WARNING: RISKS WITH INADVERTENT INTRATHECAL ADMINISTRATION FOR INTRA-ARTERIAL AND INTRAVENOUS USE ONLY. Inadvertent intrathecal administration may cause death, convulsions, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, seizures, rhabdomyolysis, hyperthermia, and brain edema [see Warnings and Precuations ( 5.1 )]. WARNING: RISKS WITH INADVERTENT INTRATHECAL ADMINISTRATION See full prescribing information for complete boxed warning. FOR INTRA-ARTERIAL AND INTRAVENOUS USE ONLY. Inadvertent intrathecal administration may cause death, convulsion, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, seizures, rhabdomyolysis, hyperthermia, and brain edema [see Warnings and Precuations ( 5.1 )].
8.1 Pregnancy Risk Summary Postmarketing data with OPTIRAY use in pregnant women are insufficient to determine if there is a risk of drug-associated adverse developmental outcomes. Ioversol crosses the placenta and reaches fetal tissues in small amounts [see Data]. In animal reproduction studies, no adverse developmental effects were observed following daily intravenous administrations of ioversol to pregnant rats (from Gestation Day 7 to 17) and rabbits (Gestation Day 6 to 18) at doses 0.35 and 0.71 times, respectively, the maximum recommended human dose. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of major birth defects, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriages in clinically recognized pregnancies is 2-4% and 15-20%, respectively. Data Human Data Literature reports show that ioversol crosses the placenta and is visualized in the digestive tract of exposed infants after birth. Animal Data Developmental toxicity studies were conducted with ioversol given intravenously at doses of 0, 0.2, 0.8, and 3.2 g iodine/kg/day from Gestation Day7 to 17 and 6 to 18, in rats and rabbits, respectively. No adverse effects on embryo-fetal development were observed in either species at the maximum dose tested (3.2 g iodine/kg/day). Maternal toxicity was observed in rabbits at 0.8 and 3.2 g iodine/kg/day.
Iodinated contrast agents increase risk of metformin-induced lactic acidosis, possibly through worsening renal function. Stop metformin at or prior to IOVERSOL administration in patients with eGFR 30-60 mL/min/1.73 m² or with hepatic impairment, alcoholism, or heart failure.
Renal toxicity reported in patients with liver impairment given oral cholecystographic agents followed by intravascular contrast agents. IOVERSOL administration should be postponed in patients recently receiving cholecystographic contrast.
Iodinated contrast agents may interfere with thyroid uptake of radioactive iodine and decrease therapeutic efficacy in thyroid carcinoma patients for 6-8 weeks.