Version May 2024
Note: Measure dose with appropriate radioactivity calibration system immediately prior to administration. Do not administer more than 1 dose. The recommended IV doses below are based on a 70 kg patient.
Brain imaging: IV: 10 to 20 mCi (370 to 740 MBq). Immediate dynamic imaging; obtain at least 1 blood-pool image in same position as flow; delayed images may be obtained 1 hour later.
GFR estimation with renal visualization: IV: 3 to 5 mCi (111 to 185 MBq). Immediate dynamic imaging; static imaging 1 to 30 minutes after administration.
GFR estimation with no renal imaging: IV: 0.2 to 0.5 mCi (7.4 to 18.5 MBq). Blood sampling only is performed.
Renal perfusion assessment (with renal visualization): IV: 10 to 20 mCi (370 to 740 MBq). Immediate dynamic imaging; static imaging 1 to 30 minutes after administration.
Lung ventilation: Inhalation (via nebulizer): 25 to 50 mCi (925 to 1,850 MBq); to achieve a lung dose of ~0.5 to 1 mCi (18.5 to 37 MBq). For imaging performed prior to perfusion imaging, the target dose is achieved after 3 to 5 minutes of inhalation or at an imaging count of 50,000 to 100,000/minute; for imaging performed after perfusion imaging, target count rate should be ~3 times that of perfusion count rate.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Technetium Tc-99m pentetate: Pediatric drug information")
Dosage guidance:
Safety: Measure dose with appropriate radioactivity calibration system immediately prior to administration. Do not administer more than 1 dose. Route of administration (IV vs inhalation) will vary with indication, and dosing units vary between weight-directed (mCi/kg) and fixed dose (mCi); use caution.
Lung ventilation: Infants, Children, and Adolescents: Inhalation (via nebulizer): 25 mCi (925 MBq). For imaging performed prior to perfusion imaging, the target dose is at an imaging count rate of 10,000 to 50,000/minute; for imaging performed after perfusion imaging, target count rate should be ~3 times that of perfusion count rate.
Renal scintigraphy:
GFR estimation with no renal imaging: Infants, Children, and Adolescents: IV: 0.2 to 0.5 mCi (7.4 to 18.5 MBq) followed by blood sampling.
Renal visualization and perfusion assessment: Infants, Children, and Adolescents: IV: 0.1 to 0.2 mCi/kg (3.7 to 7.4 MBq/kg); minimum dose: 1 mCi (37 MBq); maximum dose: 5 mCi (185 MBq). Immediate dynamic imaging; static imaging 1 to 30 minutes after administration.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
<1%, postmarketing, and/or case reports: Anaphylactoid reaction, anaphylaxis, angioedema, chills, cyanosis, dizziness, erythema, headache, hypersensitivity reaction, hypertension, hypotension, nausea, pruritus, skin rash, syncope, tachycardia, throat irritation, urticaria, vomiting, wheezing
Hypersensitivity to technetium Tc 99m pentetate or any component of the formulation.
Concerns related to adverse effects:
• Bronchospasm: With inhalation use, may result in acute bronchospasm especially in patients with heightened bronchoreactivity (eg, asthma or other lung or allergic disorders); monitor all patients for bronchoconstriction.
• Hypersensitivity: Hypersensitivity reactions (including anaphylaxis) have been reported; appropriate equipment and personnel to manage hypersensitivity should be available during use. Monitor for hypersensitivity reactions.
• Radiation accumulation: Tc 99m administration contributes to the patient's overall long-term cumulative radiation exposure. Long-term cumulative radiation exposure is associated with an increased risk for cancer. Use the lowest dose necessary for imaging. Ensure safe handling to minimize radiation exposure to the patient and health care providers. Risk is greater with pediatric patients due to greater radiosensitivity and longer life expectancy.
Special handling:
• Radiopharmaceutical: Use appropriate precautions for handling, disposal, and minimizing exposure to patients and health care personnel. Use only under supervision of individuals with experience/training in the handling of radioactive materials approved by the applicable regulatory authority. Note: Supplied as a kit for the preparation of the product, technetium Tc 99m pentetate, not the final product itself. Contents of kit are not radioactive; however, adequate shielding is required after addition of radioactive material.
Other warnings/precautions:
• Appropriate use: Patients receiving kidney imaging should be adequately hydrated prior to dosing; instruct patients to void frequently for 4 to 6 hours following administration to decrease radiation exposure to the bladder.
• Lung ventilation study: In patients with obstructive pulmonary disease there may be deposition of particles in the proximal airways which may influence the image quality and interfere with diagnostic interpretation; careful nebulizer use is essential to assure optimal particle delivery and ensure diagnostic quality. Consider additional diagnostic options if particle deposition occurs.
• Risk for misinterpretation: Image interpretation errors may occur with Tc 99m pentetate. Deposition of particles in the proximal airways may influence image quality and diagnostic interpretation; optimal particle delivery is essential therefore careful use of the nebulizer is important to ensure diagnostic quality. Consider additional diagnostic options if interference occurs.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Kit, Intravenous:
Draximage DTPA: Lyophilized pentetic acid mixture to be combined with sodium pertechnetate Tc99m injection solution (30s)
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Kit, Intravenous:
Draximage DTPA: Lyophilized pentetic acid mixture to be combined with sodium pertechnetate Tc99m injection solution (10s)
Inhalation: A disposable nebulizer is required. Rinse mouth and expectorate after use to minimize mouth and esophagus radiation exposure.
IV: Not for direct IV injection; only reconstituted technetium Tc 99m pentetate may be administered IV. See manufacturer's prescribing information for complete administration procedure. Ensure adequate hydration before and after administration; void frequently for 4 to 6 hours post administration to minimize bladder radiation exposure.
Radiopharmaceutical; use appropriate precautions for handling and disposal. Use waterproof gloves and effective radiation shielding when handling.
Radiopharmaceutical; use appropriate precautions for handling and disposal. Use waterproof gloves and effective radiation shielding, including syringe shields, when handling.
IV: Contents of vial are not for direct IV injection; only reconstituted technetium Tc 99m pentetate may be administered IV. See manufacturer's labeling for complete administration procedure. Ensure adequate hydration before and after administration; void frequently for 4 to 6 hours post administration to minimize bladder radiation exposure.
Inhalation: Contents of vial are not for direct inhalation; only reconstituted technetium Tc 99m pentetate may be used for inhalation; a disposable nebulizer is required for administration. Rinse mouth and expectorate after use to minimize mouth and esophagus radiation exposure.
Imaging agent: Radiopharmaceutical imaging agent used for brain imaging; renal visualization for renal perfusion assessment and glomerular filtration rate (GFR) estimation; lung ventilation imaging and evaluation of pulmonary embolism when used in combination with perfusion imaging.
The Institute for Safe Medication Practices (ISMP) includes this medication (intrathecal administration) among its list of drugs that have a heightened risk of causing significant patient harm when used in error.
Radiopharmaceutical: Use appropriate precaution for handling, disposal, and minimizing exposure to patients and healthcare personnel. Use under supervision of experienced personnel. Should be stored in original lead container or adequate radiation shield.
None known.
There are no known significant interactions.
Pregnancy status should be evaluated prior to use in patients who could become pregnant (SNM 2010).
Technetium Tc 99m can be detected in fetal tissue; the amount depends upon the specific formulation, route of administration, and stage of pregnancy (Adelstein 1999). The diagnostic use of technetium Tc 99m pentetate in pregnant patients has been reported (Goldstein 1988; Griffith 1992). Increased fluid intake and frequent voiding can reduce potential fetal exposure (Adelstein 1999; Goldstein 1988; ICRP 2000).
In general, the potential for a radiopharmaceutical to cause fetal harm depends on the dose absorbed by the fetus and the stage of pregnancy. High doses of radiopharmaceuticals used for therapeutic procedures are more likely to result in fetal harm. A medically required diagnostic procedure can usually be modified to decrease fetal risk. Elective diagnostic procedures should be delayed until after delivery (ACR-SPR 2018; Adelstein 1999; ICRP 2000; SNM 2010). Guidelines are available as to when lung scintigraphy for the diagnosis of pulmonary embolism should be done in pregnant patients (Leung 2011).
Technetium Tc 99m is present in breast milk.
Although an interruption of breastfeeding may not always be required (ABM [Mitchell 2019]), expressing and discarding breast milk for a period of 4 hours following technetium Tc 99m pentetate for renal or lung imaging may be considered (IAEA 2018). Patients can pump and store milk prior to the procedure, then bottle feed using the stored milk during this time (Harding 1995).
Elective diagnostic procedures should be delayed until breastfeeding has stopped (SNM 2010). Patients who are breastfeeding and caring for individuals undergoing nuclear medicine procedures do not need any additional precautions (ABM [Mitchell 2019]).
Excretion of Technetium Tc 99m into colostrum is widely variable and information is limited; therefore, recommendations related to early breastfeeding cannot be made (Mountford 1989; Rubow 1994).
Monitor for signs/symptoms of acute bronchospasm and hypersensitivity.
Radioactive diagnostic agent which decays by isomeric transition to emit a photon that can be detected by imaging.
Distribution: IV: Vss: 17 L; distributed throughout extracellular fluid space
Bioavailability: Inhalation: ~70%
Protein binding: IV: ~4% to 10%
Half-life elimination: IV: 2.1 hours; Decay half-life: 6 hours
Time to peak: Inhalation: <2 hours
Excretion: IV: Urine (~100%)
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