The Food and Drug Administration (FDA) has issued an alert to health care providers about recent changes to the labels of micro-bubble contrast agents. First, the labels warn of serious cardiopulmonary reactions during administration or within 30 minutes of stopping one of these drugs. Make sure to monitor patients with pulmonary hypertension or unstable cardiopulmonary conditions closely during this time.
   Second, some contraindications no longer appear because FDA has concluded that potential benefits may outweigh the cardiopulmonary risk in some patients. Deleted contraindications include:

• worsening or unstable heart failure
• acute myocardial infarction
• acute coronary syndromes
• serious ventricular arrhythmias
• high risk of arrhythmia from a prolonged QT interval
• respiratory failure
• severe emphysema
• pulmonary emboli
• other conditions that cause pulmonary hypertension.

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