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Gadolinium Side Effects

Gadolinium used in MRI contrast agents can cause side effects ranging from nausea to fatal thickening and scarring of connective tissue. The most common reactions occur almost immediately after injection and include headache and dizziness. Toxicity, nephrogenic systemic fibrosis (NSF) and gadolinium deposition disorder (GDD) are more serious and can happen months or years after undergoing an MRI scan.

The most common side effects of gadolinium-based contrast agents (GBCAs) are nausea, headache and dizziness, according to the drugs’ labels. Depending on the brand of drug used, people may also experience coldness at the injection site, taste perversion, widening of the blood vessels, or the sensation known as pins and needles.

A 2016 study in Magnetic Resonance Imaging found headaches, bone and nerve pain, and skin thickening were the most commonly reported reactions. In the study of 42 people with symptoms, brain fog and headaches lasted for more than three months in 29 people.

Vomiting can occur with less than 1 in 100 injections, according to Inside Radiology. Between 1 and 4 in 100 will notice nausea or a headache.

In addition, studies and adverse event reports submitted to the U.S. Food and Drug Administration link GBCAs to side effects that involve the skin and other organs. Symptoms can be severe and sometimes life-threatening.

These side effects appear mostly in patients who had pre-existing kidney conditions. For example, about 4 percent of kidney patients can expect to develop a condition called nephrogenic systemic fibrosis.

But warnings have been extended to include patients who had normal kidney function. It’s not clear how often these side effects affect those patients.

The new warnings, added in 2018, say gadolinium can stay in the body for months to years after receiving these drugs during an MRI scan. It can build up in bone, brain and kidney tissue. This is known as gadolinium retention.

Did You Know?
Gadolinium may remain in the body for months or years.
Source: U.S. Food and Drug Administration

Toxicity

Toxicity is a side effect of GBCAs that can occur within hours after undergoing an MRI scan with one of these contrast agents. Or it can manifest years later in people who have gadolinium buildup in their bodies.

Symptoms vary from person to person. The severity ranges from mild to severe.

Symptoms include:
  • Pain in the skin, bones, joints or the head
  • Burning, tingling or prickling sensations in the skin
  • Skin hardening, thickening, discoloring or tightening
  • Muscle twitching or weakness
  • Eye and vision problems
  • Memory and other cognitive or emotional problems
  • Brain fog or “chemo brain”
  • Painful tendons and ligaments that have a thickened appearance

Causes and People at Risk

Linear GBCAs are more likely to cause toxicity than macrocyclic agents. These are the two types of GBCAs available in the U.S.

A 2016 study review published in Biometals suggested one linear GBCA called Omniscan caused skin lesions, fibrosis and cell swelling in rats. Scientists linked the lesions to high gadolinium concentrations in the skin, liver and femur.

Another study published in 2004 in Investigational Radiology showed Omniscan left 2.5 times more gadolinium in human bone than ProHance, a macrocyclic agent.

Linear gadolinium-based contrast agents vs macrocyclic gadolinium-based contrast agents.
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Source: Biometals

People who have multiple MRIs with GBCAs potentially increase the risk for toxicity.

Other patients at greater risk of these problems are pregnant women, people who have kidney problems, or European-origin Caucasian women, according to a 2017 article in Applied Radiology.

The agency also says vulnerable patients include children, patients requiring multiple lifetime doses and those with inflammatory conditions.

Testing and Treatment

Few doctors understand this type of toxicity, and there are few methods to test for it. The main tests are urine and blood tests. A 24-hour urine test may be the most reliable test, according to an article in Applied Radiology.

Illustration of how chelating close bonds of gadolinium.
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The most common treatment is chelation. Chelation is a process where doctors administer chelating agents to patients. These agents bind gadolinium and remove it from the body through the kidneys.

Health providers may administer chelating agents through an IV, with a pill, as a suppository under the tongue or through a rectal suppository.

Some people who suffer skin tightening, discoloration or pain take Epsom salt baths or use saunas to detoxify the skin. Because this type of toxicity causes pain in the bones, skin or joints, people also use some type of pain relieving medication.

Some patients may respond to treatment involving immune system modulation. Immune modulation is using drugs or other agents to weaken or strengthen the immune system.

Experiencing symptoms of gadolinium toxicity? Get a Free Case Review

Nephrogenic Systemic Fibrosis (NSF)

Nephrogenic Systemic Fibrosis (NSF) is a potentially fatal disease that causes hardening and thickening of the skin and internal organs. According to the Cleveland Clinic, most, if not all, cases are caused by exposure to GBCAs.

Patients who developed the condition who had not been exposed to a GBCA in an MRI were exposed to gadolinium in another way, such as another test, surgery, an injury or an infection. Although the exact mechanism for how the chemical element causes the condition is not known, the risk increases as more linear gadolinium is used.

Researchers consider the disease to be a rare but serious side effect of GBCAs. These drugs carry a black box warning that says people with kidney problems are at risk for the disease.

About 4 percent of people with serious kidney problems develop the condition after exposure to the chemical element. At least 30 percent of cases are expected to be fatal.

The FDA first alerted the public about the link between GBCAs and NSF in 2006. The agency advises against using GBCAs in certain patients with acute or chronic kidney problems.

Researchers have not reported NSF in patients with normal kidney function after receiving GBCAs.

STUDY
About 4 percent of patients with severe renal insufficiency following exposure to GBCAs develop NSF. Close to 31 percent of NSF cases end in death.
Source: Study published in American Family Physician

Gadolinium Deposition Disease (GDD)

GDD is a relatively newly discovered condition, and it resembles NSF. However, GDD specifically occurs in people with normal kidney function.

Scientists think people who get GDD have a genetic abnormality that makes it difficult for their bodies to get rid of heavy metals.

People who had normal or near-normal kidney function when they were injected with a gadolinium-based contrast agent but then developed toxicity symptoms are suing the drugs’ makers.

Please seek the advice of a medical professional before making health care decisions.

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Michelle Llamas, Senior Content Writer
Written By Michelle Llamas Senior Writer

Michelle Llamas has been writing articles and producing podcasts about drugs, medical devices and the FDA for seven years. She specializes in fluoroquinolone antibiotics, vaccines and products that affect women’s health such as Essure birth control, transvaginal mesh and talcum powder. Michelle collaborates with experts, including board-certified doctors, patients and advocates, to provide trusted health information to the public. Some of her qualifications include:

  • American Medical Writers Association (AMWA) Engage Committee and Membership Committee member
  • Centers for Disease Control and Prevention (CDC) Health Literacy certificates
  • Original works published or cited in The Lancet, British Journal of Clinical Pharmacology and the Journal for Palliative Medicine

22 Cited Research Articles

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  2. Rogosnitzky, M & Branch, S. (2016). Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879157/
  3. Ramalho, J. et al. (2016, December). Gadolinium toxicity and treatment. Retrieved from https://www.sciencedirect.com/science/article/pii/S0730725X1630145X
  4. Robert, P. et al. (2016, February). Linear Gadolinium-Based Contrast Agents Are Associated With Brain Gadolinium Retention in Healthy Rats. Retrieved from https://journals.lww.com/investigativeradiology/Fulltext/2016/02000/Linear_Gadolinium_Based_Contrast_Agents_Are.1.aspx
  5. Gadolinium Toxicity. (n.d.). Symptoms associated with gadolinium toxicity. Retrieved from https://gadoliniumtoxicity.com/help/symptoms/
  6. Gadolinium Toxicity. (n.d.). Treatment possibilities for gadolinium toxicity. Retrieved from https://gadoliniumtoxicity.com/help/treatments/
  7. Mayo Medical Laboratories. (n.d.). Test ID: GDU, Gadolinium 24 Hour, Urine. Retrieved from https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/89301
  8. Scheinfeld, N.S. (2018, May 22). Nephrogenic System Fibrosis. Retrieved from https://emedicine.medscape.com/article/1097889-overview
  9. Shrivastava, V. (2016, November 21). Extracorporeal Photopheresis. Retrieved from https://emedicine.medscape.com/article/1131176-overview#a1
  10. Ferris, N. and Goergen, S. (2017, July 26). Gadolinium Contrast Medium (MRI Contrast agents). Inside Radiology. Retrieved from https://www.insideradiology.com.au/gadolinium-contrast-medium/
  11. U.S. Food and Drug Administration. (2018, May 16). FDA Drug Safety Communication: FDA warns that gadolinium-based contract agents (GBCAs) are retained in the body; requires new class warnings. U.S. Department of Health and Human Services. Retrieved from https://www.fda.gov/Drugs/DrugSafety/ucm589213.htm
  12. Skandhan, A.K.P. and Gaillard, F. et al. (n.d.). Nephrogenic systemic fibrosis. Radiopaedia. Retrieved from https://radiopaedia.org/articles/nephrogenic-systemic-fibrosis
  13. Schlaudecker, J.D. and Bernheisel, C.R. (2009, October 1). Gadolinium-Associated Nephrogenic Systemic Fibrosis. American Family Physician. Retrieved from https://www.aafp.org/afp/2009/1001/p711.html
  14. U.S. National Library of Medicine. (2018, February 27). Anaphylaxis. Medline Plus. NIH. Retrieved from https://medlineplus.gov/ency/article/000844.htm
  15. U.S. Food and Drug Administration. (2010, September 9). FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction. U.S. Department of Health and Human Services. Retrieved from https://www.fda.gov/Drugs/DrugSafety/ucm223966.htm
  16. RadiologyInfo.com. (2018, July 23). Contrast Materials. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=safety-contrast
  17. Hess, C. et al. (2017, November 12). MRI with Contrast (Gadolinium-Containing) Policy. UCSF Department of Radiology & Biomedical Imaging. Retrieved from https://radiology.ucsf.edu/patient-care/patient-safety/contrast/mri-with-contrast-gadolinium-policy#accordion-risk-of-gadolinium-administration-in-patients-with-impaired-kidney-function
  18. Semelka, R.C. et al. (2016, August 13). Gadolinium deposition disease: Initial description of a disease that has been around for a while. U.S. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27530966
  19. Staff News Brief. (2017, February 1). An overview of gadolinium deposition disease. Applied Radiology: The Journal of Practical Medical Imaging and Management. Retrieved from https://appliedradiology.com/articles/an-overview-of-gadolinium-deposition-disease
  20. Semelka, R.C. et al. (2016, December). Gadolinium deposition disease: Initial description of a disease that has been around for a while. Magnetic Resonance Imaging. Retrieved from https://www.sciencedirect.com/science/article/pii/S0730725X16301035?via%3Dihub
  21. Scheinfeld, N.S. (2018, May 22). Nephrogenic Systemic Fibrosis Treatment & Management. Retrieved from https://emedicine.medscape.com/article/1097889-treatment
  22. Gibby, W.A. (2004, March). Comparison of Gd DTPA-BMA (Omniscan) versus Gd HP-DO3A (ProHance) retention in human bone tissue by inductively coupled plasma atomic emission spectroscopy. Investigative Radiology. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15076005
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