Pretreatment with Corticosteroids to Alleviate Reactions to Intravenous Contrast Material

Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist

“…However, for the prevention of severe and life-threatening reactions, treatment with methylprednisolone, 32 mg orally, 2 hours before ICA exposure was not effective at reducing the risk of an adverse reaction (0.5% vs 0.2% in the corticosteroid and control groups; PϾ.05). 33 Patients who received 2 doses of oral methylprednisolone, 32 mg each (one 6-24 hours before and another 2 hours before administration of an ICA), had a 4.5-fold reduction in the incidence of severe acute reactions (0.2% vs 0.9% in the corticosteroid and control groups; Pϭ.005). 33,34 Furthermore, the use of a nonionic monomeric agent provides greater protection from a severe reaction than the use of an ionic monomer with corticosteroid prophylaxis 35 ; however, severe reaction can still occur despite corticosteroid pretreatment and the use of low-osmolarity contrast media.…”

“…33 Patients who received 2 doses of oral methylprednisolone, 32 mg each (one 6-24 hours before and another 2 hours before administration of an ICA), had a 4.5-fold reduction in the incidence of severe acute reactions (0.2% vs 0.9% in the corticosteroid and control groups; Pϭ.005). 33,34 Furthermore, the use of a nonionic monomeric agent provides greater protection from a severe reaction than the use of an ionic monomer with corticosteroid prophylaxis 35 ; however, severe reaction can still occur despite corticosteroid pretreatment and the use of low-osmolarity contrast media. 3,33,34 In patients at risk for acute reaction, pretreatment with corticosteroids is a common practice.…”

“…33,34 Furthermore, the use of a nonionic monomeric agent provides greater protection from a severe reaction than the use of an ionic monomer with corticosteroid prophylaxis 35 ; however, severe reaction can still occur despite corticosteroid pretreatment and the use of low-osmolarity contrast media. 3,33,34 In patients at risk for acute reaction, pretreatment with corticosteroids is a common practice. For adults at Mayo Clinic in Rochester, Minnesota, this consists of methylprednisolone, 32 mg orally, both 12 hours and 2 hours before the administration of an ICA (ie, "the Lasser prep").…”

Reactions to contrast media and steroid pretreatment

“…"I In high risk patients, including those who have had previous important reactions to contrast media, pretreatment with drugs such as corticosteroids, antihistamines, or P blockers has been employed. Most radiologists believe that high doses of steroids confer some protection and that they should be given at least 12 hours beforehand. Their use, however, is empirical, and no trials clearly show their effectiveness.…”

Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions

“…Though poorly sensitive, it is highly specific and when seen, the presence of a hyper techniques. The most common protocols recommend pre-medication thirteen hours before administration of contrast [22], with more acute emergency protocols recommending pre-medication at least one hour before administration of contrast [23]. This is impractical in the acute stroke setting when time is critical.…”