Drug Functionality:
Gadolinium based contrast agents (GBCA) are used in any diagnostic imaging procedures to enhance the quality of MRI of MRA in order to visualize lesions with abnormal vascularity in brain, spine and associated tissues. They can also be used to visualize those lesions that are likely to cause abnormalities in the blood- brain barrier in brain, spine or any other associated tissue.

In other words gadolinium is a paramagnetic metal ion, which moves differently within a magnetic field. It is this property of gadolinium which makes it an useful contrasting agent to be used in MRIs or MRAs. Gadolinium can form a stable complex with large organic molecules around it. This procedure is called the chelating procedure and GBCAs are prepared using this methodology. Exposure to gadolinium can result in toxicity, and it is the chelate that is used to minimize the same. Kidneys are the main organs responsible for getting rid of this component from the body.

Forms of Gadolinium:

Gadolinium is available in the form of intravenous injections. The five GBCAs existing in the market are:

  1. Magnevist
  2. MultiHance
  3. Omniscan
  4. OptiMark
  5. ProHance

Precautions:

GBCAs are known to cause nephrogenic systemic fibrosis (NSF) along with kidney dysfunction. It is also important to know that GBCAs can cause NSF in patients who are:

  • Suffering from acute kidney injury or kidney disease or
  • Have been administered higher than the recommended dose or
  • Have been administered repeated dose of GBCA or had an impaired elimination of the drug.

Healthcare Professionals need to take care of the following aspects while using GBCAs:

  1. Magnevist, Omniscan and OptiMark are not to be used in patients suffering from AKI or chronic kidney ailments as these three drugs are contraindicated with this pool of patients.
  2. Patients should be examined thoroughly using their clinical history, before administering GBCA to rule out the ones suffering from any kind of kidney disorder, as these are at high risk of developing NSF.
  3. GBCAs should be avoided in patients suspected or known to have impaired drug elimination. In cases like these, GBCA should be used only and only when the diagnostic information is inevitable and unavailable with any other non- contrasted MRI or any imaging modalities.
  4. If GBCA is administered to a patient known to have an history of impaired drug elimination, then the symptoms of NSF should be closely monitored.
  5. Only one GBCA should be administered per imaging session and should not be repeated during one single session.

Patients need to take care of the following aspects while using GBCAs

  1. The symptoms and signs of NSF should be well understood and should be monitored as though it is rare, it can happen with certain patients with kidney disease.
  2. In case you are already a kidney patient, and have been prescribed a contrast MRI or MRA, then the need of GBCA should be discussed with the health practitioner. After administration of the drug, if you experience:
    1. Burning, itching, swelling, scaling, hardening and tightening of skin
    2. Red or dark patches on the skin
    3. Stiffness in joints with trouble in moving
    4. Bending or straightening of the arms, legs or feet
    5. Pain in the hip bones or ribs
    6. Muscle weakness

Then contact the doctor and seek medical help at once.