abdominal angiography. Nondiagnostic or suboptimal angiograms are caused by technical problems or patient movement rather than contrast medium deficiencies. Likewise, iodixanol has similar imaging ability to iopamidol, iohexol or ioxaglate in patients undergoing cerebral angiography, most commonly after administration of contrast media via the carotid and/or vertebral arteries.

Iodixanol 270 and/or 320 mgl/ml have similar overall efficacy (pyelographic density and overall diagnostic information) to iopamidol 300 mgl/ml and iohexol 300 mgl/ml in patients undergoing intravenous urography. Two-fold dilutions of iodixanol 200 or 270 mgl/ml also demonstrated efficacy in a Japanese study of 60 patients undergoing retrograde urethrography. In patients undergoing computed tomography of the body, iodixanol had similar efficacy to iohexol or ioxithalamate.

Tolerability

The major difference between iodinated contrast media is their respective tolerability profiles. It appears that iodixanol induces less frequent and less intense discomfort (heat and particularly pain) than iohexol, iopamidol, iopromide or ioxaglate. Indeed, almost no pain is reported by iodixanol recipients. As regards other adverse events, iodixanol and other nonionic contrast media have similar profiles, but ioxaglate is associated with significantly more adverse events (particularly nausea, vomiting and/or skin reactions) than iodixanol. Importantly, no serious adverse events have been reported with iodixanol in patients at high risk of contrast medium-induced adverse effects.

Adverse events other than discomfort that have been reported in iodixanol recipients include chest or leg pain, visual disturbance, dizziness, hypotension, vasovagal reaction, headache, nasal symptoms, taste disturbances, coughing, dyspnoea, skin reactions, nausea, vomiting and shivering. In general, these events were infrequent. Japanese patients most commonly developed skin reactions, which occurred with similar frequency in iodixanol and iohexol recipients. Generally, few if any clinically important changes in serum chemistry were reported with contrast media in comparative clinical trials.

Iodixanol induced a smaller increase in femoral blood flow than iopromide (43.4 vs 96.3%; p < 0.02) in patients undergoing femoral arteriography. Other haemodynamic changes were generally not significantly different with iodixanol and ioxaglate or iohexol in patients undergoing cardioangiography. However, in 2 studies, ioxaglate induced a greater increase in mean heart rate than iodixanol. Large reductions (>20mm Hg) in diastolic blood pressure occurred in more iodixanol than iohexol recipients, but large increases (≥20mm Hg) occurred in fewer iodixanol than ioxaglate recipients.

Renal function changes were generally considered to be clinically unimportant and were transient in patients undergoing aortofemoral angiography with iodixanol, iopromide, iohexol or ioxaglate. Indeed, iodixanol or iohexol produced only a small transient reduction in glomerular filtration rate in 16 well-hydrated patients with chronic renal failure undergoing angiography. Iodixanol may have a greater effect on glomerular function than some other contrast media, but less effect on tubular function.

Dosage and Administration

Iodixanol is formulated in 3 strengths depending on iodine content (150, 270 and 320 mgI/ml) and is mixed with electrolytes (sodium and calcium chloride) to produce an isotonic solution and to reduce the likelihood of unwanted arrhythmogenic activity. Iodixanol is administered intravenously or intra-arterially at a dosage that depends on the type of examination, technique used and patient characteristics. The iodine concentration and volume given is approximately the same as is used with other contrast media and, as with all these agents, adequate hydration should be maintained before and after administration. Studies have been conducted in children, but results are not yet available.

Contrast media are used to increase the difference in attenuation of radiation between various tissues or organs to allow better visualisation of structures within the body. The ideal contrast medium should be highly water soluble and biologically inert and have heat and chemical stability, low viscosity, osmolality less than or equal to that of plasma, selective excretion, good tolerability and reasonable cost.[1]

This review discusses iodixanol, an isotonic and iso-osmotic contrast medium with favourable pharmacological properties (section 1) which appears to have tolerability advantages over most other contrast agents (sections 2 and 5). Iodixanol has also been investigated for use as a nonionic iso-osmotic density gradient centrifugation medium;[2] however, this application is not discussed here.

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References

  1. McClennan BL, Stolberg HO. Intravascular contrast media. Ionic versus nonionic: current status. Radiol Clin North Am 1991; 29(3): 437–54

    CAS  PubMed  Google Scholar 

  2. Ford T, Graham J, Rickwood D. Iodixanol: a nonionic iso-os-motic centrifugation medium for the formation of self-generated gradients. Anal Biochem 1994 Aug 1; 220: 360–6

    Article  CAS  PubMed  Google Scholar 

  3. Chong J, Barkin JS. Analysis of comparative studies using different contrast agents for endoscopic retrograde cholangiopancreatography. Dig Endosc 1993; 5(3): 206–12

    Article  Google Scholar 

  4. Dawson P, Howell M. The non-ionic dimers: a new class of contrast agents. Br J Radiol 1986; 59(706): 987–91

    Article  CAS  PubMed  Google Scholar 

  5. Smedby Ö. Viscosity of some contemporary contrast media before and after mixing with whole blood. Acta Radiol 1992 Nov; 33: 600–5

    Article  CAS  PubMed  Google Scholar 

  6. Almén T. The etiology of contrast medium reactions. Invest Radiol 1994; 29 Suppl. 1: S37–45

    Article  PubMed  Google Scholar 

  7. Brinker JA. Contrast and clot: the cardiologist’s perspective. Semin Hematol 1991; 28(4) Suppl. 7: 3–10

    CAS  PubMed  Google Scholar 

  8. Matthai Jr WH, Hirshfeld Jr JW. Choice of contrast agents for cardiac angiography: review and recommendations based on clinically important distinctions. Cathet Cardiovasc Diagn 1991 Apr; 22: 278–89

    Article  PubMed  Google Scholar 

  9. Pedersen HK, Jacobsen EA, Refsum H. Contrast media-induced ventricular fibrillation: an experiemental study of the effects of dimeric contrast media during wedged catheter injection in dogs. Acad Radiol 1994; 1: 136–44

    Article  CAS  PubMed  Google Scholar 

  10. Karlsson JOG, Gregersen M, Refsum H. Visipaque is isotonic to human and rat blood plasma. Acta Radiol 1995; 36 Suppl. 399: 39–42

    Google Scholar 

  11. Pedersen HK. Electrolyte addition to nonionic contrast media. Cardiac effects during experimental coronary arteriography. Acta Radiol 1996 Suppl. 405: 7–31

    Google Scholar 

  12. Kløw NE, Mortensen E, Refsum H. Left ventricular systolic and diastolic function during coronary arteriography before and after acute left ventricular failure in dogs. A comparison between iodixanol, iohexol and ioxaglate. Acta Radiol 1991 Mar; 32: 124–9

    PubMed  Google Scholar 

  13. Morris TW, Dukovic D, Pagani E. The effects of coronary injections of iodixanol, iopamidol, and ioxaglate on contractility and electrophysiology. Invest Radiol 1994; 29 Suppl. 2: S99–S101

    Article  CAS  PubMed  Google Scholar 

  14. Dundore RL, Silver PJ, Ezrin AM, et al. The effects of iodixanol and iopamidol on hemodynamic and cardiac electrophysiologic parameters in vitro and in vivo. Invest Radiol 1991 Aug; 26: 715–21

    Article  CAS  PubMed  Google Scholar 

  15. Sørensen L, Sunnegårdh O, Svanegård J, et al. Systemic and pulmonary haemodynamic effects of intravenous infusion of non-ionic isoosmolar dimeric contrast media. An investigation in the pig of two ratio 6 contrast media. Acta Radiol 1994 M; 35: 383–90

    PubMed  Google Scholar 

  16. Bååth L, Almén T, Öksendal A. Oxygen saturation of the low osmolar contrast media iohexol, ioxaglate and iodixanol. Effects on contractile force and frequency of ventricular fibrillation in the isolated rabbit heart. Acta Radiol 1990 Sep; 31: 519–23

    PubMed  Google Scholar 

  17. Jacobsen EA, Pedersen HK, Klèw N-E, et al. Cardiac effects of adding electrolytes and oxygen to iohexol in a dog model of contrast media-induced ventricular fibrillation. Acta Radiol 1995; 36: 47–53

    Article  CAS  PubMed  Google Scholar 

  18. Bååth L, Besjakov J, Öksendal A. Sodium-calcium balance in nonionic contrast media. Effects on the risk of ventricular fibrillation in the isolated rabbit heart. Invest Radiol 1993 Mar; 28: 223–7

    Article  PubMed  Google Scholar 

  19. Jynge P, Holten T, Øksendal AN. Sodium-calcium balance and cardiac function with isotonic iodixanol. An experimental study in the isolated rat heart. Invest Radiol 1993 Jan; 28: 20–5

    Article  CAS  PubMed  Google Scholar 

  20. Jynge P, Blankson H, Falck G, et al. Sodium-calcium relationships and cardiac function during coronary bolus perfusion. A physiological approach. Acta Radiol 1995; 36 Suppl. 399: 122–34

    Google Scholar 

  21. Blankson H, Holten T, Øksendal AN, et al. Changes in contractile function with low-osmolal and isosmolal contrast media for coronary angiography. Acta Radiol 1995; 36 Suppl. 399: 135–41

    Google Scholar 

  22. Dunkel JA, Bøkenes J, Karlsson JOG, et al. Cardiac effects of iodixanol compared to those of other nonionic and ionic contrast media in the isolated rat heart. Acta Radiol 1995; 36 Suppl. 399: 142–54

    Google Scholar 

  23. Pugh ND, Sissons GRJ, Ruttley M. The effect of iodixanol, a new isotonic contrast agent, on femoral blood flow in man. Clin Radiol 1992 Apr; 45: 243–5

    Article  CAS  PubMed  Google Scholar 

  24. Pugh ND, Sissons GRJ, Ruttley MST, et al. Iodixanol in femoral arteriography (phase III): a comparative double-blind parallel trial between iodixanol and iopromide. Clin Radiol 1993 Feb; 47: 96–9

    Article  CAS  PubMed  Google Scholar 

  25. Almén T. Effects of iodixanol, iopentol, iohexol and metrizoate on femoral blood flow after injection into the femoral artery of the dog. Acta Radiol Suppl Stockh 1987; 370: 69–72

    PubMed  Google Scholar 

  26. Pugh ND, Hutcheson IR, Edwards DH, et al. Angiographic contrast media relax isolated rabbit aorta through an endothelium-independent mechanism that may not depend on the presence of the iodine atom. Br J Radiol 1995; 68(805): 23–6

    Article  CAS  PubMed  Google Scholar 

  27. Pitman MR, Karlsson JOG, Griffith TM. Ionic mechanisms contributing to the vasorelaxant properties of iodinated radiographic contrast media: a comparison of iohexol and iodixanol. Oslo, Norway: Nycomed Imaging AS, 1996. (Data on file)

  28. Aspelin P, Nilsson PE, Schmid-Schönbein H, et al. Effect of four non-ionic contrast media on red blood cells in vitro. III. Deformability. Acta Radiol Suppl Stockh 1987; 370: 89–91

    CAS  PubMed  Google Scholar 

  29. Aspelin P, Nilsson PE, Schmid-Schönbein H, et al. Effect of four non-ionic contrast media on red blood cells in vitro. II. Aggregation. Acta Radiol Suppl Stockh 1987; 370: 85–7

    CAS  PubMed  Google Scholar 

  30. Aspelin P, Nilsson PE, Schmid-Schönbein H, et al. Effect of four non-ionic contrast media on red blood cells in vitro. I. Morphology. Acta Radiol Suppl Stockh 1987; 370: 79–83

    CAS  PubMed  Google Scholar 

  31. Furchgott RF, Ponder E. Disk-sphere transformation in mammalian red cells. II. The nature of the anti-sphering factor. J Exp Biol 1940; 17(2): 117–27

    CAS  Google Scholar 

  32. Rasmussen F, Georgsen J, Grunnet N. Influence of radiographic contrast media on phagocytosis. Acta Radiol 1988 Sep–Oct; 29: 589–92

    Article  CAS  PubMed  Google Scholar 

  33. Halkola H, Kormano M. Effect of iodinated contrast media on the phagocytic activity of human leukocytes. A new toxicity test. Invest Radiol 1988 Sep; 23 Suppl. 1: S200–2

    Article  CAS  PubMed  Google Scholar 

  34. Georgsen J, Rasmussen F, Pedersen JO. Granulocyte chemotaxis. Influence of radiographic contrast media on the chemoattractive properties of serum. Acta Radiol 1990 Sep; 31: 531–6

    CAS  PubMed  Google Scholar 

  35. Georgsen J, Rasmussen F, Pedersen JO. The effect of radiographic contrast media on the chemotaxis of granulocytes. Invest Radiol 1988; 23(8): 621–6

    Article  CAS  PubMed  Google Scholar 

  36. Rasmussen F, Antonsen S, Georgsen J. Granulocyte adherence is inhibited by radiographic contrast media in vitro. Acta Radiol 1992 Jul; 33: 379–83

    Article  CAS  PubMed  Google Scholar 

  37. Rasmussen F, Antonsen S, Georgsen J, et al. Radiographic contrast media and release of neutrophil specific proteins in vitro and after intravenous injection. Acta Radiol 1992 Sep; 33: 495–9

    Article  CAS  PubMed  Google Scholar 

  38. Walday P, Heglund IF, Golman K, et al. Renal effects of iodixanol in experimental animals. Acta Radiol 1995; 36 Suppl. 399: 204–12

    Google Scholar 

  39. Jakobsen JÅ, Lundby B, Kristoffersen DT, et al. Evaluation of renal function with delayed CT after injection of nonionic monomeric and dimeric contrast media in healthy volunteers. Radiology 1992 Feb; 182: 419–24

    Article  CAS  PubMed  Google Scholar 

  40. Jakobsen JÅ, Nossen JO, Jørgensen NP, et al. Renal tubular effects of diuretics and x-ray contrast media. A comparative study of equimolar doses in healthy volunteers. Invest Radiol 1993 Apr; 28: 319–24

    Article  CAS  PubMed  Google Scholar 

  41. Andersen K-J, Vik H, Eikesdal HP, et al. Effects of contrast media on renal epithelial cells in culture. Acta Radiol 1995; 36 Suppl. 399: 213–8

    Google Scholar 

  42. Torvik A, Walday P. Neurotoxicity of water-soluble contrast media. Acta Radiol 1995; 36 Suppl. 399: 221–9

    Google Scholar 

  43. Wilson AJ, Evill CA, Sage MR. Effects of nonionic contrast media on the blood-brain barrier. Osmolality versus chemo-toxicity. Invest Radiol 1991 Dec; 26: 1091–4

    Article  CAS  PubMed  Google Scholar 

  44. Aulie Michelet Å. Effects of intravascular contrast media on blood-brain barrier. Comparison between iothalamate, iohexol, iopentol and iodixanol. Acta Radiol 1987 May–Jun; 28: 329–33

    CAS  PubMed  Google Scholar 

  45. Larsen LE, Heglund IF, Fabian R, et al. Neural tolerability of iodixanol in mice and dogs after single and repeated in-tracisternal administration. Acta Radiol 1995; 36 Suppl. 399: 238–43

    Google Scholar 

  46. Maly P, Sundgren P, Bååth L, et al. Neural tolerance of the non-ionic dimers iodixanol and iotrolan and the non-ionic monomer iopamidol during myelography in non-anaesthetised rabbits. Acta Radiol 1995; 36: 644–8

    Article  CAS  PubMed  Google Scholar 

  47. Sundgren P, Bååth L, Maly P. CNS-effects from subarachnoid injections of iohexol and the non-ionic dimers iodixanol and iotrolan in the rabbit. Acta Radiol 1995 May; 36: 307–11

    Article  CAS  PubMed  Google Scholar 

  48. Morris TW, Ekholm SE, Prentice L, et al. Iotrol, iodixanol, and 2-deoxy-D-glucose effects on neural tissue CO2 production. Am J Neuroradiol 1989 Sep-Oct; 10: 1123–6

    CAS  PubMed  Google Scholar 

  49. Ekholm SE, Morris TW, Prentice L, et al. Local glucose utilization changes caused by subarachnoid contrast media in the rabbit. Acta Radiol 1990 Mar; 31: 209–12

    Article  CAS  PubMed  Google Scholar 

  50. Ekholm SE, Morris TW, Fonte D, et al. Effects of contrast media on neural tissue glucose uptake in vitro. Invest Radiol 1989 Feb; 24: 145–9

    Article  CAS  PubMed  Google Scholar 

  51. Marinetti GV, Morris TW, Ekholm SE, et al. Effects of radiopaque contrast media on calcium uptake and phos-phatidylinositol metabolism in rat brain synaptosomes. Invest Radiol 1992 Mar; 27: 224–9

    Article  CAS  PubMed  Google Scholar 

  52. Yang X, Manninen H, Soimakallio S. Comparison of angiographic opacification of ioxaglate and iodixanol by digital region-of-interest processing technique in an experimental circulation model. Invest Radiol 1994 Jan; 29: 31–4

    Article  CAS  PubMed  Google Scholar 

  53. Gould R, Brasch RC, Sievers R, et al. Comparison of vascular opacification after bolus injection of iodixanol-320 iohexol-350 [see comments]. Invest Radiol 1992 Dec; 27: 1031–4

    Article  CAS  PubMed  Google Scholar 

  54. Morris TW. Comparison of vascular opacification after bolus injection of iodixanol-320 and iohexal-350 [letter; comment]. Invest Radiol 1993 Aug; 28: 786

    Article  CAS  PubMed  Google Scholar 

  55. Yamada K, Jen CC, Kaibara K, et al. Contrast effect of DU-6807 (iodixanol) in angiography and computed tomography in experimental animal models: comparison of efficacy between DU-6807 and Omnipaque® (iohexol) [in Japanese]. Jpn Pharmacol Ther 1995; 23(6): 25–34

    Google Scholar 

  56. Svaland MG, Haider T, Langseth-Manrique K, et al. Human pharmacokinetics of iodixanol. Invest Radiol 1992 Feb; 27: 130–3

    Article  CAS  PubMed  Google Scholar 

  57. Nossen JØ, Jakobsen JÅ, Kjaersgaard P, et al. Elimination of the non-ionic X-ray contrast media iodixanol and iohexol in patients with severely impaired renal function. Scand J Clin Lab Invest 1995 Jul; 55: 341–50

    Article  CAS  PubMed  Google Scholar 

  58. Endo H. Pharmacokinetics and usefulness of isotonic x-ray contrast medium, iodixanol, in the elderly patients [in Japanese]. Yakuri to Chiryo 1995 Dec; 23: 3421–33

    Google Scholar 

  59. Bailie GR, Eisele G, Sala J, et al. In vitro iodixanol hemodialysis clearance under simulated clinical conditions [abstract no. 117]. Pharmacotherapy 1995 May–Jun; 15: 379

    Google Scholar 

  60. Harnish PP, Fountaine H, Ebrahimi R. Iodixanol. Experience in 1, 259 patients in the United States. Invest Radiol 1994 Jun; 29 Suppl 2.: S236–7

    Article  PubMed  Google Scholar 

  61. Harnish PP. Iodixanol: clinical experience in the United States. In balance with the body. Isotonic Visopaque® iodixanol. Programme and abstracts; 1995 Mar 4; Vienna, Austria, 35-37

  62. Grynne BH, Nossen JØ, Bolstad B, et al. Main results of the first comparative clinical studies on visipaque. An overview of 18 clinical trials. Acta Radiol 1995; 36 Suppl. 399: 265–70

    Google Scholar 

  63. Andersen PE, Bolstad B, Berg KJ, et al. Iodixanol and ioxaglate in cardioangiography: a double-blind randomized phase III study. Clin Radiol 1993 Oct; 48: 268–72

    Article  CAS  PubMed  Google Scholar 

  64. Klow NE, Levorstad K, Berg KJ, et al. Iodixanol in cardioangiography in patients with coronary artery disease. Tolerability, cardiac and renal effects. Acta Radiol 1993 Jan; 34: 72–7

    CAS  PubMed  Google Scholar 

  65. Tveit K, Bolz K-D, Bolstad B, et al. Iodixanol in cardioangiography: a double-blind parallel comparison between iodixanol 320 mg I/ml and ioxaglate 320 mg I/ml. Acta Radiol 1994 Nov; 35: 614–8

    CAS  PubMed  Google Scholar 

  66. Hekster RE, Moireé HH, Cleyndert P, et al. Intra-arterial digital subtraction angiography with isotonic dimeric (iodixanol) and monomeric (iohexol) nonionic contrast media: radiographic, clinical and neurophysiological evaluation. Neuroradiology 1995 Jan; 37: 48–50

    Article  CAS  PubMed  Google Scholar 

  67. Kendall BE, Sheppick A, Nossen JØ, et al. Iodixanol in intraarterial cerebral digital subtraction angiography: a comparison with iohexol. Neuroradiology 1995 Oct; 37: 512–4

    Article  CAS  PubMed  Google Scholar 

  68. Palmers Y, De Greef D, Grynne BH, et al. A double-blind study comparing safety, tolerability and efficacy of iodixanol 320 mgI/ml and ioxaglate 320 mgI/ml in cerebral arteriography. Eur J Radiol 1993 Nov; 17: 203–9

    Article  CAS  PubMed  Google Scholar 

  69. Albrechtsson U, Lárusdóttir H, Norgren L, et al. Iodixanol — a new nonionic dimer — in aortofemoral angiography. Acta Radiol 1992 Nov; 33: 611–3

    CAS  PubMed  Google Scholar 

  70. Singh K, Sundgren R, Bolstad B, et al. Iodixanol in abdominal digital subtraction angiography. A randomized, double-blind, parallel trial with iodixanol and iohexol. Acta Radiol 1993 May; 34: 242–5

    CAS  PubMed  Google Scholar 

  71. Thorstensen Ö, Albrechtsson U, Calissendorff B, et al. Iodixanol in femoral arteriography. A randomized, double-blind, phase III, parallel study with iodixanol 270 mg I/ml and iohexol 300 mg I/ml. Acta Radiol 1994 Nov; 35: 629–31

    CAS  PubMed  Google Scholar 

  72. Verow P, Nossen JØ, Sheppick A, et al. A comparison of iodixanol with iopamidol in aortofemoral angiography. Br J Radiol 1995 Sep; 68: 973–8

    Article  CAS  PubMed  Google Scholar 

  73. L’Hermine JC, Renan C-A, Ernst O, et al. Iodixanol (Visipaque®) in computed tomography enhancement of the body: a double-blind comparison with ioxithalamate. Oslo, Norway: Nycomed Imaging AS, 1996. (Data on file)

  74. Justesen P, Downes M, Grynne BH, et al. Injection-associated pain in femoral arteriography: a European multicentre study comparing safety, tolerability and efficacy of iodixanol 270 mgI/ml (Visipaque®) and iopromide 300 mgl/ml (Ultravist®). Oslo, Norway: Nycomed Imaging AS, 1996. (Data on file)

  75. Manninen H, Tahvanainen K, Borch KW, et al. Iodixanol, a new non-ionic, dimeric contrast medium in cardioangiography: a double-masked, parallel comparison with iopromide. Eur Radiol 1995; 5: 364–70

    Article  Google Scholar 

  76. Hill JA, Cohen MB, Kou WH, et al. Iodixanol, a new isosmotic nonionic contrast agent compared with iohexol in cardiac angiography. Am J Cardiol 1994 Jul 1; 74: 57–63

    Article  CAS  PubMed  Google Scholar 

  77. Gavant ML, Siegle RL. Iodixanol in excretory urography: initial clinical experience with a nonionic, dimeric (ratio 6:1) contrast medium. Work in progress. Radiology 1992 May; 183: 515–8

    Article  CAS  PubMed  Google Scholar 

  78. Lee Jr FT, Caroline DF, Thornbury JR, et al. A randomized comparison of iodixanol and iohexol in adult body computed tomography scanning. Acad Radiol 1996 Sep; 3 Suppl. 3: S500–4

    Article  PubMed  Google Scholar 

  79. Siegle RL, Gavant ML. Comparison of iodixanol with iohexol in excretory urography. Acad Radiol 1996; 3 Suppl. 3: 524–7

    Article  Google Scholar 

  80. Conroy RM, Bjartveit K, Sheppick A, et al. Iodixanol in intravenous urography: a comparison of iodixanol 270 mgI/ml, iodixanol 320 mgI/ml and iopamidol 300 mgI/ml (NIOPAMÖ). Clin Radiol 1994 May; 49: 337–40

    Article  CAS  PubMed  Google Scholar 

  81. Fischbach R, Landwehr P, Nossen JO, et al. Iodixanol and iopamidol in intravenous DSA. A comparative phase III trail [abstract 303]. Cardiovasc Intervent Radiol 1994; 17 Suppl. 2: 124

    Google Scholar 

  82. Poirier VC, Monsein LH, Newberry PD, et al. Double-blind, randomized comparison of iodixanol 320 and iohexol 300 for cerebral angiography. Invest Radiol 1994 Jun; 29 Suppl. 2: S43–4

    Article  PubMed  Google Scholar 

  83. Yabushita Y, Akiyama T, Okita K. Clinical usefulness of iodixanol 200mgI/ml, in endoscopic retrograde cholangiopancreatography [in Japanese]. Prog Med 1995; 15(12): 2545–52

    Google Scholar 

  84. Oi I et al. A clinical phase II study of iodixanol on endoscopic retrograde cholangiopancreatography [in Japanese]. Yakuri to Chiryo 1996; 24 Suppl. 3: S465–71

    Google Scholar 

  85. Sasaki Y, Aoki S, Hiramatsu K, et al. Clinical evaluation of iodixanol in computed tomography: a multicentre comparative study with iohexol [in Japanese]. Shinryo to Shinyaku 1996; 33(3): 477–88

    Google Scholar 

  86. Arisawa J, Kozuka T, Nakamura H, et al. Clinical evaluation of a new nonionic iso-osmolar contrast medium, iodixanol, in angiocardiography. A double blind study with iohexol [in Japanese]. Shinyaku to Rinsho 1996; 45(4): 795–818

    Google Scholar 

  87. Oi I, Tomatsu S, Kumazawa K, et al. A comparison of iodixanol and meglumine iotalamate in endoscopic retrograde cholangiopancreatography [in Japanese]. Yakuri to Chiryo 1996; 45(1): 57–75

    Google Scholar 

  88. Munechika H, Katayama H, Hiramatsu Y, et al. Evaluation of DU-6807 (iodixanol), a nonionic iso-osmolar contrast medium, in intravenous urography. A multicentre phase III double blind comparative study with iohexol [in Japanese]. Shinryo to Shinyaku 1996; 33(3): 489–503

    Google Scholar 

  89. Kobayashi N, Sasaki Y, Toyota M, et al. Phase II study of iodixanol (DU-6807) on enhanced CT [in Japanese]. Yakuri to Chiryo 1996; 24 Suppl.: S369–81

    Google Scholar 

  90. Hiramatsu Y, Katayama H, Sasaki A, et al. Phase II study of iodixanol on intravenous urography [in Japanese]. Yakuri to Chiryo 1996; 24 Suppl.: S447–56

    Google Scholar 

  91. Kumazaki T, Tajima H, Matsuoka A, et al. Clinical trial of iodixanol on DSA [in Japanese]. Yakuri to Chiryo 1996; 59 Suppl.: S423–35

    Google Scholar 

  92. Fransson S-G, Stenport G, Andersson M. Immediate and late adverse reactions in coronary angiography. A comparison between iodixanol and ioxaglate. Acta Radiol 1996; 37: 218–22

    Article  CAS  PubMed  Google Scholar 

  93. Tytle T, Prati RC, Azodo MVU, et al. A prospective, parallel, double-blind comparison of iodixanol and iohexol in extremity phlebography. Acad Radiol 1996; 3 Suppl. 3: 519–23

    Article  Google Scholar 

  94. Andreula C, Cardia A, Colombo MM, et al. Valutazione della sicurezza ed efficacia di iodixanolo 270 mgI/ml e 320mgI/ml a confronto con iopamidolo 300 mgI/ml nella TC cerebrale. Riv Neuroradiol 1993; 6(4): 397–400

    Article  Google Scholar 

  95. Momoshima Y, Kobayashi N, Shiga T, et al. Phase III trial of iodixanol (DU-6807) 270mgI/ml in cerebral angiography: a double-blind comparative study with iohexol 300mgI/ml [in Japanese]. Shinyaku to Rinsho 1996; 45(3): 493–516

    Google Scholar 

  96. Furuse M, Takahashi K, Shinozaki T, et al. Phase III clinical study of iodixanol for the retrograde urethrography and cystography [in Japanese]. Shinyaku to Rinsho 1996 Jan 10; 45(1): 40–55

    Google Scholar 

  97. Nycomed Imaging AS Norway. Iodixanol prescribing information. Oslo, Norway, 1996.

  98. Nossen JØ, Aakhus T, Berg KJ, et al. Experience with iodixanol, a new nonionic dimeric contrast medium. Preliminary results from the human phase I study. Invest Radiol 1990 Sep; 25 Suppl. 1: S113–4

    Article  PubMed  Google Scholar 

  99. Flinck A, Selin K, Björneid L. Iodixanol in cardioangiography [abstract no. 28]. Acta Radiol 1994; 35 Suppl. 394: 39

    Google Scholar 

  100. Jakobsen JÅ. Renal experience with visipaque. Eur Radiol 1996; 6 Suppl. 2: S16–9

    Article  PubMed  Google Scholar 

  101. Bettmann MA. Contrast agent use, regulation, and adverse events. Safety and efficacy of iodinated contrast agents. Invest Radiol 1994; 29 Suppl. 1: S33–6

    Article  PubMed  Google Scholar 

  102. Idée JM, Beaufils H, Bonnemain B. Iodinated contrast mediainduced nephropathy: pathophysiology, clinical aspects and prevention. Fundam Clin Pharmacol 1994; 8(3): 193–206

    Article  PubMed  Google Scholar 

  103. Matthai WH. Clinical and economic factors in the selection of low-osmolality contrast media. PharmacoEconomics 1994; 5(3): 188–97

    Article  CAS  PubMed  Google Scholar 

  104. Katayama H, Yamaguchi K, Kozuka T, et al. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175(3): 621–8

    Article  CAS  PubMed  Google Scholar 

  105. Palmer FJ. The RACR survey of intravenous contrast media reactions. Final report. Australas Radiol 1988; 32: 426–8

    Article  CAS  PubMed  Google Scholar 

  106. Thomsen HS, Dorph S. High-osmolar and low-osmolar contrast media. An update on frequency of adverse drug reactions. Acta Radiol 1993; 34(3): 205–9

    CAS  PubMed  Google Scholar 

  107. Latchaw RE. The use of nonionic contrast agents in neuroangiography. A review of the literature and recommendations for clinical use. Invest Radiol 1993 Nov; 28 Suppl. 5: S55–9

    Article  PubMed  Google Scholar 

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  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand

    Caroline M. Spencer & Karen L. Goa

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  1. Caroline M. Spencer
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Various sections of the manuscript reviewed by: M.A. Bettmann, Department of Radiology, Dartmouth Medical School, Lebanon, New Hampshire, USA; R.E.M. Hekster, Department of Radiology, Leyenburg Hospital, The Hague, The Netherlands; F.H. McDowell, The Winifred Masterton Burke Rehabilitation Hospital Inc., Cornell University Medical College, White Plains, New York, USA; N.D. Pugh, Department of Medical Physics and Bioengineering, University Hospital of Wales, Cardiff, Wales; F. Rasmussen, Department of Diagnostic Radiology, Århus Kommunehospital, Odense, Denmark; J.M. Stevens, Lysholm Radiological Department, The National Hospital for Neurology and Neurosurgery, London, England; O. Thorstensen, Sjúkrahús Reykjavíkur, Fossvogur, Iceland; A.J. Wilson, Department of Radiology, School of Medicine, Flinders University of South Australia, Bedford Park, South Australia, Australia.

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Spencer, C.M., Goa, K.L. Iodixanol. Drugs 52, 899–927 (1996). https://doi.org/10.2165/00003495-199652060-00013

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