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Visipaque

Visipaque

Ask a doctor about a prescription for Visipaque

This page is for general information. Consult a doctor for personal advice. Call emergency services if symptoms are severe.
About the medicine

How to use Visipaque

Leaflet accompanying the packaging: information for the user

Visipaque,550 mg/ml,(270 mg I/ml),solution for injection,
Visipaque,652 mg/ml,(320 mg I/ml),solution for injection
Iodixanol

You should carefully read the contents of the leaflet before using the medicine, as it contains important information for the patient.

  • You should keep this leaflet, so that you can read it again if you need to.
  • If you have any doubts, you should consult a doctor, pharmacist or nurse.
  • This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same as yours.
  • If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor, pharmacist or nurse. See section 4.

Table of contents of the leaflet

  • 1. What is Visipaque and what is it used for
  • 2. Important information before using Visipaque
  • 3. How to use Visipaque
  • 4. Possible side effects
  • 5. How to store Visipaque
  • 6. Contents of the packaging and other information

1. What is Visipaque and what is it used for

Product intended exclusively for diagnostic purposes.
Visipaque is used for cardioangiography, cerebral angiography (conventional),
peripheral arteriography (conventional), abdominal angiography (including DSA - digital subtraction angiography), urography, phlebography, in contrast-enhanced computed tomography.
Lumbar, thoracic and cervical myelography.

2. Important information before using Visipaque

When not to use Visipaque:

  • if the patient is allergic to iodixanol or any of the other ingredients of this medicine (listed in section 6);
  • if the patient has thyrotoxicosis with visible symptoms;
  • if the patient has had confirmed severe reactions to Visipaque.

Warnings and precautions

Before starting to use Visipaque, you should discuss it with your doctor, pharmacist or nurse.
General warnings regarding the use of all non-ionic contrast media
Hypersensitivity reactions
Particular attention should be paid to patients with a history of allergies, asthma, and unfavorable, unforeseen reactions to iodine contrast media.
In such cases, it is recommended to consider the use of premedication with glucocorticoids or histamine H1 and H2 receptor blockers.
It is believed that the risk of severe reactions after administration of Visipaque is small. However, it should be remembered that iodine contrast media can cause anaphylactoid reactions or other hypersensitivity symptoms. Therefore, it is recommended to plan and prepare the necessary medications and equipment in advance, which would be necessary to use in such a situation. Throughout the radiological examination, a venous cannula or catheter should be maintained to ensure immediate access.
One should always consider the possibility of hypersensitivity reactions, including serious, life-threatening, and fatal anaphylactic or anaphylactoid reactions. Most severe adverse reactions occur within the first 30 minutes after administration of the contrast medium. There is also a possibility of delayed hypersensitivity reactions (occurring 1 hour after administration or later).
Patients should be observed for at least 30 minutes after administration of Visipaque.
Patients taking beta-adrenergic receptor blockers may have atypical symptoms of hypersensitivity reactions, which may be mistaken for symptoms related to vagus nerve stimulation.
The use of beta-adrenergic receptor blockers may cause a greater tendency to bronchospasm after administration of contrast media in patients with asthma and may reduce the response to adrenaline treatment.
Coagulopathy
Compared to ionic contrast media, non-ionic media have a lesser effect on the coagulation system in vitro.
Cases of blood clotting after contact with syringes containing contrast media, including non-ionic media, have been reported. The use of plastic syringes instead of glass syringes reduces the likelihood of blood clotting in vitro, but does not eliminate it completely.
Severe, rarely fatal, cases of thromboembolic complications leading to myocardial infarction and stroke have been reported during angiocardiological procedures using both ionic and non-ionic contrast media.
The development of thromboembolic complications may also be influenced by many other factors, including the duration of the procedure, the material from which the catheter and syringe are made, the stage of the underlying disease, and concomitantly used medications. For this reason, it is necessary to carefully follow the proper technique of performing angiography, paying particular attention to proper catheter and guidewire manipulation, the use of branching systems and (or) three-way stopcocks, the need for frequent flushing of the catheter with heparinized saline, and minimizing the duration of the procedure, in order to reduce the risk of thrombosis or embolism related to the examination.
Immediate access to necessary, advanced life-saving measures should be ensured.
Patients with homocystinuria (risk of thromboembolic complications) should be under care.
Hydration
Before and after administration of the contrast medium, proper hydration of the patient should be ensured.
This is especially important for patients with leukemia, diabetes, renal function disorders, as well as infants, young children, and the elderly. Infants (under 1 year of age), especially newborns, are sensitive to electrolyte balance disorders and hemodynamic changes.
Cardiovascular disorders
Particular attention should also be paid to patients with severe heart diseases and pulmonary hypertension. They may experience hemodynamic disorders and arrhythmias.
Rarely, severe, life-threatening reactions or deaths have occurred due to cardiovascular disorders such as cardiac arrest, circulatory arrest and respiratory arrest, and myocardial infarction.
Central nervous system disorders
Patients with acute cerebral pathologies, a history of tumors or epilepsy, and those with a history of alcohol or drug abuse, should be under special care due to the increased risk of seizures. Also, patients with a history of alcohol or drug abuse have a lowered seizure threshold and a lowered threshold for neurological reactions. In the case of intravascular administration, patients with acute stroke or acute intracranial hemorrhage, as well as patients with changes in the blood-brain barrier, cerebral edema, or acute demyelination, should be under care.
During or shortly after the imaging procedure, a transient disturbance of brain function, called encephalopathy, may occur. If the patient notices any symptoms related to this condition, described in section 4, they should immediately inform their doctor.
Renal disorders
The primary risk factor for the development of contrast-induced nephropathy is pre-existing renal disorders. Diabetes and the volume of iodine contrast medium administered are additional risk factors for the development of this condition in patients with existing renal disorders. Other risk factors include dehydration, advanced arteriosclerosis, reduced renal blood flow, and the presence of other potentially nephrotoxic factors, such as certain medications or extensive surgical procedures.
To prevent the occurrence of acute renal failure after administration of contrast media, special care should also be taken for patients with pre-existing renal failure and diabetes.
Patients with paraproteinemias (multiple myeloma, Waldenström's macroglobulinemia) are also at increased risk.
Preventive measures:

  • identification of the risk group;
  • ensuring proper hydration; if necessary, intravenous infusion should be started before the procedure and maintained until the contrast medium is completely eliminated by the kidneys;
  • avoiding additional renal burden, such as concomitant use of medications with potential nephrotoxic properties, oral medications used during cholecystography, vascular clamps, renal artery angioplasty, or other extensive surgical procedures, until the contrast medium is completely eliminated from the body;
  • limiting the dose of contrast medium to a minimum;
  • delaying repeated administration of contrast medium until renal function parameters return to baseline values.

Iodine contrast media can be administered to patients undergoing hemodialysis, as these media are removed during dialysis.
Patients with diabetes taking metformin
To avoid lactic acidosis in diabetic patients taking metformin, serum creatinine levels should be determined before administration of contrast media.
Metformin should be discontinued at the time of or prior to contrast media administration and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been re-evaluated and found to be normal.
Renal and hepatic disorders
Particular attention should be paid to patients with concurrent severe renal and hepatic disorders, as the clearance of the medicine may be significantly prolonged. Patients undergoing dialysis may be given contrast media. The timing of contrast media administration and dialysis is not critical.
Myasthenia
Administration of contrast media may exacerbate symptoms in patients with myasthenia.
Pheochromocytoma
Caution should be exercised when administering iodine contrast media to patients with pheochromocytoma or suspected pheochromocytoma.
Patients with pheochromocytoma undergoing procedures should be given alpha-receptor blockers before the start of the examination to avoid a hypertensive crisis.
Thyroid disorders
Patients with visible but undiagnosed hyperthyroidism, patients with latent hyperthyroidism (e.g., those with nodular goiter), and patients with functional autonomy (often, for example, elderly patients, especially from regions with iodine deficiency) are more susceptible to acute thyrotoxicosis after the use of iodine contrast media. In such patients, the additional risk should be assessed before using iodine contrast media.
In patients with suspected hyperthyroidism, before administration of contrast media, it is recommended to consider performing thyroid function tests and (or) using prophylactic antithyroid treatment. Patients at risk should be monitored for the development of thyrotoxicosis in the following weeks after injection of the product.
Cases of thyroid function tests indicating hypothyroidism or decreased thyroid function after administration of iodine contrast media to adults and children, including infants, have been reported. Some patients were treated for hypothyroidism.
After administration of Visipaque to children and adults, thyroid function disorders may occur.
Infants may also be exposed to the effect of the medicine through their mothers during pregnancy.
The doctor may order thyroid function tests before and (or) after administration of Visipaque.
Children and adolescents
Particular attention should be paid to children treated under the age of 3, as the occurrence of hypothyroidism in early life can be harmful to motor, auditory, and cognitive development and may require temporary replacement therapy with T4.
The reported frequency of hypothyroidism in patients under 3 years of age who were exposed to iodine contrast media ranged from 1.3% to 15%, depending on the age of the examined patients and the dose of iodine contrast medium, and this hypothyroidism was more frequently observed in newborns and premature infants. Newborns may also be exposed to iodine contrast media through their mothers during pregnancy. In all children under 3 years of age after exposure to iodine contrast media, thyroid function should be evaluated. If hypothyroidism is detected, the need for treatment and monitoring of thyroid function until it normalizes should be considered.
Extravascular administration of Visipaque
The effects of accidental extravascular administration of Visipaque have not been described. The medicine is isotonic and it seems that pain and swelling should be less severe than after accidental extravascular administration of hyperosmolar agents.
If accidental extravascular administration occurs, it is recommended to cool and elevate the limb. In case of compartment syndrome, surgical decompression may be necessary.
Observation time after administration of Visipaque
After administration of the contrast medium, the patient should be observed for at least 30 minutes, as most adverse reactions occur during this time. Experience indicates that it is also possible for delayed hypersensitivity reactions to occur, appearing up to several hours or days after administration of the medicine.
Intrathecal administration
After myelography, the patient should rest for 1 hour with their head and chest elevated by 20 degrees. Then, the patient can leave the room, but should be warned not to bend. If they remain in bed, in a lying position, their head and chest should be elevated for 6 hours. During this time, patients with a low seizure threshold should be closely monitored. Outpatients should not be left unattended for 12 to 24 hours.
Hysterosalpingography
Hysterosalpingography should not be performed in pregnant women or women with acute pelvic inflammatory disease (PID).

Visipaque and other medicines

Tell your doctor about all medicines you are taking now or have taken recently, as well as any medicines you plan to take.
All iodine contrast media can interfere with thyroid function tests. Therefore, the ability of the thyroid gland to bind iodine may be reduced for several weeks after the examination.
High concentrations of contrast medium in serum and urine can affect laboratory test results, including bilirubin, protein, and inorganic substances such as iron, copper, calcium, and phosphates. Therefore, these substances should not be measured on the day of the radiological examination.
Administration of iodine contrast media may cause transient renal function disorders, which can lead to acidosis in diabetic patients taking metformin.
In patients who took interleukin-2 less than 2 weeks before the examination with iodine contrast media, there is an increased risk of delayed reactions, such as skin reactions and flu-like symptoms.
There is evidence that the use of beta-adrenergic receptor blockers is a risk factor for anaphylactoid reactions after administration of contrast media used in radiodiagnostics (cases of acute hypertension have been observed after administration of contrast media to patients taking beta-adrenergic receptor blockers).

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, consult your doctor or pharmacist before using this medicine.
Pregnancy
There are no clinical data on the use of Visipaque in pregnant women.
Animal studies do not show direct or indirect harmful effects on reproduction, embryonic or fetal development, pregnancy, or postnatal development.
Animal studies on reproduction are not always applicable to humans, so the product should be used in pregnant women only if necessary.
Since, if possible, exposure to X-rays should be avoided in pregnant women, it should be considered whether the benefits of the radiological examination, with or without contrast medium, outweigh the potential risk.
Visipaque should not be used in pregnant women unless the benefits outweigh the risks and the doctor considers the examination necessary.
In newborns who were exposed to iodine contrast media in utero, it is recommended to monitor thyroid function (see section Warnings and precautions).
Breastfeeding
The contrast medium passes into breast milk in small amounts and is absorbed by the gut in small amounts. Breastfeeding can be continued while the contrast medium is being administered to the mother.

Driving and using machines

No studies have been conducted on the effect of the medicine on the ability to drive and use machines. However, it is not recommended to drive vehicles or operate machines for 24 hours after intravascular administration of the medicine.
Intrathecal administration may affect the ability to drive vehicles.
The risk of severe reactions after administration of Visipaque is considered low. However, it should be remembered that iodine contrast media can cause anaphylactic or other hypersensitivity reactions.

Visipaque contains sodium

Visipaque (550 mg/ml)contains 0.76 mg of sodium (the main component of common salt) per milliliter of solution. This corresponds to 0.038% of the maximum recommended daily intake of sodium in the diet for adults.
Visipaque (652 mg/ml)contains 0.45 mg of sodium (the main component of common salt) per milliliter of solution. This corresponds to 0.023% of the maximum recommended daily intake of sodium in the diet for adults.

3. How to use Visipaque

This medicine should always be used as directed by your doctor or pharmacist. If you are unsure, consult your doctor or pharmacist.
Dosage may vary depending on the type of examination, age, weight, cardiac output, and general condition of the patient, as well as the technique of administration. Usually, the same concentrations and volumes of iodine are used as for other commonly used iodine contrast media, but in some types of examinations, slightly lower concentrations of iodine can provide clinically useful information. Before and after administration of the medicine, proper hydration of the patient should be ensured, just like when using other contrast media.
Visipaque is intended for intravenous, intra-arterial, and intrathecal use.
The recommended dosage of the medicine is given in the table. The doses for intra-arterial injections refer to a single injection, which can be repeated.

Indications (type of examination)Recommended concentrationRecommended volume
Arteriography
selective cerebral arteries270/320(1) mg I/ml5-10 ml / injection
aortography270/320 mg I/ml40-60 ml / injection
peripheral vessels270/320 mg I/ml30-60 ml / injection
selective digital subtraction angiography of visceral arteries270 mg I/ml10-40 ml / injection
Cardioangiography
Adults
Injection into the left ventricle and aortic root320 mg I/ml30-60 ml / injection
Selective coronary angiography320 mg I/ml4-8 ml / injection
Children270/320 mg I/mlDepending on age, body weight, and type of pathology. The recommended maximum total dose is 10 mg/kg body weight.

Intravenous administration

Indications (type of examination)Recommended concentrationRecommended volume
Urography
adults270/320 mg I/ml40-80 ml(2)
children <7 kg< td>270/320 mg I/ml2-4 ml/kg body weight.
children > 7 kg270/320 mg I/ml2-3 ml/kg body weight.
All doses depend on age, weight, and pathology (maximum 50 ml).
Phlebography270 mg I/ml50-150 ml/limb
Contrast-enhanced computed tomography (CT)
Adults
CT of the head
CT of the body
270/320 mg I/ml
270/320 mg I/ml
50-150 ml
75-150 ml
Children
CT of the head and body
270/320 mg I/ml2-3 ml/kg up to 50 ml (in special cases up to 150 ml).

Intrathecal administration

Indications (type of examination)Recommended concentrationRecommended volume
Lumbar and thoracic myelography (via lumbar approach)270 mg I/ml or 320 mg I/ml10-12 ml(3) or 10 ml(3)
Cervical myelography (via cervical and lumbar approach)270 mg I/ml or 320 mg I/ml10-12 ml(3) or 10 ml(3)
  • (1)Both concentrations have been studied, but a concentration of 270 mg I/ml is recommended in most cases.
  • (2)During urography, a larger dose can be used if necessary.
  • (3)To minimize the risk of adverse reactions, the total dose of iodine should not exceed 3.2 g, and symptomatic treatment should be used.

Elderly patients: the same dosage as for other adults.

Use of a higher than recommended dose of Visipaque

In patients with normal renal function, overdose is unlikely.
The examination time is crucial in the case of tolerance of large doses of the contrast medium by the kidneys (the elimination time of the medicine is about 2 hours).
In the event of accidental overdose, water and electrolytes should be supplemented intravenously. Renal function should be monitored for at least 3 subsequent days.
If necessary, iodixanol can be removed from the circulatory system by hemodialysis.
There is no specific antidote for this medicine.

Missed dose of Visipaque

A double dose should not be used to make up for a missed dose.
If you have any further doubts about the use of this medicine, consult your doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.
The following are possible side effects that may occur during the radiographic examination, including the use of Visipaque.
Side effects related to the use of Visipaque are usually mild or moderate and transient. Severe side effects, including fatal cases, have been observed very rarely. These included chronic, exacerbated renal failure, acute renal failure, anaphylactic or anaphylactoid shock, cardiac symptoms during hypersensitivity reactions (Kounis syndrome), cardiac arrest or circulatory and respiratory arrest, and myocardial infarction. The occurrence of cardiac symptoms may be contributed to by the underlying disease or the procedure.
Hypersensitivity reactions may occur in the form of respiratory symptoms and skin reactions. They may include dyspnea, rash, flushing, urticaria, itching, and angioedema.
They may occur immediately after administration of the contrast medium or several days later. Severe reactions, such as laryngeal edema, bronchospasm, or pulmonary edema, may occur.
Anaphylactoid reactions may be dose-dependent and may occur regardless of the route of administration. Mild symptoms may be the first sign of severe anaphylactoid reactions or anaphylactoid shock. In this case, administration of the contrast medium should be stopped immediately, and if necessary, intravenous treatment should be started. In patients taking beta-adrenergic receptor blockers, atypical symptoms of anaphylaxis may occur, which may be mistaken for symptoms related to vagus nerve stimulation.
After administration of iodine contrast media, a small, transient increase in serum creatinine is often observed, which usually has no clinical significance.
The frequency of possible side effects related to the use of Visipaque is classified as follows:

  • very common: (occurring in more than 1 in 10 people);
  • common: (occurring in 1 to 10 people in 100);
  • uncommon: (occurring in 1 to 10 people in 1,000);
  • rare: (occurring in 1 to 10 people in 10,000);
  • very rare: (occurring in less than 1 in 10,000 people);
  • not known: (frequency cannot be estimated from the available data).

The frequency of side effects is based on clinical documentation and published study results, involving more than 57,705 patients.

Intravascular administration (intravenous and intra-arterial)

Side effects after administration of iodine contrast media are usually mild or moderate, transient, and less frequent after administration of non-ionic media than after administration of ionic media. Severe side effects, as well as fatal cases, are observed very rarely.
Blood and lymphatic system disorders
Frequency not known: thrombocytopenia.
Immune system disorders
Uncommon: hypersensitivity reactions.
Frequency not known: anaphylactic/anaphylactoid shock, anaphylactic/anaphylactoid reactions, including life-threatening or fatal anaphylaxis.
Endocrine disorders
Frequency not known: hyperthyroidism, transient hypothyroidism.
Psychiatric disorders
Very rare: excitement, anxiety.
Frequency not known: confusion.
Nervous system disorders
Uncommon: headache.
Rare: dizziness, sensory disturbances, including taste disturbances, paresthesia, smell disturbances.
Very rare: stroke, syncope, tremor (transient), hypesthesia. Iodixanol can cross the blood-brain barrier, which allows it to be taken up by the cerebral cortex and is visible on the CT image the next day after the examination. This may cause transient confusion and cortical blindness.
Frequency not known: coma, transient cerebral dysfunction (encephalopathy), which can cause confusion, memory loss, hallucinations, visual disturbances, loss of vision, seizures, loss of coordination, loss of motor function on one side of the body, speech difficulties, and loss of consciousness.
Eye disorders
Very rare: cortical blindness (transient), transient visual disturbances (including double vision, blurred vision), eyelid edema.
Cardiac disorders
Rare: arrhythmia (including bradycardia and tachycardia), myocardial infarction.
Very rare: cardiac arrest, palpitations.
Frequency not known: heart failure, circulatory and respiratory arrest, conduction disorders, hypokinesia of the ventricles, coronary artery thrombosis, angina pectoris, coronary artery spasm.
Vascular disorders
Uncommon: flushing.
Rare: decrease in blood pressure.
Very rare: hypertension, hypoperfusion.
Frequency not known: arterial spasm, thrombosis, thrombophlebitis, shock.
Respiratory, thoracic, and mediastinal disorders
Rare: cough, sneezing.
Very rare: dyspnea, throat irritation, laryngeal edema, pharyngeal edema.
Frequency not known: pulmonary edema, bronchospasm, throat tightness, respiratory arrest, respiratory failure.
Gastrointestinal disorders
Uncommon: nausea, vomiting.
Very rare: discomfort or pain in the abdominal cavity, diarrhea.
Frequency not known: acute pancreatitis, exacerbation of pancreatitis, salivary gland enlargement.
Skin and subcutaneous tissue disorders
Uncommon: rash or drug eruption, itching, urticaria.
Rare: flushing.
Very rare: angioedema, excessive sweating.
Frequency not known: blistering or exfoliative dermatitis, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms.
Musculoskeletal and connective tissue disorders
Rare: pain in the peripheral part of a limb.
Very rare: back pain, muscle cramps.
Frequency not known: joint pain.
Renal and urinary disorders
Common: transient increase in creatinine values after administration of iodine contrast media, which usually has no clinical significance.
Uncommon: acute kidney injury or toxic nephropathy (contrast-induced nephropathy, CIN).
Very rare: renal failure, including acute renal failure. Fatal cases have been reported in high-risk patients.
Frequency not known: elevated serum creatinine levels.
General disorders and administration site conditions
Very common: mild sensation of heat and cold, sensation of heat during peripheral angiography.
Uncommon: sensation of heat, chest pain.
Rare: pain, discomfort, chills (shivering), fever, reactions at the injection site, including bruising, sensation of cold.
Very rare: weakness (e.g., fatigue, malaise), facial edema, localized edema.
Frequency not known: swelling.
Injury, poisoning, and procedural complications
Frequency not known: iodism. This syndrome is characterized by swelling and increased tension of the salivary glands, which can last up to 10 days after the examination.
Hypersensitivity reactions
Rare: dyspnea, rash, flushing, urticaria, itching, or angioedema.
Symptoms may occur immediately after administration of the contrast medium or several days later. There may be a decrease in blood pressure and fever.
Rare: acute to toxic skin reactions.
Very rare: severe reactions, such as laryngeal edema, bronchospasm, or pulmonary edema.

Intrathecal administration

Side effects after intrathecal administration may occur with a delay and after several hours or even days after the examination. The frequency of their occurrence is similar to that after diagnostic lumbar puncture.
After administration of other non-ionic contrast media, symptoms of meningeal irritation have been observed, occurring in the form of photophobia, meningeal reaction, and chemical meningitis. The possibility of infectious meningitis should be considered.
Immune system disorders
Frequency not known: hypersensitivity reactions, including anaphylactic or anaphylactoid reactions.
Nervous system disorders
Uncommon: headache (which can be severe and prolonged).
The above side effect can be attributed to the loss of cerebrospinal fluid due to lumbar puncture. In some cases, headaches can last for several days. During lumbar puncture performed during myelography, loss of cerebrospinal fluid should be avoided.
Rare: after administration of other non-ionic iodine contrast media, symptoms of meningeal irritation have been observed, occurring in the form of photophobia or neck stiffness. In case of such symptoms, the possibility of infectious meningitis should also be considered.
Very rare: after administration of other non-ionic iodine contrast media, transient cerebral dysfunction has been observed: seizures, transient confusion, sensory or motor disturbances. In some of these patients, changes in the electroencephalogram (EEG) were observed.
Frequency not known: dizziness, transient cerebral dysfunction (encephalopathy), which can cause confusion, memory loss, hallucinations, visual disturbances, loss of vision, seizures, loss of coordination, loss of motor function on one side of the body, speech difficulties, and loss of consciousness.
Gastrointestinal disorders
Uncommon: vomiting.
Frequency not known: nausea.
Musculoskeletal and connective tissue disorders
Frequency not known: muscle cramps.
General disorders and administration site conditions
Frequency not known: chills, local pain or radicular pain at the lumbar puncture site.

Hysterosalpingography (HSG)

Immune system disorders
Frequency not known: hypersensitivity reactions, including anaphylactic or anaphylactoid reactions.
Nervous system disorders
Uncommon: headache.
Gastrointestinal disorders
Uncommon: vomiting.
Frequency not known: nausea, abdominal pain.
Reproductive system and breast disorders
Very common: vaginal bleeding.
General disorders and administration site conditions
Common: fever.
Frequency not known: chills, local reactions.

Arthrography

Immune system disorders
Frequency not known: hypersensitivity reactions, including anaphylactic or anaphylactoid reactions.
General disorders and administration site conditions
Common: local pain.
Frequency not known: chills, local reactions.

Gastrointestinal tract examination

Immune system disorders
Frequency not known: hypersensitivity reactions, including anaphylactic or anaphylactoid reactions.
Gastrointestinal disorders
Common: diarrhea.
Uncommon: vomiting.
Frequency not known: nausea.
General disorders and administration site conditions
Frequency not known: chills, local reactions.

Reporting of side effects

If you experience any side effects, including any side effects not listed in this leaflet, you should tell your doctor, pharmacist, or nurse.
Side effects can be reported directly to:
Department for Monitoring of Adverse Reactions to Medicinal Products of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products:
Aleje Jerozolimskie 181C
02-222 Warsaw
Phone: +48 22 49 21 301
Fax: +48 22 49 21 309
Website: https://smz.ezdrowie.gov.pl.
Side effects can also be reported to the marketing authorization holder.
By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Visipaque

Store at a temperature below 25°C.
The medicine can be stored at 37°C for 1 month.
Protect from light and secondary X-ray radiation.
The medicine should be stored out of sight and reach of children.
Do not use this medicine after the expiry date stated on the carton after "Expiry date". The expiry date refers to the last day of the month stated.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the packaging and other information

What Visipaque contains

  • The active substance of the medicine is iodixanol.
  • The other ingredients are: trometamol, sodium chloride, calcium chloride, sodium calcium edetate, hydrochloric acid (for pH adjustment), water for injections.

What Visipaque looks like and what the pack contains

Vials and bottles made of colorless glass, closed with black chlorobutyl rubber or grey bromobutyl rubber stoppers or aluminium caps and polypropylene caps, in a cardboard box. Polypropylene bottles (USB), in a cardboard box.
Visipaque (550 mg/ml and 652 mg/ml)is available in glass packaging: 10 vials of 20 ml, 10 bottles of 50 ml, 10 bottles of 100 ml, and 6 bottles of 200 ml.
Visipaque (550 mg/ml)is available in polypropylene packaging: 10 bottles of 50 ml, 10 bottles of 100 ml.
Visipaque (652 mg/ml)is available in polypropylene packaging: 10 bottles of 50 ml, 10 bottles of 100 ml, 10 bottles of 150 ml, 10 bottles of 200 ml, 6 bottles of 500 ml.
Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder
GE Healthcare A.S.
Nycoveien 1
NO-0485 Oslo
Norway
To obtain further information, please contact the representative of the Marketing Authorisation Holder:
GE Medical Systems Polska Sp. z o.o.
ul. Wołoska 9
02-583 Warsaw
Phone: + 48 22 330 83 00
Manufacturer
GE Healthcare A.S.
Nycoveien 1
NO-0485 Oslo
Norway
GE Healthcare Ireland Limited
IDA Business Park
Carrigtohill,
Co. Cork,
Ireland

Date of last revision of the leaflet: April 2022

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Ngozi Precious Okwuosa

General medicine5 years of experience

Dr. Ngozi Precious Okwuosa is a Primary Care Physician with over 5 years of clinical experience in Hungary, Sweden, and Nigeria. A graduate of the University of Szeged (cum laude), she offers online consultations for adults in the areas of internal medicine, women’s health, and postoperative care.

Key areas of consultation:

  • Preventive and family medicine
  • Women’s health, including gynaecology and obstetrics
  • Chronic disease management: hypertension, diabetes, and more
  • Mental health support, anxiety, and counselling
  • Postoperative care and lab test interpretation
She has conducted research on the genetic background of stroke and is skilled in communicating with patients from diverse cultural backgrounds. Her approach combines clinical expertise with empathy and clear communication.
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Doctor

Tarek Agami

General medicine10 years of experience

Dr. Tarek Agami is a general practitioner registered in both Portugal and Israel, with broad experience in family and preventive medicine. He offers online consultations for adults and children, providing personalised support for primary care needs, chronic disease management, and everyday health concerns.

Dr. Agami received clinical training and worked in leading medical institutions in Israel (Kaplan Medical Center, Barzilai Medical Center, Wolfson Medical Center) and Portugal (European Healthcare City, Viscura Internacional, Hospital Dr. José Maria Grande, Hospital Vila Franca de Xira). His approach combines international medical standards with individualised attention to each patient.

Main areas of consultation:

  • Diagnosis and treatment of acute and chronic conditions (high blood pressure, diabetes, respiratory infections, cardiovascular symptoms)
  • Evaluation of symptoms and guidance on further diagnostic testing
  • Preventive check-ups and regular health monitoring
  • Medical support during travel or after relocation
  • Treatment adjustments and lifestyle recommendations based on your personal history
Dr. Agami provides medical support for patients using GLP-1 medications (such as Ozempic or Mounjaro) as part of a weight loss strategy. He offers individualised treatment planning, regular follow-up, dose adjustment, and advice on combining medication with sustainable lifestyle changes. Consultations follow the medical standards accepted in Portugal and Israel.

Dr. Agami is committed to evidence-based, patient-centred care, ensuring that each person receives trusted medical support tailored to their health goals.

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Doctor

Tetiana Fedoryshyn

General medicine29 years of experience

Dr Tetiana Fedoryshyn is a senior general practitioner, certified nutritionist, and psychologist with over 29 years of clinical experience. She combines classical internal medicine with modern approaches in lifestyle medicine, functional nutrition, and emotional health support.

Her focus is on helping patients regain health through deep understanding of symptoms, personalised nutrition plans, and evidence-based correction of deficiencies, stress-related conditions, and metabolic imbalances. Dr Fedoryshyn works with adults experiencing chronic conditions, fatigue, hormonal disruption, and post-stress exhaustion.

She integrates medical analysis, psychological insight, and real-life behaviour change tools to offer treatment plans tailored to each patient’s biochemistry, mental state, and lifestyle.

Main areas of practice:

  • Chronic condition management and medical counselling
  • Weight loss programmes based on metabolic profiling
  • Diagnosis and treatment of micronutrient deficiencies
  • Recovery from stress, burnout, and hormonal imbalances
  • Emotional support and psychosomatic symptom care
Her approach is never one-size-fits-all – each consultation begins with a deep dive into your unique health history, test results, and emotional landscape. Consultations are available in Ukrainian, Polish, and Russian.
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Doctor

Hocine Lokchiri

General medicine20 years of experience

Dr. Hocine Lokchiri is a French consultant with over 20 years of experience in General and Emergency Medicine. He works with adults and children, helping patients with urgent symptoms, infections, sudden health changes and everyday medical concerns that require timely evaluation. His background includes clinical practice in France, Switzerland and the United Arab Emirates, which allows him to navigate different healthcare systems and manage a wide range of conditions with confidence. Patients value his calm, structured approach, clear explanations and evidence-based decision-making.

Online consultations with Dr. Lokchiri are suitable for many situations when someone needs quick medical guidance, reassurance or a clear next step. Common reasons for booking include:

  • fever, chills, fatigue and viral symptoms
  • cough, sore throat, nasal congestion, breathing discomfort
  • bronchitis and mild asthma flare-ups
  • nausea, diarrhoea, abdominal pain, digestive infections
  • rashes, allergic reactions, redness, insect bites
  • muscle or joint pain, mild injuries, sprains
  • headache, dizziness, migraine symptoms
  • stress-related symptoms, sleep disturbances
  • questions about test results and treatment plans
  • management of chronic conditions in stable phases
Many patients reach out when symptoms appear suddenly and cause concern, when a child becomes unwell unexpectedly, when a rash changes or spreads, or when it’s unclear whether an in-person examination is necessary. His emergency medicine background is particularly valuable online, helping patients understand risk levels, identify warning signs and choose safe next steps.

Some situations are not suitable for online care. If a patient has loss of consciousness, severe chest pain, uncontrolled bleeding, seizures, major trauma or symptoms suggesting a stroke or heart attack, he will advise seeking immediate local emergency services. This improves safety and ensures patients receive the right level of care.

Dr. Lokchiri’s professional training includes:

  • Advanced Trauma Life Support (ATLS)
  • Basic and Advanced Cardiac Life Support (BLS/ACLS)
  • Pediatric Advanced Life Support (PALS)
  • Prehospital Trauma Life Support (PHTLS)
  • eFAST and critical care transthoracic echocardiography
  • aviation medicine
He is an active member of several professional organisations, including the French Society of Emergency Medicine (SFMU), the French Association for Emergency Physicians (AMUF) and the Swiss Society of Emergency and Rescue Medicine (SGNOR). In consultations, he works with clarity and precision, helping patients understand their symptoms, possible risks and the safest treatment options.
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Doctor

Anastasiia Shalko

Family medicine12 years of experience

Dr. Anastasiia Shalko is a general practitioner with a background in both paediatrics and general medicine. She graduated from Bogomolets National Medical University in Kyiv and completed her paediatric internship at the P.L. Shupyk National Medical Academy of Postgraduate Education. After working as a paediatrician in Kyiv, she relocated to Spain, where she has been practising general medicine since 2015, providing care for both adults and children.

Her work focuses on urgent, short-term medical concerns – situations where patients need quick guidance, symptom assessment and clear next steps. She helps people understand whether their symptoms require in-person evaluation, home management or a change in treatment. Common reasons for booking an online consultation include:

  • acute respiratory symptoms (cough, sore throat, runny nose, fever)
  • viral illnesses such as colds and seasonal infections
  • gastrointestinal complaints (nausea, diarrhoea, abdominal pain, gastroenteritis)
  • sudden changes in how a child or adult feels
  • questions about existing treatment and whether adjustments are needed
  • renewal of prescriptions when clinically appropriate
Dr. Shalko works specifically with urgent and short-term problems, providing practical recommendations and helping patients determine the safest next step. She explains symptoms clearly, guides patients through decision-making and offers straightforward medical advice for everyday acute issues.

She does not provide long-term management of chronic conditions, ongoing follow-up or comprehensive care plans for complex long-term illnesses. Her consultations are designed for acute symptoms, sudden concerns and situations where timely medical input is important.

With clinical experience in both paediatrics and general medicine, Dr. Shalko confidently supports adults and children. Her communication style is clear, simple and reassuring, helping patients feel informed and supported throughout the consultation.

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Doctor

Iryna Reznychenko

Gynecology25 years of experience

Dr Iryna Reznychenko is an obstetrician-gynaecologist, paediatric gynaecologist, and certified lactation consultant. She provides online consultations for women at all stages of life – from adolescence to menopause. Her work combines medical care for gynaecological conditions with dedicated support for breastfeeding challenges, both physical and emotional.

Areas of expertise:

  • interpretation of test results and personalised treatment planning
  • menstrual irregularities, PCOS, endometriosis
  • abnormal uterine bleeding, endometrial hyperplasia, cervical dysplasia
  • care during perimenopause and menopause, hormonal balance, cancer prevention
  • breastfeeding issues: nipple pain, cracked skin, blocked ducts, low milk supply
  • support during the postpartum and lactation period
Dr Reznychenko offers a clear, attentive and professional approach. Her consultations help prevent minor discomforts from developing into more serious concerns – all in a convenient online format.
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Doctor

Roman Raevskii

General medicine6 years of experience

Dr. Roman Raevskii is a licensed general practitioner in Spain, offering online medical consultations with a strong focus on prevention, early diagnosis, and personalized care. He combines evidence-based clinical expertise with a patient-centered approach to deliver comprehensive support.

Dr. Raevskii provides medical care in the following areas:

  • Diagnosis and management of common conditions: hypertension, diabetes, respiratory and digestive disorders.
  • Oncological consultations: early cancer detection, risk evaluation, and treatment navigation.
  • Supportive care for oncology patients – pain control, symptom relief, and side effect management.
  • Preventive medicine and health screenings.
  • Development of tailored treatment plans based on clinical guidelines.

With a patient-centred approach, Dr. Raevskii helps individuals manage both chronic illnesses and complex oncological cases. His consultations are guided by current medical standards and adapted to each patient’s needs.

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Doctor

Nuno Tavares Lopes

Family medicine17 years of experience

Dr. Nuno Tavares Lopes is a licensed physician in Portugal with 17 years of experience in emergency medicine, family and general practice, and public health. He is the Director of Medical and Public Health Services at an international healthcare network and serves as an external consultant for the WHO and ECDC.

  • Emergency care: infections, fever, chest/abdominal pain, minor injuries, paediatric emergencies
  • Family medicine: hypertension, diabetes, cholesterol, chronic disease management
  • Travel medicine: pre-travel advice, vaccinations, fit-to-fly certificates, travel-related illnesses
  • Sexual and reproductive health: PrEP, STD prevention, counselling, treatment
  • Weight management and wellness: personalised weight loss programmes, lifestyle guidance
  • Skin and ENT issues: acne, eczema, allergies, rashes, sore throat, sinusitis
  • Pain management: acute and chronic pain, post-surgical care
  • Public health: prevention, health screenings, long-term monitoring
  • Sick leave (Baixa médica) connected to Segurança Social in Portugal
  • IMT medical certificates for driving licence exchange
Dr. Nuno Tavares Lopes provides medical support for patients using GLP-1 medications (Mounjaro, Wegovy, Ozempic, Rybelsus) as part of a weight loss strategy. He offers individualised treatment planning, regular follow-up, dose adjustment, and advice on combining medication with sustainable lifestyle changes. Consultations follow the medical standards accepted in Europe.

Dr. Lopes also provides interpretation of medical tests, follow-up care for complex patients, and multilingual support. Whether for urgent concerns or long-term care, he helps patients act with clarity and confidence.

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Doctor

Duarte Meneses

Family medicine4 years of experience

Dr. Duarte Meneses is a licensed family medicine and general practice doctor based in Portugal, with additional expertise in occupational health. He provides online consultations for adults, offering medical support for both acute symptoms and chronic health conditions.

  • Common symptoms such as fever, sore throat, cough, fatigue, or digestive issues
  • Chronic conditions including hypertension, diabetes, high cholesterol, and thyroid problems
  • Mental health concerns such as stress, sleep issues, anxiety, and burnout
  • Preventive care: health check-ups, lifestyle advice, and follow-up for existing conditions
  • Work-related health questions, sick leave documentation, and medical guidance for returning to work
Dr. Meneses graduated from the University of Beira Interior and has years of experience working with diverse patient populations. He is fluent in Portuguese, English, Spanish, and French.

His approach is friendly, clear, and focused on delivering practical medical advice tailored to each patient’s needs.

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