Contrast media are widely used for percutaneous coronary interventions. Currently, about a dozen types of contrast media are available in France. On account of their overall safety, only low osmolar and isosmolar contrast media are used in practice. However, the appropriate use of contrast media remains difficult as accurate recommendations are lacking. Several doubts are still present regarding potential adverse effects of contrast media. Our review summarizes contrast media-related risks (hypersensitivity, arrhythmic risk, effects on coagulation and platelets, contrast media-induced nephrotoxicity) underlying mechanisms, prophylaxis strategies, and differences among contrast media. Many questions remain in this area and we need further prospective randomised trials.