Hepatobiliary imaging: IV (based on 70 kg patient): 2 to 5 mCi (74 to 185 MBq)
No dosage adjustment provided in the manufacturer’s labeling.
Serum bilirubin >1.5 mg/dL: 3 to 10 mCi (111 to 370 MBq)
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined: Dermatologic: Skin rash, urticaria
Hypersensitivity to technetium Tc 99m mebrofenin or any component of the formulation
Concerns related to adverse effects:
• Hypersensitivity reactions: Potential of allergic reactions in patients receiving multiple doses.
Concurrent drug therapy issues:
• Meperidine or morphine sulfate use: Recent use may delay intestinal transit of imaging agent resulting in nonvisualization of intestinal activity.
Disease-related concerns:
• Hepatic impairment: Delayed visualization or nonvisualization of the gallbladder may occur.
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: Patient should be fasting (at least 4 hours) prior to administration to prevent a false positive result (nonvisualization of gallbladder).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Intravenous:
Choletec: [contains methylparaben, propylparaben]
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Kit, Intravenous:
Choletec: [contains methylparaben, propylparaben]
IV: For IV administration. Test should be performed while patient is fasting; avoid interference with opioids by delaying the study for 4 hours after the last dose. Radiopharmaceutical; use appropriate precautions for handling and disposal.
Imaging agent: Hepatobiliary imaging agent
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.
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 on 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 mebrofenin for hepatobiliary imaging (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: Detectable in hepatic duct and gallbladder within 10 to 15 minutes and in intestinal tract within 30 to 60 minutes
Half-life elimination: 6.02 hours
Excretion: Urine (1% within 3 hours; 3% within 3 hours in patients with elevated serum bilirubin)
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