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Contrast-Induced Nephropathy Medication

  • Author: Renu Bansal, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jan 18, 2016
 

Medication Summary

NAC is acetylated L-cysteine, an amino acid. As previously mentioned, its sulfhydryl groups make it an excellent antioxidant and scavenger of free oxygen radicals. It also enhances the vasodilatory properties of nitric oxide. Twelve meta-analyses covering 29 randomized, controlled trials have been published on the effect of NAC therapy in CIN. They all suffer from significant heterogeneity. The standard oral NAC regimen consists of 600 mg twice daily for 24 hours before and on the day of the procedure. Higher doses of 1 g, 1200 mg, and 1500 mg twice daily have also been studied, with no significant dose-related or route-related (oral vs intravenous) difference. NAC has very low oral bioavailability; substantial interpatient variability and inconsistency between the available oral products obscure the picture further.[25, 33]

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Antidote, Acetaminophen

Class Summary

Used for prevention of contrast toxicity.

N-acetylcysteine (Acetadote)

 

Used for prevention of contrast toxicity in susceptible individuals such as those with diabetes mellitus. May provide substrate for conjugation with toxic metabolites.

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Antilipemic Agents

Class Summary

These agents are used for their favorable effects on endothelin and thrombus formation, plaque stabilization and anti-inflammatory properties by improving lipid profile.

Simvastatin (Zocor)

 

Indicated for hyperlipoproteinemia (Type III). Inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA reductase), which in turn inhibit cholesterol synthesis, and increases cholesterol metabolism. Increase HDL cholesterol and decrease LDL-C, total-C, apolipoprotein B, VLDL cholesterol, and plasma triglycerides.

Atorvastatin (Lipitor)

 

The most efficacious of the statins at high doses. Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA reductase), which in turn inhibits cholesterol synthesis and increases cholesterol metabolism. Reports have shown as much as a 60% reduction in LDL-C. The Atorvastatin versus Revascularization Treatment study (AVERT) compared 80 mg atorvastatin daily to standard therapy and angioplasty in patients with CHD. While events at 18 mo were the same between both groups, the length of time until the first CHD event occurred was longer with aggressive LDL-C lowering. The half-life of atorvastatin and its active metabolites is longer than that of all the other statins (ie, approximately 48 h compared to 3-4 h).

May modestly elevate HDL-C levels. Clinically, reduced levels of circulating total cholesterol, LDL-C, and serum TGs are observed.

Before initiating therapy, patients should be placed on a cholesterol-lowering diet for 3-6 mo; the diet should be continued indefinitely.

Lovastatin (Mevacor, Altoprev)

 

Adjunct to dietary therapy in reducing serum cholesterol. Immediate-release (Mevacor) and extended-release (Altocor) are available.

Fluvastatin (Lescol, Lescol XL)

 

Synthetically prepared HMG-CoA reductase inhibitor with some similarities to lovastatin, simvastatin, and pravastatin. However, structurally distinct and has different biopharmaceutical profile (eg, no active metabolites, extensive protein binding, minimal CSF penetration).

Used as an adjunct to dietary therapy in decreasing cholesterol levels.

Pravastatin (Pravachol)

 

Effective in reducing circulating lipid levels and improving the clinical and anatomic course of atherosclerosis.

Rosuvastatin (Crestor)

 

HMG-CoA reductase inhibitor that in turn decreases cholesterol synthesis and increases cholesterol metabolism. Reduces total-C, LDL-C, and TG levels and increases HDL-C level. Used adjunctively with diet and exercise to treat hypercholesterolemia.

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Contributor Information and Disclosures
Author

Renu Bansal, MD Resident Physician, Department of Internal Medicine, University of Connecticut School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Andre A Kaplan, MD, FACP, FASN Professor of Medicine, University of Connecticut School of Medicine; Director of Dialysis Program, Chief of Blood Purification, John Dempsey Hospital; Medical Director, UConn Dialysis Center; Medical Director, McDougal Correctional Institution Dialysis Unit

Andre A Kaplan, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society for Artificial Internal Organs, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, New York Academy of Medicine, American Society for Apheresis, Renal Physicians Association

Disclosure: Nothing to disclose.

Fabio Aglieco, DO Nephrologist and Internal Medicine Primary Care Provider, Nephrology Leaders and Associates; Medical Director, Brazoria County Dialysis Center

Fabio Aglieco, DO is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, International Society of Nephrology, American Society for Biochemistry and Molecular Biology, American Federation for Medical Research, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, Kentucky Medical Association, National Kidney Foundation, Phi Beta Kappa

Disclosure: Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

References
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Table 1. Physiochemical Properties of Contrast Media [16]
Class of Contrast Agent Type of Contrast Agent Iodine Dose



(mg/mL)



Iodine/Particle Ratio Viscosity



(cPs at 37°C)



Osmolality



(mOsm/kg H2 O)



Molecular Weight (Da)
High-osmolar monomers



(ionic)



Diatrizoate (Renografin)



Ioxithalamate (Telebrix)



370



350



1.5



1.5



2.3



2.5



1870



2130



636



643



Low-osmolar dimers



(ionic)



Ioxaglate (Hexabrix) 320 3 7.5 600 1270
Low-osmolar monomers



(nonionic)



Iohexol (Omnipaque)



Iopamidol (Isovue)



Iomeprol (Iomeron)



Ioversol (Optiray)



Iopromide (Ultravist)



Iopentol (Imagopaque)



350



370



400



350



370



350



3



3



3



3



3



3



10.4



9.4



12.6



9



10



12



780



790



620



790



770



810



821



777



778



807



791



835



Iso-osmolar dimers



(nonionic)



Iodixanol (Visipaque)



Iotrolan (Isovist)



320



320



6



6



11.8



8.5



290



290



1550



1620



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