Gadopentetate dimeglumine for injection (Magnevist), a complex of gadolinium with a chelating agent, diethylenetriamine penta-acetic acid, is an ionic, paramagnetic contrast medium used to provide contrast enhancement during magnetic resonance imaging (MRI) of intracranial, spinal, head, neck, and body lesions with abnormal vascularity. Although original indications encompassed spinal and cranial MRI only, in 1990 the indications for the use of gadopentetate dimeglumine were expanded to the demonstration or exclusion of lesions throughout the body. Several other contrast agents are available in the US and other countries. Differences between the available agents include the chelating agent and physiochemical properties, such as osmolality, and whether or not the contrast is ionic. When used at FDA-approved dosages and indications, differences between the contrast agents with regards to efficacy and safety are not apparent; however differences in safety could become apparent (due to physiochemical property differences) when gadopentetate is used at higher doses, faster injection rates, and for off-label indications. Cases of nephrogenic systemic fibrosis (NSF) have prompted the FDA to request a boxed warning regarding the use of gadolinium-based contrast agents in those with renal insufficiency. NSF has been reported with all currently marketed gadolinium-based contrast agents; however due to a variety of factors, the FDA is unable to determine which agents, if any, pose more risk. The FDA approved gadopentetate dimeglumine in June 1988.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
NOTE: Hypersensitivity reactions may occur. Epinephrine, antihistamines, and corticosteroids should be on hand for immediate treatment.
Route-Specific Administration
Injectable Administration
-Visually inspect solution for particulate matter and discoloration prior to administration. Do not use the solution if it is discolored or if particulate matter is present. Do not use if container has been damaged or protective seal broken.
Intravenous Administration
-The imaging procedure should be completed within 1 hour of injection of gadopentetate dimeglumine.
-Usual safety rules customary for magnetic resonance imaging (e.g., exclusion of cardiac pacemakers and ferromagnetic implants) must be observed.
-Administer as single intravenous injection. The rate of administration should not exceed 10 mL per 15 seconds.
-To ensure complete injection of the contrast medium, the injection should be followed by a 5 mL normal saline flush.
-Data for repeat injections are not available. If, in the clinical judgment of the physician, sequential or repeat examinations are required, a suitable interval of time between administrations should be observed to allow for normal clearance of the drug from the body.
-When gadopentetate dimeglumine is to be injected using a plastic disposable syringe, the contrast medium should be drawn into the syringe and used immediately.
-The product contains no antimicrobial preservatives. Discard all unused product. Discard any unused portion in accordance with regulations dealing with the disposal of such materials.
-When using the 100 mL Pharmacy Bulk Package, the contents should be used within 12 hours after the initial puncture. After 12 hours, any unused portion should be discarded.
-If nondisposable equipment is used, scrupulous care should be taken to prevent residual contamination with traces of cleansing agents.
Elevations in serum creatinine and acute renal failure (unspecified) have been reported when gadopentetate is administered to patients with renal impairment or renal failure. Most cases have occurred within 48 hours of administration and appear to be dose-related. In addition, cases of nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy) (NSF/NFD) have been reported in patients with moderate to severe renal impairment after receiving a gadolinium-based contrast agent. The NSF/NFD began 2 days to 18 months after the gadolinium-based contrast agent administration, and many patients received higher than recommended doses of the contrast agent. Postmarketing reports have included acute renal failure (unspecified), worsening renal impairment, urinary incontinence, urinary urgency, and have identified the development of NSF/NFD after single or multiple doses of gadolinium contrast agents. A specific agent was not always identified; however, gadodiamide (Omniscan) followed by gadopentetate (Magnevist) have been most commonly reported. In one retrospective study of 370 patients with severe renal insufficiency, the estimated risk for NSF/NFD was 4%. In a report by the CDC, a case-control study from a single hospital in St. Louis, Missouri found that the risk of NSF/NFD is higher in patients undergoing peritoneal dialysis compared to hemodialysis (estimated 4.6 cases/100 peritoneal dialysis patients vs. 0.61 cases/100 hemodialysis patients). The mechanism of NSF/NFD in patients receiving gadolinium-containing contrast agents is unknown; however, dissociation of gadolinium from its chelating agent after intravenous injection leading to a fibrotic reaction is hypothesized. NFD is characterized by burning, itching, swelling, scaling, tightening, and hardening of the skin, red or dark patches on the skin, stiffness in joints, resulting in trouble moving, straightening or bending the arms, legs or feet; muscle weakness, pain in hip bones or ribs. NSF involves fibrosis of organs (e.g., heart, liver, lungs) and can lead to death. Diagnosis of NSF/NFD is confirmed by skin biopsy. Patients at risk for NSF due to exposure to gadolinium-based contrast agents include certain patients with renal insufficiency and those receiving higher than recommended doses of the contrast agent. Although the efficacy of the use of hemodialysis for the prevention of NSF/NFD is unknown, for patients receiving hemodialysis, healthcare providers may consider prompt initiation of hemodialysis following the administration of gadolinium-based contrast agents to aid in the elimination of the agent from the body. Hemodialysis is preferred to peritoneal dialysis as available data indicate that continuous ambulatory peritoneal dialysis may not be as efficient as hemodialysis in eliminating gadolinium-containing contrast agents. Treatment options for NSF/NFD are minimal; patients should be enrolled in physical therapy programs. Limited data in support of plasmapheresis or photopheresis are promising.
The most commonly noted adverse reaction of gadopentetate is headache, with an incidence of 4.8%. The majority of headaches are transient and of mild to moderate severity. Migraine headaches were reported in < 1% of patients. Dizziness has been reported in 1% of patients. Seizures (including grand mal) have been reported, rarely, and tend to occur most often in patients with a history of seizure disorder. Central nervous system related adverse effects that were reported in < 1% of patients include agitation, anxiety, drowsiness, fever, paresthesias, loss of consciousness, and thirst. There have been post-marketing reports of coma, arthralgia, tremor, chills, shivering, and decreased body temperature.
Per the manufacturer, the incidence of nausea in clinical trials is 2.7%,; vomiting occurred in < 1%. In general, iodinated contrast agents that have the highest osmolality tend to be associated with the highest incidence of nausea; it is possible that this theory may apply to gadolinium-containing contrast media. Theoretically, then, gadopentetate may have a higher incidence of nausea (due to its higher osmolality) when compared to other gadolinium-containing contrast agents; however, data from clinical trials of the gadolinium-containing contrast media do not support this theory. Nausea may also be related to injection rate as the incidence of nausea is usually decreased by slowing the rate of injection. In general, bolus injections were not studied during clinical trials of the gadolinium-containing contrast agents and gadopentetate is not FDA-approved for bolus injection. While the incidence of nausea is similar between all of the gadolinium-containing contrast media when used at FDA-approved injection rates and doses, gadopentetate may be associated with more nausea due to its physiochemical properties if power injectors or faster injection rates are used.
Dysgeusia, sometimes described as a sweet taste, may be experienced by patients receiving gadopentetate (< 1%), especially by bolus injection. Other gastrointestinal related adverse effects reported in fewer than 1% of patients include abdominal pain and discomfort, diarrhea, hypersalivation, and tooth or dental pain.
An injection site reaction, described as cold or localized coldness, occurred at a rate of 2.3% in clinical trials. Other symptoms included localized warmth, localized edema, pain, and burning sensation. In animal models, gadopentetate caused the greatest tissue damage when extravasation occurred compared to other gadolinium-containing contrast media. It should be noted that gadopentetate has the highest osmolality of the gadolinium-containing contrast media available in the US and such findings are expected. Phlebitis and thrombophlebitis have been reported (< 1%) and generally occur within 24 hours of injection. In most cases, the symptoms appeared during or shortly after injection and tended to respond to supportive treatment. Rarely, more severe symptoms such as skin necrosis, soft tissue necrosis, deep vein thrombosis, fasciitis, and compartment syndrome requiring surgical intervention have been reported. Total volume and rate of injection, extravasation of contrast agent, and patient susceptibility might contribute to these reactions. The patency and integrity of the intravenous line should be determined before administration. Assessment of the dosed limb for the development of injection site reactions is recommended.
Anaphylactoid reactions, characterized by cardiovascular, respiratory, and cutaneous symptoms, have been associated with the use of all gadolinium-containing contrast media, including gadopentetate. These reactions are uncommon and are rarely fatal, though when they are fatal they tend to include cardiac arrest, respiratory arrest, respiratory distress, cyanosis, laryngeal edema, laryngospasm, pharyngeal edema, and/or angioedema. Dyspnea, bronchospasm, and cough have also characteristic of anaphylactoid reactions. Delayed hypersensitivity reactions have been reported up to several hours after administration. Urticaria has been reported in < 1% of patients and is described as very few lesions (usually only 4 or 5) generally appearing 15-30 minutes after injection and resolving without therapy. Because the onset of urticaria can be delayed, it may occur more often than is reported. Other dermatologic reactions reported in < 1% of patients during clinical trials are rash (unspecified), sweating (hyperhidrosis), pruritus, and facial edema. Erythema multiforme and pustules have been reported post-marketing.
In clinical trials of 1272 patients who received gadopentetate injection, cardiovascular adverse reactions were reported. Hypotension, hypertension, sinus tachycardia, syncope, peripheral vasodilation, and pallor occurred in < 1% of patients. Cardiac arrest, decreased heart rate, and arrhythmia were reported post-marketing.
In clinical trials of 1272 patients who received gadopentetate injection, respiratory system adverse reactions were reported. Throat irritation, rhinitis, and sneezing occurred in < 1% of patients. Respiratory arrest and pulmonary edema were reported post-marketing.
In clinical trials of 1272 patients who received gadopentetate injection, various sensory, ophthalmic, and otic related adverse reactions were reported. Conjunctivitis, taste abnormality, xerostomia, lacrimation, ocular irritation, ocular pain, diplopia, nystagmus, and otalgia occurred in < 1% of patients. Hearing impairment, visual disturbance, speech disorder, and parosmia were reported post-marketing.
In clinical trials of 1272 patients who received gadopentetate injection, < 1% of patients reported asthenia, pain (unspecified), back pain, generalized warmth, feeling cold, fatigue, chest tightness, and substernal chest pain.
Diagnostic procedures that involve the use of contrast agents, such as gadopentetate, should be carried out under direction of a physician with the prerequisite training and a thorough knowledge of the procedure to be performed.
Diagnostic procedures that involve use of contrast agents, such as gadopentetate dimeglumine, should be carried out under direction of a physician with the prerequisite training and a thorough knowledge of the procedure to be performed. As with any paramagnetic contrast agent, use of gadopentetate dimeglumine during contrast enhanced magnetic resonance imaging (MRI) may impair visualization of lesions seen on non-contrast MRI. Caution must be used when contrast-enhanced imaging is interpreted without a companion non-contrast image. In addition, gadolinium deposits may remain in patients' bodies for months to years after gadolinium-based contrast agent (GBCA) receipt. Bone has been identified as the main reservoir, retaining the highest concentration of gadolinium (nanomoles per gram of tissue) for the longest duration of time. Other organs which retain lesser amounts of gadolinium include the brain, skin, kidney, liver, and spleen. The consequences of gadolinium retention in the brain have not been established; however, retention in the skin and kidney has been associated with pathologic clinical consequences in patients with impaired renal function. There are rare reports of pathologic skin changes in patients with normal renal function. Other patients who may be at higher risk for gadolinium retention include patients requiring multiple lifetime doses, pregnant women, pediatric patients, and patients with inflammatory conditions. Limit repeated GBCA imaging studies, particularly closely spaced MRI studies, but do not defer or avoid necessary GBCA MRI scans. When choosing a GBCA, consider the retention characteristics of each agent. In general, linear GBCAs result in more retention and retention for longer periods of time than do macrocyclic GBCAs. More specifically, at equivalent doses, use of gadodiamide or gadoversetamide results in higher gadolinium concentrations remaining in the body than gadoxetate disodium, gadopentetate dimeglumine, or gadobenate dimeglumine. Gadolinium concentrations in the body are lowest after administration of gadoterate meglumine, gadobutrol, and gadoteridol. Instruct patients to inform their health care professional about all medical conditions, including if pregnant or thinking about becoming pregnant, dates and numbers of any previous gadolinium-enhanced MRIs, and history of kidney problems.
Administration to patients with a history of severe hypersensitivity reactions to gadopentetate dimeglumine is contraindicated. The drug has been associated with serious, and sometimes fatal, anaphylactoid/anaphylactic reactions, with cardiovascular, respiratory, and/or cutaneous manifestations. Patients with a history of iodinated radiopaque contrast media hypersensitivity, atopy (including hay fever, food allergies, and drug allergies), or a history of asthma or other allergic respiratory disorders are at increased risk of these reactions. Standard policies and procedures to prevent allergic-type reactions in patients at risk are not available currently. At minimum, appropriate facilities should be available for coping with the emergency treatment of severe reactions to the contrast agent; patients at risk should be closely observed during the procedure and for several hours following drug administration. One group of authors, however, recommends taking similar precautions to those that are taken in patients who have previously reacted to iodinated radiopaque contrast media that require subsequent doses. First, the necessity of contrast enhancement during MRI should be determined. If it is determined that contrast enhancement outweighs any potential risk, the intensity of a previous reaction (to either iodinated or gadolinium-based contrast media) should guide precautionary measures. If the previous reaction to contrast media was mild or nonallergic, use of a different or low-osmolar (i.e., gadoteridol or gadodiamide) agent is recommended. If the previous reaction to contrast media was moderate or severe, premedication with steroids (e.g., for adults, prednisone 50 mg PO or equivalent 13, 7, and 1 hour prior to the exam ) and antihistamines (e.g., adult dose diphenhydramine 50 mg IM/PO one hour prior to the exam ) along with the use of a different or low-osmolar contrast agent is recommended.
Gadopentetate (Magnevist) is contraindicated in patients with renal failure, acute kidney injury, and in patients with chronic, severe renal disease (GFR < 30 mL/min/1.73 m2). Serious adverse reactions, including nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy) (NSF/NFD), have been reported in patients with renal impairment after receiving gadopentetate. Although rare, NSF may result in fatal or debilitating systemic fibrosis affecting the internal organs, muscle, and skin. Patients at highest risk for NSF after receiving gadopentetate are those with impaired elimination of the drug, including those with acute renal insufficiency of any severity due to hepato-renal syndrome or liver transplant in the perioperative period. Avoid use of gadopentetate in patients with impaired drug elimination unless the diagnostic information is essential and not available with non-contrasted MRI or other modalities. NSF has not been reported in patients with normal kidney function, but use of higher than recommended doses or repeated administration may increase the risk for NSF. Re-administration should occur only after a sufficient period of time has passed for elimination of the agent from the body. Gadopentetate is removed by hemodialysis. For patients receiving hemodialysis, it may be prudent to dialyze patients after receiving the contrast agents, although a relationship between dialysis and prevention of NSF has not been determined. Of note, hemodialysis is the preferred method of dialysis as continuous ambulatory peritoneal dialysis does not appear to be as effective in eliminating gadolinium-containing contrast media. All patients should be screened for evidence of renal dysfunction by obtaining a medical history and/or laboratory results prior to the administration of gadolinium-based contrast agents. Acute kidney injury occurs commonly after surgery, severe infection, injury, or drug-induced kidney toxicity. In patients with acute kidney injury, serum creatinine concentrations and estimated GFR may not reliably assess renal function; therefore, obtaining a medical history in these patients is of utmost importance. For patients at risk of chronic renal disease (e.g., patients with hypertension, diabetes mellitus, or geriatric patients [> 60 years of age]), estimate the GFR through laboratory testing. Tell patients about the signs and symptoms of NSF/NFD. Report possible cases of NSF to the FDA through the FDA Medwatch program.
Prior to gadopentetate injection, the patency and integrity of the intravenous line should be determined. Furthermore, appropriate surveillance of the dosing limb for the development of local injection site reactions is recommended. Care should be taken to avoid extravasation as significant tissue damage may occur. 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. Phlebitis and thrombophlebitis may be observed generally within 24 hours after injection and resolve with supportive treatment. In animal models, gadopentetate caused the greatest tissue damage when extravasation occurred compared to other gadolinium-containing contrast media. Such findings were expected as gadopentetate had the highest osmolality of the gadolinium-containing contrast media tested; similar to iodinated radiopaque contrast media, extravasation of high-osmolar contrast media may cause more damage when compared to low-osmolar contrast media. Extravasation of gadopentetate is not greatly appreciated as small doses and slow injection rates are traditionally used. Total volume and rate of injection, extravasation of contrast agent, and patient susceptibility contribute to these reactions.
Deoxygenated sickle erythrocytes have been shown in vitro to align perpendicular to a magnetic field which may result in vaso-occlusive complications in vivo. The enhancement of magnetic moment by gadolinium-based contrast agents (GBCAs), such as gadopentetate dimeglumine, may possibly potentiate sickle erythrocyte alignment. Although the use of gadopentetate dimeglumine in patients with sickle cell disease and other hemoglobinopathies has not been studied, the American College of Radiology (ACR) manual on contrast media considers any special risk to sickle cell patients from administration of GBCAs to be extremely low; no restrictions for use of GBCAs are recommended by the ACR.
Use gadopentetate dimeglumine during pregnancy only if imaging is essential and cannot be delayed. Gadolinium-based contrast agents (GBCAs) cross the placenta and result in fetal exposure and gadolinium retention. Pregnant women may be at greater risk for gadolinium retention. Data on the association between GBCAs and adverse fetal outcomes in human pregnancy are limited and inconclusive. In animal studies, retarded fetal development was observed following intravenous administration of gadopentetate dimeglumine to pregnant rats for 10 days at 2-times the human dose (based on body surface area) and when administered to pregnant rabbits for 13 days at 2.4-times the human dose. No congenital anomalies were noted in rats or rabbits. The American College of Radiology (ACR) manual on contrast media states that the drug crosses the human placenta when administered in clinical doses; however, the risk to the fetus is unknown. Therefore, the ACR advises against its routine use in pregnant women; the drug should only be administered during pregnancy if absolutely necessary and only after informed consent is obtained. The Guidelines for Computed Tomography and Magnetic Resonance Imaging in Pregnancy and Lactation states that because of the potential for fetal toxicity, the drug should only be used during pregnancy if deemed absolutely essential.
Gadopentetate dimeglumine is excreted in human milk. An analysis of 18 lactating women receiving 0.1 mmol/kg found 0.001% to 0.04% of the administered gadolinium was excreted into breast milk within 24 hours; for a 70-kg woman, this correlates to less than 3 micromoles of gadolinium. There is no information on the effects of gadopentetate dimeglumine on the breast-fed infant or milk production. Consider the benefits of breast-feeding along with the mother's clinical need for gadopentetate dimeglumine and any potential adverse effects on the breast-fed infant from gadopentetate dimeglumine or the underlying maternal condition. Previous American Academy of Pediatrics (AAP) recommendations considered gadolinium-based contrast agents (GBCAs) compatible with breast-feeding. Additionally, the Guidelines for Computed Tomography and Magnetic Resonance Imaging Use During Pregnancy and Lactation and the American College of Radiology (ACR) manual on contrast media state that lactating women receiving GBCAs can continue to breast-feed without interruption. The reasoning for this recommendation is based on estimates of limited systemic exposure in the breast-fed infant and reviews that conclude maternally administered drug poses no risk to the nursing infant.
Gadopentetate dimeglumine may be associated with reproductive risk due to male infertility. In animal studies, male rats receiving repeated injections (16 to 18 injections over 23 to 25 days) of gadopentetate dimeglumine at a dose 8-times the recommended human dose (based on body surface area) developed irreversible spermatogenic cell atrophy and degeneration. However, spermatogenesis was not affected in rats or dogs receiving repeated injections over 4 weeks at doses 4-times or 14-times, respectively, the recommended human dose (based on body surface area).
For use as contrast enhancement in magnetic resonance imaging (MRI) to visualize lesions with abnormal vascularity within the central nervous system (brain, spine, and associated tissues), head, neck, and body (excluding the heart):
Intravenous dosage:
Adults, including the Geriatric: 0.2 mL/kg (0.1 mmol/kg) given intravenously at a rate not to exceed 10 mL per 15 seconds. Doses in excess of 26 mL, for patients > 130 kg (or 286 pounds) has not been studied. Data for repeat injections are not available; however, if in the clinical judgment of the physician, sequential or repeat examinations are required, a suitable interval of time between administrations should be observed to allow for normal clearance of the drug from the body. In studies of CNS MRI, no difference in safety, imaging, or diagnosis was found between 0.1 mmol/kg and 0.3 mmol/kg.
Adolescents and Children >= 2 years of age: 0.2 mL/kg (0.1 mmol/kg) given intravenously at a rate not to exceed 10 mL per 15 seconds.
Children < 2 years: Safety and efficacy have not been established.
Maximum Dosage Limits:
-Adults
0.2 mL/kg (0.1 mmol/kg) IV.
-Geriatric
0.2 mL/kg (0.1 mmol/kg) IV.
-Adolescents
0.2 mL/kg (0.1 mmol/kg) IV.
-Children
>= 2 years: 0.2 mL/kg (0.1 mmol/kg) IV.
< 2 years: Safety and efficacy have not been established.
-Infants
Safety and efficacy have not been established.
-Neonates
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed. However, patients are advised to inform their provider of any liver disease prior to receiving gadopentetate.
Patients with Renal Impairment Dosing
GFR >= 30 mL/min/1.73 m2: No dosage adjustments are recommended; do not exceed recommended dose and allow sufficient time for elimination prior to any repeat administration. For patients at higher risk for renal side effects of contrast use.; avoid use unless the diagnostic information is essential and not available with non-contrast MRI or other modalities.
GFR < 30 mL/min/1.73 m2: Contraindicated. Includes patients with chronic severe kidney disease and acute kidney injury.
Intermittent hemodialysis
Gadopentetate is removed from the body by hemodialysis.
*non-FDA-approved indication
There are no drug interactions associated with Gadopentetate products.
Gadopentetate dimeglumine, a paramagnetic agent, is used to enhance lesion detection and characterization during magnetic resonance imaging (MRI). In magnetic resonance, the visualization of normal or pathological tissue depends on changes in the radiofrequency signal intensity that occur with: differences in proton density; differences of the spin-lattice or longitudinal relaxation time (T1); and differences in the spin-spin or transverse relaxation time (T2). Gadopentetate dimeglumine causes increased signal intensity by developing a magnetic moment when placed in a magnetic field. This magnetic moment enhances the relaxation rates of water protons, thereby shortening T1 and T2 in target tissues. When administered at recommended doses, the effects are primarily observed in the T1 relaxation time. Disruption of the blood-brain barrier or abnormal vascularity allows accumulation of the diagnostic agent in lesions such as neoplasms, abscesses, and subacute infarcts.
Gadopentetate dimeglumine injection is administered intravenously. The extent of protein binding and blood cell partitioning of gadopentetate dimeglumine is not known; the volume of distribution (266 +/- 43 mL/kg) is equal to that of extracellular water.
Gadopentetate dimeglumine is exclusively eliminated in the urine with (reported as mean +/- SD) 83 +/- 14% of the dose excreted within 6 hours, and 91 +/- 13% excreted within 24 hours post-injection. There was no detectable biotransformation or decomposition of gadopentetate dimeglumine. The mean elimination half-life (reported as mean +/- SD) was 1.6 +/- 0.13 hours. The urinary and plasma clearance rates (1.76 +/- 0.39 mL/min/kg and 1.94 +/- 0.28 mL/min/kg, respectively) of gadopentetate dimeglumine are essentially identical, indicating no alteration in elimination kinetics on passage through the kidneys and that the drug is essentially cleared through the kidney; furthermore, clearance is similar to that of substances which are subject to glomerular filtration.
-Route-Specific Pharmacokinetics
Intravenous Route
Human pharmacokinetic studies show that in normal subjects intravenously administered gadopentetate dimeglumine conforms to a two compartment open model with a mean distribution half-life (reported as mean +/- SD) of about 0.2 +/- 0.13 hours. Upon injection, the meglumine salt is completely dissociated from the gadopentetate dimeglumine complex.
-Special Populations
Renal Impairment
Since gadopentetate dimeglumine is cleared from the body by glomerular filtration, caution should be exercised in patients with impaired renal function. An alternate route of excretion frequently observed in patients with renal impairment receiving iodinated contrast media is the hepatobiliary enteric pathway, although this has not been demonstrated with gadopentetate dimeglumine injection as is evidenced by the absence of gadopentetate recovered in the feces. Gadopentetate is removed by hemodialysis; 97% of the injected dose is cleared after 15 hours of hemodialysis.