Abstract Iodinated contrast agents such as Iohexol are commonly used to diagnose vascular anomalies due to efficacy. Though Iohexol has a good safety profile, it is responsible for Adverse Drug Reactions (ADRs), which vary from minor symptoms to life-threatening complications. This review combines evidence from literature regarding the safety of Iohexol in terms of incidence, type, and management of ADRs to inform clinical practice. Systematic searching of PubMed and Scopus until March 2025 employed search terms: "Iohexol," "Adverse reactions," and "angiography." Original studies that reported on Iohexol safety were included, while reviews and uncertain data were not. Two reviewers assessed titles/abstracts/full texts independently, having discrepancies resolved through consensus or third reviewer. Collected data covered study design, population, sample size, and outcomes. Twelve studies found Iohexol-related ADRs were predominantly mild-to-moderate (Nausea, vomiting, and urticaria). Severe reactions (anaphylaxis, cardiovascular collapse) were uncommon (<1%). Contrast-induced nephropathy (CIN) was notable in high-risk patients (renal impairment/diabetes). Comparative studies indicated Iohexol had fewer ADRs than ionic agents. Pre-treatment (antihistamines) and hydration minimized risks. Iohexol safety profile in angiography is good, with the majority of ADRs being mild and controllable. Rare severe reactions need special attention, particularly in high-risk populations. Preventive procedures (hydration, pre-treatment) also decrease risks. Patient evaluation, informed consent, and monitoring need to be prioritized by clinicians. Additional research should optimize risk stratification and management strategies. Keywords: Iohexol, Angiography, Adverse drug reactions.