X-ray contrast media. Watersoluble nephrotropic low-osmolar iodinated agents
Brand names: Ultravist 300, Ultravist, Ultravist 370
Updated · Methodology
First line
Iopromide is a standard contrast medium for contrast-enhanced CT: thoracic, abdominal, pelvic CT, CT angiography and CT perfusion. The concentration of 300–370 mg I/mL is matched to the task: 300 for routine CT, 370 for CT angiography and tumor vascularity assessment. Dose is calculated by body weight and study protocol (typically 1–2 mL/kg).
First line
In diagnostic and interventional angiography (coronary, peripheral, cerebral), iopromide is a primary contrast agent. Low osmolarity is important to reduce pain during arterial injection and the risk of adverse reactions. The 370 mg I/mL concentration provides optimal arterial enhancement.
Sources
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
In patients with eGFR < 30 mL/min/1.73 m², decompensated heart failure, dehydration or concurrent nephrotoxic drugs, intravenous iodinated contrast without strict indication or preparation is in the unjustified-risk category per 2021. Rational practice: assess alternatives (non-gadolinium MRI, ultrasound); when contrast is unavoidable, prepare the patient (hydration, creatinine control, withdrawal of nephrotoxic drugs).
Not recommended
2021 and recommend temporary metformin withdrawal for 48 hours before and after contrast in patients with eGFR < 30 mL/min/1.73 m² or signs of acute kidney injury. In patients with stable eGFR ≥ 30 mL/min/1.73 m², withdrawal is not required. Contrast administration during metformin therapy in renally impaired patients without withdrawal raises the risk of lactic acidosis.
A non-ionic, water-soluble iodinated contrast medium. Iodine in the molecule absorbs X-rays and produces contrast of vessels, parenchymal organs and pathological foci on CT and angiography. Low osmolarity (around 600 mOsm/kg) reduces adverse effects compared with ionic high-osmolar agents. The drug is not metabolized and is excreted unchanged by the kidneys within 24 hours.
AEMPS summary of product characteristics (section 4.6): no well-controlled studies have been done in pregnant women. Animal studies indicate no harmful effects on pregnancy, embryofetal development, parturition or postnatal development. Before an iodinated contrast agent is given in pregnancy, benefit and risk are weighed, because the fetal thyroid is sensitive to iodine and acute iodine overload after maternal administration can cause fetal thyroid dysfunction.
Transfers into breast milk in minimal amounts (less than 0.01% of dose). Interruption of breastfeeding is not required by most international guidelines (ACR 2021), although a 24-hour interruption is sometimes practiced.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
12 pairs found. Sorted from critical to minor.
Mechanism
Contrast (iopromide) and an NSAID (celecoxib) are both nephrotoxic. NSAID-induced reduction in renal blood flow amplifies contrast-induced nephropathy risk, especially in chronic kidney disease.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and in chronic kidney disease.
Management
Stop celecoxib 48 hours before planned contrast and resume 48 hours after with stable renal function. Provide contrast nephroprotection with adequate saline hydration.
Mechanism
Additive nephrotoxicity. Gentamicin (an aminoglycoside) directly injures proximal renal tubules; iodinated contrast (iopromide) adds osmotic load. Acute tubular necrosis risk multiplies.
Symptoms
Reduced urine output, rising creatinine and urea, proteinuria. Severe cases include oliguria and need for haemodialysis. Symptoms appear 1–3 days after contrast.
Management
Postpone the contrast study until the gentamicin course ends where possible. If contrast is urgent, ensure adequate hydration (saline 1 mL/kg/h for 12 hours before and after), stop other nephrotoxic drugs, and check creatinine daily.
Sources
Mechanism
Additive nephrotoxicity. Ketorolac (NSAID) suppresses prostaglandin-dependent renal blood flow; iodinated contrast (iopromide) adds osmotic load. High risk of acute kidney injury.
Symptoms
Reduced urine output, rising creatinine, proteinuria. Severe cases include oliguria and need for haemodialysis. Symptoms appear 1–3 days after contrast.
Management
Stop ketorolac 48 hours before planned contrast and resume 48 hours after with stable renal function. Alternative analgesics: paracetamol, metamizole, or a short opioid course. Provide contrast nephroprotection with adequate saline hydration.
Mechanism
Similar to iopromide + naproxen. Contrast and NSAID – additive nephrotoxicity.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and chronic kidney disease.
Management
Stop meloxicam 48 hours before planned contrast and resume 48 hours after with stable renal function. Alternative analgesic: paracetamol. Provide contrast nephroprotection with adequate hydration.
Mechanism
Intravenous iodinated contrast media (iopromide) can cause acute kidney injury via osmotic load and direct toxicity. On metformin (renally excreted), plasma levels rise and lactic acidosis risk accumulates – a rare but life-threatening complication.
Symptoms
Lactic acidosis: dyspnoea, muscle pain, nausea, confusion, hypotension. Laboratory: blood pH below 7.35 and lactate above 5 mmol/L. Symptoms appear 1–3 days after contrast.
Management
For planned contrast studies, withhold metformin on the day of the procedure. Resume 48 hours later only with stable renal function (creatinine check before resuming). Alternative imaging in renal impairment: non-gadolinium MRI.
Sources
Mechanism
Contrast-induced nephropathy lowers renal methotrexate clearance. At high oncologic methotrexate doses, plasma levels rise and severe toxicity risk (pancytopenia, mucositis, nephrotoxicity) increases.
Symptoms
Stomatitis, diarrhoea, falling leukocyte, platelet, and erythrocyte counts. Severe cases include fatal pancytopenia and acute kidney injury. Symptoms appear 3–7 days after contrast.
Management
At oncologic methotrexate doses, postpone contrast studies for 2–4 weeks after methotrexate administration. If contrast is urgent, ensure adequate hydration and check full blood count and creatinine daily. Add folinic acid rescue.
Mechanism
Contrast and NSAID (naproxen) – additive nephrotoxicity, especially in chronic kidney disease and dehydration.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and chronic kidney disease.
Management
Stop naproxen 48 hours before planned contrast and resume 48 hours after with stable renal function. Alternative analgesic: paracetamol. Provide contrast nephroprotection with adequate saline hydration.
Mechanism
Contrast (iopromide) and nephrotoxic immunosuppressant (tacrolimus) – high contrast-induced nephropathy risk. The effect is stronger in transplant patients due to already reduced renal function.
Symptoms
Reduced urine output, rising creatinine and potassium, oedema. Symptoms appear earlier in older patients and chronic kidney disease.
Management
For planned contrast studies, provide adequate hydration with saline (1 mL/kg/h for 12 hours before and after). Check tacrolimus trough (C0) 1–3 days after contrast. Alternative imaging: non-gadolinium MRI.
Mechanism
Amiodarone contains 37% iodine in its structure. With iodine contrast (iopromide), total iodine load rises sharply, which can trigger amiodarone-induced thyrotoxicosis in predisposed patients (nodular goitre, autoimmune thyroiditis).
Symptoms
Palpitations, sweating, tremor, weight loss, anxiety, hyperthermia. Symptoms develop 1–3 months after contrast.
Management
Before elective contrast imaging on amiodarone, check TSH and T4. With normal thyroid function and nodular goitre, consider non-contrast alternatives (MRI without contrast). After imaging, check TSH at 1, 3, and 6 months. In thyrotoxicosis, stop amiodarone if feasible and start thiamazole plus prednisolone.
Sources
Mechanism
Beta-blockers can make treating anaphylaxis to iodinated contrast harder – adrenaline becomes less effective due to β-blockade.
Symptoms
On anaphylaxis: resistance to standard adrenaline dose – persistent hypotension, facial and tongue swelling, bronchospasm.
Management
The beta-blocker is usually not stopped for a contrast study. Prepare higher adrenaline doses and glucagon (3–5 mg IV for refractory anaphylaxis). In patients with allergy history, consider premedication (methylprednisolone + antihistamine).
Mechanism
Additive nephrotoxicity. NSAIDs reduce renal blood flow by suppressing vasodilatory prostaglandin synthesis; contrast adds tubular osmotic load. Contrast-induced AKI risk rises 2–3-fold.
Symptoms
Decreased urine output, rising creatinine, oedema, nausea. Symptoms develop 24–72 hours after contrast.
Management
Stop diclofenac 24–48 hours before elective contrast imaging; restart 48 hours after the study once creatinine normalises. With creatinine clearance below 60 mL/min, give IV isotonic hydration 6–12 hours before and 6–12 hours after imaging. Analgesic alternative: paracetamol up to 3 g/day.
Sources
Mechanism
Additive nephrotoxicity. NSAIDs reduce renal blood flow by suppressing vasodilatory prostaglandin synthesis; contrast adds tubular osmotic load. Contrast-induced AKI risk rises.
Symptoms
Decreased urine output, rising creatinine, oedema, nausea. Symptoms develop 24–72 hours after contrast.
Management
Stop ibuprofen 24–48 hours before elective contrast imaging; restart 48 hours after the study once creatinine normalises. With creatinine clearance below 60 mL/min, give IV isotonic hydration 6–12 hours before and after imaging. Alternative: paracetamol up to 3 g/day.
Sources
Verbatim lines from the interaction sections, in the language of the label
«Biguanidas (metformina) : En pacientes con insuficiencia renal aguda o insuficiencia crónica grave, la eliminación de biguanidas puede verse disminuida, dando lugar a la acumulación y desarrollo de…»AEMPS, section 4.5 · Open on CIMA
«Neurolépticos, analgésicos, antieméticos, antihistamínicos y sedantes del grupo fenotiazínico:»AEMPS, section 4.5 · Open on CIMA
«Neurolépticos, analgésicos, antieméticos, antihistamínicos y sedantes del grupo fenotiazínico:»AEMPS, section 4.5 · Open on CIMA
«Así mismo las concentraciones elevadas de medios de contraste en suero y orina pueden interferir con el análisis de bilirrubina, proteínas y sustancias inorgánicas (hierro, cobre, calcio y fosfatos)…»AEMPS, section 4.5 · Open on CIMA
«Neurolépticos, analgésicos, antieméticos, antihistamínicos y sedantes del grupo fenotiazínico:»AEMPS, section 4.5 · Open on CIMA
«Diuréticos: Debido al riesgo de deshidratación provocada por los diuréticos, antes de administrar el medio de contraste iodado la rehidratación salina para minimizar el riesgo de insuficiencia renal…»AEMPS, section 4.5 · Open on CIMA
«Metformin: In patients with renal impairment, biguanides can cause lactic acidosis. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of…»FDA, section 7 · Open on DailyMed
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Iopromide is evaluated for the following indications with varying evidence strength: CT contrast enhancement (evidence tier A), Diagnostic angiography (evidence tier A), Iodinated contrast use during metformin therapy (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Iopromide (≥ 1 in 100): Warmth sensation, facial flushing, Nausea, Metallic taste, Transient dizziness. See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): no well-controlled studies have been done in pregnant women. Animal studies indicate no harmful effects on pregnancy, embryofetal development, parturition or postnatal development. Before an iodinated contrast agent is given in pregnancy, benefit and risk are weighed, because the fetal thyroid is sensitive to iodine and acute iodine overload after maternal administration can cause fetal thyroid dysfunction.
Transfers into breast milk in minimal amounts (less than 0.01% of dose). Interruption of breastfeeding is not required by most international guidelines (ACR 2021), although a 24-hour interruption is sometimes practiced.
Iopromide is contraindicated in: Overt hyperthyroidism; History of severe allergic reactions to iodinated contrast; Concomitant interleukin-2; Severe decompensated heart failure; Uncorrected bleeding diathesis. Full list in the Safety section.
allergy to elemental iodine is rare; reactions to contrast are hypersensitivity to the molecule and osmolarity. Seafood allergy does not increase contrast reaction risk.
hydration matters before and after the study, but «more is better» is not true – excessive hydration is harmful in heart failure.
in acute life-threatening states (trauma, pulmonary embolism, aortic dissection), contrast CT is performed when alternatives are not feasible.
Direct links to regulator labels. Open in a new tab.
Calcipotriol, Clotrimazole, Dimetindene, Enoxolone, Isotretinoin, Minoxidil, Mupirocin, Sodium bicarbonate