Lipiodol Ultra-Fluide Special Precautions

LIPIODOL ULTRA FLUIDE must not be administered intravenously, intra-arterially (apart from selective catheterisation), or intrathecally.
There is a risk of hypersensitivity whatever the dose administered.
Hypersensitivity: Before the examination: Identify patients at risk in a detailed interview on their history.
Corticosteroids and H1 antihistamines have been proposed as premedication in patients at greatest risk for hypersensitivity reactions (patients with known hypersensitivity to a contrast agent. However, they do not prevent the occurrence of serious or fatal anaphylactic shock.
Throughout the examination, maintain: medical monitoring, an indwelling intravenous catheter.
After the examination: After contrast agent administration, the patient must be monitored for at least 30 minutes, as most serious adverse reactions occur within this time period. The patient must be warned of the possibility of delayed reactions (for up to seven days) (see Adverse Reactions).
Thyroid: Possible thyroid risk factors must be investigated to prevent metabolic disorders, if iodinated contrast agents are to be administered to patients at risk, thyroid function tests must be carried out before the examination.
Trans-Arterial Chemo-Embolisation: Iodinated contrast agents can induce a transient deterioration of renal function or exacerbate pre-existing renal failure. The preventive measures are as follows: Identify patients at risk, i.e. patients who are dehydarated or who have renal failure, diabetes, severe heart failure, monoclonal gammopathy (multiple myeloma, Waldenstrom's macroglobulinemia), a history of renal failure after administration of iodinated contrast agents, children under one year of age and elderly atheromatous subjects.
Hydrate the patient before and after the examination.
Avoid combinations with nephrotoxic medicines. If such a combination is necessary, laboratory monitoring of renal function must be intensified. The medicines concerned are in particular the aminoglycosides, organoplatinums, high doses of methotrexate, pentamidine, foscarnet and certain antiviral agents (aciclovir, ganciclovir, valaciclovir, adefovir, cidofovir, tenofovir), vancomycin, amphotericin B, immunosuppressors such as cyclosporine or tacrolimus, ifosfamide.
Allow at least 48 hours between radiological examinations or interventions with iodinated contrast agent injections, or delay further examinations or interventions until renal function returns to baseline.
Check for lactic acidosis in diabetics treated with metformin, by monitoring serum creatinine. Normal renal function: Discontinue metformin before and for at least 48 hours after contrast agent administration or until renal function returns to baseline. Abnormal renal function: Metformin is contraindicated. In emergencies, if the examination is required, precautions must be taken, i.e. discontinue metformin, hydrate the patient, monitor renal function and test for signs of lactic acidosis.
Cardiovascular and/or pulmonary co-morbidities should be assessed before initiation of a Trans-Arterial Chemo-Embolisation procedure.
Other: Injection into certain fistulas requires the utmost caution to avoid any vascular penetration, taking into account the risk of fat embolisms.
Care should be taken not to inject the product into areas of bleeding or trauma.
Effects on Ability to Drive and Use Machines: No studies on the effects of LIPIODOL ULTRA-FLUIDE on the ability to drive and use machines have been performed.