Indications
Iopromide, marketed under the brand name IOVIST, has received FDA approval for use as both an intra-arterial and intravenous X-ray contrast agent. When administered intra-arterially, it is indicated for applications such as cerebral arteriography, peripheral arteriography, coronary arteriography, left ventriculography, visceral angiography, and aortography in adults. Additionally, it is utilized for the radiographic evaluation of cardiac chambers and associated arteries in pediatric patients aged two years and older. Intravenous administration of iopromide is indicated for excretory urography in both adults and pediatric patients aged two years and older. It is also used in contrast-enhanced computed tomography (CT) of the head and body, including intrathoracic, intra-abdominal, and retroperitoneal regions, for the assessment of neoplastic and non-neoplastic lesions in adults and pediatric patients from two years of age. Furthermore, iopromide is employed in contrast mammography to assist in the visualization of suspected or known breast lesions in adults, serving as an adjunct following mammography and/or ultrasound. In Canada, the product is approved as an intravascular contrasting agent, with specific indications varying based on dosage. At a concentration of 300 mg I/mL, it is indicated for use in CT, excretory urography, including pediatric cases, renal and peripheral arteriography, cerebral arteriography, phlebography of the extremities, and arthrography.
Pharmacodynamics
Upon intravenous administration of iopromide, the opacification of the renal parenchyma starts within approximately one minute. The excretion of the contrast agent becomes noticeable within one to three minutes, with optimal contrast observed in the calyces and collecting system between five to 15 minutes post-injection. In patients with nephropathic conditions, particularly those with altered excretory function, the excretion rate of the agent can vary widely, potentially delaying opacification for several hours after administration. The level of contrast enhancement achieved is directly related to the iodine concentration present in the tissue being examined.
Absorption
Following intravascular injection, iopromide rapidly attains peak plasma concentrations and is expeditiously distributed throughout the extracellular fluid compartment. It has minimal propensity for binding with serum or plasma proteins. Notably, iodinated contrast agents like iopromide can cross a compromised blood-brain barrier.
Metabolism
Iopromide is characterized by its lack of significant metabolism, deiodination, or biotransformation processes.
Mechanism of Action
Iopromide is a nonionic iodinated, water-soluble contrast medium utilized in radiographic procedures. It is available in two stable, ready-to-use formulations with iodine concentrations of 300 mg/mL and 370 mg/mL. Upon intravascular administration, iopromide enhances the radiographic visibility of the vasculature and extracellular spaces along its flow path. This opacification facilitates the diagnostic evaluation of limbs and internal organs until the medium becomes significantly diluted.
