Anaphylactoid reactions from Iopromide in patient with angina undergoing angiography - Pharmacovigilance Brief Report Essay

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Article Title:        Anaphylactoid Reactions From Iopromide In Patient With Angina Undergoing Angiography

Article Keywords:        Iopromide, Contrast Media, Anaphylactic, Anaphylactoid Reactions, Adverse Reactions

Key Points:

  • Iopromide, a non-ionic iodinated contrast media, is known to have the highest occurrence in causing anaphylactoid reactions.
  • The use of Iopromide in patient with history of angina undergoing angiography need to be monitored intensively as the adverse reactions are likely to occur.
  • Healthcare professionals who are using iodinated contrast media need to recognise and treat anaphylactic reactions immediately and appropriately.
  • In patients with previous hypersensitivity to contrast media, premedication with antihistamines and/or corticosteroids is recommended.

Word Counts:                        1379 (exclude page 1 and references)        

Anaphylactoid Reactions From Iopromide In Patient With Angina Undergoing Angiography

SUMMARY/ABSTRACT

A 55yr old patient with a history of angina is being assessed for a coronary bypass. Undergoing an angiography, on infusion of non-ionic iodinated radio contrast media (Iopromide), incidence is occurred. Clinical manifestations are consistent with anaphylactoid reactions. The patient becomes confused, appears flushed and also develops palpitations, angioedema, hypotension and bronchoconstriction. Following treatment with sympathomimetics and anti-histamines, the patient recovers and is returned to the ward.  Non-ionic iodinated radio contrast media has commonly caused adverse reactions. Iopromide-induced anaphylactoid reactions has the highest occurrence among the same drug class. Cardiologists and Radiologists should be aware in the use of Iopromide in severely ill cardiovascular patients, as the adverse reactions are likely to occur.  It is crucial to recognise and treat anaphylactoid reactions immediately and appropriately.

Key Words - Iopromide, Contrast Media, Anaphylactic, Anaphylactoid Reactions, Adverse Reactions

INTRODUCTION

Iopromide is a non-ionic iodinated contrast media, with osmolality of 0.6-0.7/kg water, considered as low osmolar contrast media. Intravascular iodinated contrast media are commonly used in imaging modalities. Iopromide is indicated mostly for angiography, arteriography, aortography, venography, urography, and tomography. 1

Contrast media is known to commonly cause incidence of anaphylactoid reactions. Based on the adverse reaction frequencies happened during hospitalisation, the risk is categorised as significance, compare to other drug categories. Within low osmolality iodinated contrast media, iopromide shows the highest number of incidence. The aetiology of causality remains unclear. The most affected organs or systems are skin and respiratory, followed by gastrointestinal and cardiovascular.2   The risk probability is higher among elderly and patient with cardiovascular disease and adverse reactions are more likely to happen. A precaution should be taken by cardiologist and radiologist for patients with recent myocardial infarction, severe coronary artery disease, unstable angina or coronary artery bypass graft and in patients with low output left ventricular failure.3

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Many studies has been conducted to observed the adverse reactions of iopromide administration, which is categorised into three classifications: pharmacological toxicity; hypersensitivity divided into two sub classifications: immediate (within one hour) and delayed (more than one hour up to one week); and unrelated event.2  Unrelated event may happen in angiography as contrast media solutions were infused through catheters into the heart chamber. Due to the catheterisation procedure, may also cause serious adverse reactions, such as myocardial infarction and cerebral embolism.

CASE REPORT

A 55yr old patient with a history of angina is being assessed for a coronary ...

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