Version May 2024
Skeletal metastases (bone pain): IV: 148 megabecquerel (MBq; 4 millicurie [mCi]) or 1.5 to 2.2 MBq (40 to 60 microCi [µCi])/kg; repeat doses should be based on individual response, symptoms, and blood counts and are generally not recommended at intervals <90 days. Measure dose by a suitable radioactivity calibration system immediately prior to administration.
There are no dosage adjustments provided in the manufacturer’s labeling. However, consider benefit versus risk due to extensive renal excretion.
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: Flushing (after rapid injection)
Hematologic & oncologic: Leukopenia, thrombocytopenia (nadir: 12 to 16 weeks; recovery: 6 months)
Neuromuscular & skeletal: Ostealgia (transient increase; duration: 36 to 72 hours)
<1%, postmarketing, and/or case reports: Chills, fever, hot flash, septicemia
There are no contraindications listed in the manufacturer’s labeling.
Concerns related to adverse effects:
• Bone marrow suppression: Bone marrow toxicity (thrombocytopenia and leukopenia) is likely to occur. Use is not recommended in patients with seriously compromised bone marrow function from prior therapies or from disease infiltration (unless potential benefit outweighs risks). Monitor CBC at least every other week. The platelet nadir typically occurs between 12 and 16 weeks following administration; platelets and WBC recovery occur slowly, generally reaching baseline levels 6 months after treatment in the absence of other therapy interventions or disease progression. Use with caution in patients with platelets <60,000/mm3 or WBCs <2,400/mm3. Carefully evaluate bone marrow status and toxicity of initial dose if considering repeat administration.
• Bone pain: A small number of patients have experienced a transient increase in bone pain at 36 to 72 hours after administration; this is generally mild and self-limiting.
• Flushing: A flushing sensation has been reported following rapid (<30 seconds) injection.
Disease-related concerns:
• Incontinence: Incontinent patients may require urinary catheterization (to minimize radioactive contamination of clothing, bedding, and/or environment).
• Renal impairment: Primarily eliminated renally; possible risk versus benefit should be evaluated 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. Patients should take the following precautions to minimize exposure (Silberstein 2003): Avoid soiling underclothing or areas around toilet bowls for 2 weeks after injection. Wash any underclothing separately if significantly stained with urine. Where a normal toilet is available, sit to urinate in preference to a urinal. Flush toilet twice after use. Wash hands thoroughly after urination.
Other warnings/precautions:
• Appropriate use: Strontium-89 is not indicated for use in patients with cancer not involving bone. Due to delayed onset of pain relief (7 to 20 days following administration), also not indicated for use in patients with a short life expectancy.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as chloride:
Generic: 1 mCi/mL (1 ea)
Yes
Solution (Strontium Chloride Sr-89 Intravenous)
1 mci/mL (per each): $18,000.00
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.
IV: Administer intravenously slowly over 1 to 2 minutes. Radiopharmaceutical; use appropriate precautions for handling and disposal.
Skeletal metastases (bone pain): Relief of bone pain in patients with skeletal metastases.
Limitation of use: Confirm the presence of bone metastases prior to therapy.
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.
Women of childbearing potential should avoid becoming pregnant.
May cause fetal harm if administered during pregnancy.
It is not known if strontium-89 is present in breast milk. Because strontium acts as a calcium analog, secretion of strontium-89 into breast milk is likely. The manufacturer recommends discontinuing breastfeeding in mothers about to receive intravenous strontium-89.
CBC with differential (at least every other week)
Strontium-89 selectively localizes in metastatic bone lesions emitting beta radiation to reduce pain.
Onset: Pain relief: 7 to 20 days
Distribution: Selectively localizes in bone mineral (preferentially to metastatic bone lesions)
Excretion: In patients with bone metastases: Urine (67%); feces (33%)
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