Note: Thyroid protective agents (potassium iodide [SSKI] or Lugol solution) equivalent to 100 mg iodide should be given at least 1 hour prior to ioflupane I 123 administration.
Brain imaging: IV: 3 to 5 mCi (111 to 185 MBq).
There are no dosage adjustments provided in the manufacturer's labeling. Note: Ioflupane I 123 is renally excreted and patients with severe renal impairment may have increased radiation exposure and altered SPECT images.
There are no dosages adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
DaTscan: 185 MBq/2.5 mL (1 ea) [pyrogen free; contains alcohol, usp]
No
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
DaTscan: 74 MBq/mL (2.5 mL, 5 mL) [contains alcohol, usp]
IV: Administer by slow IV injection over at least 20 seconds via an arm vein. Begin SPECT imaging 3 to 6 hours following IV administration; refer to manufacturer's prescribing information for additional imaging information. Ensure adequate hydration before and after administration; void frequently for the first 48 hours post administration to minimize bladder exposure.
Radiopharmaceutical; use appropriate precautions for handling and disposal.
Brain imaging: Striatal dopamine transporter (DaT) visualization using single photon emission computed tomography (SPECT) brain imaging in conjunction with other diagnostic evaluations to assist in the evaluation of adult patients with suspected Parkinsonian syndromes (PS) or suspected dementia with Lewy bodies (DLB).
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.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Gastrointestinal: Nausea (≤1%), xerostomia (≤1%)
Nervous system: Dizziness (≤1%), headache (≤1%), vertigo (≤1%)
Postmarketing:
Hypersensitivity: Hypersensitivity reaction
Local: Pain at injection site
Known severe hypersensitivity to ioflupane I 123 or any components of the formulation.
Concerns related to adverse effects:
• Hypersensitivity: Hypersensitivity reactions have been reported. Use extreme caution in patients with iodine or iodine contrast agent hypersensitivity. Appropriate equipment and emergency medications should be available during use. Hypersensitivity reactions primarily involved dyspnea, edema, erythema, pruritus, and/or rash; reactions usually resolved spontaneously or following administration of corticosteroids and antihistamines.
• Malignancy: Patients are exposed to some radiation during treatment; large cumulative amounts of radiation exposure may increase the risk of cancer.
Disease-related concerns:
• Renal impairment: Use with caution in patients with severe renal impairment; ioflupane I 123 is eliminated renally. Therefore, patients with severe renal impairment may have increased radiation exposure and altered images. Effect of renal impairment on imaging with ioflupane I 123 has not been established.
Special handling:
• Radiopharmaceutical: Use appropriate precautions for handling, disposal, and shielding to minimize exposure to patients and health care personnel. Use only under supervision of individuals with experience/training in the handling of radioactive materials approved by the applicable regulatory authority.
Other warnings/precautions:
• Appropriate use: To limit thyroid gland accumulation of iodine 123 during exposure to ioflupane I 123, administer potassium iodide oral solutions or strong iodine solution (eg, Lugol's solution) equivalent to 100 mg iodide at least 1 hour prior to administration; increased long-term risk for thyroid neoplasia can occur from failure to block thyroid uptake of iodine 123. Note: Avoid the use of potassium iodide oral solution or Lugol solution in patients with past hypersensitivity to iodine or iodide products.
• Bladder exposure: Patients should be adequately hydrated prior to and following administration; instruct patients to void frequently for 48 hours following administration to decrease radiation exposure to bladder.
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Amoxapine: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Amphetamines: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Armodafinil: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Benztropine: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
BuPROPion: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
BusPIRone: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Cocaine (Topical): May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Dexmethylphenidate: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Methylphenidate: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Modafinil: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Phentermine: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Selective Serotonin Reuptake Inhibitors: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Selegiline: May diminish the diagnostic effect of Ioflupane I 123. Risk C: Monitor therapy
Evaluate pregnancy status prior to use in females of reproductive potential.
Radioactive iodine crosses the placenta and may impair fetal thyroid function.
All radiopharmaceuticals have the potential to cause fetal harm. If use is needed during pregnancy, an appropriate thyroid-blocking agent is recommended to protect the mother and fetus from accumulation of I 123. Brain imaging during pregnancy for suspected Parkinsonian syndromes is not recommended in pregnant women (SNM [Djang 2012]).
The radiolabeled component of ioflupane, iodine 123, is present in breast milk.
If testing is needed, it is recommended that lactating women pump and discard milk for 1 to 6 days after administration of ioflupane I 123 to minimize risk to infant (SNM [Djang 2012]).
Monitor for signs/symptoms of hypersensitivity reactions. Evaluate pregnancy status prior to use in females of reproductive potential.
Binds to dopamine transporter (DaT) in brain allowing for visualization of regions of interest in the brain to aid in the diagnosis of Parkinsonian syndromes.
Note: DaTscan contains iodine-123 labeled ioflupane. The kinetics of the drug molecule ioflupane are not equivalent to the kinetics/half-life of the radiolabeled ioflupane iodine 123. The kinetics presented correspond to the radioactive ioflupane I 123.
Onset: Uptake in the brain reached ~7% at 10 minutes after administration
Duration of radioactivity: Uptake in the brain reached ~3% after 5 hours. Striata to background ratios were constant between 3 to 6 hours after administration.
Distribution: ~30% of radioactivity from the whole brain attributed to striatal uptake
Half-life elimination: Iodine 123: 13.2 hours
Excretion: At 48 hours postinjection: Urine (~60% ); fecal (~14%)
Solution (DaTscan Intravenous)
185 mbq/2.5 mL (per each): $2,961.60
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