Visipaque™ (Iodixanol)

Visipaque is an isosmolar contrast agent developed to further improve the toxicity profile of contrast agents, suitable for patients considered at high risk for cardiovascular or renal insult.42,43,44
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AT A GLANCE

25+ years of clinical use

May help mitigate risk of MARCE in comorbid patients1

Iso-osmolar and isotonic

Reducing vascular fluid shift and impact of differences in osmotic pressure2,3

May help reduce costs

Lower hospitalization costs due to shortened length of stay4,5

Consider Visipaque for patients at risk for adverse outcomes

More than 1 in 7 adults in the US are estimated to have CKD, and most don't know it.6 34.2 million Americans - just over 1 in 10 - have diabetes.7 By 2060, 1 in 4 people in the US will be aged 65+, with the number over 85 years expected to nearly triple.8

Appropriate selection of contrast media for necessary diagnostic or interventional procedure imaging in at risk patients should be considered to help mitigate the risk of adverse events.9 Visipaque is an iodinated iso-osmolar, isotonic contrast agent indicated for multiple intra-arterial and intravenous procedures in adults and pediatric patients.
FEATURES

Your choice of iodinated contrast media could help mitigate post-procedural adverse events in at risk patients

Interventional, structural, or endovascular procedures (e.g. Transcatheter Aortic Valve Implantation (TAVI), interventions for Chronic Total Occlusion (CTO), Percutaneous Coronary Intervention (PCI)) may need to use higher volumes of iodinated contrast media, potentially leading to greater incidence of acute kidney injury (AKI). Reducing the frequency of adverse reactions such as AKI, major adverse renal cardiovascular event (MARCE), and acute AEs has therefore been a driving force in the development of these diagnostic agents since their initial introduction.9,10
SAFETY

Formulated for at risk patient populations

Visipaque is an isotonic, third-generation agent with a dimeric molecular structure developed to further improve the safety profile of iodinated contrast agents.11,12 It is iso-osmolar to blood with the aim of counteracting major fluid shifts across membranes and limiting discomfort.12-14 It is also formulated with balanced electrolytes to help minimize effects on cardiac contractile force/fibrillatory
propensity.12-14 While 'low' osmolar agents form the mainstay in the general population of patients undergoing endovascular diagnostic or interventional procedures, Visipaque may be selected for more complex procedures in patients considered at risk for cardiovascular or renal adverse outcomes.1,11
PACKAGING

Get your job done easier and faster with improved packaging

Introducing the flip top cap on our +PLUSPAK™ polymer bottles. This packaging facilitates opening the cap and is an improvement on the ring pull design, with a reduced risk of injury15. This new design also helps reduce costs and environmental impact with less storage space needed and lower disposal costs.16-18 It helps to streamline processes and traceability through color coding, triple-tracking stickers, a 2D DataMatrix, and an integrated hanger with a label easy to read even when inverted.
VALUE

Can help reduce cost by reducing adverse events to at risk patients

When compared to total interventional procedure cost, contrast media is inexpensive but contrast-associated acute kidney injury (CA-AKI) and contrast media-related adverse events may increase the use of health care resources and cost of care.19 Given the growth of vulnerable patient populations, it is important to identify clinical practices that reduce the incidence and associated costs of MARCE.5

According to a study conducted to determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the US, moving on to an IOCM-only strategy may yield potential cost savings associated with MARCE to US hospitals where coronary and peripheral procedures are performed.5
REDUCE PATIENT DISCOMFORT

Increased patient comfort can help improve throughput

Enhancing patient comfort during peripheral endovascular procedures is important for both patients and efficiency, as movement during scanning may necessitate studies being repeated or prolonged. 13, 30-31

A benefit of iso-osmolar Visipaque when compared with pooled LOCMs is the reduction in discomfort associated in arteriography.12 According to the ACR, iso-osmolar CM “...are associated with the least amount of vasospasm and the least peripheral discomfort for peripheral angiograms”.32

In the interventional cardiology setting, use of iso-osmolar Visipaque is supported by:
• Robust randomized controlled trials20-23
• Meta-analyses of intra-arterial studies24-26
• Registry and real-world data analysis outcomes1, 27-29
ONCOLOGY

With cancer patients every step of the way

Contrast-enhanced CT is important to every step of a cancer patient’s journey, from diagnosis and staging to monitoring and follow-up.33 Cancer patients may be susceptible to the adverse renal effects of iodinated CM as they are exposed to multiple nephrotoxic insults, predisposed to dehydration and require many CT scans.33-35 CI-AKI and CKD are highly prevalent.36

Visipaque can help cancer patients by:
• delivering diagnostic accuracy through enabling valuable contrast-enhanced CT in patients with renal impairment37
• addressing renal complications considering vulnerable patients with multiple risk factors37-39
• minimising contrast-associated pain protecting patient comfort and care40-41

News and articles

Learn more about supporting resources for contrast media?

Kidneys and contrast media

What makes the kidneys especially prone to injury from iodinated contrast media?

Learn more

REFERENCES
  1. McCullough P et al. Major Adverse Renal and Cardiovascular Events following Intra-Arterial Contrast Media Administration in Hospitalized Patients with Comorbid Conditions. Cardiorenal Med 2021; 11(4): 193–9.
  2. Visipaque Prescribing Information. Marlborough, MA: GE HealthCare; 2023.
  3. Swanson DP, Chilton HM, Thrall JH. In: Pharmaceuticals in Medical Imaging. Collier MacMillan Publishers, London 1990
  4. Aluko P, et al. Value in Health. 25(7): S386-387. July 2022.
  5. Keuffel E et al. J Med Econ. 2018;21:356-364.
  6. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2021.
  7. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.
  8. Vespa, Jonathan, Lauren Medina, and David M. Armstrong, “Demographic Turning Points for the United States: Population Projections for 2020 to 2060,” Current Population Reports, P25-1144, U.S. Census Bureau, Washington, DC, 2020.
  9. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med. 2019;380(22):2146-2155.
  10. Christiansen C. X-ray contrast media-an overview. Toxicology. 2005; 209(2): 185-7.
  11. Widmark JM. Imaging-related medications: a class overview. Proc (Bayl Univ Med Cent). 2007; 20(4): 408-17.
  12. Almén T. Visipaque – a step forward a historical review Acta Radiol. 1995; 36(Suppl.399): 2-18.
  13. Rosenberg C et al. J Invasive Cardiology 2017; 29(1): 9-15.
  14. Fountaine H, Harnish P, Andrew E, Grynne B. Safety, tolerance, and pharmacokinetics of iodixanol injection, a nonionic, isosmolar, hexa-iodinated contrast agent. Acad Radiol. 1996; 3 Suppl 3:S475-84.
  15. Marshall G. Radiography. 2008;14:128-134.
  16. Marshall G. Sharps injuries among radiographers: Dangers associated with opening bottles of contrast agent. Radiography. 2008;14:128-134.
  17. Gricar J, Deutsch S, Blackburn J, Zyczynski T. The economic and safety impact of glass versus polymer containers in a radiology department. Radiol Manage. 2007;Sep/Oct:34-42.
  18. Dhaliwal H, Browne M, Flanagan W, Laurin L, Hamilton M. A life cycle assessment of packaging options for contrast media delivery: comparing polymer bottle vs. glass bottle. Int J Life Cycle Assess. 2014;19:1965-1973.
  19. Amin AP et al. Incremental Cost of Acute Kidney Injury after Percutaneous Coronary Intervention in the United States. Am J Cardiol. 2020 Jan 1;125(1):29-33.
  20. Aspelin P, Aubry P, Fransson S-G, Strasser R, Willenbrock R, Berg KJ. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348(6): 491-9.
  21. Harrison JK, Hermiller JB, et al. A randomized study of 1276 patients undergoing PCI using iodixanol (Visipaque) vs iopamidol (Isovue); comparison of in-hospital and 30 day major adverse cardiac event. The results of the VICC trial. Am Heart J. 2004; 147(4): 612-14.
  22. Davidson CJ, Laskey WK, et al. Randomized trial of contrast media utilization in high-risk PTCA. The COURT trial. Circulation. 2000; 101(18): 2172-7.
  23. Nie B, Cheng W-J, et al. A prospective, double-blind, randomized, controlled trial on the efficacy and cardiorenal safety of iodixanol vs. iopromide in patients with chronic kidney disease undergoing coronary angiography with or without percutaneous coronary intervention. Catheter Cardiovasc Interv. 2008; 72(7):958-65.
  24. McCullough PA, Brown JR. Effects of intra-arterial and intravenous iso-osmolar contrast medium (iodixanol) on the risk of contrast-induced acute kidney injury: a meta-analysis. Cardiorenal Med. 2011; 1(4): 220-24.
  25. Dong M, Jiao Z, Liu T, Guo F, Li G. Effect of administration route on the renal safety of contrast agents: a meta-analysis of randomized controlled trials. J Nephrol. 2012; 25(3): 290-301.
  26. Zhao F, Lei R, et al. Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis. Cancer Imaging. 2019; 19(1): 38.
  27. Iacovelli F et al. Int J Cardiol 2021; 329: 56-62.
  28. Prasad A et al. Use of iso-osmolar contrast media during endovascular revascularization is associated with a lower incidence of major adverse renal, cardiac, or limb events. Catheter Cardiovasc Interv 2021; 2022; 99(4): 1335-42.
  29. Amin AP et al. Association of Iso-Osmolar vs Low-Osmolar Contrast Media With Major Adverse Renal or Cardiovascular Events in Patients at High Risk for Acute Kidney Injury Undergoing Endovascular Abdominal Aortic Aneurysm Repair. J Invasive Cardiol 2021; 33(8): E640-6.
  30. RCR. Clinical radiology. UK workforce census 2018 report. London: RCR, April 2019.
  31. Ortiz-Lopez C, Prasad A. Iso-osmolar contrast (iodixanol) reduces patient and operator pain during peripheral angiography. Catheter Cardiovasc Interv. 2014; 84(6): 1026-7.
  32. ACR Manual on Contrast Media. Version 2024.
  33. Cosmail L et al. J Invasive Cardiol 2017, 29(1);915
  34. Ng SC et al. Cancer imaging 2018, 4559-69
  35. Del Mastro L et al. Blood Purif 2018, 18(1)30
  36. Capasso A et al. Kidney Int. 2019; 96(3)555-67
  37. Salahudeen AL et al. Clin J Am Soc Nephrol 2013; 8 34754
  38. Jackobsen J et al. Eur JRadiolo 2007, 62 (Suppl.)
  39. Davidson C et al. Am JCardiol 2006; 98 (Suppl.)
  40. Haussler MD at al. Acta Radiol 2010; 5192433
  41. Weiland FL et al. Acta Radiol 2014, 56 715, 24
  42. Prasad A et al. Catheter Cardiovasc Interv 2021; doi: 10.1002/ccd.30006
  43. McCullough P et al. Cardiorenal Med 2021; doi:10.1159/000517884.
  44. Almén T. Acta Radiol 1995; 36(Suppl.399): 2-18.

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