Specific Recommended Premedication Regimens
Several premedication regimens have been proposed to reduce the frequency and/or severity of reactions
to contrast media.
Elective Premedication
Two frequently used regimens are:
1. Prednisone – 50 mg by mouth at 13 hours, 7 hours, and 1 hour before contrast media injection, plus
Diphenhydramine (Benadryl ® ) – 50 mg intravenously, intramuscularly, or by mouth 1 hour before
contrast medium [12].
or
2. Methylprednisolone (Medrol ® ) – 32 mg by mouth 12 hours and 2 hours before contrast media
injection. An anti-histamine (as in option 1) can also be added to this regimen injection [34].
If the patient is unable to take oral medication, 200 mg of hydrocortisone intravenously may be
substituted for oral prednisone in the Greenberger protocol [35].
Emergency Premedication
(In Decreasing Order of Desirability)
1. Methylprednisolone sodium succinate (Solu-Medrol ® ) 40 mg or hydrocortisone sodium succinate
(Solu-Cortef ® ) 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 1
hour prior to contrast injection.
3. Omit steroids entirely and give diphenhydramine 50 mg IV.
Note: IV steroids have not been shown to be effective when administered less than 4 to 6 hours prior
to contrast injection.
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Also a good read on preceding pages regarding allergies and the uselessness of asking about shellfish.