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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 side effects can occur almost immediately after receiving a gadolinium-based contrast agent and include headache, nausea and dizziness. Serious side effects of these drugs, such as gadolinium toxicity, nephrogenic systemic fibrosis (NSF) and gadolinium deposition disorder (GDD), can happen months or years after undergoing an MRI scan.

Suffered from gadolinium toxicity?

If you or a loved one suffered gadolinium toxicity after using a gadolinium-based contrast agent, you may be eligible for compensation.

Gadolinium Vial
Gadolinium Side Effects
  1. Gadolinium toxicity Symptoms include pain in the skin, bones, joints or head
  2. Gadolinium Deposition Disease (GDD) Can happen when gadolinium remains in the body for months or years
  3. Nephrogenic systemic fibrosis (NSF) Causes the skin and internal organs to harden
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Studies and adverse event reports submitted to the U.S. Food and Drug Administration link gadolinium contrast agents to side effects that involve the skin and other organs. Symptoms of gadolinium-related conditions can be severe and sometimes life-threatening.

New warnings added to the labels of gadolinium-based contrast agents (GBCAs) in 2018 say gadolinium can stay in the body for months to years after receiving these drugs during an MRI scan. The metal can build up in bone, brain and kidney tissue.

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

This is known as gadolinium retention. It has led to a rare condition called nephrogenic systemic fibrosis.

Gadolinium-related risks were previously thought to only affect patients with pre-existing kidney problems. But the FDA has also received reports of adverse events involving multiple organ systems in patients with normal kidney function.

Gadolinium Toxicity

Gadolinium toxicity is a side effect of gadolinium used in MRI contrast dyes.

It can occur within hours after undergoing an MRI scan with a gadolinium-based contrast agent. Or it can manifest years later in people who have gadolinium buildup in their bodies.

Gadolinium toxicity encompasses conditions such as gadolinium deposition disease (GDD) and nephrogenic systemic fibrosis (NSF).

Patients injured by GBCAs have filed gadolinium lawsuits against the drugs’ manufacturers.

Gadolinium Toxicity Symptoms

Gadolinium toxicity symptoms vary from person to person. MRI contrast dye side effects may start within hours or years of receiving a GBCA. The severity ranges from mild to severe.

Gadolinium toxicity symptoms include:
  • Pain in the skin, bones, joints or the head
  • Burning, tingling or prickling sensations in the skin
  • Skin hardening, thickening or tightening
  • Skin discoloration
  • Muscle twitching or weakness
  • Eye and vision problems
  • Hair loss
  • Itching
  • Low body temperature
  • Swelling
  • Memory and other cognitive or emotional problems
  • Brain fog or “chemo brain”
  • Tightness in the hands and feet
  • Painful tendons and ligaments that have a thickened appearance
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What Causes Gadolinium Toxicity?

Linear gadolinium-based contrast agents are more likely to cause gadolinium 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.
Expand
Source: Biometals

Who Is at Risk for Gadolinium Toxicity?

People who have multiple MRIs with gadolinium-based agents potentially increase the risk for toxicity.

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

Patients who may be at higher risk for gadolinium retention include pregnant women, children, patients requiring multiple lifetime doses and patients with inflammatory conditions, according to the FDA.

How to Test for Gadolinium Poisoning

The main tests for gadolinium toxicity are urine and blood tests.

A 24-hour urine test may be the most reliable test for diagnosing gadolinium retention in the body, according to an article in Applied Radiology.

Few doctors understand gadolinium toxicity, and there are few methods to test for it.

Treating Gadolinium Poisoning

Illustration of how chelating close bonds of gadolinium.
Expand

The most common treatment for gadolinium toxicity or poisoning 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 gadolinium 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.

Gadolinium Deposition Disease (GDD)

GDD Symptoms
Symptoms of gadolinium deposition disease may occur within hours to days of receiving a GBCA.
Source: Applied Radiology

Gadolinium deposition disease (GDD) is a form of gadolinium toxicity. It can happen when there’s a buildup of gadolinium in the body.

GDD is a relatively newly discovered condition, and it resembles another gadolinium-related condition called nephrogenic systemic fibrosis (NSF).

NSF causes the skin and internal organs to harden in patients with pre-existing kidney issues. 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.

Diagnosis, symptoms and treatment of GDD are similar to gadolinium toxicity.

Gadolinium and Nephrogenic Systemic Fibrosis (NSF)

Nephrogenic systemic fibrosis (NSF) is a potentially fatal disease caused by gadolinium buildup in the body. It causes hardening and thickening of the skin and internal organs.

Researchers consider NSF 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.

The FDA first alerted the public about the link between GBCAs and nephrogenic systemic fibrosis 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 gadolinium-based contrast agents develop NSF. Close to 31 percent of NSF cases end in death.
Source: Study published in American Family Physician

Signs of Nephrogenic Systemic Fibrosis

Signs of NSF primarily involve the skin. But the debilitating disease can also damage internal organs. Organs that may be affected include the heart, kidneys, liver and lungs.

Nephrogenic systemic fibrosis symptoms include:
  • Swelling, tightening, scaling and hardening of the skin
  • Orange-peel-like appearance on the skin
  • Redness or darkening of the skin – or excess pigmentation
  • Burning, itching or pain in the affected areas
  • Pain in the hip bones or ribs
  • Muscle weakness
  • Joint stiffness or loss of movement in the arms, hands, legs or feet due to skin thickening
Skin on leg affected by Nephrogenic Systemic Fibrosis
Nephrogenic systemic fibrosis is a disease that affects the skin and internal organs.

Nephrogenic Systemic Fibrosis Treatment

There is no cure for NSF and the condition can be deadly. The most effective treatment for NSF seems to be extracorporeal photophoresis or ECP.

In ECP, doctors collect white blood cells from a patient and expose them to radiated light. Then, they inject the cells back into the patient.

When Can Gadolinium Side Effects Occur?

Side effects of gadolinium exposure can occur within hours, weeks or months of a GBCA injection. Mild symptoms may go away on their own. Worse symptoms may become chronic and last months or years.

The most commonly reported symptoms are headaches, bone and nerve pain, and skin thickening, according to a 2016 study in Magnetic Resonance Imaging. In the study of 42 people with symptoms, brain fog and headaches lasted for more than three months in 29 people.

People may feel minor side effects immediately after administration of GCBAs. 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.

Common Gadolinium Contrast Dye Side Effects

Common side effects associated with gadolinium-based contrast agents are usually short-term and do not cause any serious health risks. They occur almost immediately after receiving the injection.

If MRI contrast side effects persist or become severe, you should speak with your doctor.

Common side effects of gadolinium used in MRI contrast agents include:
  • Headache
  • Nausea/feeling sick
  • Dizziness
  • Feeling of coldness at the injection site

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

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21 Cited Research Articles

  1. 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/
  2. Ramalho, J. et al. (2016, December). Gadolinium toxicity and treatment. Retrieved from https://www.sciencedirect.com/science/article/pii/S0730725X1630145X
  3. 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
  4. Gadolinium Toxicity. (n.d.). Symptoms associated with gadolinium toxicity. Retrieved from https://gadoliniumtoxicity.com/help/symptoms/
  5. Gadolinium Toxicity. (n.d.). Treatment possibilities for gadolinium toxicity. Retrieved from https://gadoliniumtoxicity.com/help/treatments/
  6. Mayo Medical Laboratories. (n.d.). Test ID: GDU, Gadolinium 24 Hour, Urine. Retrieved from https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/89301
  7. Scheinfeld, N. S. (2018, May 22). Nephrogenic System Fibrosis. Retrieved from https://emedicine.medscape.com/article/1097889-overview
  8. Shrivastava, V. (2016, November 21). Extracorporeal Photopheresis. Retrieved from https://emedicine.medscape.com/article/1131176-overview#a1
  9. Ferris MD, N. and Goergen PhD, S. (2017, July 26). Gadolinium Contrast Medium (MRI Contrast agents). Inside Radiology. Retrieved from https://www.insideradiology.com.au/gadolinium-contrast-medium/
  10. 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
  11. Skandhan MD, A. K. P. and Gaillard PhD, F. et al. (n.d.). Nephrogenic systemic fibrosis. Radiopaedia. Retrieved from https://radiopaedia.org/articles/nephrogenic-systemic-fibrosis
  12. Schlaudecker MD, J. D. and Bernheisel MD, C. R. (2009, October 1). Gadolinium-Associated Nephrogenic Systemic Fibrosis. American Family Physician. Retrieved from https://www.aafp.org/afp/2009/1001/p711.html
  13. U.S. National Library of Medicine. (2018, February 27). Anaphylaxis. Medline Plus. NIH. Retrieved from https://medlineplus.gov/ency/article/000844.htm
  14. 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
  15. RadiologyInfo.com. (2018, July 23). Contrast Materials. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=safety-contrast
  16. Hess MD, 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
  17. 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
  18. 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
  19. 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
  20. Scheinfeld, N.S. (2018, May 22). Nephrogenic Systemic Fibrosis Treatment & Management. Retrieved from https://emedicine.medscape.com/article/1097889-treatment
  21. Gibby, WA. (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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