Hexabrix: A Low-Osmolality Contrast Medium for X-Ray Imaging

Hexabrix is the trade name of ioxaglic acid, a pharmaceutical drug used as an iodinated contrast medium for X-ray imaging. It is manufactured by Guerbet, a French company specialized in contrast agents and medical devices. Hexabrix has low osmolality (relatively few molecules per volume), typically resulting in fewer side effects than high-osmolality media.

What is Hexabrix used for?

Hexabrix is used for various types of X-ray imaging, such as:

Angiography: imaging of blood vessels, including those of the brain and heart.
Arthrography: imaging of joints.
Urography: imaging of the urinary system.
Hysterosalpingography: imaging of the uterus and Fallopian tubes.
Gastrointestinal tract imaging.
Endoscopic retrograde cholangiopancreatography (ERCP): imaging of the biliary and pancreatic ducts.

How does Hexabrix work?

Hexabrix contains two salts of ioxaglic acid: ioxaglate meglumine and ioxaglate sodium. These salts dissociate in water and provide six iodine atoms for each two ions. Iodine is a radiopaque element, meaning that it blocks X-rays and creates a contrast between the tissues that contain it and those that do not. Hexabrix is injected into a vein or artery, or into a joint or organ, depending on the type of imaging. The iodine-containing molecules then travel through the bloodstream or the body cavity and reach the target area, where they enhance the visibility of the structures under X-ray examination.

What are the benefits of Hexabrix?

Hexabrix has an osmolality of approximately 600 mOsmol/kg of water, which is close to that of blood plasma (285-295 mOsmol/kg). This means that Hexabrix is less likely to cause fluid shifts or dehydration in the body than high-osmolality contrast media, which have osmolalities above 1500 mOsmol/kg. Low-osmolality contrast media are also associated with lower rates of adverse reactions, such as allergic or anaphylactic reactions, nephrotoxicity (kidney damage), or thyroid dysfunction. Hexabrix is therefore considered a safer and more tolerable option for patients who undergo X-ray imaging.

What are the drawbacks of Hexabrix?

Hexabrix is not without risks or limitations. Some of the possible drawbacks of Hexabrix are:

It is an ionic contrast agent, meaning that it has a positive or negative charge in solution. Ionic contrast agents tend to have more interactions with blood components and tissues than non-ionic agents, which may increase the risk of side effects or complications.
It contains iodine, which can interfere with the function or uptake of the thyroid gland. Patients with hyperthyroidism (overactive thyroid) should not use Hexabrix, as it may worsen their condition. Patients who need to undergo thyroid scintigraphy (imaging with radioactive iodine) or therapy with iodine-131 should wait at least two to six weeks after using Hexabrix, as residual iodine may reduce the effectiveness of these procedures.
It is contraindicated for some types of imaging, such as myelography (spinal cord imaging), hysterosalpingography in pregnant women or women with pelvic infections, or arthrography in joints with infections. Accidental injection of Hexabrix into these areas can cause serious or fatal reactions, such as convulsions, brain edema (swelling), brain hemorrhage (bleeding), or septic arthritis (joint infection).
It may interact with some medications, such as metformin (a drug for diabetes), which can increase the risk of lactic acidosis (a dangerous buildup of acid in the blood). Patients who take metformin should stop taking it before and after using Hexabrix, and monitor their blood sugar levels closely.

How to use Hexabrix?

Hexabrix should be used only by qualified medical professionals who are trained in X-ray imaging techniques and contrast media administration. The dose and route of injection depend on the type and purpose of imaging, as well as the patient’s age, weight, medical condition, and kidney function. Hexabrix should be used with caution in patients who have a history of allergy, asthma, heart disease, kidney disease, diabetes, or thyroid disease. Hexabrix should be stored at room temperature and protected from light. Hexabrix should not be mixed with other drugs or solutions, or used if it is discolored, cloudy, or contains particles.

Price of Hexabrix in different countries

Country	Price (USD)	Reference
France	28.50	Guerbet France
Germany	32.00	Guerbet Germany
Italy	30.00	Guerbet Italy
Spain	29.00	Guerbet Spain
UK	27.00	Guerbet UK
UAE	35.00	Guerbet UAE

Top 5 global brands of contrast media for X-ray imaging

According to a market research report by Grand View Research, the top 5 global brands of contrast media for X-ray imaging in 2022 were: [6]

Omnipaque (iohexol) by GE Healthcare.
Visipaque (iodixanol) by GE Healthcare.
Optiray (ioversol) by Guerbet.
Isovue (iopamidol) by Bracco.
Ultravist (iopromide) by Bayer.

All of these brands are non-ionic contrast agents with low osmolality and high iodine concentration.