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USP DI Vol. II - RADIOPHARMACEUTICALS (Diagnostic)

RADIOPHARMACEUTICALS (Diagnostic)

This information applies to the following medicines when used for diagnosis:
1.	Ammonia N 13 (a-MOE-nya)
2.	Cyanocobalamin Co 57 (sye-an-oh-koe-BAL-a-min)
3.	Ferrous Citrate Fe 59 (FER-us SI-trate)
4.	Fludeoxyglucose F 18 (flu-dee-ox-ee-GLOO-kose)
5.	Gallium Citrate Ga 67 (GAL-ee-um)
6.	Indium In 111 Oxyquinoline (IN-dee-um ox-i-KWIN-oh-leen)
7.	Indium In 111 Pentetate (PEN-te-tate)
8.	Indium In 111 Pentetreotide (pen-te-TREE-oh-tide)
9.	Indium In 111 Satumomab Pendetide (sa-TYOO-mo-mab)
10.	Iobenguane, Radioiodinated (eye-oh-BEN-gwane)
11.	Iodohippurate Sodium I 123 (eye-oh-doe-HIP-yoor-ate SOE-dee-um)
12.	Iodohippurate Sodium I 131 (eye-oh-doe-HIP-yoor-ate SOE-dee-um)
13.	IofetamineI 123 (eye-oh-FET-a-meen)
14.	Iothalamate Sodium I 125 (eye-oh-thal-A-mate)
15.	Krypton Kr 81m (KRIP-tonn)
16.	Methionine C 11 (me-THYE-oh-neen)
17.	RadioiodinatedAlbumin (ray-dee-oh-EYE-oh-din-nay-tedal-BYOO-min)
18.	Rubidium Rb 82 (roo-BID-ee-um)
19.	SodiumChromate Cr 51 (KROE-mate)
20.	Sodium Fluoride F 18 (FLOR-ide)*?
21.	Sodium Iodide I 123 (EYE-oh-dyed)
22.	SodiumIodide I 131 (EYE-oh-dyed)
23.	Sodium Pertechnetate Tc 99m (per-TEK-ne-tate)
24.	Technetium Tc 99m Albumin (tek-NEE-see-um al-BYOO-min)
25.	Technetium Tc 99m Albumin Aggregated
26.	Technetium Tc 99m Albumin Colloid
27.	Technetium Tc 99m Arcitumomab
28.	TechnetiumTc 99m Bicisate (bye-SIS-ate)
29.	Technetium Tc 99m Disofenin (DYE-so-fen-in)
30.	TechnetiumTc 99m Exametazime (ex-a-MET-a-zeem)
31.	Technetium Tc 99m Gluceptate (gloo-SEP-tate)
32.	TechnetiumTc 99m Lidofenin (lye-doe-FEN-in)
33.	Technetium Tc 99m Mebrofenin (ME-bro-fen-in)
34.	TechnetiumTc 99m Medronate (ME-droe-nate)
35.	Technetium Tc 99m Mertiatide (meer-TYE-a-tide)
36.	Technetium Tc 99m Nofetumomab Merpentan?
37.	Technetium Tc 99m Oxidronate (OX-i-dron-ate)
38.	Technetium Tc 99m Pentetate (PEN-te-tate)
39.	TechnetiumTc 99m Pyrophosphate (peer-oh-FOS-fate)
40.	Technetium Tc 99m (Pyro- and trimeta-) Phosphates
41.	Technetium Tc 99m Sestamibi (SES-ta-mi-bi)
42.	TechnetiumTc 99m Succimer (SUX-sim-mer)
43.	Technetium Tc 99m Sulfur Colloid
44.	Technetium Tc 99m Teboroxime (te-boe-ROX-eem)
45.	Technetium Tc 99m Tetrofosmin (te-troe-FOS-min)?
46.	Thallous Chloride Tl 201 (THA-luss KLOR-ide)
47.	Xenon Xe 127 (ZEE-non)
48.	Xenon Xe 133
* Not commercially available in the U.S.
? Not commercially available in Canada

Description

Radiopharmaceuticals (ray-dee-oh-far-ma-SOO-ti-kals) are agents usedto diagnose certain medical problems or treat certain diseases. They may begiven to the patient in several different ways. For example, they may be givenby mouth, given by injection, or placed into the eye or into the bladder.

These radiopharmaceuticals are used in the diagnosis of:

Abscess and infection?Gallium Citrate Ga 67, Indium In 111Oxyquinoline
Biliary tract blockage?Technetium Tc 99m Disofenin, TechnetiumTc 99m Lidofenin, Technetium Tc 99m Mebrofenin
Blood volume studies?Radioiodinated Albumin, Sodium ChromateCr 51
Blood vessel diseases?Sodium Pertechnetate Tc 99m
Blood vessel diseases of the brain?Ammonia N 13, IofetamineI 123, Technetium Tc 99m Bicisate, Technetium Tc 99m Exametazime, Xenon Xe133
Bone diseases?Sodium Fluoride F 18, Technetium Tc 99m Medronate,Technetium Tc 99m Oxidronate, Technetium Tc 99m Pyrophosphate, TechnetiumTc 99m (Pyro- and trimeta-) Phosphates
Bone marrow diseases?Sodium Chromate Cr 51, Technetium Tc 99mAlbumin Colloid, Technetium Tc 99m Sulfur Colloid
Brain diseases and tumors?Fludeoxyglucose F 18, Indium In 111Pentetreotide, Iofetamine I 123, Sodium Pertechnetate Tc 99m, Technetium Tc99m Exametazime, Technetium Tc 99m Gluceptate, Technetium Tc 99m Pentetate
Cancer; tumors?Fludeoxyglucose F 18, Gallium Citrate Ga 67,Indium In 111 Pentetreotide, Indium In 111 Satumomab Pendetide, MethionineC 11, Radioiodinated Iobenguane, Sodium Fluoride F 18, Technetium Tc 99m Arcitumomab,Technetium Tc 99m Nofetumomab Merpentan
Colorectal disease?Technetium Tc 99m Arcitumomab
Disorders of iron metabolism and absorption?Ferrous CitrateFe 59
Heart disease?Ammonia N 13, Fludeoxyglucose F 18, RubidiumRb 82, Sodium Pertechnetate Tc 99m, Technetium Tc 99m Albumin, TechnetiumTc 99m Sestamibi, Technetium Tc 99m Teboroxime, Technetium Tc 99m Tetrofosmin,Thallous Chloride Tl 201
Heart muscle damage (infarct)?Ammonia N 13, FludeoxyglucoseF 18, Rubidium Rb 82, Technetium Tc 99m Pyrophosphate, Technetium Tc 99m (Pyro-and trimeta-) Phosphates, Technetium Tc 99m Sestamibi, Technetium Tc 99m Teboroxime,Technetium Tc 99m Tetrofosmin, Thallous Chloride Tl 201
Impaired flow of cerebrospinal fluid in brain?Indium In 111Pentetate
Kidney diseases?Iodohippurate Sodium I 123, Iodohippurate SodiumI 131, Iothalamate Sodium I 125, Technetium Tc 99m Gluceptate, TechnetiumTc 99m Mertiatide, Technetium Tc 99m Pentetate, Technetium Tc 99m Succimer
Liver diseases?Ammonia N 13, Fludeoxyglucose F 18, TechnetiumTc 99m Albumin Colloid, Technetium Tc 99m Disofenin, Technetium Tc 99m Lidofenin,Technetium Tc 99m Mebrofenin, Technetium Tc 99m Sulfur Colloid
Lung diseases?Krypton Kr 81m, Technetium Tc 99m Albumin Aggregated,Technetium Tc 99m Pentetate, Xenon Xe 127, Xenon Xe 133
Parathyroid diseases; parathyroid cancer?Technetium Tc 99mSestamibi, Thallous Chloride Tl 201
Pernicious anemia; improper absorption of vitamin B ₁₂ from intestines?Cyanocobalamin Co 57
Red blood cell diseases?Sodium Chromate Cr 51
Salivary gland diseases?Sodium Pertechnetate Tc 99m
Spleen diseases?Sodium Chromate Cr 51, Technetium Tc 99m AlbuminColloid, Technetium Tc 99m Sulfur Colloid
Stomach and intestinal bleeding?Sodium Chromate Cr 51, SodiumPertechnetate Tc 99m, Technetium Tc 99m (Pyro- and trimeta-) Phosphates, TechnetiumTc 99m Sulfur Colloid
Stomach problems?Technetium Tc 99m Sulfur Colloid
Tear duct blockage?Sodium Pertechnetate Tc 99m
Thyroid diseases; thyroid cancer?Fludeoxyglucose F 18, IndiumIn 111 Pentetreotide, Radioiodinated Iobenguane, Sodium Iodide I 123, SodiumIodide I 131, Sodium Pertechnetate Tc 99m, Technetium Tc 99m Sestamibi
Urinary bladder diseases?Sodium Pertechnetate Tc 99m

Radiopharmaceuticals are radioactive agents. However, when small amountsare used, the radiation your body receives from them is very low and is consideredsafe. When larger amounts of these agents are given to treat disease, theremay be different effects on the body.

When radiopharmaceuticals are used to help diagnose medical problems, onlysmall amounts are given to the patient. The radiopharmaceutical then passesthrough, or is taken up by, an organ of the body (which organ depends on whatradiopharmaceutical is used and how it has been given). Then the radioactivityis detected, and pictures are produced, by special imaging equipment. Thesepictures allow the nuclear medicine doctor to study how the organ is workingand to detect cancer or tumors that may be present in the organ.

Some radiopharmaceuticals are used in larger amounts to treat certain kindsof cancer and other diseases. In those cases, the radioactive agent is takenup in the cancerous area and destroys the affected tissue. The information that follows applies only to radiopharmaceuticals when usedin small amounts to diagnose medical problems.

The dosages of radiopharmaceuticals that are used to diagnose medical problemswill be different for different patients and depend on the type of test. Theamount of radioactivity of a radiopharmaceutical is expressed in units calledbecquerels or curies. Radiopharmaceutical dosages given may be as small as0.185 megabecquerels (5 microcuries) or as high as 1295 megabecquerels (35millicuries). The radiation received from these dosages may be about the sameas, or even less than, the radiation received from an x-ray study of the sameorgan.

Radiopharmaceuticals are to be given only by or under the direct supervisionof a doctor with specialized training in nuclear medicine.

Before Having This Test

In deciding to use a diagnostic test, any risks of the test must be weighedagainst the good it will do. This is a decision you and your doctor will make.Also, test results may be affected by other things. For radiopharmaceuticals,the following should be considered:

Allergies?If you will be receiving albumin in the form of radioiodinatedalbumin, technetium Tc 99m albumin aggregated, technetium Tc 99m albumin colloid,or technetium Tc 99m albumin for your test, tell your doctor if you have everhad any unusual or allergic reaction to products containing human serum albumin.Also tell your doctor if you are allergic to any other substance, such asfoods, preservatives, or dyes.

Pregnancy?Radiopharmaceuticals usually are not recommendedfor use during pregnancy. This is to avoid exposing the fetus to radiation.Some radiopharmaceuticals may be used for diagnostic tests in pregnant women,but it is necessary to inform your doctor if you are pregnant so the doctormay reduce the radiation dose to the baby. This is especially important withradiopharmaceuticals that contain radioactive iodine, which can go to thebaby's thyroid gland and, in high enough amounts, may cause thyroid damage.Be sure you have discussed this with your doctor.

Breast-feeding?Some radiopharmaceuticals pass into the breastmilk and may expose the baby to radiation. If you must receive a radiopharmaceutical,it may be necessary for you to stop breast-feeding for some time after receivingit. Be sure you have discussed this with your doctor.

Children?For most radiopharmaceuticals, the amount of radiationused for a diagnostic test is very low and considered safe. However, be sureyou have discussed with your doctor the benefit versus the risk of exposingyour child to radiation.

Older adults?Many medicines have not been studied specificallyin older people. Therefore, it may not be known whether they work exactlythe same way they do in younger adults or if they cause different side effectsor problems in older people. Although there is no specific information comparinguse of most radiopharmaceuticals in the elderly with use in other age groups,problems would not be expected to occur. However, it is a good idea to checkwith your doctor if you notice any unusual effects after receiving a radiopharmaceutical.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are goingto receive a radiopharmaceutical, it is especially important that your doctorknow if you are taking any other prescription or nonprescription (over-the-counter[OTC]) medicine.

In addition, if you will be receiving radioactive iodine (sodium iodideI 123, sodium iodide I 131) or sodium pertechnetate Tc 99m for a thyroid test,it is especially important that your doctor know if you have been taking iodinethrough other medicine or foods. For example, the results of your test maybe affected if:

You are taking iodine-containing medicines, including certain multivitaminsand cough syrups.

You eat large amounts of iodine-containing foods, such as iodizedsalt, seafood, cabbage, kale, rape (turnip-like vegetable), or turnips.

You have had an x-ray test recently for which you were given a specialdye that contained iodine.

Other medical problems?The presence of other medicalproblems may affect the use of radiopharmaceuticals. Make sure you tell yourdoctor if you have any other medical problems.

Preparation for This Test

The nuclear medicinedoctor may have special instructions for you in preparation for your test.For example, before some tests you must fast for several hours, or the resultsof the test may be affected. For other tests you should drink plenty of liquids.If you do not understand the instructions you receive or if you have not receivedany instructions, check with the nuclear medicine doctor in advance.

Precautions After Having This Test

There are usually no special precautions to observe for radiopharmaceuticalswhen they are used in small amounts for diagnosis.

Some radiopharmaceuticals may accumulate in your bladder. Therefore, toincrease the flow of urine and lessen the amount of radiation to your bladder,your doctor may instruct you to drink plenty of liquids and urinate oftenafter certain tests.

For patients receiving radioactive iodine (iodohippuratesodium I 123, iodohippurate sodium I 131, iofetamine I 123, iothalamate I125, radioiodinated albumin, or radioiodinated iobenguane):

Make sure your doctor knows if you are planning to have any futurethyroid tests. Even after several weeks, the results of the thyroid test maybe affected by the iodine solution that may be given before the radiopharmaceutical.

Side Effects of This Medicine

Along with its needed effects,a medicine may cause some unwanted effects. When radiopharmaceuticals areused in very small doses to study an organ of the body, side effects are rareand usually involve an allergic reaction. These effects may occur almost immediatelyor a few minutes after the radiopharmaceutical is given. It may be helpfulto note the time when you first notice any side effect. Your doctor, nuclearmedicine physician and/or technologist, or nurse will be prepared to giveyou immediate medical attention if needed.

Check with your doctoror nurse immediately if any of the following side effects occur:

Rare

Chills; difficulty breathing; drowsiness (severe); fainting; fast heartbeat; fever; flushing or redness of skin; headache(severe); nausea or vomiting; skin rash, hives, or itching; stomach pain; swelling of throat, hands, or feet

Other side effects not listed above may also occur insome patients. If you notice any other effects, note the time when they startand check with your doctor.