Version May 2024
Imaging (localization of stroke; adjunct to CT or MRI): IV (based on 70 kg patient): 10 to 30 mCi (370 to 1,110 MBq) as a single dose. Measure dose by a suitable radioactivity calibration system immediately prior to administration.
There are no dosage adjustments provided in the manufacturer’s labeling; use with caution (primarily excreted by the kidney).
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
≤1%:
Cardiovascular: Angina pectoris, cardiac failure, hypertension, syncope
Central nervous system: Agitation, altered sense of smell, anxiety, dizziness, drowsiness, hallucination, headache, malaise, seizure
Dermatologic: Skin rash
Gastrointestinal: Nausea
Respiratory: Apnea, cyanosis
Frequency not defined: Abnormal serum calcium, phosphate imbalance
There are no contraindications listed in the manufacturer’s labeling.
Disease-related concerns:
• Renal impairment: Primarily excreted by the kidney; use with caution 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.
Other warnings/precautions:
• Appropriate use: Instruct patients to void frequently for 2 to 6 hours after the completion of the injection; encourage adequate hydration to facilitate frequent voiding.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, for Injection:
Neurolite: Bicisate dihydrochloride 0.9 mg per vial (2s, 5s) [to be combined with sodium pertechnetate Tc99m injection solution (not included)]
No
IV: For IV administration. Ensure adequate hydration prior to administration and encourage patient to drink fluids following administration. To minimize bladder exposure, patients should void frequently, especially during the 2 to 6 hours following administration.
Radiopharmaceutical; use appropriate precautions for handling and disposal.
Imaging agent: Adjunct to conventional CT or MRI imaging in localization of stroke in patients in whom stroke has been diagnosed
Limitations of use: Not indicated for assessment of functional viability of brain tissue and not indicated for distinguishing between stroke and other brain lesions
Radiopharmaceutical: Use appropriate precaution for handling, disposal, and minimizing exposure to patients and health care 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 4 hours after receiving technetium Tc 99m bicisate (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.
Onset of Action: 10 minutes
Duration of Action: 6 hours
Distribution: Distributes to brain
Metabolism: Metabolized by endogenous enzymes to the mono- and di-acids of Technetium Tc99m bicisate
Time to peak: 30-60 minutes
Excretion: Urine (74% after 24 hours); feces (12.5% after 48 hours)
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