Indications & Uses
Visican injection is a radiographic contrast agent used for the following purposes. For intra-arterial procedures, in adults and pediatric patients 12 years of age and over, it is used for intra-arterial digital subtraction angiography (270 and 320 mg Iodine/mL), as well as angiocardiography (left ventriculography and selective coronary arteriography), peripheral arteriography, visceral arteriography, and cerebral arteriography (320 mg Iodine/mL). In pediatric patients less than 12 years of age, it is used for angiocardiography, cerebral arteriography, and visceral arteriography (320 mg Iodine/mL). For intravenous procedures, in adults and pediatric patients 12 years of age and over, it is used for computed tomography (CT) imaging of the head and body and excretory urography (270 and 320 mg Iodine/mL), CT imaging peripheral venography (270 mg Iodine/mL), and coronary computed tomography angiography (CCTA) to assist diagnostic evaluation of patients with suspected coronary artery disease (320 mg Iodine/mL). In pediatric patients less than 12 years of age, it is used for CT imaging of the head and body and excretory urography (270 mg Iodine/mL).
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Adult Dosage: For intra-arterial use, at a concentration of 270/320 mg I/ml, arteriographies are given as 5 to 10 ml per injection, selective cerebral arteriography as 40 to 60 ml per injection, and peripheral aortography as 30 to 60 ml per injection. For angiocardiography, at a concentration of 320 mg I/ml, the left ventricle and aortic root are given 30 to 60 ml per injection, and selective coronary arteriography is given 4 to 8 ml per injection. For intravenous use, at a concentration of 270/320 mg I/ml, urography CT enhancement uses 40 to 80 ml, CT of the body uses 50 to 150 ml, and CT of the head uses 75 to 150 ml. Paediatric Dosage: For intra-arterial use, at a concentration of 320 mg I/ml, cardioangiography is given as 1 to 2 ml/kg, with a maximum recommended dose of 10 ml/kg; all doses depend on age, weight and pathology. For intravenous use, at a concentration of 270/320 mg I/ml, urography in children under 7 kg and in children over 7 kg is given as 2 to 3 ml/kg up to 50 ml, though up to 150 ml may be given in a few cases. CT enhancement, at a concentration of 270/320 mg I/ml, for CT of the body is given as 2 to 3 ml/kg up to 50 ml, though up to 150 ml may be given in a few cases. For upper gastrointestinal studies in children, at a concentration of 320 mg I/ml, the dosage must be adjusted individually to allow optimal visualization, generally around 5 ml/kg body weight, with doses of 10 to 240 ml having been studied.
Side Effects
After Visican injection, adult patients most often reported (in more than 0.5% of cases) discomfort, warmth, and pain. Cardiovascular reactions included angina. Gastrointestinal reactions included diarrhea, nausea, and vomiting. Nervous system reactions included agitation, anxiety, insomnia, nervousness, dizziness, headache, migraine, unusual skin sensations, sensory disturbance, fainting, and a sensation of spinning. Skin reactions included itchy rash, severe itching, and hives. Special senses could be affected through alteration of smell, taste, and vision. Pediatric patients experienced similar adverse reactions.
Cautions & Contraindications
Warnings & Precautions
Precautions for use of non-ionic contrast media in general: The risk of serious reactions in connection with use of Visican is regarded as minor. However, iodinated contrast media may provoke anaphylactoid reactions or other manifestations of hypersensitivity. A course of action should therefore be planned in advance, with necessary drugs and equipment available for immediate treatment, should a serious reaction occur. It is advisable always to use an indwelling cannula or catheter for quick intravenous access throughout the entire X-ray procedure. As with other iodinated contrast agents, the use of Visican injection contrast enhancement may obscure some lesions which are seen on previously unenhanced CT scans. In patients with normal blood-brain barriers and renal failure, iodinated contrast agents have been associated with blood-brain barrier disruption and accumulation of contrast in the brain. Enhancement of the inferior vermis following contrast agent administration has resulted in false positive diagnosis. Hydration Patients should be well hydrated prior to, and following, administration of any contrast medium, including Visican, in order to prevent from acute renal failure. This applies especially to patients with multiple myeloma, diabetes mellitus, renal dysfunction and elderly patients. Preparatory dehydration is dangerous and may contribute to acute renal failure in patients with pre-existing renal insufficiency, diabetes or advanced vascular disease. It is believed that overnight fluid restriction prior to excretory urography generally does not provide better visualization in normal patients. To avoid contrast induced nephropathy, the following should be considered: Identification of high risk patients Ensuring adequate hydration. The patient should be hydrated (e.g. at least 100 ml per hour of soft drinks or intravenous saline up to 24 hours after contrast medium administration. In warm areas more fluid should be given). If necessary by maintaining an i.v. infusion from before the procedure until the contrast medium has been cleared by the kidneys. Avoiding additional strain on the kidneys in the form of nephrotoxic drugs, oral cholecystography agents, arterial clamping, renal arterial angioplasty, or major surgery, until the contrast medium has been cleared. Postponing a repeat contrast medium examination until renal function returns to preexamination levels. Monitor renal function (serum creatinine), serum lactic acid and pH of blood. Look for symptoms of lactic acidosis (vomiting, somnolence, nausea, epigastric pain, anorexia, hyperpnea, lethargy, diarrhoea and thirst).
Contraindications
Iodixanol Injection is not indicated for intrathecal use. In the pediatric population prolonged fasting and the administration of a laxative before Visican injection are contraindicated.