Lumber myelography: Amidol 300, 5-10 ml; Amidol 370, 6-13 ml
Thoraco-cervical myelography: Amidol 300, 5-10 ml; Amidol 370, 6-13 ml
Cerebral angiography: Amidol 300, 5-10 ml; Amidol 370, 6-13 ml
Selective coronary arteriography: Amidol 300/370, 4-8 ml/artery
Peripheral arteriography: Amidol 300/370, 20-50 ml
Venography: Amidol 300, 20-50 ml; Amidol 370, 24-60 ml
Angiocardiography: Amidol 300/370, 30-80 ml
Left ventriculography: Amidol 300/370, 30-80 ml
Percutaneous transfemoral / renal arteriography: Amidol 300/370, 30 ml
Selective renal arteriography: Amidol 300/370, 5-10 ml
Selective visceral arteriography: Hepatic angiography: Amidol 300, 30 ml; Amidol 370, 70 ml
Coeliac angiography: Amidol 300/370, 40-70 ml
Superior mesenteric angiography: Amidol 300/370, 25-50 ml
Inferior mesenteric angiography: Amidol 300/370, 5-30 ml
Digital subtraction angiography: 30-50ml (10-20 ml/sec ) of Amidol
300/370,i.v 25 ml (left ventricle), 2-5 ml (coronary arteries) ,15
ml/sec. of Amidol 300/370 i.a for cardiac imaging
Amidol 300/370, 40-80 ml i.v up to 1.5 ml/kg in severe renal disease.
OTHER DIAGNOSTIC PROCEDURES
Contrast enhancement in CT scanning: Amidol 300/370, 0.5-2.0 ml /kg
Arthrography: Amidol 300, 1-10 ml
Children: 1-2.5 ml/kg.
Method of administration
Lumber myelography: A slow sub-arachnoid injection is made through a
fine lumber puncture needle into one of the lower interspinous spaces
(L3-L4 or L4-L5). Optimum contrast appears immediately after injections
and films should be obtained promptly.
Thoraco-cervical myelography: Following a slow sub-arachnoid injection
the patient should be turned on his/her side and tilted 10o-20o head
down under fluoroscopic control. In this manner it is possible to
control movement of the contrast medium column into the dorsal region.
If the cervical region is to be examined, the contrast medium should be
run into the cervical region first, before the examination of the dorsal
areas where it is progressively diluted. Amidol 300/370 may also be
injected sub-occipitally or by lateral puncture technique .Care should
be taken to ensure that the contrast medium does not move
intracranially. It is generally recommended that in intrathecal use the
patient should remain with a raised bed head and be kept well hydrated;
following hydration it is preferable that the patient be allowed to be
Cerebral angiography: Any current technique is suitable for radiological
visualization of the cerebral vasculature with Amidol 370/300
injection. Carotid and vertebral angiography, performed by
catheterization or percutaneous injection techniques, require rapid
injection which, if necessary, may be repeated.
Peripheral arteriography and venography: Percutaneous injection into the
appropriate blood vessel is used for visualization of peripheral
arteries and veins.
Angiocardiography, left ventriculography, selective coronary
arteriography: Amidol 370/300 injection may be administered by rapid
injection through a catheter into a suitable peripheral artery or vein.
It can also be introduced under pressure through a cardiac catheter in
to any of the heart chambers, or injected into large vessel for
immediate visualization. The contrast medium may also be administered
during selective catheterization of the coronary arteries.
Aortography: The contrast medium may be introduced directly or by
intra-arterial injection for visualization of the aorta and its main
Selective visceral angiography: Visualization can be achieved by
selective catheterization and injection into the hepatic, coeliac or
Digital subtraction angiography: For cardiac imaging the contrast medium
may be administered intra-arterially by selective catheterization to
provide substrated images. Amidol 370/300 injected intravenously either
centrally or peripherally is also recommended for use this modality.
The contrast medium injected intravenously and rapidly eliminated
through the kidneys. In patients with severe renal failure, high dose
urography should be used.
OTHER DIAGNOSTIC PROCEDURES
Arthrography: Visualization of joint cavities and articular surfaces can
be achieved either single or double contrast examination.
Contrast enhancement in CT scanning: Contrast enhancement for brain
scans can be achieved between one and three minutes after i.v. injection
Amidol 370/300 are also be used for total body scanning examinations
after i.v.administration as a bolus, as a drip infusion or by
combination of the two methods.
use of organic Iodine compounds may cause untoward side effects and
manifestations of anaphylaxis. The symptoms include nausea, vomiting,
widespread erythema, generalized heat sensation, headache, coryza,
fever, sweating, asthenia, dizziness, pallor, dyspnea, and moderate
hypotension. Skin reactions occur in the form of various types of rash
or diffuse blister formation. More severe reactions involving the
cardiovascular system such as peripheral vasodilation with pronounced
hypotension, tachycardia, dyspnea, agitation, cyanosis and loss of
consciousness, may require emergency treatment. During intracardiac and
/or coronary arteriography, ventricular arrhythmia may infrequently
occur. Hyperthyroidism may recur in patients previously treated for
Amidol 370/300 should not be drawn into the syringe until immediately
before use. The bottle, once opened, must be used immediately. In
consideration of possible serious side effect the use of organoiodinate
contrast media should be limited to cases for which there is a precise
need for radiographic contrast examination. This should be evaluated
according to clinical status of the patient, in particular in relation
to pathologies of the cardiovascular, urinary or hepatobiliary system.
In particular contrast media designed for cardioangiography should be
used in hospitals or clinics equipped and staffed for intensive care in
emergencies. For other diagnostic procedures requiring the use of
iodinised contrast media, in the public or institutions where such
procedures take place, resuscitation equipment and therapeutic measures
should be immediately available .When examining small children or
babies, do not limit fluid intake before administering a hypertonic
contrast solution. Also correct any existing water and electrolyte
imbalance. X-ray examination of woman should also, if possible be
conducted during the pre-ovulation phage of menstrual cycle. In patients
scheduled for thyroid examination with a radioactive Iodine tracer, one
must take into consideration that Iodine uptake in the thyroid gland
will be reduced for several days (up to two weeks) after dosing with an
iodinised contrast medium that is eliminated through kidney. Biguanide
oral anti diabetic agents e.g. Metformin, are excreted unchanged through
the kidneys. They therefore compete for excretion in the kidneys with
contrast media and this could lead to reduction in kidney function.
Patient with NIDDM who are taking Metformin or other biguanides should
therefore be instructed not to take any doses of Metformin for 48 hours
before and 48 hours after the X-ray examination.
In the event of CSF blockade, remove as much of the administrated
contrast solution as possible. The use of organic Iodine contrast media
may be contraindicated for patients with a history of epilepsy. Also the
presence of blood in the CSF contraindicates the use of Amidol: in such
cases, physician should carefully assess the need for the diagnostic
procedure against possible risk to the patient. Patients receiving
treatment with anticonvulsant drugs must continue such treatment before
and after the procedure. Should a convulsive seizure develop during the
examination, administer diazepam or sodium Phenobarbital intravenously.
Neuroleptics must be absolutely avoided because they lower the seizure
threshold .The same applies to analgesics, antiemetics, antihistamines
and sedatives of the phenothiazine group. Whenever possible, treatment
with such drug should be discontinued at least 48 hours before
administration of the contrast medium and not to be resumed less than 12
hours after completion of the procedure.
The use of Amidol as a contrast medium for cerebral angiography, may
cause side effects, which are usually mild and short duration. Many
patient report a sensation of heat in the face and neck; a few complain
of headache. A fairly frequent cardiovascular reaction to dosing with
Amidol is bradycardia associated with systemic hypotension. The reaction
is transient and requires no treatment. Severe neurological sequelae
may arise as direct complications of pre-existing pathology in the
individual patient. Such reactions are diverse and may include
tonic/clonic convulsions, aphasia fainting, hemiparesis and coma. The
risk associated with a particular investigation involved may be
increased by conditions such as advanced arteriosclerosis, hypertension,
heart failure, major systemic disease and recent cerebral embolism or
thrombosis. In patients undergoing angiocardiographic procedures special
attention should be paid to the status of the right and pulmonary
circulation. Right heart insufficiency and pulmonary hypertension may
precipitate bradycardia and systemic hypotension when the organic iodine
solution is injected. In paediatric roentgenology, one should proceed
with great caution when injecting the contrast medium in to the right
heart chambers of cyanotic neonates with pulmonary hypertension and
impaired cardiac function. In examination of aortic arch the tip of the
catheter should be positioned carefully to avoid hypotension,
bradycardia, and CNS injury due to the excess pressure transmitted from
the injector pump to the brachiocephalic branches of the aorta.
Likewise, in abdominal aortography, excess pressure from the pump may
cause renal infarction, spinal cord injury, retroperitoneal bleeding,
intestinal infarction and necrosis.
Care should be exercised in patients with moderate to severe impairment
of renal function. Substantial deterioration in renal function is
minimised if the patient is well hydrated. Renal function parameters,
especially urine out put, should be monitored after the examination in
Use in pregnancy and lactation: In pregnant woman, Iopamidol injection
should be administered only if the procedure is considered essential by
the physician. Fertility and mutagenicity studies have shown that
Iopamidol has no influence on these parameters. Teratogenicity studies
in rats and rabbits have shown no influence of Iopamidol up to 8.2g /kg
(rat) and 4.1 g /kg (rabbit)
are no definite or absolute contraindications to the use of Amidol,
with the possible exception of waldenstrom\'s macroglobulinemia,
multiple myeloma and severe liver and kidney disease.
Use in Pregnancy & Lactation
pregnant woman, Iopamidol injection should be administered only if the
procedure is considered essential by the physician. Fertility and
mutagenicity studies have shown that Iopamidol has no influence on these
parameters. Teratogenicity studies in rats and rabbits have shown no
influence of Iopamidol up to 8.2g /kg (rat) and 4.1 g /kg (rabbit).
function test-use of Amidol 370/300 may interfere with tests or thyroid
function. Biguanide oral anti diabetic agents e.g. Metformin, are
excreted unchanged through the kidneys .They therefore compete for
excretion in the kidneys with contrast media and this could lead to
reduction in kidney function. Patient with NIDDM who are taking
Metformin or other biguanides should therefore be instructed not to take
any doses of Metformin for 48 hours before or 48 hours after the x-ray
Treatments of an overdose is directed toward the support of all vital functions and prompt institution of symptomatic therapy.
Keep Iopamidol away from light. Store below 30o C. Exceptionally
crystallization of Iopamidol injections can occur. It has been shown
that such a phenomenon is caused by a damaged container and therefore
the product should not be used in this case. The bottle once opened,
must be used immediately. Any residue of contrast medium must be
370/300 injection is presented in glass bottle made of type II glass
(Ph, Eur.). Bottles are closed with halobutyl stoppers and aluminium
crimp top seal-polypropylene caps.
Amidol 300: Each bottle (50 ml) contains: 30.62 g of Iopamidol equivalent to 300 mg of Iodine per ml.
Amidol 370: Each bottle (50 ml) contains: 37.76 g of Iopamidol equivalent to 370 mg of Iodine per ml.
Amidol 370: Each bottle (100 ml) contains: 75.53 g of Iopamidol equivalent to 370 mg of Iodine per ml.