Adverse reactions after administration of iodinated contrast agents may be worsened in patients displaying agitation, anxiety, and pain. Appropriate management, such as sedation, may be required before the procedure ^L1883. Adequate hydration and normal electrolyte balance must be ensured, especially in elderly patients, infants, small children, patients with renal damage (oliguria, polyuria) or hyperuricemia, multiple myeloma, patients diagnosed with plasmacytoma or diabetes mellitus, particularly if it is longstanding ^L1883.

As this drug is a contrast agent, it may cause minor or major reactions that may be serious or lethal ^L1883. They may be rapid (within 60 minutes) or delayed (up to 1 week) ^L1883.

Emergency measures must be immediately available in high risk individuals, especially in patients taking B-blockers in whom adrenaline and vascular perfusion would not be effective ^L1883.

There are several conditions in which caution must be observed while administering this contrast drug ^L1883:

Renal Disease/Hepatic Disease

Particular attention is required if the patient has both hepatic and renal failure, which increases the risk of contrast agent retention ^L1883.

Cardiovascular Disease
In patients with manifest or incipient heart failure, coronary disease, pulmonary hypertension, or valvular heart disease, the risks of pulmonary edema, myocardial ischemia and arrhythmia and severe hemodynamic disturbances is heightened after the administration of an iodinated contrast agent.

Cases of Torsade de Pointes have been identified in patients using sodium and meglumine ioxaglate, therefore loxaglic acid should be administered very carefully to patients who have/may develop prolongation of QTc, including patients taking other medicines that contribute to cardiovascular QT prolongation ^L1883.

Pheochromocytoma Patients

Patients with phaeochromocytoma may suddenly develop hypertension after intravascular administration of a contrast agent, which may require appropriate management before the examination ^L1883

Thyroid Disease

Following injection of iodinated contrast agent, specifically in patients with goiter or a history of hypothyroidism, there is a risk of either an episode of hyperthyroidism or induction of a new episode of hypothyroidism.

There is also a risk of hypothyroidism in newborns who have received, or whose mother has received, an iodinated contrast agent.

Screening for hypothyroidism should be performed routinely after administration of the product to newborns and judiciously to premature babies by assaying TSH and possibly free T4, 7-10 days and 1 month after iodine overload ^L1883.

Asthma

Asthma should be controlled before injecting the iodinated contrast agent ^L1883.

Particular attention is required if the asthmatic attack has occurred within eight days prior to administration of loxagic acid, because of the increased risk for bronchospasm.

Myasthenia gravis

Administration of a contrast agent may exacerbate the symptoms of myasthenia gravis ^L1883.

Use in pregnancy

In the patient screening and with appropriate tests, it is advisable to identify possible pregnancy in women of childbearing age. Exposure of the female genital tract to x-rays warrants careful evaluation of the benefit-to-risk ratio ^L1883.