Ionic dimers are used as x-ray contrast agents. They are formed by joining 2 ionic monomers and eliminating 1 carboxyl group and contain 6 iodine atoms for every 2 particles in solution (CM ratio=3).
Ionic dimers have an intermediate osmolarity, intermediate viscosity and an intermediate hydrophilicity between that of ionic and nonionic monomers. The only commercially available ionic dimer is ioxaglate (Hexabrix). Ioxaglate is used primarily for peripheral arteriography.

The first-generation contrast agents were all ionic monomers, consisting of a tri-iodinated benzene ring with 2 organic side chains and a carboxyl group. Diatrizoate or iothalamate are common iodinated anions, conjugated with a cation, sodium or meglumine. The ionization at the carboxyl-cation bond makes the agent water soluble.
Ionic monomers have the highest osmolality (high-osmolar contrast media (HOCM) possess an osmolality seven to eight times higher than plasma) of the different groups of contrast agents (CM ratio=1.5) and the lowest viscosity. The osmolality in solutions of ionic monomers ranges from 600 to 2100 mOsm/kg (human plasma = 290 mOsm/kg). These high osmolality is related to some of the adverse reactions. HOCM's have been widely replaced by newer contrast agents with improved tolerability and safety profiles.
Examples of HOCM's are Renografin®-60, Hypaque 76, Hypaque Meglumine, Hypaque Sodium and Conray®.

See also Ionic Contrast Agents.

Nonionic monomers are used as x-ray contrast agents. To create a nonionic monomer, the tri-iodinated benzene ring is made water soluble by the addition of hydrophilic hydroxyl groups to organic side chains (CM ratio=3). Nonionic monomers have an intermediate osmolarity, intermediate viscosity and elevated hydrophilicity with three atoms of iodine per molecule. Lacking a carboxyl group, nonionic monomers do not ionize in solution. A nonionic monomer is potentially less chemotoxic than an ionic monomer.
Common nonionic monomers are iohexol (Omnipaque), iopamidol (Isovue®), ioversol (Optiray®), and iopromide (Ultravist®). Nonionic monomers are contrast agents with a wide range of indications due to their nonionic nature and lower osmolalities.

Ultravist® is an iodinated contrast agent with low osmolality and low viscosity, enabling ease of administration and rapid iodine delivery rate. Ultravist® is available in 4 concentrations. Introduced in Europe 1985 and in the US in 1995, Ultravist® is being used today in over 100 countries worldwide.
See also Low-Osmolar Contrast Media.