The side effects such as decrease in cardiac activity, renal toxicity, vascular pain and possible allergic reactions are inherent to most contrast agents used in angiography. To reduce these side reactions low-osmolarity ionic or non-ionic contrast agents became available nowadays. ´It is evident that these new agents have much less side effects, but their other pharmacologic properties are not fully investigated yet. One of the properties concerning with angiography is the compatibility with other drugs used simultaneously such as Epinephrine, Papaverine, Lidocaine or Heparin etc.
Hexabrix is one of the low-osmolarity ionic contast agents widely used in angiography recently. Papaverine is used as a vasodilator in pudendal and peripheral arteriography. Pilla et al. (1986) have reported an incompatibility of Hexabrix and Papaverine: mixture of the two agents caused formation of white amorphous precipitate in vitro. They warned its use caused_ thrombotic obstruction in angiography.
Y The author performed experimental studies of the incompatibility of serveral contrast media (Hex-
abrix, Conr.aY´ Telebrix, Urografin RaYvist, Angiografin HYPaque, Amipaque Ultravist, Om-
:rr nipaque and Isovist) with pharmacologic agents (Papaverine, Epinephrine; Cimetidine, Lidocaine,
x= Heparin and Vasopressin) in vitro. Focusing the incompatibility of Hexabrix and Papaverine the
author performed the experimental study with. both agents in vitro and in vivo. The results were as follows:
1. In vitro study
(1) Mixing of 1 ml (30 :mg) of Papaverine with 5 ml of Hexabrix resulted in dense precipitation.
(2) Mixing of 1 ml of Papaverine with 5 ml of Hexabrix diluted in 10 ml of normal saline resulted in suspension but cleared immediately.
r (3) Mixing of 2 ml (60 mg) of Papaverine with 5 ml of Hexabrix diluted in 10 ml of normal
14..´ L, t saline resulted in small-precipitation but cleared immediately
(4) Mixing of 2 ml of Papaverine with 5 ml of Hexabrix diluted in 20 ml of normal saline resulted k " in suspension but cleared immediately.
;.
(5) Mixing of 1 ml´ of Papaverine with 5 ml of Urografin or. Hypaque resulted in late precipitation.
(6) Mixing of 1 ml of Cimetidine with 5 ml of Hexabrix resulted in threadlike precipitation (7) Mixing of 1 ml of Epinephrine, Lidocaine, Heparin or Vasopressin with 5´ ml of Conray,
Telebrix; Urografin., Rayvist, Angiografin, Hypaque, Hexabrix, Amipaque, Ultravist, Om-
nipaque or Isovist no precipitation resulted.
2. In vivo study
. 3 types of angiogram were performed 25 times in a dog.
(1) Baseline angiogram :was- performed with - Hexabrix. _
(2) Angiogram of following sequence (catheter flush with normal saline-injection of 2 ml of
Papaverine - catheter flush - injection of Hexabrix) was performed. v
(3) Angiogram of following sequence (injection of precipitate from Hexabrix and Papaverine
mixture-injection of Hexabrix) was performed. E
None showed-any evidence of arterial occlusion.
Though precipitates were formed by mixing of Papaverine and Hexabrix in high concentration
in vitro, they did not cause intraarterial occlusion in vivo study. But´ catheter flush with normal
saline between injection were recommended for possible arterial occlusion.
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