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Gadoteric acid, sold under the brand name Dotarem among others, is a macrocycle-structured gadolinium-based MRI contrast agent (GBCA). It consists of the organic acid DOTA as a chelating agent , and gadolinium (Gd 3+ ), and is used in form of the meglumine salt (gadoterate meglumine).
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DOTA is derived from the macrocycle known as cyclen.The four secondary amine groups are modified by replacement of the N-H centers with N-CH 2 CO 2 H groups. The resulting aminopolycarboxylic acid, upon ionization of the carboxylic acid groups, is a high affinity chelating agent for di- and trivalent cations.
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The most severe reaction to gadobutrol is nephrogenic system fibrosis (NSF) among patients with impaired elimination of the drug. The risk is highest among patients with chronic, impaired kidney function and those with acute kidney injury. NSF may result in death or severe impairment of the skin, muscle, and internal organs. [8]