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Thallium-201: Drug information

Thallium-201: Drug information
For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Pharmacologic Category
  • Radiopharmaceutical
Dosing: Adult

Note: Dose should be individualized; utilize the lowest dose necessary to obtain images.

Myocardial perfusion

Myocardial perfusion: IV:

Planar scintigraphy: 37 to 74 MBq (1 to 2 mCi)

Single-photon emission computed tomography (SPECT): 74 to 111 MBq (2 to 3 mCi)

Parathyroid hyperactivity localization

Parathyroid hyperactivity localization: Planar or SPECT: 75 to 130 MBq (2 to 3.5 mCi).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Cardiovascular: Cardiac arrhythmia, cerebrovascular accident, flushing, hypotension, myocardial infarction

Central nervous system: Chills

Dermatologic: Diaphoresis, pruritus, skin rash

Gastrointestinal: Mild diarrhea, nausea, vomiting

Hypersensitivity: Anaphylactoid reaction

Neuromuscular & skeletal: Tremor

Ophthalmic: Blurred vision, conjunctivitis

Respiratory: Bronchoconstriction, dyspnea

Miscellaneous: Fever

Contraindications

There are no contraindications listed in the manufacturer’s labeling

Warnings/Precautions

Concerns related to adverse effects:

• Cardiovascular events: Arrhythmias, bronchoconstriction, cerebrovascular events, chest pain, ECG abnormalities, hypotension or hypertension, and myocardial infarction (MI) have occurred due to pharmacologic agents used in conjunction with stress imaging. Appropriate measures for monitoring and resuscitation should be available during use.

• Hypersensitivity reactions: Anaphylactoid reactions (flushing, hypotension, pruritus, and diffuse rash) have been reported.

• Local reactions: Local injection site reactions (eg, burning, pain, redness) may occur. Administer intravenously only to avoid local tissue accumulation and irradiation. Ensure proper catheter or needle position prior to and during injection.

Dosage form specific issues:

• Latex: The vial stopper in some products may contain latex.

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.

Other warnings/precautions:

• Appropriate use: Administer thallous chloride Tl 201 injection close to calibration time to minimize the effect of higher levels of radionuclidic contaminants present at pre- and post-calibration dates.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Generic: 37 MBq (1 mCi)/mL (1 ea [DSC]); 74 MBq (2 mCi)/mL (1 ea [DSC])

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Thallous Chloride TL 201 Intravenous)

2 mci/mL (per each): $162.58 - $731.57

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Generic: 37 MBq/mL (1 ea)

Administration: Adult

IV: Radiopharmaceutical; use appropriate precautions for handling and disposal.

For IV administration only. Thallous chloride Tl 201 has a risk for extravasation. Confirm intravenous patency before injection.

Myocardial perfusion imaging: For resting myocardial studies, start imaging 10 to 20 minutes after injection administration; to improve myocardial-to-background ratio images, ensure patients are injected upright (reduces hepatic and gastric thallium Tl-201 concentration) and in the fasting state. For exercise stress testing, administer injection at the start of maximum stress which is sustained for ~30 seconds after injection; start imaging within 10 minutes after administration to obtain maximum target-to-background ratios.

Parathyroid hyperactivity localization: Administer injection before, with, or after a minimal dose of appropriate thyroid imaging agent (eg, sodium pertechnetate Tc 99m or sodium iodide I-123) to enable thyroid subtraction imaging.

Use: Labeled Indications

Myocardial perfusion imaging: Imaging with planar scintigraphy or single photon emission computed tomography (SPECT) for the diagnosis of coronary artery disease by localization of nonreversible defects (myocardial infarction), and reversible defects (myocardial ischemia) when used in conjunction with exercise or pharmacologic stress.

Parathyroid hyperactivity imaging: Localization of sites of parathyroid hyperactivity pre- and postoperatively in patients with elevated serum calcium and parathyroid hormone levels.

Medication Safety Issues
Other safety concerns:

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.

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

Reproductive Considerations

Evaluate pregnancy status prior to use in females of reproductive potential.

Pregnancy Considerations

Animal reproduction studies have not been conducted. Thallous chloride Tl 201 has been shown to cross the placenta.

Breastfeeding Considerations

Thallous chloride Tl 201 is excreted into breast milk. The manufacturer recommends advising patients who continue breast-feeding to express and discard milk for a minimum of 2 weeks after administration. Close contact with infant should be minimized if administered dose would result in an effective dose greater than 1 mSv (0.1 rem) to the infant.

Mechanism of Action

Radioactive diagnostic agent which decays by electron capture to mercury Hg 201 that can be detected by imaging. It is distributed to the myocardium, correlating to regional perfusion.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Primarily distributed in the myocardium, thyroid, liver, kidneys and stomach

Half-life elimination: Bi-exponential: Initial radioactive half-life: ~5 minutes; remainder ~40 hours; Biologic half-life: 2.4 days

Time to peak: Myocardium uptake: ~10 minutes

Excretion: Urine (4% to 8% of injected activity within 24 hours); feces

  1. Thallous Chloride Tl 201 Injection [prescribing information] Maryland Heights, MO: Curium US LLC; December 2018.
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