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.
There are no dosage adjustments provided in the manufacturer's labeling.
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.
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
There are no contraindications listed within the manufacturer's labeling.
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.
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]
No
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.
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.
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.
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 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
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 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).
Radioactive diagnostic agent that decays by isomeric transition to emit a photon that can be detected by imaging.
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)
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