Contrast Media Pre Medication

Non-emergent Pre-medication

• Methylprednisolone 32mg PO at 12 hours and 2 hours before contrast injection, plus diphenhydramine (Benadryl®) 50 mg PO/IV/IM 1 hour before contrast injection.
• Note: If oral medications cannot be taken, hydrocortisone 200 mg IV may be substituted for oral prednisone and given 4 – 6 hours before contrast injection Diphenhydramine 50 mg IV should also be administered 1 hour before contrast injection

Emergent Pre-medication (In Decreasing Order of Desirability)

• Methylprednisolone sodium succinate (Solu-Medrol®) 40 mg IV or hydrocortisone sodium succinate (Solu-Cortef®) 200 mg IV 4 – 6 hours before contrast injection, plus diphenhydramine 50 mg IV 1 hour before contrast injection.
• Dexamethasone sodium sulfate (Decadron®) 7.5 mg IV or betamethasone 6 mg IV 4 – 6 hours before contrast injection if there is a known allergy to methylprednisolone, aspirin, or non-steroidal anti-inflammatory drugs, especially if asthmatic. Diphenhydramine 50 mg IV should also be administered 1 hour before contrast injection.
• If the scan must be performed immediately, give diphenhydramine 50 mg IV. IV steroids have not been shown to be effective when administered less than 4 – 6 hours prior to contrast injection.
• Note: Diphenhydramine should not be given to a hypotensive patient.

References:

1. Committee on Drugs and Contrast Media of the American College of Radiology. Manual on Contrast Media, Version 9.0