Which medications should be withdrawn prior to administration of contrast media (CM)?

Updated: Dec 18, 2018
  • Author: Anita Basu, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

If possible,potentially nephrotoxic drugs (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], aminoglycosides, amphotericin B, cyclosporine, tacrolimus) should be withdrawn in patients at risk (eGFR < 60 mL/min).

Metformin, though not nephrotoxic, should be used prudently, because if renal failure does occur, there is risk of concomitant lactic acidosis. Therefore, metformin should be stopped at the time of the procedure and resumed 48 hours later if renal function remains normal.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) cause a 10-15% rise in SCr by reducing intraglomerular pressure. While they should not be started at the time of CM use, current guidelines do not recommend stopping them if the patient is already on them.


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