Iodixanol

Toxicity

Non-ionic radiocontrast agents like iodixanol are cytotoxic to renal cells. The toxic effects include apoptosis, cellular energy failure, disruption of calcium homeostasis, and disturbance of tubular cell polarity, and are thought to be linked to oxidative stress.

Chemical properties

White Solid

Originator

OptiPrep,Nycomed Pharma,Norway

The Uses of Iodixanol

Nonionic, dimeric x-ray contrast medium. Diagnostic aid (radiopaque medium).

Background

Iodixanol is a nonionic hydrophilic compound commonly used as a contrast agent during coronary angiography, particularly in individuals with renal dysfunction, as it is believed to be less toxic to the kidneys than most other intravascular contrast agents.

Indications

Iodixanol is a contrast agent during coronary angiography.

What are the applications of Application

Iodixanol is a radiopaque medium

Definition

ChEBI: A dimeric, non-ionic, water-soluble, radiographic contrast agent, used particularly in coronary angiography.

Manufacturing Process

Dimethyl 5-nitroisophthalate (215 g) and 1-amino-2,3-propandiol (196 g)were refluxed in methanol (500 ml). After twenty hours the solution was cooled and stored in a refrigerator overnight. The product 5-nitro-N,N'- bis(2,3-dihydroxypropyl)-isophthalamide was filtered and washed with methanol. Yield: 270 g (84%). M.p. 128-132°C.
5-Nitro-N,N'-bis(2,3-dihydroxypropyl)-isophthalamide (18.1 g) was suspended in water (250 ml), conc. hydrochloric acid (4.2 ml) and 10% PdO/charcoal (0.5 g) were added, and the mixture hydrogenated in a Parr apparatus for one day. After filtration the filtrate was heated at 80-90°C and 3.88 M NaICl2 (42.5 ml) was added through a dropping funnel over 1 hour. The solution was heated for 2.5 hours. After cooling to 20°C 5-amino-2,4,6-triiodo-N,N'- bis(2,3-dihydroxypropyl)-isophthalamide crystallized out.
5-Amino-2,4,6-triiodo-N,N'-bis(2,3-dihydroxypropyl)-isophthalamide (110 g) was suspended in acetic anhydride (480 ml) and heated to 50°C. Concentrated sulfuric acid (3 ml) was then added. The starting material was dissolved after a few minutes, and the reaction mixture was heated at 60°C for 75 min. After cooling the residue dissolved in methanol (300 ml) with water (150 ml) the solution was heated to 50°C and the pH adjusted to about 10.5 by 10 N sodium hydroxide. After 4-5 hours the pH didn't decrease, and the hydrolysis was complete. The reaction mixture was cooled to 20°C and neutralized by adding hydrochloric acid. After stirring overnight 5-Acetamido- 2,4,6-triiodo-N,N'-bis(2,3-dihydroxypropyl)-isophthalamide was filtered and washed with water. Yield: 94 g (80%). Melting point 275°C, dec.
2-Methoxyethanol (300 ml) and sodium hydroxide (20 g) was added to the reactor at 50°C, and 5-acetamido-N,N'-bis(2,3-dihydroxypropyl)-2,4,6- triiodoisophtalamide (304 g) was added after two hours of stirring. All solids were allowed to dissolve overnight before cooling to 30°C and adjustment to pH 12 with diluted hydrochloric acid. Epichlorohydrin (11 g) was added to the solution after further cooling to 15°C, and the reaction was allowed to proceed for 51 hours. As a result 1,3-bis(acetamido)-N,N'-bis[3,5-bis(2,3- dihydroxypropylaminocarbonyl)-2,4,6-triiodophenyl]-2-hydroxypropane was obtained.

brand name

Visipaque (GE Healthcare).

Therapeutic Function

Diagnostic aid

General Description

Iodixanol is a viscous, isosmolar,nonionic, water-soluble dimer with 49% iodine content.It is formulated as an isotonic solution for intravascular injectionand indicated for excretory urography, angiography,and CT procedures.

Pharmacokinetics

Iodixanol is a contrast agent commonly used during coronary angiography, particularly in individuals with renal dysfunction, as it is believed to be less toxic to the kidneys than most other intravascular contrast agents. It is an imaging contrast agent with the same osmolality as blood (290mOsm/kg H20).

Metabolism

Excreted unchanged