Perflutren lipid microspheres, often referred to as simply perflutren microspheres, are a type of contrast agent used in medical imaging, particularly in echocardiography. These microspheres contain perflutren gas encapsulated within a lipid shell. Perflutren is a type of fluorocarbon gas that is highly echogenic, meaning it reflects ultrasound waves very effectively.

In medical imaging, contrast agents like perflutren microspheres are used to enhance the visibility of specific structures or organs. When injected into the bloodstream, these microspheres circulate and then accumulate in the vascular system, enhancing the ultrasound signal and improving the clarity of images produced by ultrasound machines.

Perflutren microspheres are primarily used during echocardiograms to improve the visualization of the heart chambers, valves, and blood flow patterns. They are particularly useful in situations where standard echocardiography may not provide sufficient clarity or when detailed imaging of cardiac structures is necessary for accurate diagnosis.

Luminity is a preparation containing Perflutren lipid microspheres that are used as an ultrasound contrast agent for better evaluation.

Luminity (Perflutren lipid microspheres) Uses:

• Cardiovascular imaging:
  • Opacification of the left ventricular chamber and improvement of delineation of the left ventricular endocardial border in patients with suboptimal echocardiograms
• Use: Off-Label: Adult
  • Focal liver lesion evaluation

Luminity (Perflutren lipid microspheres) Dose in Adults

Luminity (Perflutren lipid microspheres) Dose in Cardiovascular imaging:

Preparation:

• Before giving the dose, a baseline noncontrast echocardiography is done.
• This is to have a comparison with the images after the dose.
• The ultrasound machine settings are adjusted to keep the mechanical index at 0.8 or lower.

IV Bolus:

• The dose is given through an intravenous (IV) injection.
• It's given based on the person's weight at a rate of 10 microliters (mcL) per kilogram of activated product.
• After the injection, 10 milliliters (mL) of saline solution is flushed through the IV line.
• If necessary, the dose can be repeated once after 30 minutes, again followed by a saline flush.
• However, no more than two bolus doses are given per imaging session.

IV Infusion:

• Alternatively, instead of a bolus, the dose can be given as an IV infusion.
• Initially, it's administered at a rate of 4 mL per minute (or 240 mL per hour).
• The infusion rate can be adjusted to get the best possible images.
• Only one IV infusion is given per imaging session.

These doses and procedures are followed to optimize the imaging quality while ensuring the safety of the individual undergoing the procedure.

Luminity (Perflutren lipid microspheres) Dose in the evaluation of focal liver lesions:

• IV Bolus: The dose administered is between 0.1 to 0.6 milliliters (mL) per injection, followed by a flush of 5 milliliters (mL) of saline solution. This process can be repeated at least every 5 minutes or when most of the microbubbles have disappeared. The maximum total dose should not exceed 10 microliters (mcL) per kilogram of the person's weight.

This dosing regimen is based on various studies and guidelines and is used off-label for evaluating focal liver lesions. It's important to adhere to these guidelines to ensure safety and effectiveness in imaging while evaluating liver lesions.

Luminity (Perflutren lipid microspheres) Dose in Children

Not indicated in children.

Pregnancy Risk Category B

• Because perflutren lipid microspheres have a very short half-life, giving them during pregnancy isn't likely to lead to significant exposure of the fetus to the medication that would cause any noticeable effects.

Perflutren lipid use during breastfeeding:

• The presence of perflutren lipid microspheres in breast milk is currently unknown.
• Therefore, when considering breastfeeding while undergoing therapy with this medication, it's important to weigh the potential risks of infant exposure against the benefits of breastfeeding for the baby and the benefits of treatment for the mother.
• However, it's worth noting that the medication's very short half-life should limit its presence in breast milk.

Luminity (Perflutren lipid microspheres) Dose in Kidney Disease:

• The manufacturer's labeling for perflutren lipid microspheres does not include any specific dosage adjustments for individuals with renal impairment.
• This suggests that the medication is likely safe to use in people with kidney problems without needing to modify the dosage.

Luminity (Perflutren lipid microspheres) Dose in Liver Disease:

• The manufacturer's labeling for perflutren lipid microspheres does not include any dosage adjustments because it has not been studied for specific dosage modifications in various populations.
• This means that there is limited information available regarding how the medication may affect certain groups of people differently, such as those with renal impairment or other medical conditions.

Side Effects of Luminity (Perflutren lipid microspheres):

• Cardiovascular:
  • Flushing
• Central nervous system:
  • Headache
• Gastrointestinal:
  • Nausea
• Neuromuscular & skeletal:
  • Back pain
• Renal:
  • Renal pain

Contraindication to Luminity (Perflutren lipid microspheres):

• Perflutren lipid microspheres should not be used in individuals who have a known hypersensitivity or allergic reaction to perflutren or any component of the formulation.
• This includes any history of severe allergic reactions to perflutren or any related substances.

Warnings and Precautions

Anaphylactoid reactions:

• Post-marketing reports have indicated anaphylactoid reactions, including shock, hypersensitivity, bronchospasm, throat tightness, angioedema, and various types of swelling (oropharyngeal, palatal, peripheral, and localized).
• Other reported reactions include facial hypoesthesia, rash, urticaria, pruritus, flushing, and erythema.
• These reactions have occurred even in patients with no prior exposure. Monitoring for signs and symptoms of anaphylactoid reactions is crucial.

Serious cardiopulmonary reactions: [US Boxed Warning]:

• Serious cardiopulmonary reactions, including fatalities, have been observed during or after administration, with most serious reactions occurring within 30 minutes.
• Prior to administration, all patients should be assessed for conditions that might preclude the use of perflutren lipid microspheres.
• Availability of resuscitation equipment and trained personnel for handling medical emergencies is essential.
• While patients with unstable cardiopulmonary conditions may be at increased risk, studies suggest that perflutren-based ultrasound contrast agents can be used safely in patients with significant cardiopulmonary disease or critical illness.

Ventricular arrhythmias:

• High ultrasound mechanical indices, with or without end-systolic triggering, may lead to microsphere cavitation or rupture, resulting in ventricular arrhythmias.
• The safety of activated perflutren lipid microspheres with mechanical indices >0.8 or the use of end-systolic triggering has not been established.

Cardiac shunts:

• Patients with cardiac shunts should be evaluated for embolic phenomena following administration.
• Perflutren lipid microspheres have the potential to bypass lung filtering and enter the arterial circulation.
• Patients with small degrees of right-to-left shunting through patent foramen ovales are not considered at increased risk for microvascular occlusion with perflutren-based ultrasound contrast agents.

Monitoring Parameters:

Cardiopulmonary Reactions (Rare):

• Cardiopulmonary reactions to perflutren lipid microspheres are rare but can occur. These reactions involve the heart and lungs and may be serious.
• It's important to monitor patients according to their clinical condition.

Anaphylactoid Reactions (Rare):

• Anaphylactoid reactions, although rare, can also occur with perflutren lipid microspheres. These reactions involve a severe allergic response that may be life-threatening.
• Monitoring patients appropriately based on their clinical status is essential.

Monitoring Approach:

• According to a study by Muskula in 2017, there's no need for specific monitoring parameters based solely on the administration of perflutren lipid microspheres.
• Instead, monitoring should be tailored to the individual patient's clinical condition and disposition. This means observing for any unexpected or concerning symptoms and responding accordingly.

This approach ensures that patients receive appropriate care while undergoing imaging procedures involving perflutren lipid microspheres, with a focus on their overall clinical status rather than specific monitoring parameters related to the medication.

How to administer Luminity (Perflutren lipid microspheres)?

IV Bolus (Undiluted):

• Cardiovascular Imaging: Activate the solution using the Vialmix apparatus before administration. Inject undiluted solution within 30 to 60 seconds of activation. Follow each injection with a 10 mL saline flush.
• Focal Liver Lesion Evaluation (Off-label Use): Activate the solution using the Vialmix apparatus before administration. Follow each injection with a 5 mL saline flush.

IV Bolus (Diluted):

• Activate the solution using the Vialmix apparatus before administration. Administer slowly up to 3 mL of the diluted solution. Additional boluses of 1 to 2 mL may be given as needed.

IV Infusion Rate:

• Initially, set the infusion rate at 4 mL/minute (or 240 mL/hour). Adjust the flow rate as needed, up to a maximum of 10 mL/minute (or 600 mL/hour), for optimal image enhancement. The rate should be adjusted based on the patient's response and imaging requirements.

Mechanism of action of Luminity (Perflutren lipid microspheres):

• Activated perflutren lipid microspheres are used to enhance the visibility of the endocardial borders during echocardiography.
• This contrast agent helps to improve the clarity of ultrasound images, making it easier for healthcare providers to visualize and assess the structures within the heart.
• By providing enhanced contrast, activated perflutren lipid microspheres enable more accurate diagnosis and evaluation of cardiac function and abnormalities during echocardiographic procedures.

Onset of Action:

• Immediate - Upon administration, perflutren lipid microspheres quickly provide contrast enhancement, allowing for immediate visualization during echocardiography.

Duration:

• IV Bolus: 3.4 minutes - The contrast enhancement lasts for approximately 3.4 minutes after administering an IV bolus of perflutren lipid microspheres.
• IV Infusion: 7.1 minutes - When administered via IV infusion, the duration of contrast enhancement extends to around 7.1 minutes.

Metabolism:

• Octafluoropropane gas (OFP): Not metabolized - The gas component of perflutren lipid microspheres, octafluoropropane, is not metabolized.
• Phospholipid component: Metabolized to free fatty acids - The phospholipid component is metabolized into free fatty acids within the body.

Half-life Elimination:

• OFP:
  • Healthy patients: 1.3 minutes
  • Patients with COPD: 1.9 minutes - The half-life of octafluoropropane gas is approximately 1.3 minutes in healthy patients and slightly longer, about 1.9 minutes, in patients with chronic obstructive pulmonary disease (COPD).

International Brands of Perflutren lipid microspheres:

• Definity
• Luminity
• Lumminity

Perflutren lipid microspheres Brand Names in Pakistan:

No Brands Available in Pakistan.