Universal reference book for medicines
Product name: ULTRAVIST ® (ULTRAVIST ® )

Active substance: iopromide

Type: Radiopaque non-ionic diagnostic preparation for intravascular, intracavitary and subarachnoidal administration

Manufacturer: BAYER SCHERING PHARMA (Germany)
Composition, form of production and packaging
The solution for injections is
transparent, free of foreign particles.

1 ml

iopromide 499 mg,

which corresponds to the content of iodine 240 mg

osmolality at 37 ° C - 0.48 osm / kg H 2 O Viscosity at 20 ° C - 4.9 mPa.s, at 37 ° C - 2.8 mPa s at a density of 2063 ° C - 1.263 g / ml, at 37 ° C - 1.255 g / ml pH 6.5-8.0

Excipients: sodium calcium edetate - 100 mcg, trometamol - 2.42 mg, hydrochloric acid 10% - 5.6 mg, water d / and - 755.46 mg.

10 ml - bottles of glass (10) - packs of cardboard.

50 ml - bottles of glass (10) - packs of cardboard.

The solution for injections is transparent, free of foreign particles.

1 ml

iopromide 623 mg,

which corresponds to the content of iodine 300 mg

osmolality at 37 ° C - 0.59 osm / kg H2O, viscosity at 20 ° C is 8.9 mPa.s, at 37 ° C is 4.7 mPa.s, density at 20 ° C is 1.328 g / ml, at 37 ° C is 1.322 g / ml pH 6.5-8.0

Excipients: sodium calcium edetate - 100 mcg, trometamol - 2.42 mg, hydrochloric acid 10% - 5.6 mg, water d / and - 696.78 mg.

10 ml - bottles of glass (10) - packs of cardboard.

20 ml - bottles of glass (10) - packs of cardboard.

50 ml - bottles of glass (10) - packs of cardboard.

100 ml - bottles of glass (10) - packs of cardboard.

200 ml - bottles of glass (10) - packs of cardboard.

500 ml - glass bottles (8) - cardboard packs.

100 ml - plastic cartridges (5) - cardboard packages (2) - cardboard packs.

150 ml - plastic cartridges (5) - cardboard packages (2) - packs cardboard.

The solution for injections is transparent, free of foreign particles.

1 ml

iopromide 769 mg,

which corresponds to an iodine content of 370 mg

osmolality at 37 ° C - 0.77 osm / kg H 2 O Viscosity at 20 ° C - 22 mPa.s, at 37 ° C - 10 mPa.s at 20 ° C density - 1.409 g / ml, at 37 ° C - 1.399 g / ml pH 6.5-8.0

Excipients: sodium calcium edetate - 100 mcg, trometamol - 2.42 mg, hydrochloric acid 10% - 5.6 mg, water d / and - 628.72 mg.

30 ml - bottles of glass (10) - packs of cardboard.

50 ml - bottles of glass (10) - packs of cardboard.

100 ml - bottles of glass (10) - packs of cardboard.

200 ml - bottles of glass (10) - packs of cardboard.

500 ml - glass bottles (8) - cardboard packs.

100 ml - plastic cartridges (5) - cardboard packages (2) - cardboard packs.

150 ml - plastic cartridges (5) - cardboard packages (2) - packs cardboard.

INSTRUCTION FOR THE SPECIALIST.

Description of the drug approved by the manufacturer for the printed edition of 2013.

PHARMACHOLOGIC EFFECT

Non-ionized, low-osmolar triiodinated radiopaque means, which increases the contrast of the image due to the absorption of X-rays by iodine, which is part of its composition.

PHARMACOKINETICS

Distribution

Yopromide after intravascular injection is very quickly distributed in the intercellular space.

T 1/2 in the distribution phase is 3 minutes.

Binding to plasma proteins at a concentration of 1.2 mg iodine / ml is 0.9 ± 0.2%.
Ultravist ® does not penetrate intact BBB, but in a small amount passes through the placental barrier (shown in rabbits).
After 1-5 min after bolus in / in the administration of Ultravist ® 300 mg / ml in plasma, 28 ± 6% of the administered amount is detected irrespective of the dose.
After the introduction of cerebral C max iodine in plasma is 4.5% of the administered dose and is observed after 3.8 hours.
Metabolism

Metabolites are not found.

Excretion

T 1/2 in patients with normal renal function is approximately 2 hours irrespective of the dose.
When used in doses recommended for diagnostic purposes, the drug is excreted from the body by glomerular filtration. 30 minutes after the administration of the drug, about 18% of the administered dose is excreted by the kidneys, after 60%, after 3 hours, and 92% after 24 hours. The total clearance with low (150 mg iodine / ml) and high (370 mg iodine / ml) dose is 110 ml / min and 103 ml / min, respectively.
After lumbar myelography, Ultravist® is almost completely excreted by the kidneys in 72 hours.

Pharmacokinetics in special clinical cases

In patients with terminal stage of renal failure, nonionic contrast agents can be eliminated by dialysis.

Violation of the liver function does not affect the removal of the drug Ultravist ® , since for 3 days with feces only 1.5% of the administered dose is released.

INDICATIONS

The drug is intended only for diagnosis.

- enhanced contrast in CT imaging, arteriography and venography (including intravenous / intraarterial digital subtraction angiography / CCA), intravenous urography, endoscopic retrograde cholangiopancreatography (ERCP), arthrography, and other body cavity studies.

Solution for injection 240 mg iodine / ml is also designed to study subarachnoid space.

Solution for injection 370 mg iodine / ml has special advantages for angiocardiography.

Solutions for injection 300 mg iodine / ml and 370 mg iodine / ml are not recommended for studies of subarachnoid space.

DOSING MODE

Before use, the injection solution should be heated to body temperature.

Before administration, you should carefully inspect the bottle.
When the integrity of the bottle is violated, significant color changes, the detection of visible particle particles (including crystals), the drug should not be used. Since Ultravist® is a highly concentrated solution, crystallization (the appearance of milk-like turbidity and / or sediment or crystals in the form of a slurry) can occur extremely rarely.
To inject a contrast agent solution, it is necessary to use an automatic injector or other special instruments with preservation of sterility.
Recruit Ultravist ® in a syringe or infusionum immediately before administration.
Do not make more than one puncture of the rubber stopper in order to prevent a large number of microparticles from entering the prepared solution from the plug.Therefore, to puncture the rubber plug and the set of contrast agent, it is recommended to use cannulae with long tips with a diameter of no more than 18 G (marking cannulae with a side opening such as Nocore-Admix are best suited).

The solution of the drug unused after opening the vial should be destroyed.

Vials containing 200 and 500 ml of the drug should be used only for intravascular injection.
For the introduction it is necessary to use an automatic injector or other equipment that provides sterility of the drug. Follow the instructions for using an automatic injector or other equipment. Unused after opening the bottle the drug can be used within 10 hours after the first opening. Then it should be destroyed.
Cartridges should be used in accordance with the instructions supplied with the equipment for using cartridges.
The solution of the drug unused after use of the cartridge should be destroyed.
Intravascular administration

Intravascular administration of a contrast agent, if possible, is best done when the patient is lying down.

In patients with severe renal and cardiovascular insufficiency, as well as with an overall poor condition, the dose of contrast agent should be as low as possible.
In such patients, it is recommended that kidney function be monitored for at least 3 days after the examination.
The dose of the contrast agent should correspond to the age, body weight, the clinical problem being solved and the research method.

Doses given below should be considered only as recommended;
they are the usual dose for an average adult person with a body weight of 70 kg. The dose is expressed in ml for a single injection or per kg of body weight.
As a rule, doses up to 1.5 g iodine / kg body weight are well tolerated.
Between individual injections, the body should be given sufficient time to leave the fluid from the interstitial space to normalize the increased serum osmolality. If necessary, in some cases, exceed the total dose of 300-350 ml in adults, the introduction of water and, possibly, electrolytes is indicated.
The following doses for single injections are recommended.

Ordinary angiography

Type of study Ultravist ® (concentration of iodine mg / ml) Dose (ml)

Angiography of the arch of the aorta 300 50-80

Selective angiography 300 6-15

Thoracic aortography 300/370 50-80

Abdominal aortography 300 40-60

Arteriography of the upper extremities 300 8-12

Arteriography of the lower extremities 300 20-30

Angiocardiography of the ventricles of the heart 370 40-60

Coronary angiography 370 5-8

Venography of the upper limbs 240 50-60

300 15-30

Lower limb venography 240 50-80

300 30-60

In / in digital subtraction angiography (CSA)

For the administration of large vessels in adults , Ultraavist ® solutions for injection of 300 mg of iodine / ml and 370 mg of iodine / ml in a volume of 30-60 ml are used in adults .
The drug is administered bolus at a rate of 8-12 ml / sec to the ulnar vein or at a rate of 10-20 ml / s through the catheter into the vena cava. The time of contact of the contrast medium with the vein wall can be shortened by the rapid bolus injection of an isotonic sodium chloride solution immediately after the administration of Ultravist.
Intraarterial CSA

When carrying out intra-arterial CSA, in contrast to conventional angiography, smaller amounts of Ultravist® and its lower concentrations can be administered.

Computed Tomography (CT)

If possible, Ultravist® should be injected into the vein bolus using an automatic injector.
Only with slow scanning, about half the dose should be administered bolus, and the rest for 2-6 minutes to ensure a relatively constant concentration of the drug in the blood.
Spiral CT and especially multilayer CT allows a large amount of data to be obtained with one breathing delay.
To get the optimal diagnostic effect from IV bolus injection (80-150 ml of Ultravist ® in the form of 300 mg iodine / ml injection solution) it is recommended to use an automatic injector in the area under investigation (peak, time and duration of contrast) and to control the time interval from the beginning of the introduction of the contrast agent before the start of the scan.
Whole body CT

The necessary doses of the contrast agent and the speed of their administration depend on the organ being examined, the diagnostic problem being solved and, in particular, on the differences in scanning and the duration of image reconstruction.

CT of the skull

Adults are prescribed in the following doses.

Ultravist ® solution for injection 240 mg iodine / ml: 1-2.5 ml / kg body weight.

Ultravist® injection 300 mg iodine / ml: 1-2 ml / kg body weight.

Ultravist® injection for 370 mg iodine / ml: 1-1.5 ml / kg body weight.

In / in urography

In connection with the physiologically weak concentration ability of immature kidney nephrons, children need relatively high doses of contrast agent.

The following doses of Ultravist ® are recommended.

Age Amount of iodine (g / kg body weight) Ultravist® (ml / kg body weight)

240 mg iodine / ml 300 mg iodine / ml 370 mg iodine / ml

Newborns (<1 month) 1.2 5 4 3.2

1 month-2 years 1 4.2 3 2.7

Children (2-11 years old) 0.5 2.1 1.5 1.4

Adolescents and adults 0.3 1.3 1 0.8

If necessary, in some cases, adults may increase these doses.

The timing of the images after the administration of the drug Ultravist® 300 mg iodine / ml and Ultravist® 370 mg iodine / ml with a duration of 1-2 minutes (3-5 min in the case of the administration of the drug Ultravist® 240 mg iodine / ml) is for renal parenchyma 3 -5 minutes (5-10 minutes in the case of the administration of the drug Ultravist® 240 mg iodine / ml), and for visualization of the renal pelvis and ureter system - 8-15 min (12-20 min in the case of the administration of the drug Ultravist® 240 mg iodine / ml ) after the start of the contrast agent.

The younger the patient, the earlier the picture is taken.
Usually, you should take the first shot 2-3 minutes after the injection of the contrast agent. In newborns, infants and patients with impaired renal function, taking pictures at a later date can improve the visualization of the urinary tract.
Introduction to meninges

Doses for adults depend on the clinical problem being solved, the method and the scope of the examination.

If there is equipment that allows recording the image in all projections without changing the position of the patient's body and with the introduction of a contrast agent under fluoroscopic control, smaller volumes of the diagnostic drug may be sufficient.

Myelography

Ultravist® 240 mg iodine / ml is prescribed in a dose of up to 12.5 ml.
The maximum dose of Ultravist® 240 mg iodine / ml (12.5 ml) corresponds to a total dose of iodine of 3 g and it should not be exceeded for one study.
After the examination, the contrast agent should be directed to the lumbar region, which is achieved by giving the patient a straight sitting position or raising the head 15 ° from the bed level for at least 6 hours.

In children, the safety and efficacy of the Ultravist ® preparation in myelography have not been studied.

When injected into the body cavity

In the conduct of arthrography, ERCP and hysterosalpingography, the administration of a contrast agent should be carried out under the control of fluoroscopy.

The dose depends on the age, body weight, general condition of the patient, as well as on the clinical problem being solved, the technical equipment used and the field of examination.
Below are the average doses recommended for adult patients .
For arthrography, prescribe 5-15 ml of Ultravist® 240 mg of iodine / ml, or Ultravist® 300 mg of iodine / ml, or Ultravist® 370 mg of iodine / ml.

In hysterosalpingography, 10-25 ml of Ultravist® 240 mg of iodine / ml is prescribed.

In ERCP and the study of other cavities, the dose depends on the clinical problem being solved and the size of the visualized structure.

SIDE EFFECT

Side effects are usually mild, moderate and transient in nature and when injected non-ionic agents are less common than with the introduction of ionic drugs.However, it is possible to develop severe and life-threatening reactions, up to the development of a lethal outcome.

The frequency of side effects was determined on the following scale: often (? 1/100), infrequently (? 1/1000, but <1/100), rarely (<1/1000).

Most often, with intravascular injection, nausea, vomiting, pain, and a feeling of heat were observed.

For all types of administration

Allergic reactions: infrequently - hypersensitivity reactions, anaphylactoid reactions, urticaria, pruritus, rash, erythema;
rarely anaphylactic shock (including fatal cases), vascular edema, mucocutaneous skin syndrome (for example, Stevens-Johnson syndrome or Lyell's syndrome).
From the endocrine system: rarely - a change in the function of the thyroid gland, thyrotoxic crisis.

From the side of the central nervous system and peripheral nervous system: often - headache;
infrequently - dizziness, restlessness; rarely paresthesia, hypesthesia, confused consciousness, fear, agitation, amnesia, speech impairment, drowsiness, loss of consciousness, coma, tremor, convulsions, paresis, paralysis, cerebral ischemia / infarction, stroke, transient cortical blindness.
From the side of the organ of vision: infrequently - blurred vision, visual impairment;
rarely - conjunctivitis, lacrimation.
From the side of the hearing organ: rarely - hearing impairment.

From the cardiovascular system: infrequently - arrhythmia, vasodilation;
rarely - palpitations, chest pain, a feeling of restraint, aetiology, tachycardia, cardiac arrest, heart failure, myocardial ischemia / myocardial infarction, cyanosis, raising or lowering blood pressure, shock, vasospasm, thromboembolism.
From the respiratory system: infrequently - sneezing, coughing;
rarely - rhinitis, shortness of breath, swelling of the mucous membranes, bronchial asthma, dysphonia, swelling of the larynx, pharynx, tongue, face, bronchospasm, spasm of the larynx / pharynx, pulmonary edema, respiratory failure, respiratory arrest.
From the digestive system: often - nausea;
infrequently - vomiting, taste disorder; rarely - pharyngeal irritation, dysphagia, swelling of the salivary glands, stomach pain, diarrhea.
From the urinary system: infrequently - a violation of kidney function;
rarely acute renal failure.
From the body as a whole: often - a feeling of warmth or pain;
infrequently - malaise, chills, increased sweating, fainting; rarely pallor, changes in body temperature.
Local reactions: rarely - edema, local pain, slight fever and swelling, inflammation and tissue damage in the case of extravasal administration.

When administered under the membranes of the brain

In addition to the side effects listed earlier, when non-ionic contrast media are administered to the brain, the following undesirable effects are possible.

Often: neuralgia, meningism.

Infrequent: difficulty urinating.

Rarely: paraplegia, psychosis, aseptic meningitis, changes on the EEG, back pain, pain in the limbs, pain in the injection site.

Headache, including cases of its severe long form, nausea, vomiting are rare.
Most adverse reactions after myelography or contrasting body cavities occur within a few hours after the administration of contrast medium.
ERCP

In addition to the listed undesirable effects in carrying out ERCP, it is often possible to increase the level of pancreatic enzymes, rarely - the development of pancreatitis.

CONTRAINDICATIONS

There are no absolute contraindications.

With caution

The following warnings and precautions apply to all routes of contrast agent administration, but the noted risk is higher with its intravascular administration:

- Hypersensitivity, especially in the presence of severe cardiovascular diseases;

- Thyroid dysfunction;

- patients of advanced age;

- a serious condition of the patient.

Intravascular administration

Renal damage

Nephrotoxicity caused by contrast agents, which is a transient impairment of renal function, may occur after administration of the drug Ultravist ® . In rare cases, acute renal failure may develop.
Risk Factors:
- precedes kidney failure;
- dehydration;

- diabetes;

- Multiple myeloma / paraproteinemia;
- the introduction of Ultravist in repeated and / or high doses.
Cardiovascular disease
Patients with severe heart disease or severe coronary artery disease are at increased risk of developing clinically significant hemodynamic changes and arrhythmia. In patients with valvular disease and pulmonary hypertension administration of contrast agents may lead to severe hemodynamic compromise. Reactions involving ischemic ECG changes and severe arrhythmias, the most common in elderly patients and in patients with cardiac pathology in history.
Intravascular administration of contrast agents may cause pulmonary edema in patients with heart failure.
CNS disorders
In patients with seizures in history or other CNS disorders may be at increased risk of seizures or neurological complications due to the introduction of the drug Ultravist ® .
Pheochromocytoma
In patients with pheochromocytoma have a risk of hypertensive crisis. It recommended premedication with alpha-blockers.
Patients with autoimmune diseases
Cases of severe vasculitis or syndrome, such Stevens-Johnson syndrome, in patients with a history of autoimmune disease.
Myasthenia gravis

Introduction of iodinated contrast agents can enhance the severity of symptoms of myasthenia gravis.
Alcoholism
Acute or chronic form of alcohol can increase the permeability of the BBB. The facilitated penetration of contrast agent into the brain may lead to reactions with the CNS.
Introduction of a shell brain
Precautions should be used on patients with a history of seizures, as they have increased risk of seizures due to drug administration Ultravist ® under the lining of the brain. You need to have ready for the treatment of seizures.
Introduction into other body cavities
before performing hysterosalpingography pregnancy must be excluded.
Inflammation of the bile duct or fallopian tubes may increase the risk of reactions following ERCP or hysterosalpingography.
PREGNANCY AND LACTATION

Appropriate well-controlled studies in pregnant women have not been conducted. If pregnancy should be avoided whenever possible radiological examinations. The benefits of any X-ray examination, with or without contrast agent should be carefully weighed against the possible risk. At the same time the results of animal studies indicate no danger of Iopromide diagnostic purposes in humans in the course of pregnancy, development of the embryo / fetus, childbirth and postnatal development.
Safety of the drug Ultravist ® in infants who are breast-fed, has not been studied. Ultravist excretion in breast milk is low and unlikely to represent a danger to infants.
APPLICATION FOR FUNCTIONS OF THE LIVER

All patients administered Ultravist ® , should ensure adequate hydration before administration of the contrast agent, preferably by intravascular infusion before and after the procedure, while contrast agent will not be displayed by the kidneys.
Before removing the contrast agent by the kidneys is necessary to eliminate an additional strain on the kidneys in the form of nephrotoxic drugs, oral holetsistograficheskih means of arterial blood flow restriction in the kidney, renal artery angioplasty, major surgery.
It should defer the new study with the introduction of a contrast agent prior to recovery of renal function to the original level.
APPLICATION FOR CHILDREN

In children the safety and efficacy of the drug Ultravist ® have not been studied during myelography.
B / in urography
In connection with physiologically weak concentration ability immature kidney nephrons in children require relatively high doses of contrast agent.
The recommended dose of the drug Ultravist ® .
Age amount of iodine (g / kg body weight) Ultravist ® (ml / kg body weight)
240 mg of iodine / ml to 300 mg iodine / ml, 370 mg iodine / ml
Newborns (<1 month) 1.2 Apr. 5 3.2
1 month 2 years 1 4.2 3 2.7
Children (2-11 years) 0.5 2.1 1.5 1.4
Adolescents and adults 0.3 1.3 0.8 1
The younger the patient, the earlier picture is taken. Typically, the first picture should be made 2-3 minutes after the administration of contrast agent. In newborns, infants and patients with impaired renal function Taking pictures at a later date may improve visualization of the urinary tract.
APPLICATION IN ELDERLY PATIENTS

Carefully.
SPECIAL INSTRUCTIONS

The patient should refrain from taking food for 2 hours before the study.
Before and after intravascular administration of Ultravist or its administration under the lining of the brain should consume adequate amounts of fluid, which is especially important for patients with multiple myeloma, diabetes mellitus, polyuria, hyperuricemia, as well as to infants, small children and elderly patients.
Infants (under one year) and especially newborns are characterized by sensitivity to electrolyte imbalance and haemodynamic disorders. Particular attention should be given a dose of the contrast agent, technical support radiological examination and the patient's condition.
Ultravist ®As a water-soluble low-osmolar contrast agent used older due to the fact that these patients have an increased risk of aspiration, intestinal obstruction and penetration of contrast agent from the intestinal lumen into the abdominal cavity during routine gastrointestinal studies in newborns, infants and children.
In the presence of the state of excitement, fear and pain may increase the risk of side effects or the intensity of the reactions caused by contrast medium. Such patients may have a sedative.
The contrast medium which has been warmed to body temperature before administration, it is better tolerated and easily administered due to decreased viscosity of the solution. Heated in an oven to 37 ° C is only that amount of drug that is expected to be used. When protection from daylight heat for a longer period does not alter the purity of the drug, but it should not exceed more than 3 months.
Using a small amount of contrast agent for sensitivity testing is not recommended as he has no predictive value. Moreover, such testing in itself may lead to serious adverse reactions.
Sometimes, after the application of non-ionic contrast media are observed allergic like hypersensitivity reactions or other manifestations of idiosyncrasy on the part of the cardiovascular, respiratory system and skin. Usually these reactions, the severity of which may be moderate to severe, including shock, occur within one hour after the administration of contrast agent. However, in rare instances can evolve delayed reactions (hours to days).
Patients with known hypersensitivity to Ultravist or any of its components or to previously took place by reaction of hypersensitivity to any other iodine containing contrast agents, there is an increased risk of developing hypersensitivity reactions (including severe reactions, but these reactions are rare and unpredictable), which requires particularly carefully weigh the benefit / risk ratio.
Patients with hypersensitivity or a previous took place reactions to iodinated contrast media are at increased risk of severe reactions. However, such reactions are rare and unpredictable.
Risk of allergic reactions is also increased with a history of asthma or other allergic diseases, and with a history of reactions to iodinated contrast agents.
In patients with severe cardiovascular disease have an increased risk of severe or even fatal side effects.
Due to the possibility of severe hypersensitivity reactions after administration of contrast agent after the procedure is necessary to monitor the patient's condition.
In all cases, you must be prepared to provide emergency assistance to the patient.
At occurrence of hypersensitivity reactions administering the contrast agent should be discontinued immediately and start appropriate therapy, if necessary, preferably in a w / w. Therefore, for / in the introduction of a contrast agent is advisable to use a flexible catheter. That in urgent cases, be able to take emergency measures, it is necessary to have ready the appropriate drugs, endotracheal tube and ventilator apparatus. It should be noted that patients taking beta-blockers may be resistant to treatment with drugs hypersensitivity reactions, having beta-agonist activity. Care should be taken when using iodine-containing contrast agents in patients receiving beta-blockers.
Premedication is recommended during the use of corticosteroids.
Especially carefully weigh the risk / benefit ratio should be in patients with established or suspected hyperthyroidism or goitre, as iodinated contrast agents can cause them to hyperthyroidism or thyrotoxic crisis. The evaluation function need to be considered thyroid before administration Ultravist ® and / or assign prophylactically tireostaticheskim therapy in patients with established or suspected hyperthyroidism.
Vascular pathology and neurological disorders commonly found in elderly people, increase the risk of adverse reactions to iodinated contrast media.
Nebhodimo study should be carefully evaluated in patients with severe general condition.
All patients administered Ultravist ® , should ensure adequate hydration before administration of the contrast agent, preferably by intravascular infusion before and after the procedure, while contrast agent will not be displayed by the kidneys.
Before removing the contrast agent by the kidneys is necessary to eliminate an additional strain on the kidneys in the form of nephrotoxic drugs, oral holetsistograficheskih means of arterial blood flow restriction in the kidney, renal artery angioplasty, major surgery.
It should defer the new study with the introduction of a contrast agent prior to recovery of renal function to the original level.
In patients undergoing dialysis administered contrast agents are excreted from the body in the process of dialysis.
The presence of intracranial tumors or metastases, as well as epilepsy, may increase the frequency of occurrence of convulsive episodes after administration of contrast agent. Neurological complications occur more frequently during cerebral angiography or similar studies.
Care must be taken during the study in patients with alcoholism and drug abuse in connection with the possibility of lowering the seizure threshold.
One of the properties of non-ionic contrast agents is their extremely low impact on normal physiological functions. That is why non-ionic contrast agents have less anticoagulant activity in vitro, than ionic. A number of factors in addition to the properties of the contrast agent, such as the duration of the study, the number of injections, the properties of the catheter and the syringe, stage of disease and treatment, it may affect the development of thromboembolic complications. Therefore, during the catheterization of the vessel must take into account these factors and to focus on the implementation of angiography equipment, as well as to wash the catheter with saline (if necessary with the addition of heparin) and minimize the timing of the procedure, to minimize the risk of thrombosis and embolism.
The use of plastic syringes in place of glass can reduce, but not eliminate the likelihood of blood coagulation in vitro.
Care should be taken in the study of patients with homocystinuria because of the risk of thrombosis and embolism.
Most adverse reactions after myelography develops within a few hours after administration of a contrast agent. During this period, should monitor the patient's condition. Patients with a history of epilepsy or receiving anticonvulsant therapy should continue treatment with the appropriate drugs during the study with the introduction of contrast medium under the lining of the brain.
Care should be taken in the study of patients with alcoholism and drug abuse due to the possibility of lowering seizure threshold.
After the myelography the more the patient is moving or straining your muscles after injection of a contrast agent, the more likely it is mixed with body fluids other areas not related to the surveyed area. Consequently contrasting density decreases faster than usual.
To eliminate the discomfort caused by the loss of cerebrospinal fluid of the patient need to rest about 18 hours. During this period should ensure the possibility of side reactions. Patients with a reduced threshold for seizure activity must be under the close supervision in particular for a few hours.
OVERDOSE

In the study of acute toxicity in animals revealed no risk of acute toxicity after the application of the drug Ultravist ® .
Intravascular injection
Symptoms: possible violation of the balance of fluids and electrolytes, kidney failure, complications of the cardiovascular system and lungs.
Treatment: The need to control the liquid level, electrolytes, renal function. Treatment of overdose should be directed at maintaining vital functions. Ultravist ®It can be removed from the body by dialysis. In case of erroneous excess intravascular dose as administered drug in the human body, it is necessary to compensate for the loss of water and electrolytes by infusion. It is necessary to carry out monitoring of renal function of at least 3 days.
If necessary, it can be used to derive hemodialysis main part of the contrast agent from the human body.
Injection under the shell of the brain
may develop serious neurological complications. It is recommended to carefully monitor the patient's condition.
To prevent large quantities of the drug Ultravist ®in the ventricles of the brain should be made as far as possible the complete aspiration of contrast medium. In case of erroneous excess dose when administered drug under the lining of the brain, it is necessary to closely monitor the displays pronounced disorders of the CNS at least within the first 12 hours. These features may be
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