Version May 2024
Note: A low residue diet the day prior to procedure and a laxative the night before are recommended. A scout film is recommended prior to contrast administration.
Retrograde cystourethrography: Bladder instillation: 25 to 300 mL; dose depends on the patient’s age and the degree of bladder irritability; may use >300 mL if bladder capacity allows. Results are best when bladder is filled with contrast agent.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing:
Dermatologic: Contact hypersensitivity (after voiding contrast material; resembling a superficial burn) (Wood 1988)
Endocrine & metabolic: Hypothyroidism, thyroid dysfunction (underactive; premature infants and infants with underlying medical conditions are more vulnerable; FDA Safety Alert 2015)
Hypersensitivity to diatrizoate meglumine, salts of diatrizoic acid, or any component of the formulation
Concerns related to adverse effects:
• Allergic reactions: Severe sensitivity reactions may occur; reactions are more likely to occur in patients with a history (personal or family) of bronchial asthma, significant allergies, or prior reaction to contrast agents. A history of sensitivity to iodine or to other contrast agents is not an absolute contraindication, although extreme caution should be exercised.
• Hypothyroidism: Thyroid function tests indicative of hypothyroidism or transient thyroid suppression have been reported (uncommon) in adult and pediatric patients (including infants); some patients were treated for hypothyroidism.
Disease-related concerns:
• Myasthenia gravis: Use may worsen myasthenia gravis (MG); use with caution and monitor for worsening MG (AAN [Narayanaswami 2021]).
• Urinary infection: Use with caution in patients with known active urinary tract infection.
Other warnings/precautions:
• Appropriate use: Intended for bladder instillation only; not for intravascular or IV administration. Safe and effective use depends on proper dosage, correct technique, adequate precautions, and preparation for potential emergencies. Use sterile technique for administration. Avoid excessive pressure, rapid or acute bladder distention, and trauma.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Urethral:
Cystografin: 30% (100 mL, 300 mL)
Cystografin-Dilute: 18% (300 mL)
No
Solution (Cystografin Urethral)
30% (per mL): $0.37
Solution (Cystografin-Dilute Urethral)
18% (per mL): $0.13
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
For bladder instillation only. Not for intravascular or IV use. After sterile catheterization, fill bladder to capacity using a sterile bladder administration set. Avoid using excessive pressure, rapid or acute bladder distention, and trauma. Bladder discomfort or reflux/spontaneous voiding generally indicate a full bladder.
Bladder instillation: For bladder instillation only. Not for intravascular or IV use. After sterile catheterization, fill bladder to capacity using a sterile bladder administration set. Avoid using excessive pressure, rapid or acute bladder distention, and trauma. Bladder discomfort or reflux/spontaneous voiding generally indicate a full bladder.
Retrograde cystourethrography: Diagnostic agent for retrograde cystourethrography
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aldesleukin: May enhance the potential for allergic or hypersensitivity reactions to Iodinated Contrast Agents. Risk C: Monitor therapy
Loop Diuretics: May enhance the nephrotoxic effect of Iodinated Contrast Agents. Risk C: Monitor therapy
Sodium Iodide I131: Iodinated Contrast Agents may diminish the therapeutic effect of Sodium Iodide I131. Management: Discontinue iodinated contrast agents before sodium iodide I-131 administration, and avoid concurrent use. Stop water soluble agents 2 months before, and stop lipophilic agents 6 months before, sodium iodide I-131 administration. Risk X: Avoid combination
Diatrizoate crosses the placenta (Dean 1977).
Iodinated contrast media agents may cross the placenta. Due to theoretical concerns that exposure to free iodide may adversely affect the fetus, use should be avoided unless absolutely required to obtain diagnostic information that will influence the care of the mother or fetus during pregnancy (ACOG 723 2017; ACR 2018).
Iodine can be detected in breast milk following diatrizoate meglumine injection (Weyrauch 1977).
Because of the low expected excretion of iodinated contrast agents into breast milk and the low absorption from an infant’s GI tract, breastfeeding may be continued without interruption after instillation of agent (ACOG 723 2017; ACR 2018). Theoretically, the taste of milk could be altered if it contains contrast media. Women who prefer to temporarily withhold breastfeeding may express and discard milk from both breasts during a period of 12 to 24 hours after the administration of contrast media. They can pump and store milk prior to the procedure then bottle feed using the stored milk during this time (ACR 2018).
Some products contain sodium.
Monitor for signs/symptoms of hypersensitivity.
Radiopaque contrast agent.
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