Nonionic Contrast Media

Nonionic contrast media are neutral water-soluble triiodobenzene derivatives the solubility is provided by hydrophilic groups in the side chains, preferentially hydroxy groups. 

KatayamaH.YamaguchiK,KoznkaT,etal Adverse lO reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990 175 621-628. 

Prediction of severe adverse reactions to ionic and nonionic contrast media in Japan evaluation of pretesting. 

MMautz H, Fichte F,Wegscheider K (1989) In Taenzer V, Wende S (eds) Recent development in nonionic contrast media. Ceorg Thieme Verlag, Stuttgart, p 16... 

Rudnick MR, Goldfarb S, Wexler L, et al. Nephrotoxicity of ionic and nonionic contrast media in I 196 patients a randomized trial. The lohexol Cooperative Study. Kidney Int 1995 47 254-261. 

Siegle RL. Rates of idiosyncratic reactions. Ionic versus nonionic contrast media. Invest Radiol 1993 28(Suppl 5) S95-8. 

Hill JA, Winniford M, Cohen MB, Van Fossen DB, Murphy MJ, Halpem EF, Ludbrook PA, Wexler L, Rudnick MR, Goldfarb S. Multicenter trial of ionic versus nonionic contrast media for cardiac angiography. The lohexol Cooperative Study. Am J Cardiol 1993 72(ll) 770-5. 

Baath L, Almen T, Oksendal A. Cardiac effects from addition of sodium ions to nonionic contrast media for coronary arteriography. An investigation of the isolated rabbit heart. Invest Radiol 1990 25(Suppl 1) S137 0. 

Donadio C,Tramonti G, Giordani R, Lucchetti A, Calderazzi A, Sbragia P, Bianchi C. Glomerular and tubular effects of ionic and nonionic contrast media (diatrizoate and iopamidol). Contrib Nephrol 1988 68 212-219. 

Rosovsky MA, Rusinek H, Berenstein A, Basak S, Setton A, Nelson PK. High-dose administration of nonionic contrast media a retrospective review. Radiology 1996 200 119-122. 

TaliercioCP, McCallister SH, Holmes DR, llstrup DM,Vlietstra RE. Nephrotoxicity of nonionic contrast media after cardiac angiography. Am J Cardiol 1989 64 815-816. 

One of the methods for synthesis of iohexol (7b), a nonionic contrast agent, is shown in equation (10.5) (246). Nonionic contrast media are more costly to manufacture than are ionic constrast media. The cost of nonionic contrast media is determined by the number of synthetic steps, overall yield, cost of the intermediates, difficulties in isolation and purification, and other associated manipulations. Many alternate paths of synthesis and purification of nonionic contrast agents have been reported. For example, the nonionic contrast agent ioxilan (7j) can alternately be prepared... 

Novel reactions can also be used to prepare nonionic contrast media (252). For example, iomeprol in alkaline solution undergoes the... 

Nonionic contrast media have a multiplicity of optical and rotational isomers and diastereoisomers (201, 261, 264-267). Optical isomerism is derived from the chiral centers in... 

Nonionic contrast media, by virture of the large number of hydroxyl groups, 4 to 6 in monomers and 8 to 12 in bis compounds, are highly water soluble. These hydroxyl groups are evenly distributed throughout the contrast molecule and leave no lipophilic regions in the molecule free to bind with proteins. The hexaiodinated nonionic bis compound iodixa-... 

Nonionic contrast media are intrinsically ion-free but iohexol, iopentol, and iodixanol, for example, contain cations at subplasma concentration levels to avoid negative effects on myocardium contractility, electric conduction, and red blood cell aggregation during coronary arteriography. An oxygenated iohexol solution (350 mg I/mL) containing (in mM/L) Na-" 30, Ca + 0.15, 0.9, and Mg - 0.1,... 

Greater use of nonionic contrast media for routine X-ray procedures is clearly the trend of the future. It was estimated that in 1991, approximately 69% of the procedures performed in the United States used nonionic contrast media compared to about 66% in Europe and more than 80%in Japan. In 1994 the percentage increased to about 80% in the United States, 75% in Europe, and 92%in Japan (540). In the United States, in 1994 as many as 18 million patients received intravascular contrast media, and an estimated 170 million contrast medium-enhanced radiologic studies were performed from 1978 to 1994 (541). 

Mortality as a direct consequence of use of iodinated contrast media is a rare occurrence. Hatayama et al. (535) observed two deaths among 337,647 cases in which iodinated contrast media were injected intravenously. Spring et al. (542) showed that 37% more deaths were reported each year in 1987-1994 than in 1978-1986. Most of the increase was associated with the use of nonionic contrast media. In 1978-1987, 376 deaths were reported and in 1987-1994,474. In 1987-1994, 220 deaths were associated with use of ionic HOCM alone, 32 with ionic LOCM alone, and 214 with nonionic LOCM alone. The calculated occurrence of 1 death per 200,000 or more examinations was comparable with published data. The authors remarked that the... 

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