Dosing and uses of Omnipaque, Oraltag (iohexol)
Adult dosage forms and strengths
injection solution
- 180mg/mL
- 240mg/mL
- 300mg/mL
intravenous solution
- 140mg/mL
- 350mg/mL
powder for oral solution (Oraltag)
- 9.7g/bottle (equivalent to 4.5g carbon bound iodine)
- The packaging allows for preparation of the iohexol in a single-use bottle
- There are 5 fill lines premolded on the bottle for accurate dilution of the product to a desired concentration
Intrathecal
Omnipaque 180 (180 mgI/mL)
- Lumbar Myelography, via lumbar injection 10-17 mL
- Cervical Myelography, via C1-C2 injection: 7-12.5 mL
Omnipaque 240 (240 mgI/mL)
- Lumbar Myelography, via lumbar injection: 7-12.5 mL
- Thoracic Myelography, via lumber/cervical injection: 6-12.5 mL
- Cervical Myelography, via lumbar injection: 6-12.5 mL; via C1-C2 injection: 6-12.5
- Total Columnar Myelography, via lumbar injection: 6-12.5 mL
Omnipaque 300 (300 mgI/mL)
- Thoracic Myelography, via lumbar/cervical injection: 6-10 mL
- Cervical Myelography, via lumbar injection: 6-10 mL; via C1-C2 injection: 4-10 mL
- Total Columnar Myelography, via lumbar injection: 6-10 mL
Administration
- Rate of injection: Slowly over 1-2 min
- Not to exceed 300 mg/mL or 3060 mg iodine per single myelographic procedure
Intravascular
Omnipaque 140/300/350
Angiocardiography: ventriculography, pulmonary arteriography, venography & studies of collaterol arteries
- Ventriculography: 40 mL, range of 30-60 mL; may be repeated as needed, not to exceed 250 mL
- Selective Coronary Arteriography: 5 mL. range 3-14 mL per injection
- Aortic Root and Arch Study: 50 mL, range 20-75 mL, when used alone
- Pulmonary Angiography: 1 mL/kg
- Combined Angiographic Procedures: Multiple Procedures not to exceed 5 mL/kg or 250 mL
- Aortography and Selective Arteriography
- - Aorta: 50-80 mL
- - Major branches incl celiac, mesenteric arteries: 30-60 mL
- - Renal arteries: 5-15 mL; not to exceed 291 mL/Omnipaque 300 or 250 mL/Omnipaque 350 when repeat injection indicated
- Cerebral Arteriography: Common Carotid Artery: 6-12 mL
- Internal Carotid Artery: 8-10 mL
- External Carotid Artery: 6-9 mL
- Vertebral Artery: 6-10 mL
CT Scanning of the Body
Head Imaging via injection: 70-150 mL (Omni 300); 80 mL (Omni 350)
Head Imaging via infusion: 120-250 mL (Omni 240)
Body Imaging via injection: 50-200 mL (Omni 300); 60-100 mL (Omni 350)
Digital Subtraction
Omni 350
- Usual amount used for IV digital technique is 30-50 mL
- Administer as bolus at 7.5-30 mL/sec using pressure injector
Omni 140
- Intra-arterial use for head, neck, abdominal, renal, and peripheral vessel
- Administer 1 or more bolus via intra-arterial injection of Omni 140
- Aorta: 20-45 mL at 8-20 mL/sec
- Carotid: 5-10 mL at 3-6 mL/sec
- Femoral: 9-20 mL at 3-6 mL/sec
- Vertebral: 4-10 mL at 2-8 mL/sec
- Renal: 6-12 mL at 3-6 mL/sec
- Other Branches of Aorta: 8-25 mL at 3-10 mL/sec
Excretory Urography
Omnipaque 300/350: 200-350 mgI/kg body weight
Oral
Oraltag
- Indicated for opacification of the GI tract during CT of the abdomen and pelvis
- 1-2 bottles of prepared solution (4.5-9 g iodine) PO 20-60 minutes before image acquisition
Omnipaque 240/300/350
- GI Tract
- Omni 350 (undiluted): 50-100 mL, dependent on nature of procedure and patient size
- CECT of abdomen
- Omni 300: Dilute PO dose to 6-9 mg(iodine)/mL and administer in combo with IV dose
- Recommended PO dose: 500-1000 mL
- Recommended IV dose: 100-150 mL
- Administer PO dose 20-40 min prior to IV dose
Intracavity
Usual: 50-150 mL IV OR 100-250 mL IV of (240 mgI/mL)
Hysterosalpingography
- Omnipaque 240: 15-20 mL, but varies with anatomy and/or disease state
- Omnipaque 300: 15-20 mL, but varies with anatomy and/or disease state
Body Imaging
25-75 mL IV OR 50-150 mL IV infusion; not to exceed 150 mL
For 240 mg/mL: 35-100 mL IV OR 70-200 mL IV infusion; not to exceed 250 mL
Pediatric dosage forms and strengths
injection solution
- 180mg/mL
- 240mg/mL
- 300mg/mL
intravenous solution
- 140mg/mL
- 350mg/mL
powder for oral solution (Oraltag)
- 9.7g/bottle (equivalent to 4.5g carbon bound iodine)
- The packaging allows for preparation of the iohexol in a single-use bottle
- There are 5 fill lines premolded on the bottle for accurate dilution of the product to a desired concentration
Intrathecal
Recommended total doses for lumbar, thoraic, cervical, and/or total columnar myelography
Omnipaque 180 (180 mgI/mL)
- 0 to <3 months: 2-4 mL
- 3 to <36 months: 4-8 mL
- 3 to <7 years: 5-10 mL
- 7 to <13 years: 5-12 mL
- 13-18 years: 6-15 mL
Administration
- Rate of injection: Slowly over 1-2 min
- Not to exceed 180 mg/mL or 2700 iodine per single myelographic procedure
Intravascular
Omnipaque 240/300/350
Angiocardiography: ventriculography, pulmonary arteriography, venography & studies of collaterol arteries
- Ventriculography: Omnipaque 350: 1.25 mL/kg, range 1-1.5 mL/kg; not to exceed 5 mL/kg or 250 mL, when multiple injections given
- Omnipaque 300: 1.75 mL/kg, range 1.5-2 mL/kg; not to exceed 6 mL/kg or 291 mL, when multiple injections given
- Pulmonary Angiography: 1 mL/kg
- Combined Angiographic Procedures - Multiple Procedures
- - Omnipaque 350: Not to exceed 5 mL/kg or 250 mL
- - Omnipaque 300: Not to exceed 6 mL/kg or 291 mL
- Aortography and selective arteriography: 1 mL/kg single inj dose; not to exceed 5 mL/kg or 250 mL
CT Scanning of the Body
Head imaging: 1-2 mL/kg; not to exceed 28 gI (Omni 240) or 35 gI Omni 300
Head imaging via infusion: 120-250 mL (Omni 240)
Body imaging via injection: 50-200 mL (Omni 300); 60-100 mL (Omni 350)
Excretory Urography
Omnipaque 300: 0.5-3 mL/kg of body weight
Infants/children: According to age and body weight
Usual dose: 1-1.5 mL/kg; not to exceed 3 mL/kg
Oral
Oraltag
- Indicated for opacification of the GI tract during CT of the abdomen and pelvis
- <3 years
- Up to 4.5 g of iodine PO 20-60 minutes before image acquisition
- From portion of 1 bottle of prepared solution; 120-300 mL, depending on size of patient
- 3-18 years
- Up to 9 g of iodine PO 20-60 minutes before image acquisition
- From <1 bottle up to 2 bottles of prepared solution; 280-750 mL, depending on size of patient
Omnipaque 180/240/300 mg(iodine)/mL
- GI tract
- For oral pass through, dependent on nature of procedure and patient size
- <3 months: Omnipaque 180: 5-30 mL
- 3 months to 3 years: Omnipaque 180/240/300: up to 60 mL
- 4-10 years: Omnipaque 180/240/300: up to 80 mL
- >10 years: Omnipaque 180/240/300: up to 100 mL
- When given rectally, larger volumes may be used
- CECT of abdomen
- Omni 300: dilute PO dose to conc of 9-21 mgI/mL (180-750 mL) and administer in combo with IV dose
- <3 years: Not to exceed 5 gI
- 3-18 years: Not to exceed 10 gI
- Give total oral dose all at once or over 30-45 min, if there is difficulty consuming
- Recommended IV dose, given in conjunction with dilute PO dose, of Omni 240/300
- Recommended PO dose: 180-750 mL
- Recommended IV dose: 2 mL/kg; range 1-2 mL/kg; not to exceed 3 mL/kg
- Administer PO dose 30-60 min prior to IV dose
Geriatric dosage forms and strengths
In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy
Warnings
Contraindications
For procedural contraindications see package insert
Intrathecal administration of corticosteroids with Omnipaque
DO NOT immediate repeat myelography because of technical problem (see Dosing)
Significant bacterial infection
Cautions
Inhibits blood coagulation
Patient should be well hydrated before and after procedure
Caution in severe renal impairment, combined renal/hepatic disease, severe thyrotoxicosis, multiple myeloma, anuria, pheochromocytoma, sickle cell, CHF, severe arterial/venous disease
May cause renal failure in patients advanced vascular disease, diabetes; should be well hydrated before/after procedure
Hypersensitivity to contrast medium, iodine
Hydrate patients before and after examination
Use extreme caution in pheochromocytoma
Focal and generalized motor seizures reported patients with history of epilepsy when higher than recommended doses used
Allergies (bronchial asthma, hay fever, food allergies)
Serious and fatal thromboembolic events causing myocardial infarction or stroke reported during angiographic procedures
Pregnancy and lactation
Pregnancy category: B
Lactation: Not known; not recommended
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Omnipaque, Oraltag (iohexol)
Mechanism of action
Allows for radiographic visualization through the opacification of vessels and anatomical structures in the path of flow of the contrast media
Pharmacokinetics
Protein binding: MinimaL
Excretion: Urine (80-90%)
Duration: 30 min following intrathecal administration, 60 min following IV administration; 15-120 seconds in serum
Administration
Oral Preparation (Oraltag)
Reconstitute powder in the single use bottle with water or other beverages (eg, infant formula, milk, juice, carbonated beverage, sports drink) just before use
Use the 5 fill lines premolded and labeled on the bottle to determine the volume for the 5 target concentrations (ie, 9, 12, 15, 18, and 21 mg(iodine)/mL)
Variables of patient age, weight, or medical condition, may require adjustment of the concentration and/or volume of solution to be prepared for administration; if it is anticipated that the patient will have difficulty in consuming the required volume, a higher concentration of solution (up to 21 mg (iodine) per mL) can be prepared and a smaller volume administered
Do not mix with other pharmaceuticals
Once dissolved, the solution can then be directly administered from the bottle
Protect prepared solution from strong daylight and direct exposure to sunlight
Oral Administration
Oraltag: Administer 20-60 minutes before image acquisition
Discard any unused portions
