Visipak

Visipak is a radiopaque medicine containing iodine (non-ionic type).

When used intravenously, organically synthesized iodine passes into the vessels and individual tissues (thyroid, kidney, etc.), as well as the cerebrospinal fluid, forming their X-ray contrast. After the procedure, this iodine absorbs radiation. [1]

Testing with volunteers did not show strong deviations in most of the hemodynamic parameters, coagulation values, and clinical and biochemical characteristics after drug administration. [2]

Indications Visipak

It is used for cardioangiography, cerebral angiography , DSA procedure, peripheral arteriography, venography , peritoneal angiography, urography , as well as for contrast potentiation during CT x-rays. [3]

Release form

The release of the medication is realized in the form of a liquid, inside the bottles: iodine 0.27 g / ml - 0.05 or 0.1 l each. There are 10 such bottles in a pack. Iodine 0.32 g / ml - in bottles of 0.02, 0.05, 0.1, 0.2 or 0.5 liters. There are 10 bottles inside the box.

Pharmacokinetics

After the introduction of the drug into the vascular bed, iodixanol is distributed at a high speed in the extracellular fluid area. The average score of the distribution term is approximately 21 minutes.

Protein synthesis - less than 2%. The half-life is approximately 2 hours. No metabolic elements of drugs were found. The excretion of iodixanol is mainly realized through the kidneys by means of CF.

With an intravenous injection in volunteers, about 80% of the portion after 4 hours gets inside the urine, and after 24 hours - 97% of drugs. Only 1.2% of the dosage is excreted in the faeces within 72 hours. The Cmax level inside urine is determined approximately 1 hour after the injection.

Dosing and administration

General information regarding the use of the medication.

The medication is administered intravenously or intravenously. Like other substances intended for parenteral procedures, Visipak must be visually examined before use - in order to identify the possible presence of insoluble elements, violations in the integrity of the bottle and changes in the shade of the medicinal liquid.

The substance is drawn into the syringe just before the research procedure. The vials can only be used once; residues that were not used during the procedure must be disposed of.

It is forbidden to mix the medication with other substances. Separate needles and syringes are used for different products.

The process of preparing a patient for an injection.

Before the introduction of a contrast element, it is required to obtain accurate information about the patient - among these information are laboratory test indications (for example, serum creatinine indicators, a history of allergies, ECG values, and pregnancy).

Before starting the procedure, it is necessary to eliminate the disorders of EBV parameters and provide the patient with the required intake of water-salt elements. This is especially important for people with polyuria, multiple myeloma or gout, but also for diabetics, infants, newborns, infants and the elderly.

The last meal should be done no later than 120 minutes before the injection.

During the procedure, the patient should be in a supine position. For half an hour after the completion of the study, the patient's condition should be monitored by a physician - because most of the negative signs develop precisely during this period. It is forbidden to perform preliminary tests of personal tolerance with the introduction of low doses of the drug, as this can provoke severe symptoms of hypersensitivity.

People who feel fear in anticipation of the procedure are premedicated with the use of sedatives.

The contrast liquid must be warmed up to the body temperature before use.

During angiographic procedures, you must very carefully follow their methodology and regularly flush the used catheters (for example, with heparinized physiological fluid) to reduce the likelihood of embolism and thrombosis.

Dosages may vary depending on the type of procedure being performed, weight, age, hemodynamic parameters, as well as the general condition of the patient and the testing technique used. Often, iodine concentrations and injection volumes are used, which are used with the introduction of other modern radiopaque substances containing iodine.

The following portions can be used (dosages intended for intravenous injections are 1-time, but they can be reused if necessary):

Intra-arterial procedures.

Arteriography:

• selective cerebral: 0.27 / 0.32 g / ml of iodine - injection of 5-10 ml;
• selective cerebral DSA procedure (i / a): 0.15 g / ml of iodine - injection of a portion of 5-10 ml;
• aortography: 0.27 / 0.32 g / ml of iodine - injection of 40-60 ml;
• peripheral: 0.27 / 0.32 g / ml of iodine - injection of 30-60 ml;
• peripheral DSA (i / a): 0.15 g / ml of iodine - injection of 30-60 ml;
• selective visceral DSA (intra-arterial): 0.27 g / ml iodine - 10-40 ml injection.

Cardioangiography for an adult:

• aortic root with left ventricle: 0.32 g / ml of iodine - injection of 30-60 ml;
• selective coronary angiography: 0.27 g / ml of iodine - injection of 4-8 ml.

Intravenous examinations:

• urography: 0.27 / 0.32 g / ml of iodine - injection of 40-80 ml (2);
• venography: 0.27 g / ml of iodine - injection of 50-80 ml into the limb area.

Potentiation during CT:

• CT scan in the brain area: 0.27 / 0.32 g / ml of iodine - 50-150 ml;
• CT scan in the body area: 0.27 / 0.32 g / ml of iodine - 75-150 ml.

Application for children

The medication is used in pediatrics when performing urography, cardioangiography, examinations of the digestive system and for contrast potentiation during the CT scan.

Use Visipak during pregnancy

It is forbidden to use Visipak during pregnancy, except in situations where the likely benefit is more expected than the risks of negative consequences, and there is also a strict need to prescribe such an analysis.

Contrast agents are poorly excreted in breast milk and are poorly absorbed inside the intestine. Because of this, the possibility of negatively affecting the infant is rather low. But it is still recommended to stop breastfeeding for 24 hours if you need to use the medicine.

Contraindications

The main contraindications:

• severe intolerance associated with radiopaque drugs containing iodine;
• a history of information regarding strong side effects associated with the drug;
• HF (stages 2-3), chronic renal failure, liver failure, dehydration, active phases of renal / hepatic dysfunction and hyperthyroidism in a severe stage;
• epilepsy;
• multiple myeloma;
• hysterosalpingography is prohibited in active phases of inflammation affecting the pelvic area;
• the ERCP procedure is not performed in people with an active phase of pancreatitis;
• you can not use the medication intrathecally.

Side effects Visipak

Side signs that appear with intravascular injection:

• lesions of the blood system and lymph: thrombocytopenia may develop;
• immune disorders: sometimes symptoms of intolerance appear. Development of anaphylactoid shock or anaphylactoid manifestations is possible;
• mental disorders: anxiety or agitation occurs singly. Confusion may occur;
• problems with the function of the NA: sometimes headaches appear. Dizziness is occasionally noted. Amnesia, stroke, fainting, paresthesia and sensory disturbances (among them a change in taste) occur singly. Perhaps the development of seizures, tremors, motor dysfunction, coma, disturbances of consciousness or temporary encephalopathy of a contrast-induced nature (this includes hallucinations);
• visual impairment: single visual disturbances or temporary cortical blindness appear;
• disturbances in the work of the CVS: arrhythmia is occasionally noted (this includes tachycardia with bradycardia) or myocardial infarction. Cardiac arrest occurs occasionally. Perhaps the appearance of spasms or thrombosis in the area of coronary arteries, heart failure, angina pectoris, cardiac conduction disorders, ventricular hypokinesia and respiratory arrest with the heart;
• disorders of the vascular system: sometimes hot flashes appear. Occasionally, blood pressure values decrease. Ischemia occurs occasionally or the level of blood pressure increases. Perhaps the development of spasm of the arteries, shock, thrombophlebitis or thrombosis;
• lesions of the mediastinum, sternum and respiratory organs: occasionally there is a cough. Dyspnea occurs singly. It is possible to stop breathing processes, develop respiratory failure or pulmonary edema;
• digestive disorders: sometimes vomiting or nausea appears. Single - discomfort or pain in the abdomen. There may be an active phase of pancreatitis or its exacerbation, as well as an increase in the size of the salivary glands;
• lesions of the subcutaneous layer and epidermis: sometimes hives, rashes and itching occur. Single - erythema or Quincke's edema. TEN, erythema polyform, drug eruptions accompanied by eosinophilia and general manifestations, SS, dermatitis of a bullous or allergic nature, epidermal desquamation, toxidermia or pustulosis of an exanthematous nature (generalized form in the active phase) may develop;
• disorders associated with ODA and connective tissues: spasms of the muscles and pain in the back occur. Arthralgia may develop;
• disturbances in the work of the urethra and kidneys: renal dysfunctions are observed singly, including acute renal failure;
• systemic lesions and changes at the injection site: sometimes there is pain in the sternum area and a feeling of heat. Occasionally - chills, discomfort and pain, hyperthermia and signs in the injection area, including extravasation. Asthenia (severe fatigue and malaise) or a feeling of cold is observed singly;
• intoxication, injury and complications caused by the study: iodism may develop.

Negative symptoms that appear with intrathecal application.

Side effects are delayed and can develop several hours or days after intrathecal injection. The frequency of occurrence is approximately similar to the frequency of development of disorders with lumbar puncture without the use of a contrast agent. The introduction of other non-ionic contrast elements can lead to the appearance of symptoms of irritation of the lining of the brain (meningism, photophobia, or meningitis of a chemical nature). In addition, you need to take into account the risk of developing meningitis of an infectious genesis. Among other violations:

• immune lesions: signs of intolerance may appear, including anaphylactoid / anaphylactic symptoms;
• disorders of the NS function: sometimes headaches occur (can be prolonged and intense). It is also possible to develop temporary encephalopathy of the contrast-induced type (among the manifestations - amnesia, hallucinations, confusion and other neurological signs) or dizziness;
• digestive problems: sometimes vomiting develops. The appearance of nausea is possible;
• disorders associated with the work of connective tissues and ODA: muscle spasms may occur;
• systemic signs and changes in the injection area: tremors or pain may develop in the area of drug administration.

Negative effects caused by performing the HSG procedure (hysterosalpingography):

• immune manifestations: signs of hypersensitivity may develop;
• problems with the activity of the National Assembly: headaches are often observed;
• digestive dysfunctions: mainly pains appear in the abdominal area. Nausea is often noted. Development of vomiting is possible;
• reproductive disorders: bleeding from the vagina is mainly observed;
• systemic manifestations and changes at the injection site: hyperthermia is often noted. Symptoms at the injection site or tremors may occur.

Negative signs provoked by performing arthrography:

• immune disorders: symptoms of intolerance may appear, including anaphylactic or anaphylactoid symptoms;
• systemic disorders, as well as changes in the injection site: pain often develops in the area of the injection. Shivering is possible.

Negative reactions that arise with the intracavitary use of drugs:

• immune disorders: intolerance effects may occur, including anaphylactoid or anaphylactic manifestations;
• problems with digestive function: nausea, diarrhea and pain in the abdomen are often noted. Sometimes vomiting occurs;
• systemic signs and changes at the injection site: tremors may develop.

Overdose

In individuals with healthy renal function, the risk of poisoning with Visipac is very small. With the introduction of large portions of drugs, the duration of the procedure is very important in relation to its effect on the kidneys (the term of the half-life of the drug is approximately equal to 2 hours).

With the development of accidental poisoning, the loss of water-salt indicators is replenished through an infusion.

It is necessary to monitor the work of the kidneys in the patient for a period of at least 3 days after the end of the study. If you need to remove iodixanol from the body, hemodialysis can be performed. The drug has no antidote.

Interactions with other drugs

The use in combination with pain relievers, antipsychotics and antidepressants can lead to a decrease in the seizure threshold, increasing the likelihood of negative signs.

The administration of a medication to people with diabetic nephropathy who use biguanides (for example, metformin) can provoke temporary renal dysfunction and the appearance of lactic acidosis. To prevent such violations, you need to cancel the use of biguanides 2 days before testing, and resume it only after the renal function is completely normalized.

Persons who used IL-2 less than 14 days before the study procedure are prone to an increase in the incidence of negative manifestations (epidermal symptoms or flu-like conditions).

In people who use β-blockers, the signs of anaphylaxis may be atypical and may therefore be mistaken for vagal manifestations.

Storage conditions

Visipak should be kept in a dark place, closed from the access of children. Liquid must not be frozen. Temperature values are within 30 ° C.

Shelf life

Visipack can be used within a maximum of 36 months from the date of manufacture of the pharmaceutical substance.

Analogs

Analogues of drugs are the medicines Tomohexol, Iomeron, Pamir with Omnipak, Unipak and Scanlux with Optirey, as well as Ultravist.