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Drug-Drug Interactions with Iohexol (Omnipaque®) Interaction Severity Metformin CONTRAINDICATED Summary Amiodarone MAJOR Drugs that Lower the Seizure Threshold: Phenothiazine Derivatives MAOIs Antidepressants CNS stimulants Intrathecal Corticosteroids Aldesleukin (Proleukin) NOT RECOMMENDED CONTRAINDICATED MODERATE Clinical Management Concurrent use of metformin is contraindicated in patients receiving intravascular iodinated contrast media Injection of iodinated contrast materials in metformin-treated patients has been associated with lactic acidosis and can lead to acute renal failure Concurrent administration of amiodarone and iohexol has an additive effect on the prolongation of QT interval. A retrospective screening showed that QT intervals were significantly prolonged after cardiac catheterization with use of iohexol contrast media for coronary angiography in patients taking amiodarone. Seizures have been reported upon administration of iohexol, thus drugs lowering the seizure threshold should not be used. Significant bacterial infections are documented when iohexol is given via intrathecal route concurrently with intrathecal corticosteroids. Contrast Media (Non-ionic) may enhance the potential for allergic or hypersensitivity reactions to Aldesleukin. Do not administer both drugs simultaneously. Monitor for increased risk of delayed hypersensitivity reactions to Aldesleukin if administered after iodinated contrast media. Metformin should be discontinued temporarily in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials Withhold metformin prior to or at the time of the procedure and for 48 hours following the procedure. Restart metformin only after kidney function has been reevaluated and found to be normal. Monitor QT interval for up to 48 hours in patients taking amiodarone and undergoing angiography iohexol contrast media. Discontinue drug that lowers the seizure threshold at least 48 hours prior to intrathecal use and do not resume until 24 hours post procedure Prophylactic anticonvulsant therapy should be considered in patients requiring a larger dose. References: MicroMedex Online 2013; http://www.hsls.pitt.edu UpToDate Online 2013; http://www.hsls.pitt.edu Omnipaque Product Information. GE Healthcare Inc. 2010.