DailyMed Label: Omnipaque

DailyMed Label: OMNIPAQUE

2024

DailyMed Prescription

OMNIPAQUE

Iohexol

GE Healthcare Inc.

NDC: 0407-1412

NDC: 0407-1413

NDC: 0407-1414

NDC: 0407-1412

NDC: 0407-1413

NDC: 0407-1414

NDC: 0407-1412

NDC: 0407-1413

NDC: 0407-1414

NDC: 0407-1412

NDC: 0407-1413

NDC: 0407-1414

NDC: 0407-1412

NDC: 0407-1412

NDC: 0407-1413

NDC: 0407-1413

NDC: 0407-1414

NDC: 0407-1414

OMNIPAQUE (iohexol) injection is a nonionic, x-ray or radiographic contrast medium for intrathecal, intravenous, oral, rectal and body cavity use. OMNIPAQUE oral solution is for oral use only. OMNIPAQUE injection and OMNIPAQUE oral solution are both provided as sterile, pyrogen-free and gluten-free solutions. OMNIPAQUE injection and OMNIPAQUE oral solution are colorless to pale yellow solutions. The chemical name of iohexol is Bis(2,3-dihydroxypropyl)-5-[ N -(2,3-dihydroxypropyl)-acetamido]-2,4,6- triiodoisophthalamide with a molecular weight of 821.14 (iodine content 46.36%). Iohexol has the following structural formula: OMNIPAQUE injection is available in five strengths: OMNIPAQUE 140 mg iodine/mL (302 mg of iohexol/mL): Each mL contains 140 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium OMNIPAQUE 180 mg iodine/mL (388 mg of iohexol/mL): Each mL contains 180 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium OMNIPAQUE 240 mg iodine/mL (518 mg of iohexol/mL): Each mL contains 240 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium OMNIPAQUE 300 mg iodine/mL (647 mg of iohexol/mL): Each mL contains 300 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium OMNIPAQUE 350 mg iodine/mL (755 mg of iohexol/mL): Each mL contains 350 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium OMNIPAQUE oral solution is available in two strengths: OMNIPAQUE oral solution 9 mg iodine/mL (19 mg of iohexol/mL): Each mL contains 9 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium OMNIPAQUE oral solution 12 mg iodine/mL (26 mg of iohexol/mL): Each mL contains 12 mg organically bound iodine, 1.21 mg tromethamine and 0.1 mg edetate calcium disodium The pH is adjusted between 6.8 and 7.7 with hydrochloric acid or sodium hydroxide. OMNIPAQUE injection and OMNIPAQUE oral solution are sterilized by autoclaving and contain no preservatives. Chemical Structure OMNIPAQUE injection and OMNIPAQUE oral solution have the following physical properties: Presentation Concentration (mg iodine/mL) Osmolality By vapor-pressure osmometry. (mOsmol/kg water) Absolute Viscosity (cP) Specific Gravity 20°C 37°C 37°C OMNIPAQUE 140 140 322 2.3 1.5 1.164 OMNIPAQUE 180 180 408 3.1 2.0 1.209 OMNIPAQUE 240 240 520 5.8 3.4 1.280 OMNIPAQUE 300 300 672 11.8 6.3 1.349 OMNIPAQUE 350 350 844 20.4 10.4 1.406 OMNIPAQUE oral solution 9 9 38 1.1 0.8 1.011 OMNIPAQUE oral solution 12 12 45 1.1 0.8 1.014 OMNIPAQUE 140, OMNIPAQUE 180, OMNIPAQUE 240, OMNIPAQUE 300, and OMNIPAQUE 350 have osmolalities from approximately 1.1 to 3.0 times that of plasma (285 mOsmol/kg water) or cerebrospinal fluid (301 mOsmol/kg water) as shown in the above table and are hypertonic under conditions of use. OMNIPAQUE oral solution 9 and OMNIPAQUE oral solution 12 are hypotonic under conditions of use (see table above).

OMNIPAQUE (iohexol) injection is a radiographic contrast agent indicated for intrathecal, intravascular, oral, rectal, intraarticular and body cavity use. OMNIPAQUE oral solution is indicated for oral use only in conjunction with OMNIPAQUE injection administered intravenously for computed tomography (CT) of the abdomen ( 1 ). Adults OMNIPAQUE 180, 240, and 300 Myelography (lumbar, thoracic, cervical, total columnar) Computerized Tomography (CT) (myelography, cisternography, ventriculography) Pediatrics OMNIPAQUE 180 Myelography (lumbar, thoracic, cervical, total columnar) CT (myelography, cisternography) Adults OMNIPAQUE 140 Intra-arterial digital subtraction angiography of the head, neck, abdominal, renal and peripheral vessels OMNIPAQUE 240 CT head imaging Peripheral venography (phlebography) OMNIPAQUE 300 Aortography including studies of the aortic arch, abdominal aorta and its branches CT head and body imaging Cerebral arteriography Peripheral venography (phlebography) Peripheral arteriography Excretory urography OMNIPAQUE 350 Angiocardiography (ventriculography, selective coronary arteriography) Aortography including studies of the aortic root, aortic arch, ascending aorta, abdominal aorta and its branches CT head and body imaging Intravenous digital subtraction angiography of the head, neck, abdominal, renal and peripheral vessels Peripheral arteriography Excretory urography Pediatrics OMNIPAQUE 240 CT head and body imaging OMNIPAQUE 300 Angiocardiography (ventriculography) Excretory urography CT head and body imaging OMNIPAQUE 350 Angiocardiography (ventriculography, pulmonary arteriography, venography, and studies of the collateral arteries) Aortography including the aortic root, aortic arch, ascending and descending aorta Adults OMNIPAQUE 350 Oral radiographic examination of the gastrointestinal tract Pediatrics OMNIPAQUE 180, 240 and 300 Oral and rectal radiographic examination of the gastrointestinal tract Diluted OMNIPAQUE Injection Adults OMNIPAQUE 240, 300 and 350 diluted and administered orally in conjunction with OMNIPAQUE 300 administered intravenously CT of the abdomen Pediatrics OMNIPAQUE 240, 300 and 350 diluted and administered orally in conjunction with OMNIPAQUE 240 or OMNIPAQUE 300 administered intravenously CT of the abdomen OMNIPAQUE Oral Solution Adults OMNIPAQUE oral solution 9 and 12 administered orally in conjunction with OMNIPAQUE 300 administered intravenously CT of the abdomen Pediatrics OMNIPAQUE oral solution 9 and 12 administered orally in conjunction with OMNIPAQUE 240 or OMNIPAQUE 300 administered intravenously CT of the abdomen Adults OMNIPAQUE 240, 300, and 350 Arthrography Adults OMNIPAQUE 240 Endoscopic retrograde pancreatography (ERP) and cholangiopancreatography (ERCP) Herniography Hysterosalpingography OMNIPAQUE 300 Hysterosalpingography Pediatrics OMNIPAQUE 240, 300 and 350 diluted Voiding cystourethrography (VCU)

The concentration and volume required will depend on the indication, size and condition of the patient, and the equipment and imaging technique used. For CT of the head and body, OMNIPAQUE may be used with an automated contrast injection system or contrast media management system cleared for use with OMNIPAQUE. See full prescribing information for complete dosing information ( 2 ). OMNIPAQUE 140, 180, 240, 300 and 350 are indicated for intravascular, oral, rectal, intraarticular, and body cavity administration. OMNIPAQUE 180, 240, and 300 are indicated for intrathecal administration [ see Boxed Warning , Contraindications (4) , and Warnings and Precautions (5.1) ]. Use sterile technique for all handling and administration of OMNIPAQUE for intravascular, intrathecal, intraarticular, and body cavity administration. OMNIPAQUE oral solution 9 and 12 are indicated for oral use only [ see Contraindications (4) and Warnings and Precautions (5.2) ]. Do not use if tamper-evident ring is broken or missing. OMNIPAQUE injection may be administered at either body (37°C, 98.6°F) or room temperature (20° to 25°C, 68° to 77°F). Inspect OMNIPAQUE injection for particulate matter or discoloration before administration, whenever solution and container permit. Do not administer if OMNIPAQUE injection contains particulate matter or is discolored. Do not mix OMNIPAQUE injection with, or inject in intravenous lines containing, other drugs or total nutritional admixtures. Use the lowest dose necessary to obtain adequate visualization. Individualize the volume, strength, and rate of administration of OMNIPAQUE injection. Consider factors such as age, body weight, vessel size, blood flow rate within the vessel, anticipated pathology, degree and extent of opacification required, structures or area to be examined, disease processes affecting the patient, and equipment and technique to be employed. Avoid extravasation when administering OMNIPAQUE injection intravascularly, especially in patients with severe arterial or venous disease [ see Warnings and Precautions (5.6) ] . Hydrate patients before and after intravascular administration of OMNIPAQUE injection [ see Warnings and Precautions (5.4) ] . Each bottle of OMNIPAQUE injection and oral solution is intended for one procedure only. Discard any unused portion. Rate of injection: Injection should be made slowly over 1 to 2 minutes Repeat procedures: If sequential or repeat examinations are required, a suitable interval of time between administrations should be observed to allow for normal clearance of the drug from the body; at least 48 hours should be allowed before repeat examination; however, whenever possible, 5 days to 7 days is recommended. If computerized tomographic (CT) myelography follows myelography, delay imaging several hours to allow the degree of contrast to decrease. TABLE 1 - INTRATHECAL ADULTS The usual recommended total doses for use in lumbar, thoracic, cervical, and total columnar myelography in adults are 1,200 mg iodine to 3,100 mg iodine (see below). STUDY TYPE INJECTION TYPE CONCENTRATION (mg iodine/mL) VOLUME (mL) * A total dose of 3,100 mg iodine or a concentration of 300 mg iodine/mL should not be exceeded in adults. LUMBAR MYELOGRAPHY LUMBAR OMNIPAQUE 180 OMNIPAQUE 240 10 to 17 7 to 12.5 THORACIC MYELOGRAPHY LUMBAR CERVICAL OMNIPAQUE 240 OMNIPAQUE 300 6 to 12.5 6 to 10 CERVICAL MYELOGRAPHY LUMBAR OMNIPAQUE 240 OMNIPAQUE 300 6 to 12.5 6 to 10 CERVICAL MYELOGRAPHY C1-2 OMNIPAQUE 180 OMNIPAQUE 240 OMNIPAQUE 300 7 to 10 6 to 12.5 4 to 10 TOTAL COLUMNAR MYELOGRAPHY LUMBAR OMNIPAQUE 240 OMNIPAQUE 300 6 to 12.5 6 to 10 TABLE 2 – INTRATHECAL PEDIATRICS The usual recommended total doses for lumbar, thoracic, cervical, and/or total columnar myelography by lumbar puncture in children are 360 mg iodine to 2700 mg iodine (see below). Actual volumes administered depend largely on patient age and the following guidelines are recommended. AGE STUDY TYPE INJECTION TYPE CONCENTRATION (mg iodine/mL) VOLUME (mL) *A total dose of 2,700 mg iodine or a concentration of 180 mg iodine/mL should not be exceeded in a single myelographic examination in pediatrics. 0 up to 3 mos. LUMBAR, THORACIC, CERVICAL AND/OR TOTAL COLUMNAR MYELOGRAPHY LUMBAR PUNCTURE OMNIPAQUE 180 2 to 4 3 up to 36 mos. OMNIPAQUE 180 4 to 8 3 up to 7 yrs. OMNIPAQUE 180 5 to 10 7 up to 13 yrs. OMNIPAQUE 180 5 to 12 13 to 18 yrs. OMNIPAQUE 180 6 to 15 Intra-arterial Procedures TABLE 3 ANGIOCARDIOGRAPHIC PROCEDURES PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 350 VENTRICULOGRAPHY The recommended single dose is 40 mL (Range of 30 mL to 60 mL) May be combined with selective coronary arteriography SELECTIVE CORONARY ARTERIOGRAPHY The recommended single dose is 5 mL (Range of 3 mL to 14 mL) Doses may be repeated as necessary. Maximum volume with multiple injections should not exceed 250 mL. Pediatrics OMNIPAQUE 300 VENTRICULOGRAPHY The recommended single dose is 1.75 mL/kg (Range of 1.5 mL/kg to 2 mL/kg) May be repeated as necessary Maximum dose with multiple injections should not exceed 6 mL/kg up to a total volume of 291 mL. OMNIPAQUE 350 VENTRICULOGRAPHY Recommended single dose is 1.25 mL/kg (Range of 1 mL/kg to 1.5 mL/kg). May be repeated as necessary Maximum dose with multiple injections should not exceed 5 mL/kg up to a total volume of 250 mL. PULMONARY ANGIOGRAPHY (PULMONARY ARTERIOGRAPHY AND/OR PULMONARY VENOGRAPHY) The recommended single dose is 1 mL/kg. TABLE 4 AORTOGRAPHY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 300 and 350 AORTOGRAPHY AND SELECTIVE VISCERAL ARTERIOGRAPHY The recommended single dose is: 50 mL to 80 mL for the aorta (aortic arch, ascending aorta) 30 mL to 60 mL for abdominal aorta and its branches (celiac, mesenteric, hepatic and splenic arteries) 5 mL to 15 mL for renal arteries Injections may be repeated if indicated, but the total volume should not exceed: 290 mL of OMNIPAQUE 300 250 mL of OMNIPAQUE 350 OMNIPAQUE 350 AORTIC ROOT AND ARCH STUDY WHEN USED ALONE The recommended single dose is 50 mL (Range of 20 mL to 75 mL) Pediatrics OMNIPAQUE 350 AORTOGRAPHY (AORTIC ROOT, AORTIC ARCH, AND DESCENDING AORTA) The recommended single dose is 1 mL/kg. May be repeated as necessary Maximum dose should not exceed 5 mL/kg up to a total volume of 250 mL. TABLE 5 CEREBRAL ARTERIOGRAPHY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 300 Single dose for cerebral arteriography is as follows: Common carotid artery (6 mL to 12 mL) Internal carotid artery (8 mL to 10 mL) External carotid artery (6 mL to 9 mL) Vertebral artery (6 mL to 10 mL) TABLE 6 INTRA-ARTERIAL DIGITAL SUBTRACTION ANGIOGRAPHY HEAD, NECK, ABDOMINAL, RENAL AND PERIPHERAL VESSELS PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Mechanical or hand injection can be used to administer one or more bolus intra-arterial injections of OMNIPAQUE 140. Adults OMNIPAQUE 140 ARTERIES VOLUME/INJECTION (mL) RATE OF INJECTION (mL/sec) Aorta 20 to 45 8 to 20 Carotid 5 to 10 3 to 6 Femoral 9 to 20 3 to 6 Vertebral 4 to 10 2 to 8 Renal 6 to 12 3 to 6 Other branches of aorta (includes subclavian, axillary, innominate and iliac) 8 to 25 3 to 10 TABLE 7 PERIPHERAL ARTERIOGRAPHY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 300 and 350 The recommended dose for use in peripheral angiography is as follows: Aortofemoral runoffs: 30 mL to 90 mL of OMNIPAQUE 300 20 mL to 70 mL of OMNIPAQUE 350 Selective arteriograms: 10 mL to 60 mL of OMNIPAQUE 300 10 mL to 30 mL of OMNIPAQUE 350 Intravenous Procedures TABLE 8 PERIPHERAL VENOGRAPHY (PHLEBOGRAPHY) PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 240 and 300 The recommended dose (per leg) is: 20 mL to 150 mL of OMNIPAQUE 240 40 mL to 100 mL of OMNIPAQUE 300 TABLE 9 EXCRETORY UROGRAPHY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 300 and 350 The recommended dose is: 0.6 mL/kg to 1.2 mL/kg body weight Pediatrics OMNIPAQUE 300 Dose ranging from 0.5 mL/kg to 3 mL/kg of body weight: The usual dose for children is 1 mL/kg to 1.5 mL/kg. The total administered dose should not exceed 3 mL/kg. TABLE 10 DIGITAL SUBTRACTION ANGIOGRAPHY HEAD, NECK, ABDOMINAL, RENAL AND PERIPHERAL VESSELS PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) RATE OF INJECTION (mL/sec) Adults OMNIPAQUE 350 The usual dose for the intravenous digital technique is 30 mL to 50 mL. Frequently three or more doses may be required, up to a total volume not to exceed 250 mL 7.5 mL/second to 30 mL/second using a pressure injector TABLE 11 CT SCANNING OF THE HEAD AND BODY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME OMNIPAQUE may be used with an automated contrast injection system or contrast management system cleared for use with OMNIPAQUE [see Dosage and Administration (2.8)]. See device labeling for device indications, additional information, and instructions for use. (mL) Adults OMNIPAQUE 240, 300 and 350 Head and body imaging by rapid injection CT Imaging – Head: 70 mL to 150 mL of OMNIPAQUE 300 80 mL of OMNIPAQUE 350 CT Imaging – Body: 50 mL to 200 mL of OMNIPAQUE 300 60 mL to 100 mL of OMNIPAQUE 350 Head imaging by infusion CT Imaging – Head: 120 mL to 250 mL of OMNIPAQUE 240 Pediatrics OMNIPAQUE 240 and 300 CT Imaging – Head and Body: 1 mL/kg to 2 mL/kg (with maximum = 3 mL/kg) Maximum single dose = 116 mL Oral and Rectal Administration – Undiluted OMNIPAQUE Injection for Radiographic Examination of the Gastrointestinal (GI) Tract TABLE 12 DOSING FOR RADIOGRAPHIC EXAMINATION OF THE GI TRACT PATIENT POPULATION CONCENTRATION (mg iodine/mL) ORAL VOLUME (mL) RECTAL VOLUME When given rectally, larger volumes may be used. (mL) Adults OMNIPAQUE 350 The recommended dose is 50 mL to 100 mL - Pediatrics OMNIPAQUE 180, 240 and 300 The recommended dose is 5 mL to 100 mL The recommended dose is 5 mL to 100 mL Less than 3 months old OMNIPAQUE 180 5 mL to 30 mL - Three months to 3 years OMNIPAQUE 180, 240 and 300 Up to 60 mL - Four years to 10 years OMNIPAQUE 180, 240 and 300 Up to 80 mL - Greater than 10 years Up to 100 mL - See Table 16 for concurrent intravenous dosing. Oral Administration of Diluted OMNIPAQUE Injection in Conjunction with Intravenous Administration of OMNIPAQUE Injection for CT of the Abdomen TABLE 13 DOSING OF DILUTED Dilutions of OMNIPAQUE should be prepared just prior to use and any unused portion discarded after the procedure. OMNIPAQUE INJECTION FOR ORAL ADMINISTRATION PATIENT POPULATION ORAL CONCENTRATION (mg iodine/mL) ORAL VOLUME (mL) ADMINISTRATION INSTRUCTIONS Adults OMNIPAQUE 240, 300 and 350 DILUTED to 6 to 12 mg iodine/mL (See Table 14 below) Recommended oral dose is: 500 mL to 1,000 mL Smaller administered volumes can be given if the iodine concentration in final diluted product is increased (See Table 14 below) The oral dosage may be given all at once or over a period of up to 45 minutes if there is difficulty in consuming the required volume. Pediatrics OMNIPAQUE 240, 300 and 350 DILUTED to 9 to 21 mg iodine/mL (See Table 14 below) Recommended oral dose is: 180 mL to 750 mL Do not exceed an oral dose of 5 grams iodine for patients less than 3 years old. Do not exceed an oral dose of 10 grams iodine for patients 3 to 18 years old. Smaller administered volumes can be given if the iodine concentration in final diluted product is increased (See Table 14 below) The oral dosage may be given all at once or over a period of up to 45 minutes if there is difficulty in consuming the required volume. TABLE 14 PROCEDURE FOR PREPARATION OF DILUTED OMNIPAQUE INJECTION FOR ORAL ADMINISTRATION OMNIPAQUE to be mixed with liquid such as water, carbonated beverage, milk, infant formula, or juice to achieve one liter of oral contrast agent. Final Iodine Concentration of Diluted Contrast Agent (mg iodine/mL) OMNIPAQUE 240 OMNIPAQUE 300 OMNIPAQUE 350 Volume of Contrast Agent (mL) Volume of Liquid (mL) Volume of Contrast Agent (mL) Volume of Liquid (mL) Volume of Contrast Agent (mL) Volume of Liquid (mL) 6 25 975 20 980 17 983 9 38 962 30 970 26 974 12 50 950 40 960 35 965 15 63 937 50 950 43 957 18 75 925 60 940 52 948 21 88 912 70 930 60 940 Oral Administration of OMNIPAQUE Oral Solution in Conjunction with Intravenous Administration of OMNIPAQUE Injection for CT of the Abdomen TABLE 15 DOSING AND ADMINISTRATION OF OMNIPAQUE ORAL SOLUTION PATIENT POPULATION ORAL CONCENTRATION (mg iodine/mL) ORAL VOLUME (mL) ADMINISTRATION INSTRUCTIONS Adults OMNIPAQUE oral solution 9 and 12 The recommended oral dose is: 500 mL to 1,000 mL The oral dosage may be given all at once or over a period of up to 45 minutes if there is difficulty in consuming the required volume. Pediatrics OMNIPAQUE oral solution 9 and 12 The recommended oral dose is: 180 mL to 750 mL Do not exceed an oral dose of 5 grams iodine for patients less than 3 years old. Do not exceed an oral dose of 10 grams iodine for patients 3 to 18 years old. The oral dosage may be given all at once or over a period of up to 45 minutes if there is difficulty in consuming the required volume. TABLE 16 INTRAVENOUS ADMINISTRATION OF OMNIPAQUE INJECTION FOR CT OF THE ABDOMEN IN CONJUNCTION WITH ORALLY ADMINISTERED DILUTED OMNIPAQUE INJECTION OR OMNIPAQUE ORAL SOLUTION PATIENT POPULATION INTRAVENOUS CONCENTRATION (mg iodine/mL) INTRAVENOUS VOLUME (mL) ADMINISTRATION INSTRUCTIONS *OMNIPAQUE may be used with an automated contrast injection system or contrast management system cleared for use with OMNIPAQUE [see Dosage and Administration (2.8) ]. See device labeling for device indications, additional information, and instructions for use. Adults OMNIPAQUE 300 The recommended dose is: 100 mL to 150 mL Administer up to 40 minutes AFTER consumption of the oral dose Pediatrics OMNIPAQUE 240 and 300 The recommended dose is: 2 mL/kg with a range of 1 mL/kg to 2 mL/kg (maximum 3 mL/kg) Administer up to 60 minutes AFTER consumption of the oral dose TABLE 17 ARTHROGRAPHY PATIENT POPULATION LOCATION CONCENTRATION (mg iodine/mL) VOLUME (mL) DOUBLE CONTRAST/SINGLE CONTRAST Adults Knee Passive or active manipulation is used to disperse the medium throughout the joint space. OMNIPAQUE 240 5 to 15 Lower volumes recommended for double-contrast examinations; higher volumes recommended for single-contrast examinations. OMNIPAQUE 300 5 to 15 OMNIPAQUE 350 5 to 10 Adults Shoulder OMNIPAQUE 240 3 OMNIPAQUE 300 10 Adults Temporomandibular OMNIPAQUE 300 0.5 to 1 Body Cavity Administration - Undiluted OMNIPAQUE Injection TABLE 18 ENDOSCOPIC RETROGRADE PANCREATOGRAPHY (ERP) ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ECRP) PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 240 10 mL to 50 mL but may vary depending on individual anatomy and/or disease state. TABLE 19 HYSTEROSALPINGOGRAPHY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 240 and 300 15 mL to 20 mL but may vary depending on individual anatomy and/or disease state. TABLE 20 HERNIOGRAPHY PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Adults OMNIPAQUE 240 50 mL but may vary depending on individual anatomy and/or disease state. Body Cavity Administration - Diluted OMNIPAQUE Injection TABLE 21 VOIDING CYSTOURETHROGRAPHY (VCU) (CAN BE PERFORMED IN CONJUNCTION WITH EXCRETORY UROGRAPHY) PATIENT POPULATION CONCENTRATION (mg iodine/mL) VOLUME (mL) Pediatrics The concentration may vary depending upon the patient's size and age and with the technique and equipment used. OMNIPAQUE injection may be diluted with Sterile Water for Injection. (See Table 22 below). OMNIPAQUE injection may be diluted, utilizing aseptic technique, with Sterile Water for Injection to a concentration of 50 mg iodine/mL to 100 mg iodine/mL for voiding cystourethrography. Range: 50 mL to 300 mL of DILUTED OMNIPAQUE at a concentration of 100 mg iodine/mL 50 mL to 600 mL of DILUTED OMNIPAQUE at a concentration of 50 mg iodine/mL. TABLE 22 PROCEDURE FOR PREPARATION OF DILUTED Dilutions of OMNIPAQUE should be prepared just prior to use and any unused portion discarded after the procedure. OMNIPAQUE INJECTION FOR VCU Final Iodine Concentration of Diluted Contrast Agent (mg iodine/mL) Volume of OMNIPAQUE 240 (mL) Volume of Sterile Water for Injection (mL) Volume of OMNIPAQUE 300 (mL) Volume of Sterile Water for Injection (mL) Volume of OMNIPAQUE 350 (mL) Volume of Sterile Water for Injection (mL) 100 100 140 100 200 100 250 90 167 233 289 80 200 275 338 70 243 330 400 60 300 400 483 50 380 500 600 OMNIPAQUE may be used with an automated contrast injection system cleared for use with contrast media. See above Important Dosage and Administration Instructions for OMNIPAQUE (2.1) . See device labeling for information on device indications, instructions for use, and techniques to help assure safe use. OMNIPAQUE 300 mg iodine/mL and 350 mg iodine/mL in 150 mL bottles may be used with a contrast media management system cleared for use with OMNIPAQUE 300 mg iodine/mL and 350 mg iodine/mL in 150 mL bottles. See device labeling for information on device indications, instructions for use, and techniques to help assure safe use. Use sterile technique for penetrating the container closure of OMNIPAQUE 300 and 350 and transferring OMNIPAQUE solution. The container closure may be penetrated only one time with a suitable sterile component of the contrast media management system cleared for use with OMNIPAQUE 300 and 350 in 150 mL bottles. Once the OMNIPAQUE 300 and 350 Injection is punctured, do not remove the bottle from the work area during the entire period of use. Maximum use time is 4 hours after initial puncture. Each bottle is for one procedure only. Discard unused portion.

OMNIPAQUE Injection ( 3 ) 140 mg of iodine per mL (302 mg of iohexol/mL) in +Plus Pak™ polymer bottles 180 mg of iodine per mL (388 mg of iohexol/mL) in glass vials 240 mg of iodine per mL (518 mg of iohexol/mL), 300 mg of iodine per mL (647 mg of iohexol/mL) and 350 mg of iodine per mL (755 mg of iohexol/mL) in glass vials and bottles and +Plus Pak™ polymer bottles OMNIPAQUE Oral Solution ( 3 ) 9 mg of iodine per mL (19 mg of iohexol/mL) and 12 mg of iodine per mL (26 mg of iohexol/mL) in +Plus Pak™ polymer bottles OMNIPAQUE (iohexol) Injection and Oral Solution Sterile, pyrogen-free, gluten-free, colorless to pale yellow solution containing the nonionic, water-soluble x-ray contrast medium iohexol, and available in the following strengths and formats: OMNIPAQUE (iohexol) Injection 140 mg of organically bound iodine per mL (302 mg iohexol/mL) Available in + PLUS PAK™ (polymer bottle) 180 mg of organically bound iodine per mL (388 mg iohexol/mL) Available in glass vials 240 mg of organically bound iodine per mL (518 mg iohexol/mL) 300 mg of organically bound iodine per mL (647 mg iohexol/mL) 350 mg of organically bound iodine per mL (755 mg iohexol/mL) Available in glass vials and bottles and + PLUS PAK™ polymer bottles. OMNIPAQUE Oral Solution 9 mg of organically bound iodine per mL (19 mg iohexol/mL) 12 mg of organically bound iodine per mL (26 mg iohexol/mL) Available in + PLUS PAK™ polymer bottles.

OMNIPAQUE 140 and OMNIPAQUE 350 are contraindicated for intrathecal use [see Warnings and Precautions (5.1) ] : OMNIPAQUE oral solution 9 and 12 are contraindicated for parenteral administration [see Warnings and Precautions (5.2) ] : OMNIPAQUE body cavity 240 and 300 for hysterosalpingography is contraindicated during pregnancy or suspected pregnancy, menstruation or when menstruation is imminent, within 6 months after termination of pregnancy, within 30 days after conization or curettage, when signs of infection are present in any portion of the genital tract including the external genitalia, and when reproductive tract neoplasia is known or suspected because of the risk of peritoneal spread of neoplasm. OMNIPAQUE injection 140 and 350 are contraindicated for intrathecal use ( 4 ) OMNIPAQUE oral solution 9 and 12 are contraindicated for parenteral use ( 4 ) OMNIPAQUE body cavity 240 and 300 for hysterosalpingography is contraindicated during pregnancy (or suspected pregnancy), menstruation (or when menstruation is imminent), within 6 months after termination of pregnancy, within 30 days after conization or curettage, when signs of infection are present in any portion of the genital tract, including the external genitalia, and when reproductive tract neoplasia is known or suspected. ( 4 )

Hypersensitivity Reactions: Life-threatening or fatal reactions can occur. Always have emergency equipment and trained personnel available. ( 5.3 ) Contrast-Induced Acute Kidney Injury: Acute injury including renal failure can occur. Minimize dose and maintain adequate hydration to minimize risk. ( 5.4 ) Cardiovascular Adverse Reactions: Hemodynamic disturbances including shock and cardiac arrest may occur during or after administration. ( 5.5 ) Thyroid Dysfunction in Pediatric Patients 0 to 3 Years of Age: Individualize thyroid function monitoring based on risk factors such as prematurity. ( 5.9 ) OMNIPAQUE injection 140 and 350 are contraindicated for intrathecal use [ see Contraindications (4) and Dosage and Administration (2.1) ] . Inadvertent intrathecal administration can cause death, convulsions/seizures, cerebral hemorrhage, coma, paralysis, arachnoiditis, acute renal failure, cardiac arrest, rhabdomyolysis, hyperthermia, and brain edema. OMNIPAQUE oral solution 9 and 12 are contraindicated for parenteral administration [ see Contraindications (4) and Dosage and Administration (2.1) ]. Adverse reactions such as hemolysis may occur if administered intravascularly. Do not administer OMNIPAQUE oral solution 9 and 12 parenterally. OMNIPAQUE can cause life-threatening or fatal hypersensitivity reactions including anaphylaxis. Manifestations include respiratory arrest, laryngospasm, bronchospasm, angioedema, and shock. Most severe reactions develop shortly after the start of the injection (within 3 minutes), but reactions can occur up to hours later. There is an increased risk in patients with a history of a previous reaction to contrast agent, and known allergies (i.e., bronchial asthma, drug, or food allergies) or other hypersensitivities. Premedication with antihistamines or corticosteroids does not prevent serious life-threatening reactions, but may reduce both their incidence and severity. Obtain a history of allergy, hypersensitivity, or hypersensitivity reactions to iodinated contrast agents and always have emergency resuscitation equipment and trained personnel available prior to OMNIPAQUE administration. Monitor all patients for hypersensitivity reactions. Acute kidney injury, including renal failure, may occur after parenteral administration of OMNIPAQUE. Risk factors include: pre-existing renal impairment, dehydration, diabetes mellitus, congestive heart failure, advanced vascular disease, elderly age, concomitant use of nephrotoxic or diuretic medications, multiple myeloma/paraproteinaceous diseases, repetitive and/or large doses of an iodinated contrast agent. Use the lowest necessary dose of OMNIPAQUE in patients with renal impairment. Adequately hydrate patients prior to and following parenteral administration of OMNIPAQUE. Do not use laxatives, diuretics, or preparatory dehydration prior to OMNIPAQUE administration. Life-threatening or fatal cardiovascular reactions including hypotension, shock, cardiac arrest have occurred with the parenteral administration of OMNIPAQUE. Most deaths occur during injection or five to ten minutes later, with cardiovascular disease as the main aggravating factor. Cardiac decompensation, serious arrhythmias, and myocardial ischemia or infarction can occur during coronary arteriography and ventriculography. Based upon clinical literature reported deaths from the administration of iodinated contrast agents range from 6.6 per million (0.00066%) to 1 in 10,000 (0.01%). Use the lowest necessary dose of OMNIPAQUE in patients with congestive heart failure and always have emergency resuscitation equipment and trained personnel available. Monitor all patients for severe cardiovascular reactions. Angiocardiography Serious, rarely fatal, thromboembolic events causing myocardial infarction and stroke can occur during angiocardiography procedures with both ionic and nonionic contrast media. During these procedures, increased thrombosis and activation of the complement system occurs. Risk factors for thromboembolic events include: length of procedure, catheter and syringe material, underlying disease state, and concomitant medications. To minimize thromboembolic events, use meticulous angiographic techniques, and minimize the length of the procedure. Avoid blood remaining in contact with syringes containing iodinated contrast agents, which increases the risk of clotting. Avoid angiocardiography in patients with homocystinuria because of the risk of inducing thrombosis and embolism. Extravasation of OMNIPAQUE during intravascular injection may cause tissue necrosis and/or compartment syndrome, particularly in patients with severe arterial or venous disease. Ensure intravascular placement of catheters prior to injection. Monitor patients for extravasation and advise patients to seek medical care for progression of symptoms. Thyroid storm has occurred after the intravascular use of iodinated contrast agents in patients with hyperthyroidism, or with an autonomously functioning thyroid nodule. Evaluate the risk in such patients before use of OMNIPAQUE. Thyroid dysfunction characterized by hypothyroidism or transient thyroid suppression has been reported after both single exposure and multiple exposures to iodinated contrast media (ICM) in pediatric patients 0 to 3 years of age. Younger age, very low birth weight, prematurity, underlying medical conditions affecting thyroid function, admission to neonatal or pediatric intensive care units, and congenital cardiac conditions are associated with an increased risk of hypothyroidism after ICM exposure. Pediatric patients with congenital cardiac conditions may be at the greatest risk given that they often require high doses of contrast during invasive cardiac procedures. ​ An underactive thyroid during early life may be harmful for cognitive and neurological development and may require thyroid hormone replacement therapy. After exposure to ICM, individualize thyroid function monitoring based on underlying risk factors, especially in term and preterm neonates. ​​ ​ Hypertensive crisis has occurred after the use of iodinated contrast agents in patient with pheochromocytoma. Monitor patients when administering OMNIPAQUE intravascularly if pheochromocytoma or catecholamine-secreting paragangliomas are suspected. Inject the minimum amount of contrast necessary, assess the blood pressure throughout the procedure, and have measures for treatment of a hypertensive crisis readily available. Iodinated contrast agents when administered intravascularly may promote sickling in individuals who are homozygous for sickle cell disease. Hydrate patients prior to and following OMNIPAQUE administration and use OMNIPAQUE only if the necessary imaging information cannot be obtained with alternative imaging modalities. Severe cutaneous adverse reactions (SCAR) may develop from 1 hour to several weeks after intravascular contrast agent administration. These reactions include Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), acute generalized exanthematous pustulosis (AGEP) and drug reaction with eosinophilia and systemic symptoms (DRESS). Reaction severity may increase and time to onset may decrease with repeat administration of contrast agents; prophylactic medications may not prevent or mitigate severe cutaneous adverse reactions. Avoid administering OMNIPAQUE to patients with a history of a severe cutaneous adverse reaction to OMNIPAQUE.

The following clinically significant adverse reactions are described elsewhere in the labeling:

Metformin In patients with renal impairment, metformin can cause lactic acidosis. Iodinated contrast agents appear to increase the risk of metformin-induced lactic acidosis, possibly as a result of worsening renal function. Stop metformin at the time of, or prior to, OMNIPAQUE administration in patients with an eGFR between 30 and 60 mL/min/1.73 m 2 ; in patients with a history of hepatic impairment, alcoholism or heart failure; or in patients who will be administered intra-arterial iodinated contrast. Re-evaluate eGFR 48 hours after the imaging procedure, and reinstitute metformin only after renal function is stable. Radioactive Iodine Administration of iodinated contrast agents may interfere with thyroid uptake of radioactive iodine (I-131 and I-123) and decrease therapeutic and diagnostic efficacy in patients with carcinoma of the thyroid. The decrease in efficacy lasts for 6 to 8 weeks. Beta-adrenergic Blocking Agents The use of beta-adrenergic blocking agents lowers the threshold for and increases the severity of contrast reactions and reduces the responsiveness of treatment of hypersensitivity reactions with epinephrine. Because of the risk of hypersensitivity reactions, use caution when administering OMNIPAQUE to patients taking beta-blockers. Drugs that Lower Seizure Threshold Drugs that lower seizure threshold, especially phenothiazine derivatives including those used for their antihistaminic or antinauseant properties, are not recommended for use with intrathecal administration of OMNIPAQUE. CNS Active Drugs Drugs such as monoamine oxidase (MAO) inhibitors, tricyclic antidepressants, CNS stimulants, psychoactive drugs described as analeptics, major tranquilizers, or antipsychotic drugs. Such medications should be discontinued at least 48 hours before myelography, should not be used for the control of nausea or vomiting during or after myelography, and should not be resumed for at least 24 hours post procedure. In non-elective procedures in patients on these drugs, consider prophylactic use of anticonvulsants. Effect on Thyroid Tests If iodine-containing isotopes are to be administered for the diagnosis of thyroid disease, the iodine-binding capacity of thyroid tissue may be reduced for up to 2 weeks after contrast medium administration. Thyroid function tests that do not depend on iodine estimation, e.g., T 3 resin uptake or direct thyroxine assays, are not affected.

Lactation: A lactating woman may pump and discard breast milk for 10 hours after OMNIPAQUE administration. ( 8.2 ) Risk Summary Hysterosalpingography is contraindicated in pregnant women due to the potential risk to the fetus from an intrauterine procedure [see Contraindications (4) ]. There are no data with iohexol use in pregnant women to inform any drug-associated risks. Iohexol crosses the placenta and reaches fetal tissues in small amounts (see Data ). In animal reproduction studies, no developmental toxicity occurred with intravenous iohexol administration to rats and rabbits at doses up to 0.4 (rat) and 0.5 (rabbit) times the maximum recommended human intravenous dose ( see Data ). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Data Human Data Literature reports show that intravenously administered iohexol crosses the placenta and is visualized in the digestive tract of exposed infants after birth. Animal Data Iohexol was neither embryotoxic nor teratogenic in either rats or rabbits at the following dose levels tested: 1.0, 2.0, 4.0 g iodine/kg in rats, administered intravenously to 3 groups of 25 dams once daily during days 6 through 15 of pregnancy; 0.3, 1.0, 2.5 g iodine/kg in rabbits, administered intravenously to 3 groups of 18 rabbits dosed once a day during days 6 through 18 of pregnancy. Risk Summary Published literature reports that breast feeding after intravenous iohexol administration to the mother would result in the infant receiving an oral dose of approximately 0.7% of the maternal intravenous dose; however, lactation studies have not been conducted with oral, intrathecal, or intracavity administration of iohexol. There is no information on the effects of the drug on the breastfed infant or on milk production. Iodinated contrast agents are excreted unchanged in human milk in very low amounts with poor absorption from the gastrointestinal tract of a breastfed infant. Exposure to iohexol to a breastfed infant can be minimized by temporary discontinuation of breastfeeding (see Clinical Considerations ). The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for OMNIPAQUE and any potential adverse effects on the breastfed infant from OMNIPAQUE or from the underlying maternal condition. Clinical Considerations Interruption of breastfeeding after exposure to iodinated contrast agents is not necessary because the potential exposure of the breastfed infant to iodine is small. However, a lactating woman may consider interrupting breastfeeding and pumping and discarding breast milk for 10 hours (approximately 5 elimination half-lives) after OMNIPAQUE administration to minimize drug exposure to a breastfed infant. Intrathecal Use The safety and effectiveness of OMNIPAQUE 180 have been established in pediatric patients 2 weeks to 17 years of age for myelography (lumbar, thoracic, cervical, total columnar) and for CT (myelography, cisternography). Use of OMNIPAQUE 180 is supported by controlled clinical studies in adults for myelography, in addition to clinical studies in pediatric patients undergoing myelography. The safety and effectiveness of OMNIPAQUE 180 have not been established for intrathecal use in patient pediatric patients less than 2 weeks of age. The safety and effectiveness of OMNIPAQUE 240 and 300 have not been established in pediatric patients for myelography (lumbar, thoracic, cervical, total columnar) and for CT (myelography, cisternography, or ventriculography). Intravascular Use Angiocardiography ( Ventriculography, Pulmonary Arteriography, Venography, and Studies of the Collateral Arteries) and Aortography The safety and effectiveness of OMNIPAQUE 300 have been established in pediatric patients from birth to 17 years of age for angiocardiography (ventriculography) and of OMNIPAQUE 350 in pediatric patients from birth to 17 years of age for angiocardiography (ventriculography, pulmonary arteriography, venography, and studies of the collateral arteries) and aortography. Use of OMNIPAQUE 300 and 350 is supported by controlled clinical studies in adults for angiocardiography and aortography, in addition to controlled clinical studies in pediatric patients undergoing angiocardiography, including aortography. The safety and effectiveness of OMNIPAQUE 300 have not been established in pediatric patients for aortography. Intra-arterial Digital Subtraction Angiography, Intravenous Digital Subtraction Angiography, Cerebral Arteriography, or Peripheral Arteriography and Venography The safety and effectiveness of OMNIPAQUE have not been established in pediatric patients for intra-arterial digital subtraction angiography, intravenous digital subtraction angiography, cerebral arteriography, or peripheral arteriography and venography. CT of the Head and Body The safety and effectiveness of OMNIPAQUE 240 and 300 have been established in pediatric patients from birth to 17 years of age for CT imaging of the head and body. Use of OMNIPAQUE 240 and 300 is supported by controlled clinical studies in adults for head and body CT, in addition to clinical studies in pediatric patients undergoing head CT and in 69 pediatric patients undergoing CT of the abdomen after oral administration of diluted OMNIPAQUE plus intravenous administration of OMNIPAQUE. The safety and effectiveness of OMNIPAQUE 350 have not been established in pediatric patients for CT imaging of the head and body. Urography The safety and effectiveness of OMNIPQUE 300 have been established in pediatric patients from birth to 17 years of age for urography. Use of OMNIPAQUE 300 is supported by controlled clinical studies in adults for urography, in addition to controlled clinical studies in pediatric patients undergoing urography and clinical safety data in pediatric patients down to birth. Oral or Rectal Use Undiluted OMNIPAQUE Injection The safety and effectiveness of OMNIPAQUE 180, 240, and 300 administered orally and rectally have been established in pediatric patients, from birth to 17 years of age for examination of the GI tract. Use of OMNIPAQUE 180, 240, and 300 administered orally and rectally is supported by controlled studies in adults for examination of the GI tract, in addition to clinical studies in pediatric patients undergoing examination of the GI tract. Oral Use in Conjunction with Intravenous Use Diluted OMNIPAQUE Injection The safety and effectiveness of OMNIPAQUE injection diluted to concentrations from 9 to 21 mg iodine/mL administered orally in conjunction with OMNIPAQUE injection administered intravenously for CT of the abdomen have been established in pediatric patients from birth to 17 years of age. Use is supported by clinical trials in adults, in addition to clinical studies in 69 pediatric patients undergoing CT of the abdomen after oral administration of diluted OMNIPAQUE plus intravenous administration of OMNIPAQUE. OMNIPAQUE Oral Solution The safety and effectiveness of OMNIPAQUE oral solution 9 and 12 administered orally in conjunction with OMNIPAQUE injection administered intravenously for CT of the abdomen in pediatric patients have been established in pediatric patients from birth to 17 years of age. Use is supported by the data establishing safety and effectiveness for OMNIPAQUE injection diluted and administered orally in conjunction with OMNIPAQUE injection administered intravenously for CT of the abdomen in pediatric patients. Intraarticular Use The safety and effectiveness of OMNIPAQUE have not been established in pediatric patients for arthrography. Body Cavity Use OMNIPAQUE 240, 300, 350 diluted to concentrations from 50 mg iodine/mL to 100 mg iodine/mL is indicated for use in pediatric patients from birth to 17 years of age for voiding cystourethrography (VCU). The use for voiding cystourethrography is supported by clinical studies in 51 pediatric patients undergoing VCU. The safety and effectiveness of OMNIPAQUE have not been established in pediatric patients for ERCP, herniography, or hysterosalpingography. In general, the frequency of adverse reactions in pediatric patients was similar to that seen in adults [ see Adverse Reactions (6.1) ]. Pediatric patients at higher risk of experiencing adverse events during contrast-medium administration may include those having asthma, a sensitivity to medication and/or allergens, congestive heart failure, a serum creatinine greater than 1.5 mg/dL or those less than 12 months of age. Thyroid function tests indicative of thyroid dysfunction, characterized by hypothyroidism or transient thyroid suppression have been reported following iodinated contrast media administration in pediatric patients, including term and preterm neonates. Some patients were treated for hypothyroidism. After exposure to iodinated contrast media, individualize thyroid function monitoring in pediatric patients 0 to 3 years of age based on underlying risk factors, especially in term and preterm neonates [see Warnings and Precautions (5.9) and Adverse Reactions (6.2) ]. In clinical studies of OMNIPAQUE for CT, 52/299 (17%) of patients were 70 and over. No overall differences in safety were observed between these patients and younger patients. Other reported clinical experience has not identified differences in response between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. In general, dose selection for an elderly patient should be cautious usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

Volume/Concentration Configuration NDC OMNIPAQUE 240 (240 mg iodine/mL) – Boxes of 10 50 mL + PLUS PAK™ (polymer bottle) 0407-1412-38 OMNIPAQUE 300 (300 mg iodine/mL) – Boxes of 10 50 mL + PLUS PAK™ (polymer bottle) 0407-1413-86 100 mL + PLUS PAK™ (polymer bottle) 0407-1413-87 150 mL +PLUSPAK™ (polymer bottle) 0407-1413-88 OMNIPAQUE 350 (350 mg iodine/mL) – Boxes of 10 50 mL + PLUS PAK™ (polymer bottle), 0407-1414-82 100 mL +PLUSPAK™ (polymer bottle) 0407-1414-84 125 mL fill in 200 mL bottle with hanger 0407-1414-85 125 mL fill in 200 mL + PLUS PAK™ (polymer bottle) 0407-1414-83 150 mL +PLUSPAK™ (polymer bottle) 0407-1414-86 200 mL +PLUSPAK™ (polymer bottle) 0407-1414-87 The container closure system components (bottle, vial, stopper and cap) of OMNIPAQUE injection and OMNIPAQUE oral solution are not made with natural rubber latex. Protect OMNIPAQUE glass vials and bottles and + PLUS PAK™ polymer bottles from light. Do not freeze. Discard any product that is inadvertently frozen, as freezing may compromise the closure integrity of the immediate container. OMNIPAQUE Injection 140, 180, 240, 300 and 350 Store at controlled room temperature, 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature]. May be stored in a contrast media warmer for up to one month at 36° to 38°C (96.8° to 100.4°F). OMNIPAQUE Oral Solution 9 and 12 Store between 0° and 30°C (32° to 86°F).

The iodine atoms in iohexol provide attenuation of X-rays in direct proportion to the concentration of iohexol. Since concentration changes over time, iohexol provides time-dependent image contrast which may assist in visualizing body structures. Intrathecal Administration The initial concentration and volume of the contrast medium, in conjunction with patient manipulation and the volume of cerebrospinal fluid (CSF) into which the contrast medium is placed, will determine the extent of the contrast that can be achieved. Following intrathecal injection in conventional radiography, OMNIPAQUE 180, 240, and 300 will continue to provide contrast for at least 30 minutes. Slow diffusion of iohexol takes place throughout the CSF with subsequent absorption into the bloodstream. At approximately 1 hour following injection, contrast will no longer be sufficient for conventional myelography. After administration into the lumbar subarachnoid space, computerized tomography shows the presence of contrast medium in the thoracic region in about 1 hour, in the cervical region in about 2 hours, and in the basal cisterns in 3 to 4 hours. Intravascular Administration Following intravascular administration of OMNIPAQUE, the degree of contrast enhancement is directly related to the iodine concentration of an administered dose; peak iodine blood concentrations occur immediately (15 seconds to 120 seconds) following rapid intravenous injection. The time to maximum contrast enhancement can vary, depending on the organ, from the time that peak blood iodine concentrations are reached to one hour after intravenous bolus administration. When a delay between peak blood iodine concentrations and peak contrast is present, it suggests that radiographic contrast enhancement is at least in part dependent on the accumulation of iodine containing agent within the lesion and outside the blood pool. Oral Administration Orally administered OMNIPAQUE produces visualization of the gastrointestinal tract. Less than 1% of orally administered iohexol is recovered in the urine, suggesting minimal amounts are absorbed from the normal gastrointestinal tract. This amount may increase in the presence of bowel perforation or bowel obstruction. Intraarticular Administration Visualization of the joint spaces can be accomplished by direct injection of contrast medium. For intraarticular cavities, the injected iohexol is absorbed into the surrounding tissue and subsequently absorbed into systemic circulation. Body Cavity Administration For most body cavities, the injected iohexol is absorbed into the surrounding tissue and subsequently absorbed into systemic circulation. Examinations of the uterus (hysterosalpingography) and bladder (voiding cystourethrography) involve the almost immediate drainage of contrast medium from the cavity upon conclusion of the radiographic procedure. Following the intravenous administration of iohexol (between 500 mg iodine/kg to 1500 mg iodine/kg) to 16 adult human subjects, apparent first-order terminal elimination half-life was 12.6 hrs and total body clearance was 131 (98 to 165) mL/min. Clearance was not dose dependent. Absorption As evidenced by the amount recovered in urine, <1% of orally administered iohexol is absorbed from the normal gastrointestinal tract. This amount may increase in the presence of bowel perforation or bowel obstruction. Distribution In 16 adult subjects (receiving between 500 mg iodine/kg to 1500 mg iodine/kg intravenous iohexol) the plasma volume of distribution was165 (108 to 219) mL/kg. In five adult patients receiving 16 mL to 18 mL of OMNIPAQUE (180 mg iodine/mL) by lumbar intrathecal injection the plasma volume of distribution was 559 (350 to 849) mL/kg. Elimination Metabolism No significant metabolism, deiodination or biotransformation occurs. Excretion Following intravascular or intrathecal administration, iohexol is excreted unchanged by glomerular filtration. Approximately 90% of the intravenously injected iohexol dose is excreted within the first 24 hours. Following intravascular administration, peak urine concentration occurs in the first hour after injection.

Long-term animal studies have not been performed with iohexol to evaluate carcinogenic potential. Iohexol was not genotoxic in a series of studies, including the Ames test, the mouse lymphoma TK locus forward mutation assay, and a mouse micronucleus assay. Iohexol did not impair the fertility of male or female rats when repeatedly administered at intravenous dosages up to 4 g iodine/kg.

520-Y Contains 10 x 50 mL Bottles NDC 0407-1412-38 Omnipaque™ (iohexol) Injection 240 mgI/mL 50 mL NOVAPLUS ® Single-Dose Bottle. Sterile Aqueous Solution For Injection or Oral Use. PRINCIPAL DISPLAY PANEL - 50 mL Bottle Box Label - 1412