What is the prophylaxis regimen against anaphylactic reactions to radiocontrast media?

Updated: May 16, 2018
  • Author: S Shahzad Mustafa, MD; Chief Editor: Michael A Kaliner, MD  more...
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Prophylaxis for IgE-independent anaphylactic reactions to radiocontrast media involves prednisone (or hydrocortisone), diphenhydramine, and possibly ranitidine (or another H2 antihistamine), and/or the use of a different contrast agent.

Administer prednisone (50 mg PO) or hydrocortisone (200 mg IV) at 13, 7, and 1 hour before the radiocontrast procedure.

Administer diphenhydramine (50 mg PO/IV) and ranitidine (150 mg PO or 50 mg IV) with or without ephedrine (25 mg PO) 1 hour before the procedure. Ephedrine should not be used in patients with hypertension, coronary artery disease (CAD), a strong family history of CAD (for older patients), arrhythmia, thyrotoxicosis, monoamine oxidase inhibitor use, or porphyria.

Select a radiocontrast agent with lower osmolarity.

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