Safe and Appropriate Use of lodinated Radiographic Contrast Agents: Is There a Reason to Use High-Osmolality lodinated Contrast Agents?

Abstract

The improved safety profile of low-osmolality compared with high-osmolality iodinated radiographic contrast agents supports the use of low-osmolality iodinated contrast agents in patients with a high risk for adverse reactions to contrast agents. Current pressures in the health care industry to minimize costs may warrant the continued use of high-osmolality agents in patients with relatively low risk for contrast reactions. Health-system management and pharmacists should continue to review the clinical and pharmacoeconomic issues surrounding the use of high-osmolality agents, because market factors have caused the prices of high-osmolality agents and second-generation low-osmolality agents to fluctuate. Moreover, the introduction of new agents will continue to change the risk—benefit–cost relationship. Administration guidelines and appropriate patient monitoring are important, because both low-osmolality and high-osmolality agents carry the risk of adverse reactions. Pharmacologic pretreatment to alleviate adverse reactions to contrast agents when high-osmolality agents are used should be encouraged. Pharmacists—in cooperation with diagnostic imaging departments—should ensure that the use of iodinated radiographic contrast agents conforms to accepted guidelines.