Results of randomized controlled trials of low-versus high-osmolality contrast media.

Abstract

The authors reviewed 100 randomized controlled trials (RCTs) conducted in humans to compare safety or efficacy of new low-osmolality contrast media (LOM) with that of high-osmolality contrast media (HOM). Findings of the 43 RCTs judged to be of the highest quality suggest that the efficacy of LOM in imaging is equal or superior to that of HOM for all routes of administration. Heat sensation occurred less often with LOM for all routes and pain occurred less often with LOM for intraarterial routes. No differences were seen in nephrotoxicity or in frequency of nausea, vomiting, urticaria, bronchospasm, laboratory test abnormalities, or neurologic events. Greater cardiovascular changes were seen with HOM, including increased or decreased heart rate, increased left ventricular end-diastolic pressure, decreased systolic pressure, and QT prolongation, depending on route of administration. To demonstrate whether a reduction in clinically significant adverse outcomes truly occurs with LOM, trials will need to enlist larger numbers of patients and employ appropriate outcome measures. Future trials should stratify patients according to their risk of adverse reactions to provide better information about benefits of LOM in low- versus high-risk patients.

Selective use of low-osmolality contrast media in computed tomography

“…The advent of a new generation of low-osmolality contrast media in the middle and late 1980s supposed an opportunity to reduce patient's discomfort and the incidence of adverse reactions, although these new contrast media were clearly more expensive than conventional HOCM. All reported series agree that LOCM cause fewer adverse reactions than HOCM [7,8,9]. But the use of LOCM has not been shown to reduce mortality.…”

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

“…Common benign reactions include pain on intravascular injection, nausea and vomiting, rash, and hemodynamic changes. Pain after injection is most commonly encountered with ionic monomers, such as diatrizoate, 22 and is thought to be related to the high osmolarity and greater association of endothelial injury with ionic agents. 23,24 Nausea and vomiting occur in up to 6.7% of patients who receive ICAs and, as with pain on injection, are more common with the high-osmolarity ionic monomeric agents.…”

Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

“…These effects have been explained by factors that include high osmolality, high sodium concentration, chemical toxicity of the contrast molecule and calcium binding properties of the chelates used for some of these agents [1,6]. Contrast agents with a lower osmolality (ionic dimeric or nonionic monomeric agents) have much less pronounced hemodynamic effects [1,2,[7][8][9][10][11][12]. This has been assumed to reduce the risk of provoking myocardial ischemia during coronary angiography or ventriculography [13].…”