Radiographic contrast media: an introduction to its use, adverse-effect profile, and economic impact

To provide an overview of the development, chemistry, adverse-effect profile, and economic impact of radiographic contrast media (CM).

Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of CM. References cited in published review articles and manufacturer's product information also were used.

Studies, review articles, and editorials were selected for review if they addressed the synthesis, clinical use, or economic impact of CM. Comparative studies conducted in humans were used to address the adverse-effect profile of CM.

Data were extracted from reviews and editorials when the information from multiple sources was consistent and pertained to the purpose of this review. Comparative reviews addressing adverse reactions were reviewed by the author for appropriate methodology and reporting of results.

Radiographic CM are iodine-containing compounds that can be injected intravascularly or intrathecally for multiple diagnostic tests. CM are differentiated according to water solubility, viscosity, radiopacity, and osmolality. In the past decade, low-osmolality CM (LOCM) have been developed that may impart fewer adverse effects, such as flushing, nausea, vomiting, allergic reactions, cardiovascular effects, and nephrotoxicity. The use of LOCM has steadily increased since their introduction in 1985. The cost of LOCM is approximately 10-to 20-fold higher than previously available CM. This represents a growing financial burden to the healthcare system.

CM are an integral tool in diagnostic medicine. LOCM appear to be safer than previous agents; however, they are also more expensive. Balancing safety and financial concerns will be a recurring issue facing both the medical society and third-party payers when selecting appropriate CM to administer to patients.