Meglumine iotroxate (BiliscopinTM) is an iodinated, intravenous contrast agent that is preferentially excreted into the biliary tree and is used in CT intravenous cholangiography.
The typical dose is 100 mL Biliscopin (105 mg meglumine iotroxate/mL; 5.0 g iodine), which is administered via slow IV infusion (over 30-60 minutes) to optimize biliary concentration.
Biliary opacification may be limited in cases of hyperbilirubinemia (due to stasis or poor hepatocyte function), hyperproteinemia, or in patients with excessively dilated ducts. Preferential renal excretion may occur in these patients 4. Bilirubin levels should be <30 µmol/L to ensure optimal opacification, as opacification drops off when bilirubin levels are greater than 2-3 times normal 6.
Contraindications
Contraindications include (but not limited to) 3:
- hyperbilirubinemia: limited biliary opacification due to stasis or poor hepatocyte function
- severe heart failure
- iodinated-contrast hypersensitivity or allergy
- thyrotoxicosis
- severe hepatic or renal dysfunction
- pregnancy: safety has not been established; demonstrated to be embryotoxic in rabbits 3
Complications
Adverse reactions are uncommon (~2%; range 0.8-3.4%) with no fatal reactions recorded and severe reactions (e.g. anaphylaxis) rare. Common reactions include pruritus, rash, hives and nausea 1,2.
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