Anaphylactoid and anaphylactic reactions with cardiovascular, respiratory, and/or cutaneous manifestations rarely resulting in death have occurred. The risk of hypersensitivity reactions is higher in patients with a history of reaction to contrast media, bronchial asthma, or allergic disorders. Hypersensitivity reactions can occur with or without prior exposure to GBCAs.
Have appropriately trained personnel administer Magnevist in a facility that has immediate availability of resuscitative equipment. If a hypersensitivity reaction occurs, stop Magnevist injection and immediately begin appropriate therapy.
Observe closely patients with a history of drug reactions, allergy, or other hypersensitivity disorders, during and up to several hours after Magnevist injection.
In patients with renal impairment, acute renal failure (acute kidney injury) requiring dialysis or worsening renal function has occurred, mostly within 48 hours of Magnevist injection. The risk of acute renal failure is higher with increasing dose of contrast. Use the lowest possible dose, evaluate renal function in patients with renal impairment, and allow sufficient time for contrast elimination before re-administration. Elimination half-life in patients with mild or moderate renal impairment is 3 to 4 hours. Elimination half-life in patients with severe renal impairment is about 11 hours. Magnevist is cleared by glomerular filtration and is dialyzable. After 3 dialysis sessions of 3 hours each, about 97% of the administered dose is eliminated from the body; each dialysis session removes about 70% of the circulating drug [see Clinical Pharmacology (12.3)].
Skin and soft tissue necrosis, thrombosis, fasciitis, and compartment syndrome requiring surgical intervention (e.g. compartment release or amputation) have occurred very rarely at the site of contrast injection or the dosed limb. Total volume and rate of Magnevist injection, extravasation of contrast agent, and patient susceptibility might contribute to these reactions. Phlebitis and thrombophlebitis may be observed generally within 24 hours after Magnevist injection and resolve with supportive treatment. Determine the patency and integrity of the intravenous line before administration of Magnevist injection. Assessment of the dosed limb for the development of injection site reactions is recommended.
As with any paramagnetic contrast agent, Magnevist injection might impair the visualization of lesions seen on non-contrast MRI. Therefore, caution should be exercised when Magnevist MRI scans are interpreted without a companion non-contrast MRI scan.
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The mean age of the 1272 patients who received Magnevist injection in pre-market clinical trials was 46.4 years (range 2 to 93 years). Of these patients, 55% (700) were male and 45% (572) were female. Of the 1271 patients who received Magnevist injection and for whom race was reported, 82.1% (1043) were Caucasian, 9.7% (123) were Black, 5.3% (67) were Hispanic, 2.1% (27) were Oriental/Asian, and 0.9% (11) were other.
The most common adverse reaction was headache (4.8%). The majority of headaches were transient and of mild to moderate severity. Other adverse reactions that occurred in ≥ 1% of patients included: nausea (2.7%), injection site coldness/localized coldness (2.3%) and dizziness (1%).
The following additional adverse reactions occurred in less than 1% of the patients:
General Disorders: Injection site reactions, including phlebitis, pain, localized warmth, localized edema, and burning sensation [see Warnings and Precautions (5.5)]. Substernal chest pain, back pain, pyrexia, asthenia, feeling cold, generalized warmth, fatigue, and chest tightness, and anaphylactoid reactions characterized by cardiovascular, respiratory and/or cutaneous symptoms, such as dyspnea, bronchospasm, and cough.
Cardiovascular: Hypotension, hypertension, tachycardia, migraine, syncope, vasodilatation, pallor.
Gastrointestinal: Abdominal discomfort, teeth pain, increased salivation, abdominal pain, vomiting, diarrhea.
Nervous System: Agitation, anxiety, thirst, somnolence, diplopia, loss of consciousness, convulsions (including grand mal), paresthesia.
Respiratory System: Throat irritation, rhinitis, sneezing.
Skin: Rash, sweating (hyperhidrosis), pruritus, urticaria (hives), facial edema.
Special Senses: Conjunctivitis, taste abnormality, dry mouth, lacrimation, eye irritation, eye pain, ear pain.
The following additional adverse reactions have been identified during postmarketing use of Gadopentetate dimeglumine. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
- Anaphylactic shock, respiratory distress, and laryngeal edema [see Warnings and Precautions (5.2)]
- Cardiac/respiratory arrest, shock
- Nephrogenic systemic fibrosis [see Warnings and Precautions (5.1)]
- General Disorders and Administrations Site Conditions: Adverse events with variable onset and duration have been reported after GBCA administration [see Warnings and Precautions (5.3)]. These include fatigue, asthenia, pain syndromes, and heterogeneous clusters of symptoms in the neurological, cutaneous, and musculoskeletal systems.
- Skin: Gadolinium associated plaques
The most frequently reported adverse reactions in the postmarketing experience were nausea, vomiting, urticaria, and rash.
General Disorders and Administration Site Conditions: Nephrogenic systemic fibrosis [see Warnings and Precautions (5.1)] , body temperature decreased, tremor, shivering (chills), injection site reactions including skin and soft tissue necrosis.
Hypersensitivity Reactions: Anaphylactic/anaphylactoid reactions that may be fatal and include cardiac or respiratory arrest, respiratory distress, cyanosis, laryngeal edema, laryngospasm, pharyngeal edema, and angioedema [see Warnings and Precautions (5.2)].
Delayed hypersensitivity reactions have been reported up to several hours after administration of Gadopentetate dimeglumine.
Renal and Urinary: Acute renal failure, worsening renal impairment [see Warnings and Precautions (5.4)] urinary incontinence, urinary urgency.
Vascular: Thrombophlebitis, deep vein thrombophlebitis, compartment syndrome requiring surgical intervention.
Cardiac: Cardiac arrest, heart rate decreased, arrhythmia.
Ear and Labyrinth Disorders: Hearing impairment.
Eye Disorders: Visual disturbance.
Musculoskeletal and Connective Tissue Disorder: Arthralgia.
Nervous System Disorders: Coma, parosmia, speech disorder.
Respiratory System: Respiratory arrest, pulmonary edema.
Skin: Erythema multiforme, pustules
There are no known drug interactions. Magnevist does not interfere with serum and plasma calcium measurements determined by colorimetric assays.
GBCAs cross the placenta and result in fetal exposure and gadolinium retention. The human data on the association between GBCAs and adverse fetal outcomes are limited and inconclusive (see Data).
In animal reproduction studies, repeated intravenous dosing of gadopentetate dimeglumine during organogenesis resulted in delayed fetal development in pregnant rats and rabbits at doses 2 times and 2.4 times, respectively, the recommended human dose (based on body surface area [BSA]). No teratogenic effects were observed in rats or rabbits at doses 7.3 times (rats) and 9.7 times (rabbits) the recommended human dose, based on BSA (see Data). Because of the potential risks of gadolinium to the fetus, use Magnevist only if imaging is essential during pregnancy and cannot be delayed.
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and is 15 to 20%, respectively.
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