Drug Safety

, Volume 37, Issue 9, pp 703–710 | Cite as

Adverse Reactions to Contrast Media: An Analysis of Spontaneous Reports in the Database of the Pharmacovigilance Programme of India

  • Vivekanandan Kalaiselvan
  • Surbhi Sharma
  • Gyanendra Nath Singh
Original Research Article

Abstract

Background

Contrast media are used widely to improve medical imaging. Like all other pharmaceuticals, these agents are not completely devoid of risk, and continuous monitoring of adverse reactions with these agents is important. Spontaneous reporting is the simplest method for understanding the safety profile of pharmaceutical products after their approval.

Objective

Our objective was to identify the pattern and characteristics of adverse reactions attributed to contrast media in the Indian population reported to the National Coordination Centre for the Pharmacovigilance Programme of India (NCC-PvPI).

Methods

Individual case safety reports (ICSRs) attributed to contrast media submitted spontaneously to the NCC-PvPI were extracted from the database for July 2010 to September 2013. We analysed these reports for information related to reporter’s professional category, patient’s age and sex, reporter’s diagnosis of the reaction, seriousness of the reaction, type of contrast media exposure, system organ class (SOC) affected (as described in World Health Organization Adverse Reaction Terminology [WHO-ART]) and outcome.

Results

Of the total 59,915 ICSRs in the database, 415 (0.7 %) were suspected adverse reactions to contrast media; 44 reports were serious, including three fatal cases. The most affected SOCs were skin and appendage disorders, body as a whole–general disorders, gastrointestinal system disorders and respiratory system disorders. Hypersensitivity reactions were reported in the majority of ICSRs. The contrast media with the highest number of reports were iohexol (40.7 %), iomeprol (17.8 %), iopamidol (12 %) and diatrizoate (12 %).

Conclusions

Most of the reactions to contrast media were allergic-like, and no previously unrecognised adverse reactions were observed in the Indian population. Further data and increased awareness among healthcare professionals is required to signal and prevent the consequences of adverse reactions attributed to contrast media.

Keywords

Contrast Medium Adverse Reaction Hypersensitivity Reaction Diatrizoate System Organ Class 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Funding and Conflicts of Interest

No sources of funding were used to assist in the preparation of this study. Vivekanandan Kalaiselvan, Surbhi Sharma and Gyanendra Nath Singh have no conflicts of interest that are directly relevant to the content of this study.

References

  1. 1.
    Meth MJ, Maibach HI. Current understanding of contrast media reactions and implications for clinical management. Drug Saf. 2006;29(2):133–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Khachman D, Gandia P, Sallerin F, Mailly N. Immediate and delayed hypersensitivity reaction to iodinated radiographics contrast agents: an update. Therapie. 2009;64(5):331–9.PubMedCrossRefGoogle Scholar
  3. 3.
    American college of radiology (ACR) Mannual on Contrast Media. Version 9. 2013.Google Scholar
  4. 4.
  5. 5.
    Olsson S. Role of WHO programme on international drug monitoring in co-ordinating world-wide drug safety efforts. Drug Saf. 1988;19:1–10.CrossRefGoogle Scholar
  6. 6.
    Thomas M, Peedicayil J, Koshi T, Korah I. Adverse reactions to radiocontrast media in an Indian population. Br J Radiol. 1999;72:648–52.PubMedCrossRefGoogle Scholar
  7. 7.
    International Conference on Harmonisation; E2D: post-approval safety data management: definitions and standards for expedited reporting. November 2003. Available from URL http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E2D/Step4/E2D_Guideline.pdf. Accessed 02 Feb 2014.
  8. 8.
    Available from URL http://www.who-umc.org Accessed 18 May 2014.
  9. 9.
    Brockow K, The EAACI interest group on drug hypersensitivity. Management of hypersensitivity reactions to iodinated contrast media. Allergy. 2005;60:150–68.PubMedCrossRefGoogle Scholar
  10. 10.
    Ring J, Behrendt H. Anaphylaxis and anphylactoid reactions. Classification and pathophysiology. Clin Rev Allergy Immunol. 1999;17:387–99.PubMedCrossRefGoogle Scholar
  11. 11.
    Thomsen HS, Morcos SK. Radiographic contrast media. BJU Int. 2000;86:1–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsura K. Adverse reactions to ionic and non-ionic contrast media. Radiology. 1990;175:621–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Lasser EC, Lyon SG, Berry CC. Reports on contrast media reactions: analysis of data from reports to the US Food and Drug Administration. Radiology. 1997;203:605–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Cochran ST, Bomyea K, Sayre JW. Trends in adverse events after iv administration of contrast media. Am J Roentgenol. 2001;176:1385–8.CrossRefGoogle Scholar
  15. 15.
    Cutroneo P, Polimeni G, Curcuruto R, et al. Adverse reactions to contrast media: an analysis from spontaneous reporting data. Pharmacological Res. 2007;56:35–41.CrossRefGoogle Scholar
  16. 16.
    Singh J, Daftary A. Iodinated contrast media and their adverse reactions. J Nucl Med Technol. 2008;36(2):69–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Morcos SK. Acute serious and fatal reactions to contrast media: our current understanding. Br J Radiol. 2005;78:686–93.PubMedCrossRefGoogle Scholar
  18. 18.
    Browkow K. Contrast media hypersensitivity: scope of the problem. Toxicology. 2009;209:189–92.CrossRefGoogle Scholar
  19. 19.
    Cochran ST. Anaphylactoid reactions to radiocontrast media. Curr Allergy Asthma Rep. 2005;5:28–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Laroche D, Namour F, Lefrancois C, et al. Anaphylactoid and anaphylactic reactions to iodinated contrast material. Allergy. 1995;54(suppl 58):13–6.Google Scholar
  21. 21.
    Leone R, Conforti A, Venegoni M, Montola D, Moretti U, Mrneghelli I, et al. Drug induced anaphylaxis. Drug Saf. 2005;28:547–56.PubMedCrossRefGoogle Scholar
  22. 22.
    Bettman MA, Heeren T, Greenfield A, et al. Adverse events with radiographic contrast agents: results of the SCVIR contrast agent registry. Radiology. 1997;203:611–20.CrossRefGoogle Scholar
  23. 23.
    Lang DM, Alpern MB, Visintainer PF, Smith ST. Gender risk for anaphylactoid reaction to radiographic contrast media. J Allergy Clin Immunol. 1995;95:813–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Spring DB, Bettmann MA, Barkan HE. Deaths related to iodinated contrast media reported spontaneously to ht US Food and Drug Administration 1978–1994—effects of the availability of low-osmolality contrast media. Radiology. 1997;204:333–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Shehadi WH, Toniolo G. Adverse reactions to contrast media. Radiology. 1980;137:299–302.PubMedCrossRefGoogle Scholar
  26. 26.
    Ansell G, Tweedie MC, West CR, Evans P, Couch L. The current status of reactions to intravenous contrast media. Investig Radiol. 1980;15:S32–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Vivekanandan Kalaiselvan
    • 1
  • Surbhi Sharma
    • 1
  • Gyanendra Nath Singh
    • 1
  1. 1.Indian Pharmacopoeia CommissionGhaziabadIndia

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