Acetylcysteine and fenoldopam. Promising new approaches for preventing effects of contrast nephrotoxicity.

The prevalence of nephrotoxic effects after administration of contrast material is increasing. Other than good hydration before the radiological procedure, previous attempts to prevent the effects of contrast nephrotoxicity have been ineffective. Fenoldopam and acetylcysteine are possible preventive medications being used in selected cases. Both drugs await approval from the Food and Drug Administration for use in preventing contrast-induced nephrotoxic effects. The onset of action of the 2 drugs differs, and each drug has different pharmacological actions. Determining which drug should be used is based on whether the patient can be given anything by mouth, whether the procedure is emergent, cost, degree of renal insufficiency before the radiological procedure, blood pressure, and whether the patient has diabetes. Further studies will determine if one drug is preferred over the other or if their combined use is the preferred approach for high-risk patients. Future options could include an intravenous form of acetylcysteine and an oral form of fenoldopam.