Version May 2024
Breast imaging: IV: 20 to 30 mCi (740 to 1,110 MBq).
Myocardial imaging: IV (based on 70 kg patient): 10 to 30 mCi (370 to 1,110 MBq).
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.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Cardiovascular: Angina pectoris (2%), chest pain (2%), ST Segment changes on ECG (1%)
Gastrointestinal: Dysgeusia (7%)
Genitourinary: Mastalgia (2%)
<1%, postmarketing, and/or case reports: Abdominal pain, altered sense of smell, angioedema, arthritis (transient), cardiac arrhythmia, dizziness, edema, fatigue, fever, flushing, headache, inflammation at injection site, nausea, pruritus, seizure-like activity, severe hypersensitivity, skin rash, syncope, urticaria, vomiting, xerostomia
There are no contraindications listed within the manufacturer’s labeling.
Concerns related to adverse effects:
• Serious adverse events: Arrhythmias, bronchoconstriction, cerebrovascular events, hypotension, and myocardial infarction (MI) have occurred due to pharmacologic agents used in conjunction with stress imaging. Appropriate measures for resuscitation should be available during use.
• Hypersensitivity reactions: Rarely, severe allergic reactions or anaphylactic type reactions of angioedema and urticarial have occurred; emergency treatment should be immediately available.
Disease-related concerns:
• Coronary artery disease: Patients with known or suspected coronary artery disease should undergo continuous cardiac monitoring during diagnostic evaluation with technetium Tc 99m sestamibi; emergency cardiac treatment should be immediately available.
Special handling:
• Radiopharmaceutical: Use appropriate precautions for handling, disposal, and minimizing exposure to patients and healthcare personnel. Use only under supervision of individuals with experience/training in the handling of radioactive materials approved by the applicable regulatory authority. Note: Contents of kit are not radioactive; however, adequate shielding is required after addition of radioactive material.
Other warnings/precautions:
• Appropriate use: Myocardial imaging may be done while patients are at rest or under pharmacologic stress conditions.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Intravenous:
Cardiolite: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (5s, 20s) [pyrogen free; vial contents to be combined with Technetium Tc 99m pertechnetate sodium (not included)]
Generic: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (5s, 20s, 30s) [vial contents to be combined with Technetium Tc 99m pertechnetate sodium (not included)]
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Intravenous:
Cardiolite: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (2s, 5s, 20s, 30s) [vial contents to be combined with Technetium Tc 99m pertechnetate sodium (not included)]
Draximage Sestamibi: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (2s, 5s, 10s) [vial contents to be combined with Technetium Tc 99m pertechnetate sodium (not included)]
Generic: 2-methoxyisobutyl isonitrile (MIBI) copper tetrafluoroborate 1 mg (5s)
IV: Not for direct IV injection; only reconstituted technetium Tc 99m sestamibi may be administered IV. See manufacturer’s prescribing information for complete administration procedure. Begin breast images 5 minutes after administration.
Radiopharmaceutical; use appropriate precautions for handling and disposal. Waterproof gloves should be worn and shielding should be used during handling and administration.
Imaging agent: Myocardial perfusion agent used in detection of coronary artery disease in conjunction with exercise stress testing or pharmacologic stress testing to identify reversible myocardial ischemia with or without myocardial infarction; planar breast imaging after mammography to assist in evaluation of breast lesions in patients with abnormal mammogram or palpable breast mass (second-line)
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.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Inhibitors of the Proton Pump (PPIs and PCABs): May diminish the diagnostic effect of Technetium Tc 99m Sestamibi. Management: Consider holding/stopping proton pump inhibitor therapy for at least 3 days prior to the use technetium Tc 99m sestamibi in cardiac imaging procedures. Risk D: Consider therapy modification
Pregnancy status should be determined in women of childbearing potential (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).
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).
Technetium Tc 99m sestamibi is present in breast milk.
Breast milk concentrations are 0.01% to 0.03% of the maternal injected activity of technetium Tc 99m sestamibi. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Interruption of breastfeeding following maternal administration is not necessary. However, the manufacturer suggests lactating women restrict close contact with a breastfed infant to ≤5 hours during the first 24 hours following administration to minimize radiation exposure.
Elective diagnostic procedures should be delayed until breastfeeding has stopped (SNM 2010). Women who are breastfeeding and caring for individuals undergoing nuclear medicine procedures do not need any additional precautions (ABM [Mitchell 2019]).
Protein binding: <1%
Half-life elimination: Physical half-life: 6.02 hours
Excretion: Urine (27% of injected activity within 48 hours); feces (33% of injected activity within 48 hours)
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