Iobitridol

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Iobitridol
Iobitridol.png
Clinical data
Trade names Xenetix
AHFS/Drugs.com UK Drug Information
Routes of
administration 		Intravenous, joint injection, instillation into body cavities
ATC code
Legal status
Legal status
  • UK: POM (Prescription only)
Pharmacokinetic data
Protein binding ~2%
Metabolism none
Elimination half-life 1.8 hours
Excretion unchanged via kidneys
Identifiers
  • 1-N,3-N-bis(2,3-dihydroxypropyl)-5-[3-hydroxy-2-(hydroxymethyl)propanamido]-2,4,6-triiodo-1-N,3-N-dimethylbenzene-1,3-dicarboxamide
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula C20H28I3N3O9
Molar mass 835.169 g·mol−1
3D model (JSmol)
  • CN(CC(CO)O)C(=O)c1c(c(c(c(c1I)NC(=O)C(CO)CO)I)C(=O)N(C)CC(CO)O)I
  • InChI=1S/C20H28I3N3O9/c1-25(3-10(31)7-29)19(34)12-14(21)13(20(35)26(2)4-11(32)8-30)16(23)17(15(12)22)24-18(33)9(5-27)6-28/h9-11,27-32H,3-8H2,1-2H3,(H,24,33) X mark.svgN
  • Key:YLPBXIKWXNRACS-UHFFFAOYSA-N X mark.svgN
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Iobitridol (trade name Xenetix) is a pharmaceutical drug used as an iodine-based radiocontrast agent in X-ray imaging. [1] It is injected into blood vessels, joints, or body cavities such as the uterus, and filtered out by the kidneys. [2] Its most common adverse effect is nausea. Severe allergic reactions are rare. [1] [2]

Contents

The drug received its first marketing approval in 1994 in France [3] and is approved for use in many European countries including the UK, [4] but not in the US. [1] It is manufactured by Guerbet. [3]

Medical uses

Iobitridol is used for intravenous urography (imaging of the urinary system via a vein), angiography (imaging of blood vessels), angiocardiography (heart and coronary arteries), arthrography (joints), hysterosalpingography (uterus and fallopian tubes), and imaging of the cranium and the whole body. [2] It is approved for use in adults and children. [5]

Contraindications

The drug is contraindicated in people with manifest hyperthyreosis because of its iodine content. It must not be used to image the uterus or fallopian tubes in pregnant women. [2] [6]

Adverse effects

Iobitridol is generally well tolerated. [5] The only side effect observed in more than 1% of patients is nausea. Rare side effects (in fewer than 1 per 10.000 people) include anaphylaxis (severe allergic reactions), circulatory collapse, kidney failure, thyroid-related effects, and skin reactions such as Stevens–Johnson syndrome. Rare side effects in brain imaging include convulsions, transient sight disorders, memory loss, and coma. [2] [6]

Overdose

Overdosing is unlikely. It is managed by rehydration therapy and monitoring of the kidney function for at least three days. If necessary, iobitridol can be removed from the body by haemodialysis. [2] [6]

Interactions

Drug interactions are the same as with other iodine-containing contrast agents: patients taking diuretics are at a higher risk of developing kidney failure under iobitridol unless they receive a water and electrolyte infusion before imaging. [2] As the diabetes drug metformin is eliminated via the kidneys, it is recommended that people with severe kidney impairment should pause metformin during and after they are given iobitridol. [7]

Certain antihypertensive (blood pressure lowering) drugs such as beta-blockers, ACE inhibitors, and sartans can prevent the heart from compensating for low blood pressure, with an increased risk of circulatory collapse. Iodine-131, a radioactive isotope used for thyroid imaging (scintigraphy) and therapy of thyroid cancers, can be less effective when used within several weeks after the application of iobitridol because of residual iodine in the body. [2]

Interleukin 2 cancer therapy has been thought to result in more severe side effects than iobitridol, [2] but a 2009 literature search has found no such risk. [8]

Pharmacology

Mechanism of action

CT scan of three brain metastases from breast cancer. Before (left image) and after (right image) injection of an iodinated contrast agent similar to iobitridol. BrainMetastasisFromBreastCancer.jpg
CT scan of three brain metastases from breast cancer. Before (left image) and after (right image) injection of an iodinated contrast agent similar to iobitridol.

Iobitridol is an iodine-containing radiocontrast agent. [2] [5] The iodine atoms readily absorb X-rays, resulting in better contrast in radiography images. [9] The quality of images made with this drug is equally good as with other low– or medium–osmolarity iodinated contrast agents such as iopamidol or iohexol. [5]

Pharmacokinetics

After intravenous infusion, iobitridol is distributed in the circulatory system and the interstitium. The substance is only marginally bound to blood plasma proteins (to about 2%) and membrane proteins because the hydrophilic side chains of the molecule efficiently mask the central iodinated benzene ring. It is not metabolized but eliminated in the unchanged form via the kidneys by glomerular filtration without active secretion or reabsorption. The elimination half-life is 1.8 hours. [2] [5]

In people with kidney failure, the substance is instead eliminated via the bile duct. [2]

Chemistry

Of the molecular mass, 45.6% is contributed by the three iodine atoms. Iobitridol is nonionic but water-soluble, [1] having some OH groups in its side chains designed to mask the central hydrophobic benzene ring. [5]

The solution has a low osmolarity of 695 (Xenetix 300) or 915 mOsm/kg H2O (Xenetix 350), which means it causes fewer allergic and allergy-like reactions, as well as less extravasation (leakage of blood vessels) than contrast agents with higher osmolarities. [2] [5] [10]

Related Research Articles

Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography, projectional radiography, and fluoroscopy. Radiocontrast agents are typically iodine, or more rarely barium sulfate. The contrast agents absorb external X-rays, resulting in decreased exposure on the X-ray detector. This is different from radiopharmaceuticals used in nuclear medicine which emit radiation.

<span class="mw-page-title-main">Iodinated contrast</span> Substance to enhance X-ray imaging

Iodinated contrast is a form of water-soluble, intravenous radiocontrast agent containing iodine, which enhances the visibility of vascular structures and organs during radiographic procedures. Some pathologies, such as cancer, have particularly improved visibility with iodinated contrast.

The Jod-Basedow effect is hyperthyroidism following administration of iodine or iodide, either as a dietary supplement, iodinated contrast medical imaging, or as a medication.

<span class="mw-page-title-main">Iotrolan</span> Chemical compound

Iotrolan is an iodine-containing radiocontrast agent, a substance used to improve the visibility of body structures on images obtained by X-ray techniques.

<span class="mw-page-title-main">Diatrizoate</span> Chemical compound

Diatrizoate, also known as amidotrizoate, Gastrografin, is a contrast agent used during X-ray imaging. This includes visualizing veins, the urinary system, spleen, and joints, as well as computer tomography. It is given by mouth, injection into a vein, injection into the bladder, through a nasogastric tube, or rectally.

A contrast agent is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radiopharmaceuticals, which emit radiation themselves. In x-ray imaging, contrast agents enhance the radiodensity in a target tissue or structure. In magnetic resonance imaging, contrast agents shorten the relaxation times of nuclei within body tissues in order to alter the contrast in the image.

Pyelogram is a form of imaging of the renal pelvis and ureter.

<span class="mw-page-title-main">Iohexol</span> Chemical compound

Iohexol, sold under the trade name Omnipaque among others, is a contrast agent used for X-ray imaging. This includes when visualizing arteries, veins, ventricles of the brain, the urinary system, and joints, as well as during computed tomography. It is given by mouth, injection into a vein, or into a body cavity.

Iodixanol, sold under the brand name Visipaque, is an iodine-containing non-ionic radiocontrast agent.

<span class="mw-page-title-main">Computed tomography angiography</span> Medical investigation technique

Computed tomography angiography is a computed tomography technique used for angiography—the visualization of arteries and veins—throughout the human body. Using contrast injected into the blood vessels, images are created to look for blockages, aneurysms, dissections, and stenosis. CTA can be used to visualize the vessels of the heart, the aorta and other large blood vessels, the lungs, the kidneys, the head and neck, and the arms and legs. CTA can also be used to localise arterial or venous bleed of the gastrointestinal system.

<span class="mw-page-title-main">Iopamidol</span> Contrast agent

Iopamidol (INN), sold under the brand name Isovue among others, is a nonionic, low-osmolar iodinated contrast agent, developed by Bracco Diagnostics.

<span class="mw-page-title-main">Iopromide</span> Chemical compound

Iopromide is an iodinated contrast medium for X-ray imaging. It is marketed under the name Ultravist which is produced by Bayer Healthcare. It is a low osmolar, non-ionic contrast agent for intravascular use; i.e., it is injected into blood vessels.

<span class="mw-page-title-main">Iopentol</span> Chemical compound

Iopentol is a pharmaceutical drug that was used as a radiocontrast agent for X-ray imaging in Europe.

<span class="mw-page-title-main">Iomeprol</span> Chemical compound

Iomeprol is a pharmaceutical drug used as a radiocontrast agent in X-ray imaging. It is sold under the trade names Imeron and Iomeron.

<span class="mw-page-title-main">Metrizoic acid</span> Chemical compound

Metrizoic acid is a pharmaceutical drug that was used as an iodinated contrast medium for X-ray imaging. Its uses included angiography and urography, but it has been discontinued, at least in the US.

<span class="mw-page-title-main">Acetrizoic acid</span> Chemical compound

Acetrizoic acid is a pharmaceutical drug that was used as an iodinated contrast medium for X-ray imaging. It was applied in form of its salt, sodium acetrizoate, but is no longer in clinical use.

<span class="mw-page-title-main">Ioxaglic acid</span> Chemical compound

Ioxaglic acid is pharmaceutical drug used as an iodinated contrast medium for X-ray imaging. It has low osmolality, typically resulting in fewer side effects than high-osmolality media. It is manufactured by Guerbet, but marketing in the US has been discontinued. As of 2021, it may still be available in some European countries.

<span class="mw-page-title-main">Gadoteric acid</span> Chemical compound

Gadoteric acid, sold under the brand name Dotarem among others, is a macrocycle-structured gadolinium-based MRI contrast agent (GBCA). It consists of the organic acid DOTA as a chelating agent, and gadolinium (Gd3+), and is used in form of the meglumine salt (gadoterate meglumine). The paramagnetic property of gadoteric acid reduces the T1 relaxation time (and to some extent the T2 and T2* relaxation times) in MRI, which is the source of its clinical utility. Because it has magnetic properties, gadoteric acid develops a magnetic moment when put under a magnetic field, which increases the signal intensity (brightness) of tissues during MRI imaging.

<span class="mw-page-title-main">Contrast CT</span> Medical imaging technique

Contrast CT, or contrast enhanced computed tomography (CECT), is X-ray computed tomography (CT) using radiocontrast. Radiocontrasts for X-ray CT are generally iodine-based types. This is useful to highlight structures such as blood vessels that otherwise would be difficult to delineate from their surroundings. Using contrast material can also help to obtain functional information about tissues. Often, images are taken both with and without radiocontrast. CT images are called precontrast or native-phase images before any radiocontrast has been administered, and postcontrast after radiocontrast administration.

<span class="mw-page-title-main">Medical imaging in pregnancy</span> Types of pregnancy imaging techniques

Medical imaging in pregnancy may be indicated because of pregnancy complications, intercurrent diseases or routine prenatal care.

References

  1. 1 2 3 4 Cheng KT (2004). "5-(3-Hydroxy-2-hydroxymethyl-propionamido)-N,N´-dimethyl-N,N´-bis-(2,3-dihydroxypropyl)-2,4,6-triiodoisophthalamide". Molecular Imaging and Contrast Agent Database (MICAD) [Internet]. PMID   20641966.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Xenetix 300 (300 mg Jod/ml)-Parenterale Röntgenkontrastmittellösung.
  3. 1 2 "Xenetix / ScanBag by Xenetix (Iobitridol)". Guerbet . Retrieved 2021-03-19.
  4. ↑ "Iobitridol: List of nationally authorised medicinal products - PSUSA/00001761/201904" (PDF). European Medicines Agency. 2020-04-03.
  5. 1 2 3 4 5 6 7 McCormack PL (February 2013). "Iobitridol: a review of its use as a contrast medium in diagnostic imaging". Clinical Drug Investigation. 33 (2): 155–66. doi:10.1007/s40261-013-0055-3. PMID   23341290. S2CID   5311763.
  6. 1 2 3 Xenetix 300 (300 mgI/ml) Solution for Injection: UK Drug Information . Accessed 2021-03-18.
  7. ↑ American College of Radiology (2021). "ACR Manual on Contrast Media" (PDF). pp. 45–46.
  8. ↑ Boehm I (September 2009). "Is interleukin-2 therapy still a risk factor for adverse reactions in concert with iodinated contrast medium injection?". Acta Radiologica. 50 (7): 752–3. doi:10.1080/02841850903061452. PMID   19629773. S2CID   44833077.
  9. ↑ Bae KT (July 2010). "Intravenous contrast medium administration and scan timing at CT: considerations and approaches". Radiology. 256 (1): 32–61. doi:10.1148/radiol.10090908. PMID   20574084.
  10. ↑ Haberfeld H, ed. (2020). Austria-Codex (in German). Vienna: Österreichischer Apothekerverlag. Xenetix 350 (350 mg Jod/ml)-Parenterale Röntgenkontrastmittellösung.
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