Gadodiamide

Medical uses

Gadodiamide is a contrast medium used for cranial and spinal magnetic resonance imaging (MRI) and for general MRI of the body after intravenous administration. It provides contrast enhancement and facilitates visualisation of abnormal structures or lesions in various parts of the body including the central nervous system (CNS). It crosses intact the blood brain barrier.

Adverse effects

Gadodiamide is one of the main GBCA associated with nephrogenic systemic fibrosis (NSF), a toxic reaction occurring in some people with kidney problems. No cases have been seen in people with normal kidney function.

A 2015 study found gadolinium deposited in the brain tissue of people who had received gadodiamide. Other studies using post-mortem mass spectrometry found most of the deposit remained at least 2 years after an injection and deposit also in individuals with no kidney issues.

In vitro studies found it to be neurotoxic.

An Italian task force recommended that breastfeeding mothers precautionally avoid any contrast agent, such as gadodiamide, that has been associated with nephrogenic systemic fibrosis.

Like other gadolinium-based contrast agents (GBCAs), gadodiamide may cause a range of adverse reactions. The most common include mild symptoms such as nausea, headache, or injection site discomfort. However, rare but serious reactions have been reported.

Hypersensitivity and anaphylaxis

Gadodiamide can cause severe allergic or hypersensitivity reactions, including anaphylaxis—a potentially life-threatening condition requiring immediate medical attention and treatment with epinephrine (adrenaline). Post-marketing surveillance and case studies have documented such events in patients who received gadodiamide.

Data from the U.S. FDA Adverse Event Reporting System (FAERS) also list anaphylaxis and other hypersensitivity reactions among the reported adverse effects associated with gadodiamide.

Patients with a known history of allergic reactions to contrast media or other drugs should inform their healthcare provider before undergoing imaging studies with gadodiamide. In high-risk individuals, premedication and pre-screening protocols may be considered to mitigate the risk of severe reactions.

Society and culture

Gadodiamide was suspended along with gadopentetic acid (Magnevist) by the European Medicines Agency in 2017.

References

References

1. (February 2024). "Product monograph brand safety updates".
2. "Omniscan- gadodiamide injection".
3. (14 January 2021). "Active substance: gadodiamide". European Medicine Agency.
4. (November 2020). "Retention of Gadolinium in Brain Parenchyma: Pathways for Speciation, Access, and Distribution. A Critical Review". Journal of Magnetic Resonance Imaging.
5. (January 2018). "Magnetic Resonance Imaging (MRI), Gadolinium". StatPearls Publishing.
6. (2008). "Gadolinium-associated nephrogenic systemic fibrosis: the need for nephrologists' awareness". Journal of Nephrology.
7. (26 March 2015). "Gadolinium Found in Brain Tissue".
8. (August 2019). "Gadolinium-Based MRI Contrast Agents Induce Mitochondrial Toxicity and Cell Death in Human Neurons, and Toxicity Increases With Reduced Kinetic Stability of the Agent". Investigative Radiology.
9. (August 2014). "Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy". European Radiology.
10. (March 2020). "Phonotactic steering and representation of directional information in the ascending auditory pathway of a cricket". Journal of Neurophysiology.
11. "FDA Adverse Event Reporting System (FAERS) Public Dashboard". U.S. Food and Drug Administration.
12. (14 December 2017). "Gadolinium-containing contrast agents: removal of Omniscan and iv Magnevist, restrictions to the use of other linear agents".