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Technetium Tc-99m tetrofosmin: Drug information

Technetium Tc-99m tetrofosmin: Drug information
(For additional information see "Technetium Tc-99m tetrofosmin: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Myoview;
  • Myoview 30mL
Pharmacologic Category
  • Radiopharmaceutical
Dosing: Adult
Myocardial perfusion imaging; ventricular function imaging

Myocardial perfusion imaging; ventricular function imaging: IV: Dosage range: 5 to 33 mCi (185 to 1221 MBq). When rest and stress imaging are performed on the same day, administer a first dose of 5 to 12 mCi (185 to 444 MBq) followed by a second dose of 15 to 33 mCi (555 to 1221 MBq) ~1 to 4 hours later.

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.

1% to 10%: Hematologic & oncologic: Leukocytosis (<4%)

<1%, postmarketing, and/or case reports: Abdominal distress, allergic skin reaction, altered sense of smell, angina pectoris, burning sensation of mouth, dyspnea, fever, hypersensitivity reaction, hypertension, hypotension, metallic taste, skin rash, torsades de pointes, urticaria, ventricular arrhythmia, visual disturbance, vomiting

Contraindications

There are no contraindications listed within the manufacturer's labeling.

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity reactions: Hypersensitivity reactions, including abdominal pain, anaphylaxis, bronchospasm, chest pain, coughing, cutaneous reactions, dyspnea, hypotension, tachycardia, and throat tightness, have occurred; emergency treatment should be immediately available.

• Malignancy: Patients are exposed to some radiation during treatment; large cumulative amounts of radiation exposure may increase the risk of cancer.

• 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.

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 tetrofosmin; 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: Patients should be adequately hydrated prior to dosing; instruct patients to void frequently following administration to decrease radiation exposure to the bladder. Myocardial imaging may be done while patients are at rest and/or under pharmacologic stress conditions.

Dosage Forms: US

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

Kit, Intravenous:

Myoview: Tetrofosmin 1.38 mg (5s) [to be combined with sodium pertechnetate Tc99m injection solution (not included)]

Myoview 30mL: Tetrofosmin 1.38 mg (5s) [to be combined with sodium pertechnetate Tc99m injection solution (not included)] [pyrogen free]

Generic Equivalent Available: US

No

Administration: Adult

IV: Not for direct IV injection; only reconstituted technetium Tc 99m tetrofosmin may be administered IV See manufacturer's prescribing information for complete administration procedure. Ensure adequate hydration before and after administration; void frequently to minimize bladder exposure. Imaging may begin 15 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.

Use: Labeled Indications

Myocardial perfusion imaging: Radiopharmaceutical imaging agent used for myocardial perfusion imaging under rest and/or exercise or pharmacologic stress conditions to delineate regions of reversible myocardial ischemia or infarcted myocardium in patients with known or suspected coronary artery disease.

Ventricular function imaging: Radiopharmaceutical imaging agent used to assess left ventricular function including left ventricular ejection fraction and wall motion in patients with known or suspected heart disease.

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

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 Tetrofosmin. Risk C: Monitor therapy

Reproductive Considerations

Pregnancy status should be evaluated prior to use in women of reproductive potential (SNM 2010).

Pregnancy Considerations

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).

Breastfeeding Considerations

Technetium Tc 99m tetrofosmin 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 tetrofosmin for myocardial perfusion imaging may be considered (IAEA 2018). The manufacturer recommends patients pump and discard breast milk for 60 hours after administration to decrease radiation exposure to the breastfed infant. 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).

Mechanism of Action

Radioactive diagnostic agent that decays by isomeric transition to emit a photon that can be detected by imaging.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Distributed in the myocardium, blood, liver, and lung

Half-life elimination: Physical half-life: 6.03 hours

Time to peak: Myocardium uptake: 5 minutes

Excretion: Urine (40% of injected activity within 48 hours); feces (26% of injected activity within 48 hours)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (CO) Colombia: Myoview;
  • (FR) France: Myoview;
  • (JP) Japan: Myoview;
  • (KR) Korea, Republic of: Myoview;
  • (NL) Netherlands: Myoview;
  • (NO) Norway: Myoview;
  • (PT) Portugal: Myoview;
  • (RU) Russian Federation: Myoview
  1. Adelstein SJ. Administered Radionuclides in Pregnancy. Teratology. 1999;59(4):236-239. [PubMed 10331526]
  2. American College of Radiology (ACR), Society for Pediatric Radiology (SPR). ACR–SPR practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation (resolution 39). Revised 2018. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf?la=en. Accessed February 24, 2020.
  3. Harding LK, Bossuyt S, Pellet C, et al. Recommendations for Nuclear Medicine Physicians Regarding Breastfeeding Mothers. Eur J Nucl Med. 1995;22(5)BP17.
  4. International Atomic Energy Agency. IAEA Safety Standards for Protecting People and the Environment: Radiation Protection and Safety in Medical Uses of Ionizing Radiation. Specific Safety Guide No. SSG-46. IAEA; 2018. https://www​.iaea.org​/publications/11102/radiation-protection-and-safety-in-medical-uses-of-ionizing-radiation.
  5. International Commission on Radiological Protection (ICRP). Pregnancy and Medical Radiation. Ann ICRP. 2000;30(1):iii-viii, 1-43. [PubMed 11108925]
  6. Mitchell KB, Fleming MM, Anderson PO, Giesbrandt JG; Academy of Breastfeeding Medicine. ABM Clinical Protocol #31: radiology and nuclear medicine studies in lactating women. Breastfeed Med. 2019;14(5):290‐294. doi:10.1089/bfm.2019.29128.kbm [PubMed 31107104]
  7. Mountford PJ, Coakley AJ. A Review of the Secretion of Radioactivity in Human Breast Milk: Data, Quantitative Analysis and Recommendations. Nucl Med Commun. 1989;10(1):15-27. [PubMed 2645546]
  8. Myoview (technetium Tc99m tetrofosmin) [prescribing information]. Arlington Heights, IL: GE Healthcare Medi-Physics Inc; December 2022.
  9. Rubow S, Klopper J, Wasserman H, et al. The Excretion of Radiopharmaceuticals in Human Breast Milk: Additional Data and Dosimetry. Eur J Nucl Med. 1994;21(2):144-153. [PubMed 8162938]
  10. Society of Nuclear medicine (SNM). Society of Nuclear Medicine procedure guideline for general imaging. Version 6.0. Revised 2010. http://s3.amazonaws.com/rdcms-snmmi/files/production/public/docs/General_Imaging_Version_6.0.pdf. Accessed July 22, 2019.
Topic 86873 Version 81.0

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