Concomitant drugs with exposure to contrast media

The increasing number of radiological procedures performed in old patients with high co-morbidity may be one of the problems physicians have to deal with when regarding the increasing number of acute renal failures. A key question when addressing the patients scheduled to receive iodinated contrast media (CM) is which concomitant medications prescribed to the patient are potentially harmful or helpful in terms of the risk of contrast-induced nephropathy. This overview summarizes the knowledge of concomitant medications in the setting of CM application and gives suggestion for prescription. In general, due to the unique (yet not fully understood and of high complexity) mechanism of renal damage proposed for a variety of nephrotoxic drugs including CM, physicians should carefully monitor patients' renal function and hydration status whenever concomitant nephrototoxic drugs are used. Recommendations are to monitor kidney function with more sensitive measurements of glomerular filtration rate (i.e. cystatin C).