Iopamidol and metrizamide for myelography: prospective double-blind clinical trial

Abstract

In a comparative randomizeddouble-blind study, 73 patients underwent myelography using iopamidol (36 patients) or metrizamide (37 patients) as contrast medium. The overall diagnostic adequacy of iopamidol myelography was found to be comparable to that of metrizamide myelography. The incidence of examinations graded as superior (64%) or adequate (36%) with iopamidol was equivalent to that with metrizamide (57% superior, 43% adequate). Adverse reactions after iopamidol myelography were fewer, less severe, and generally of shorter duration than those associated with metrizamide.In the iopamidol group, adverse reactions occurred in nine (25%) patients, all of whom experienced mild or moderate headache, one with nausea, vomiting, and fatigue. In the metrizamide group, adverse reactions occurred in 17 (46%) patients, all of whom experienced mild or moderate headache, six with nausea and vomiting and four with back and leg pain. Of nine individuals who underwent myelography using 300 mg I/mI metrizamide injected via lateral C1-C2 puncture, three experienced a toxic encephalopathy with confusion, dysphasia, headache, nausea, and vomiting, and a fourth individual suffered severe nausea, vomiting, fever, and irregular pulse. Encephalopathy was not observed in any of the I I patients in whom myelography was performed via lateral Cl-C2 puncture with a similar concentration of iopamidol. No seizures were encountered, and no clinically significant changes in laboratory studies were observed with either contrast medium.

Seizures following myelography with iopamidol

“…Therefore, they suggested that individual sensitivity to iopamidol was an important factor. In other studies, there have been no seizures noted in series of 100 1121,80 15},65 [21,30 131,36 [4], and 21 patients 171.…”

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision

“…Although animal studies have shown iopamidol to be more epileptogenic than metrizamide 45 and the excitative neurotoxic potential of iodixanol, 46 clinical trials of these newer nonionic agents have shown them to be safe and effective, with fewer adverse effects than metrizamide. 8,16,22,47 The risk of seizure with the currently used contrast media is reported to be in the range of 0.093%-0.847%. 19,48 Review of the literature revealed only case reports of seizure activity after myelography with iopamidol 13,21 and iohexol (On-line Table 3).…”

The Role and Contribution of Lumbar Myelography in the Diagnosis and Treatment of Patients With Lumbar Degenerative Disorders: Clinical and Statistical Evaluation of Post-Myelography Treatment of 63 Patients

“…In the 1970s, metrizamide, the first non-ionic water-soluble contrast agent, came into use [14]. In the next decade, Iohexol and Iopamidol were developed [15,16]. Although the contrast agents used today are not completely risk-free, they have much lighter side effects than the previous ones [17,18].…”