Iohexol

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Medically reviewed

Laura Arias

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Iohexol

Quick Facts

Feature Detail
Classification Non-ionic, water-soluble, iodinated contrast agent
Administration Intravascular (IV), intrathecal, or into body cavities
Primary Use Enhancing visibility of blood vessels and soft tissues on X-ray and CT scans
Commercial Brand Omnipaque

What is Iohexol?

Iohexol is a pharmaceutical agent belonging to the class of non-ionic, low-osmolality contrast media. It is a substance containing iodine that is specifically designed to be highly visible on X-ray and Computed Tomography (CT) scans. The term “non-ionic” means that the molecule does not dissociate into charged particles when dissolved in water. This is a key feature that makes Iohexol generally associated with a lower risk of adverse reactions compared to older, high-osmolality ionic contrast agents. The low osmolality—meaning a concentration similar to that of human blood—helps the body tolerate the injection better.

Iohexol's primary and most common use is as a radiocontrast agent. When injected into the body, typically intravenously, it travels through the bloodstream, temporarily filling blood vessels and tissues. Since iodine strongly absorbs X-rays, this enhances the contrast between soft tissues and vascular structures, allowing clearer diagnostic images of organs, arteries, veins, and the urinary tract.

It is also one of the few contrast agents specifically approved for intrathecal administration (injection into the space surrounding the spinal cord) for procedures like myelography or cisternography. Manufactured and sold under the common brand name Omnipaque, Iohexol is globally recognized and utilized for a wide range of diagnostic imaging procedures, solidifying its role as a standard tool in modern medical diagnostics.

Regulatory References

  1. iohexol injection, solution OMNIPAQUE - DailyMed - NIH

What side effects are possible with Iohexol?

Possible Side Effects and Safety Information

The official safety profile of Iohexol is structured around the categories of adverse reactions documented in clinical use and is defined by the medicine's various routes of administration. This regulatory framework allows for a clear understanding of the officially known risks associated with the diagnostic agent.


Frequency-Classified Adverse Reactions

Adverse reactions classified as most common (Incidence ge 1.0%) in adult clinical trials vary based on the administration route:

  • Intravascular: Pain, vision abnormalities, headache, taste perversion, and nausea.
  • Intrathecal: Headaches, pain (e.g., backache), nausea, vomiting, and dizziness.

Reactions are grouped by official labeling into System-Organ Classes including Nervous System Disorders, Cardiovascular System, Gastrointestinal Disorders, and Immune System Disorders.


Serious Adverse Reactions and Safety Constraints

The regulatory documentation highlights specific, clinically significant safety constraints and serious adverse reactions:

  • Hypersensitivity: The risk of serious, life-threatening, or fatal Anaphylactic/Anaphylactoid Reactions is documented, which can occur regardless of the amount or route of administration. These events usually manifest within one hour following application, though delayed reactions are also reported.
  • Renal Risk: Contrast-Induced Acute Kidney Injury (AKI), including renal failure, is a documented concern, especially in patients with pre-existing renal impairment.
  • Administration Error: The severe, life-threatening risk of death, seizures, and paralysis is documented specifically for the inadvertent intrathecal administration of the non-intrathecal preparations.

Population-Specific Notes: Safety considerations are specifically noted in the official labeling for certain groups, including elderly patients (increased cardiac reactions) and pediatric patients (0-3 years) (risk of thyroid dysfunction).

Overdose and Emergency Response

Overdose and when to seek help

Regulatory documentation on Iohexol overdose identifies two critical risks: accidental overexposure and the severe danger of inadvertent intrathecal administration of non-myelographic concentrations. An injection of unapproved concentrations into the spinal fluid is associated with life-threatening Central Nervous System (CNS) effects, including convulsions/seizures, cerebral hemorrhage, paralysis, coma, and death.

An overdose due to an excessive systemic dose may result in severe hemodynamic disturbances or acute renal failure (AKI). Official labeling states that excretion is delayed in patients with severe renal impairment, which can prolong exposure.

Immediate medical attention is required for any severe or life-threatening symptoms. The administration of the contrast medium must be terminated immediately in the event of an imminent state of shock. Overdose management is strictly symptomatic and supportive, and no specific antidote is known. Procedures such as dialysis can be used to remove the agent from the body. Patients should be kept under supervision for at least 30 minutes following administration.

Therapeutic Uses of Iohexol

What Iohexol Treats: Main Uses and Benefits

Iohexol is a diagnostic agent that assists with medical assessment by providing enhanced visualization relevant for diagnosis across various clinical scenarios. Its primary benefit is supporting detailed medical imaging, which can help clinicians address the symptoms patients experience.

The agent is applied across domains where additional symptomatic support is needed for patients presenting with conditions characterized by systemic or localized discomfort. It is commonly used for specialized imaging of the vascular system (angiography), the central nervous system (myelography), the urinary tract (urography), and for functional assessment of the kidneys. The diagnostic clarity it provides helps support general well-being during symptomatic phases by assisting the physician with obtaining the information needed for informed decisions.

“The utilization of this agent supports the identification of structural causes underlying symptoms related to pain, weakness, and organ dysfunction.”

This diagnostic support is relevant in contexts involving heightened systemic burden, such as in patients with diabetes or hypertension, by supporting the monitoring of kidney function.

Quick Fact: Diagnostic Support for Unexplained Symptoms
Primary Benefit Assists with the diagnosis of structural issues like blockages or lesions.
Symptom Relevance Used when chronic pain, weakness, or organ symptoms require visualization.
Context of Use Common in pre-surgical planning and monitoring chronic conditions.

Regulatory References

  1. DailyMed (NIH) drug labeling

Eligibility and Restrictions for Use

Iohexol's eligibility is strictly defined by regulatory bodies based on population, health status, and the specific procedure being performed.

Populations Who Cannot Use Iohexol (Contraindications)

Formal non-eligibility is established for the following groups and conditions:

  • Hypersensitivity: Individuals with a known hypersensitivity to Iohexol or any other iodinated contrast agent must not use the medicine.
  • Manifest Thyrotoxicosis: The agent is contraindicated in patients with this severe form of hyperthyroidism.
  • Procedure-Specific: For Hysterosalpingography (HSG), use is contraindicated in women who are pregnant, suspected of being pregnant, or who have an active infection in the genital tract.
  • Formulation/Route Restriction: High-concentration Iohexol formulations (e.g., 140 mg I/mL and 350 mg I/mL) are formally contraindicated for intrathecal administration (spinal injection).

Age and Condition-Based Eligibility

Eligibility rules vary across age groups and require special caution in the presence of certain comorbidities:

Population Category Eligibility Rule / Restriction
Pediatric Patients Approved for use in various procedures, including intrathecal administration for patients aged 2 weeks and older.
Infants (0 to 3 Years) Requires individualized thyroid function monitoring following administration due to the documented risk of transient hypothyroidism.
Older Adults Dose selection must be cautious, reflecting the greater frequency of decreased cardiac, renal, or hepatic function in this population.
Renal Impairment Patients with pre-existing kidney problems are at increased risk of Acute Kidney Injury (AKI), necessitating adequate hydration and minimized dose.
Homocystinuria Patients with this condition should avoid angiography due to the increased risk of thromboembolic events.

Pregnancy and Lactation

  • Pregnancy (General Use): There are no human data on risks associated with general intravenous use; it is not assigned an FDA pregnancy category.
  • Lactation: Iohexol is excreted into human milk. The manufacturer advises that a woman may pump and discard breast milk for 10 hours after administration to minimize infant exposure.

What should I know about interactions with other medicines?

Interactions with other medicines and products

The official regulatory interaction profile for Iohexol is structured around three primary domains: formal prohibition of specific combinations, timing constraints for agents affecting the central nervous system or renal function, and interference with certain diagnostic tests.

Category Official Regulatory Documentation Statement
Medicinal product categories Drugs that lower the seizure threshold (e.g., phenothiazines, MAO inhibitors, tricyclic antidepressants); agents affecting renal function (Metformin); and radioactive diagnostic agents (e.g., I-131).
Formal Prohibitions Corticosteroids are formally contraindicated for intrathecal co-administration with Iohexol, as documented in FDA labeling.
Timing-based rules Metformin must be withheld for at least 48 hours following the procedure in certain populations, such as those with eGFR 30–60 or hepatic impairment, due to the additive risk of lactic acidosis. Seizure-lowering drugs are noted to be discontinued 48 hours before and 24 hours after intrathecal administration to mitigate the additive pharmacodynamic risk.
Mechanistic Basis Documented effects include additive pharmacodynamic risk (seizure potential) and reduced renal clearance of co-administered agents (e.g., Iobenguane I 123), increasing their systemic exposure.

The administration of Iohexol is officially documented to interfere with the thyroid uptake of Radioactive Iodine, which can reduce the efficacy of subsequent diagnostic or therapeutic procedures utilizing these agents. This interaction profile is heavily constrained by the specific route of administration used (intrathecal versus intravascular) and the presence of pre-existing patient conditions. The official regulatory documents do not specify restrictions concerning interactions with food, alcohol, or herbal products.

Mechanism of Action

X-ray Attenuation via High-Z Iodine

The fundamental action of Iohexol is based on a physicochemical interaction with X-ray photons, not the modulation of biological targets like receptors or enzymes. The core of this mechanism lies with the iodine atoms integrated into the molecule, which possess a high atomic number (Z=53). When an X-ray beam is applied, these atoms efficiently absorb and scatter (attenuate) the photons, instantaneously and transiently increasing the radiodensity of the fluid compartment the agent occupies. This physical cascade results directly in a differential X-ray signal transmission.

Minimizing Osmotic Disruption

Iohexol's non-ionic, low-osmolality molecular structure is critical for minimal physiological disruption. Iohexol creates a minimal osmotic gradient relative to blood plasma, which reduces the osmotic movement of water out of cells and tissues. This mechanism ensures that the injection causes less osmotic stress and vessel irritation, facilitating the physical mechanism by ensuring the agent remains non-pharmacologically active in the systemic circulation.

️ Concentration-Dependent Limits on Action

The effectiveness of Iohexol's contrast mechanism is entirely concentration-dependent: the clarity of the resulting radiodensity is proportional to the density of the iodine atoms present. This mechanism has limitations, as high localized concentrations can trigger non-specific chemotoxic effects on cellular function, which imposes a mechanistic ceiling and restricts the maximum concentration that can be applied without triggering non-specific cellular interference.

Dosage and Administration Information

How to Use Iohexol: Official Administration Guidelines

Iohexol is used as a diagnostic imaging agent under the strict control of a healthcare professional. Its administration follows precise rules, with dosing and delivery methods tailored to the specific diagnostic procedure.


Approved Administration Routes

Iohexol is approved for multiple routes to target different areas of the body for visualization:

  • Intravascular: Injection into veins (intravenous, IV) and arteries (intra-arterial) for studies such as angiography and CT scans.
  • Intrathecal: Injection into the space surrounding the spinal cord for myelography and CT cisternography. Note: Only specific concentrations (e.g., 180 mg I/mL to 300 mg I/mL) are approved for this route.
  • Oral/Rectal: Used to enhance imaging of the gastrointestinal (GI) tract during CT of the abdomen and pelvis.
  • Other: Includes intra-articular (joint) and various body cavity administrations for specialized exams.

Dosing and Procedural Requirements

Iohexol is a single-use agent for a diagnostic examination, not a part of a chronic regimen. Dosing involves administering a specific volume and concentration, which varies significantly. For example, IV doses for a CT scan may range from 50 mL to 200 mL, while the total mass of iodine administered intrathecally must not exceed 3,060 mg in a single adult procedure.

Procedural Requirement Official Instruction Summary
Preparation The solution must be clear and checked for particles; may be warmed to 37°C before use.
Hydration Adequate hydration must be ensured before and after administration, particularly for at-risk groups.
Interval If a repeat intrathecal exam is required, a minimum interval of 48 hours is recommended to allow for clearance.
Special Caution Dose selection for older adults should be cautious, often using the low end of the dosing range.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Iohexol


Evidence for Diagnostic Imaging of the Spinal Cord (Myelography)

Research examined Iohexol's role in radiographic visualization of the fluid-filled space surrounding the spinal cord. Studies in this area include comparative short-term clinical trials that examined the agent's performance. These studies monitored the quality of the resulting image and the occurrence of acute physical discomfort post-procedure. Findings describe patterns observed where Iohexol provided opacification suitable for diagnostic interpretation, and trials reported patterns of differential tolerability compared to older contrast agents. Long-term outcomes related to the procedure are not typically characterized in this specific body of research.


Evidence for Diagnostic Imaging of Blood Vessels (Angiography)

Iohexol's role in imaging blood vessels (angiography) was evaluated in Randomized Controlled Trials (RCTs) and prospective observational studies. These studies explored the agent’s use for contrast enhancement in major blood vessels. Researchers tracked physiological measures, such as acute changes in kidney function biomarkers. Data show patterns related to short-term changes in biomarkers, which helped contextualize the agent's tolerability profile. However, comparative findings across studies were mixed when evaluating acute kidney-related biomarkers in narrowly defined, high-risk groups. Evidence is limited for functional outcomes beyond the short, acute period following the diagnostic procedure.


Evidence for Measuring Kidney Function (Glomerular Filtration Rate)

Iohexol was evaluated in methodological validation studies and crossover trials to measure the rate at which the kidneys filter waste (GFR). Study populations included healthy volunteers and patients with Chronic Kidney Disease (CKD). Findings describe patterns related to Iohexol clearance and GFR measurements across a range of kidney functions, as researchers explored short-term changes in this functional measure. Research describes the agent’s movement through the body when evaluated as a filtration marker. Data for certain groups, such as critically ill patients, remain insufficient for optimizing measurement methods.


What Research Gaps and Uncertainties Remain

Research describes the main limitations in the existing evidence landscape. Comparative evidence is lacking in some areas, particularly in head-to-head comparisons with the newest-generation contrast agents for all approved uses. The follow-up durations were limited, meaning that long-term effects are not fully established. Additionally, data remain limited regarding the full range of effects in narrowly defined patient populations.

Frequently Asked Questions (FAQ)

Common questions about Iohexol (FAQ)

Q: How quickly does Iohexol leave the body?

A: Iohexol is primarily eliminated by the kidneys through a filtering process. According to official product information, about 90% or more of the administered dose following an intravenous injection is typically eliminated within the first 24 hours in healthy individuals. The elimination half-life for the main phase is described as being around two hours.


Q: Can people with kidney issues receive Iohexol?

A: Official documents state that Iohexol is not formally contraindicated (prohibited) for use in patients with pre-existing kidney problems. However, this group is noted to be at an increased risk of developing an acute kidney injury (AKI). Official documentation requires special precautions, which often include ensuring adequate hydration and administering a minimal necessary dose.


Q: Can a person develop a delayed reaction to Iohexol hours later?

A: Yes, while severe allergic reactions typically occur within the first hour, medical literature and safety reports confirm that delayed hypersensitivity reactions are also reported. These reactions can potentially occur anywhere from one hour up to one week after the injection. When reported, these delayed responses most often involve skin symptoms such as a rash or itching.


Q: Does drinking extra water help flush Iohexol out of the system?

A: Regulatory guidelines emphasize ensuring adequate hydration, as this precaution is intended to support the kidneys, which are responsible for eliminating the agent, thereby assisting the body's clearance process. This is noted as being particularly important for at-risk groups.


Q: Are there any long-term side effects associated with Iohexol?

A: The existing research and regulatory documents focus primarily on acute and short-term safety outcomes. The follow-up periods in most studies were limited, meaning that potential long-term effects are not fully characterized in the existing clinical literature.


Q: Is there a limit on how often a person can have Iohexol administered?

A: The official documentation addresses the timing for specific procedures. For a repeat intrathecal (spinal) examination, official guidelines recommend a minimum interval of 48 hours between administrations to allow for clearance. The prescribing information does not define a general maximum frequency for all other administration routes.


Q: Why do patients sometimes need to fast before getting Iohexol?

A: Any fasting requirements are typically related to the specific medical imaging procedure being performed, as the contrast agent's label does not mandate fasting. Fasting is generally a standard precaution to reduce the risk of complications, such as aspiration, if a patient experiences nausea or requires sedation.


Q: Why is hydration important when receiving Iohexol?

A: Official product information notes that dehydration is a significant risk factor that may contribute to acute renal failure in susceptible patients. Ensuring adequate hydration is required to support the kidneys in their function of eliminating the Iohexol from the body.


Q: Will Iohexol make me feel warm or flushed?

A: Yes, a feeling of warmth or flushing is documented in regulatory-sourced information as one of the commonly observed physiological reactions following the intravascular injection of Iohexol. This sensation is generally described as temporary.


Q: Is the burning sensation at the injection site a common reaction?

A: Safety reports indicate that local injection site reactions, including pain, swelling, or redness, can occur transiently. Clinical literature further suggests a temporary stinging or burning sensation is often reported as part of this pain. Pain is classified as one of the most common adverse reactions following intravascular administration.


Q: Can Iohexol cause a rash or itching after the procedure?

A: Yes, rash and pruritus (itching) are listed among the documented post-marketing adverse reactions in official safety documentation. These symptoms are recognized as possible signs of a hypersensitivity reaction, which can range in severity.


Q: Why do some people feel nauseous after receiving Iohexol?

A: Official documents classify nausea as a common physiological reaction to the presence of the agent in the system, and it is listed as one of the most common adverse reactions following both intravascular and intrathecal administration, although the precise reason for the reaction may vary by administration route.


Q: What is the chemical structure of Iohexol?

A: Iohexol is described in official documents as a non-ionic, tri-iodinated, water-soluble molecule. Its chemical structure is based on a triiodobenzene ring and the full molecular formula is C19H26I3N3O9.


Q: Why is Iohexol generally considered a low-osmolar contrast agent?

A: The term low-osmolality means the concentration of particles in the Iohexol solution is relatively similar to that of human blood plasma. This non-ionic property is described in official documents as critical because it causes less osmotic stress and vessel irritation compared to older, high-osmolality ionic contrast agents.


Q: Are there special precautions for older adults receiving Iohexol?

A: Official labeling states that dose selection must be cautious for older adults, reflecting the greater frequency of decreased cardiac, renal, or hepatic function commonly seen in this population. Monitoring for increased cardiac reactions is also noted as a necessary safety consideration in this age group.


Q: What happens if a small amount of Iohexol leaks out of the vein?

A: If the agent leaks out of the blood vessel (known as extravasation), local injection site reactions, including pain, swelling, warmth, or redness, are described in regulatory documents as possible symptoms. Safety documents note that serious complications are rare but possible, particularly when larger volumes leak out or in specific anatomical areas.

How should Iohexol be stored and disposed of?

Storage and Disposal of Iohexol

Iohexol injection must be stored at controlled room temperature, specifically between 20 C to 25 C (68 F to 77 F), with excursions permitted up to 30 C. The product is sensitive and must be protected from light and must not be frozen.

For controlled warming, glass containers may be stored at 37 C for up to three months, while polypropylene containers are limited to one month at this temperature. The solution must be visually inspected for particulate matter before use. Due to its sterile, preservative-free nature, aseptic technique is required during handling.

Any unused portion remaining in the container after the diagnostic procedure must be discarded.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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