Version May 2024
Skeletal imaging: IV: 10 to 20 mCi (370 to 740 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. Frequency not defined.
Cardiovascular: Hypotension
Central nervous system: Chills, dizziness
Dermatologic: Pruritus, skin rash, urticaria
Gastrointestinal: Nausea, vomiting
Hypersensitivity: Hypersensitivity reaction
Neuromuscular & skeletal: Weakness
There are no contraindications listed in the US manufacturer's labeling.
Canadian labeling: Hypersensitivity to technetium Tc 99m medronate or any component of the formulation.
Disease-related concerns:
• Hypocalcemia: May form complexes with cations (eg, calcium); use with caution in hypocalcemic patients or in patients at risk of developing hypocalcemia.
• Obesity: Image quality may be affected in obese patients.
• Renal impairment: Image quality may be affected in patients with renal impairment.
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.
Special populations:
• Older adult: Image quality may be affected in patients with advanced age.
Other warnings/precautions:
• Appropriate use: Patients should be adequately hydrated prior to and after dosing; instruct patients to void frequently for 4 to 6 hours following administration to decrease radiation exposure to the bladder. If a brain scan is anticipated, it should precede bone imaging procedures.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Intravenous:
Generic: Medronic acid 20 mg (5s, 30s) [vial contents to be combined with Technetium Tc 99m pertechnetate sodium (not included)]
Yes
IV: For IV administration. Imaging is optimal 1 to 4 hours after administration. Patients should be adequately hydrated before and after dosing; instruct patients to void immediately before imaging and frequently for 4 to 6 hours following administration to decrease radiation exposure to the bladder.
Radiopharmaceutical; use appropriate precautions for handling and disposal.
Skeletal imaging: Skeletal imaging agent to detect areas of altered osteogenesis
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.
Etidronate: May diminish the diagnostic effect of Technetium Tc 99m Medronate. Management: Consider performing bone scintigraphy with technetium Tc 99m medronate before, or at least 2 to 4 weeks after, etidronate administration. Risk D: Consider therapy modification
Pregnancy status should be evaluated prior to use in women of reproductive potential (SNM 2010).
The manufacturer recommends elective studies be conducted during the first 10 days of the menstrual cycle in women of reproductive potential.
Technetium Tc 99m medronate crosses the placenta (McKenzie 1994); the amount of technetium Tc 99m that can be detected in fetal tissue depends on 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 (Adelstein 1999; ICRP 2000; SNM 2010).
Technetium Tc 99m is present in breast milk.
Very little technetium Tc 99m medronate 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 medronate for a bone scan may be considered (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).
Radioactive diagnostic agent which decays by isomeric transition to emit a photon that can be detected by imaging
Half-life elimination: Physical: ~6 hours
Excretion: Urine (~50% within 24 hours)
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