Version May 2024
Positron emission tomography (PET) imaging (oncology, cardiology, and neurology settings): IV (based on 70 kg patient): 5 to 10 mCi (185 to 370 MBq).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).
Refer to adult dosing.
Positron emission tomography (PET) imaging (neurology setting): IV: 2.6 mCi (96.2 MBq); optimal dose adjustment on body size or weight has not been determined
There are no dosage adjustments provided in manufacturer's labeling (has not been studied).
There are no dosage adjustments provided in manufacturer's labeling (has not been studied).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Endocrine & metabolic: Hyper-/hypoglycemia (14%)
1% to 10%:
Cardiovascular: Transient hypotension
Hepatic: Transient alkaline phosphatase increased
There are no contraindications listed in the US manufacturer's labeling.
Canadian labeling: Hypersensitivity to fludeoxyglucose or any component of the formulation.
Disease-related concerns:
• Diabetes mellitus: In patients in the oncology or neurology setting with inadequately regulated blood glucose levels, suboptimal imaging may occur; consider medical therapy and laboratory testing to assure 2 days of normal blood glucose prior to administration.
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.
Other warnings/precautions:
• Patient information: Instruct patients in oncology or neurology settings to fast 4 to 6 hours prior to administration. In the cardiology setting, intake of 50 to 75 grams of glucose-containing foods or liquids will facilitate localization of cardiac ischemia. Encourage patients to adequately hydrate for 4 hours prior to administration; patients should void when imaging is complete and as often as possible thereafter for at least 1 hour to minimize bladder exposure.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Generic: 20-300 MCI/ML (1 ea)
Solution, Intravenous [preservative free]:
Generic: 20-500 MCI/ML (1 ea)
Yes
Solution (Fludeoxyglucose F 18 Intravenous)
20-300 mci/mL (per each): $222.00
20-500 mci/mL (per each): $365.17
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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Cyclodx: 0.5-232 GBq (18 mL)
FluGlucoScan: 0.5 GBq (20 mL)
Glucovision (Citrate): 453 GBQ (10 mL, 30 mL) [contains alcohol, usp]
Glucovision (Phosphate): 540 GBQ (10 mL, 30 mL) [contains alcohol, usp]
Generic: 4240 mCi (10 mL, 20 mL, 30 mL); 18.5 mCi/mL (30 mL); 0.5 GBq (10 mL, 16 mL, 20 mL, 29 mL); 0.5-232 GBq (29 mL); 1-441 GBq (10 mL, 30 mL); 10-200 MCI/ML (1 ea)
Solution Prefilled Syringe, Intravenous:
Glucovision: 453 GBQ (1 mL, 3 mL, 5 mL) [contains alcohol, usp]
Glucovision (Phosphate): 540 GBQ (1 mL, 3 mL, 5 mL) [contains alcohol, usp]
IV: Administer as an IV injection. Initiate imaging within 40 minutes of administration; obtain static emission images 30 to 100 minutes after injection. Encourage patients to adequately hydrate for 4 hours prior to administration. Instruct patients in oncology or neurology settings to fast 4 to 6 hours prior to administration; also, consider medical therapy or laboratory testing to ensure at least 2 days of normoglycemia prior to administration. In the cardiology setting, administering 50 to 75 g of glucose-containing foods or liquids prior to administration will facilitate localization of cardiac ischemia. To minimize bladder exposure, patients should void when imaging is complete and as often as possible thereafter for at least 1 hour.
Radiopharmaceutical; use appropriate precautions for handling and disposal. Waterproof gloves should be worn and effective shielding should be used during handling and administration.
IV: Note: Radiopharmaceutical; use appropriate precautions for handling and disposal. Waterproof gloves should be worn and effective shielding should be used during handling and administration.
PET imaging (Neurology setting): Administer as an IV injection. Initiate imaging within 40 minutes of administration. Encourage patients to adequately hydrate for 4 hours prior to administration. Instruct patients to fast 4 to 6 hours prior to administration; also, consider medical therapy or laboratory testing to ensure at least 2 days of normoglycemia prior to administration. To minimize bladder exposure, patients should void when imaging is complete and as often as possible thereafter for at least 1 hour.
Positron emission tomography (PET) imaging: Fluorinated deoxyglucose used in conjunction with positron emission tomography (PET) imaging for assessment of abnormal glucose metabolism to assist in evaluating malignancy in patients with known or suspected abnormalities found by other testing modalities or in patients with diagnosis of cancer; in conjunction with myocardial perfusion imaging to identify left ventricular myocardium with residual glucose metabolism and reversible loss of systolic function in patients with coronary artery disease and left ventricular dysfunction; to detect areas in the brain with abnormal glucose metabolism linked with foci of epileptic seizures
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.
MetFORMIN: May diminish the diagnostic effect of Fludeoxyglucose F 18. Management: Consider holding metformin for 48 hours or longer prior to PET scans using fludeoxyglucose F18 (FDG-F18) when imaging of the colon or intestine is required. Consider increased monitoring of blood glucose when metformin is held. Risk D: Consider therapy modification
Fludeoxyglucose F 18 crosses the placenta and can be detected in the fetus.
The amount of fludeoxyglucose F 18 absorbed by the fetus is greater when exposure is via positron emission tomography (PET)/CT versus PET alone. Exposure also varies by gestational age, with higher exposure occurring earlier in pregnancy. Exposure can be decreased with more frequent voiding (Takalkar 2011; Zanotti-Fregonara 2015; Zanotti-Fregonara 2017). Adverse fetal effects or radiation-related risks have not been identified for diagnostic procedures involving <50 mGy. Long-term effects to a child following in utero exposure are not known.
Fludeoxyglucose F 18 is present in breast milk.
The uptake of fludeoxyglucose F 18 by breast tissue may vary in relation to maternal age, timing of menstrual cycle, and presence of mastitis. Uptake may differ between breasts in women who are breastfeeding (Abhyankar 2012; Dong 2016; Hicks 2001; Ko 2013; Shor 2002).
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, benefits of breastfeeding to the infant, and benefits of treatment to the mother. To decrease radiation exposure to the infant, the infant should be fed prior to the injection and close breast contact should be avoided for 9 to 12 hours after the maternal injection of fludeoxyglucose F 18. Although the manufacturer recommends lactating women express and discard milk during this time, milk collected during this period may be used to bottle feed to avoid close contact with the breast (Jamar 2013).
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