Version May 2024
Note: Measure dose with appropriate radioactivity calibration system immediately prior to administration. Dose is based on a 70 kg patient:
Nasolacrimal drainage system imaging: Dacryoscintigraphy (ophthalmic instillation with micropipette or similar method): Maximum: 0.1 mCi (3.7 MBq)
Salivary gland imaging: IV: 1 to 5 mCi (37 to 185 MBq)
Thyroid gland imaging: IV: 1 to 10 mCi (37 to 370 MBq)
Urinary bladder vesicoureteral imaging: Intravesicular (via urethral catheter): 0.5 to 1 mCi (18.5 to 37 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.
(For additional information see "Technetium Tc-99m sodium pertechnetate : Pediatric drug information")
Note: Measure dose with appropriate radioactivity calibration system immediately prior to administration.
Thyroid gland imaging: Children and Adolescents: IV: 0.06 to 0.08 mCi/kg (2.2 to 2.96 MBq/kg).
Urinary bladder imaging (direct isotopic cystography): Children and Adolescents: Intracatheter (urethral): 0.5 to 1 mCi (18.5 to 37 MBq).
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. Frequency not defined.
Hypersensitivity: Anaphylaxis (infrequent)
There are no contraindications listed in the manufacturer's labeling.
Concerns related to adverse effects:
• Hypersensitivity: Hypersensitivity reaction, including serious signs/symptoms of anaphylaxis and allergic reactions (rash, hives, itching) have been reported. Appropriate equipment and personnel for emergency treatment should be immediately available.
• Radiation accumulation: Tc 99m administration contributes to a 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. Risk is greater with pediatric patients due to greater radiosensitivity and longer life expectancy. Ensure safe handling to minimize radiation exposure to the patient and health care providers.
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: Patients should be adequately hydrated prior to intravenous or intravesicular administration; instruct patients to void immediately after imaging study is complete and then frequently over the next 12 hours to decrease radiation exposure to the bladder. Instruct patients to blow nose and/or wash eyes after ophthalmic administration to decrease dose of radiation absorbed.
• Radiation exposure: Unintended exposure to molybdenum Mo-99 contributes to overall cumulative radiation dose. Strict adherence to the eluate testing protocol must be followed.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Combination [preservative free]:
LEU TechneLite:
TechneLite:
No
Salivary gland and thyroid imaging: Administer IV.
Nasolacrimal drainage system imaging: Ophthalmic instillation via a micropipette or similar method to ensure dosage accuracy. Instruct patient to blow nose and wash eyes with sterile distilled water or isotonic sodium chloride to minimize radiation dose absorbed following procedure.
Urinary bladder and ureters imaging (direct isotopic cystography): Instill via urethral catheter directly into the bladder. After instillation flush catheter with ~200 mL of sterile saline directly into the bladder. Patients should void immediately after imaging study is complete and then frequently over the next 12 hours to decrease radiation exposure to the bladder.
Patients should be adequately hydrated before and after intravenous or intravesicular administration.
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 when handling. Patients should be adequately hydrated before and after intravenous or intravesicular administration.
Thyroid gland imaging: Administer IV.
Urinary bladder and ureters imaging (direct isotopic cystography): Intravesicular: Instill via urethral catheter directly into the bladder. After instillation flush catheter with ~200 mL of sterile saline directly into the bladder.
Imaging agent: Radiopharmaceutical imaging agent used for nasolacrimal drainage system imaging (dacryoscintigraphy); salivary gland imaging; thyroid imaging; urinary bladder imaging (direct isotopic cystography) for the detection of vesico-ureteral reflux
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 women of reproductive 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 is present in breast milk.
Available guidelines recommend lactating women interrupt breastfeeding for a period of ≤24 hours after receiving technetium Tc 99m sodium pertechnetate (depending on dose). During this time, women can continue to express milk. This milk can either be discarded or stored under refrigeration for later use when radioactivity is no longer present (~60 hours) (ABM [Mitchell 2019]; IAEA 2018). During the period of breastfeeding interruption, the manufacturer recommends substituting formula for breast milk. Alternatively, women can pump and store breast milk prior to the procedure, which can be bottle-fed (Harding 1995).
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]).
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 hypersensitivity.
Radioactive diagnostic agent which distributes in the body similarly to the iodide ion, however is not organified in the thyroid (pertechnetate is released from the thyroid unchanged).
Distribution: Pertechnetate concentrates in the gastric mucosa, thyroid gland, salivary glands, and urinary bladder.
Half-life elimination: Physical half-life: 6.02 hours.
Time to peak: IV: 3.5 hours (cerebral spinal fluid); 0.25 to 2 hours (thyroid [euthyroid patients]).
Excretion: Urine (27% in 1 day; 31% in 4 days; 34% in 8 days).
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