Emergency Premedication for Patients with History of Contrast Allergy

The ACR Manual on Contrast Media [1] recommends the following options for premedication in the acute setting in patients undergoing planned contrast enhanced imaging procedure (e.g. CT Pulmonary Angiogram). Options #1 or #2 should be used in all Emergency Department situations unless there is an extreme urgency.

IV steroids have not been shown to be effective when administered less than 4 to 6 hours prior to contrast injection

Emergency Premedication

In Decreasing Order of Desirability

  1. Methylprednisolone sodium succinate (Solu-Medrol®) 200 mg intravenously every 4 hours (q4h) until contrast study required plus diphenhydramine 50 mg IV 1 hour prior to contrast injection [35].
  2. Dexamethasone sodium sulfate (Decadron®) 7.5 mg or betamethasone 6.0 mg intravenously q4h until contrast study must be done in patent with known allergy to methylpred-nisolone, aspirin, or non-steroidal anti-inflammatory drugs, especially if asthmatic. Also diphenhydramine 50 mg IV 1hour prior to contrast injection.
  3. Omit steroids entirely and give diphenhydramine 50 mg IV.