Sulfur hexafluoride lipid microspheres (Lumason) is a contrast agent that is used in echocardiography to delineate the left ventricle for optimal study and in ultrasonographic procedures of the liver and the urinary tract.

Sulfur hexafluoride lipid microspheres Uses:

• Cardiovascular imaging:

  • The left ventricular chamber can be opacified and the delineation of the left ventricular endocardial border can be improved with its use in adults with suboptimal echocardiograms.

• Hepatic ultrasonography:

  • Can characterize focal liver lesions in both adult and pediatric patients.

• Urinary tract ultrasonography:

  • To evaluate suspected or known VUR (vesicoureteral reflux) in pediatric patients.

• SonoVue [Canadian product]:

  • Cardiovascular imaging: The ] cardiac chambers visualization and endocardial border delineation can be improved with its use during echocardiography.
  • Diagnostic vessel assessment:  Doppler evaluation of cerebral and extracranial carotid and peripheral arteries can be facilitated; also enhances the Doppler image quality and the duration of clinically useful signal enhancement in abdominal and renal arteries and in portal vein assessment.
  • Limitations of use: Only to be used in patients whose examinations without contrast enhancement are inconclusive.

Sulfur hexafluoride lipid microspheres (Lumason) Dose in Adults

Sulfur hexafluoride lipid microspheres (Lumason) Dose in the Cardiovascular imaging:

• IV: During echocardiography give 2 mL intravenously; dose may be repeated once during the procedure to prolong contrast enhancement.

Note: The mechanical index for the ultrasound device should be adjusted to 0.8 or lower after baseline non-contrast echocardiography is complete. The imaging should be continued after injection.

Sulfur hexafluoride lipid microspheres (Lumason) Dose in the Hepatic ultrasonography:

• IV:  During ultrasonography 2.4 mL should be given intaveouly; dose may be repeated once during the procedure.

Note: The mechanical index for the ultrasound device should be adjusted to 0.4 or lower after identification of the target focal lesion on non-contrast ultrasound examination. The imaging should be continued after injection.

Sulfur hexafluoride lipid microspheres (Lumason) Dose in the Diagnostic vessel assessment:

• SonoVue [Canadian product]: IV: During Doppler ultrasound 1.2 mL should be given via intravenous route ; dose may be repeated once during procedure

Sulfur hexafluoride lipid microspheres (Lumason) Dose in Childrens

Sulfur hexafluoride lipid microspheres (Lumason) Dose in the Hepatic ultrasonography:

• Children and Adolescents:

  • IV: During ultrasonography 0.03 mL/kg should be given; the dose may be repeated once during the procedure. The maximum dose is 2.4 mL/dose.

Note: The mechanical index for the ultrasound device should be adjusted to 0.4 or lower after identification of the target focal lesion on non-contrast ultrasound examination. The imaging should be continued after injection.

Sulfur hexafluoride lipid microspheres (Lumason) Dose in the Urinary ultrasonography:

• Infants, Children, and Adolescents:

  • Intravesical: During ultrasonography 1 mL should be given .

Note: The mechanical index for the ultrasound device should be adjusted to 0.4 or lower after baseline non-contrast ultrasound examination. Perform continuous alternate ultrasound imaging of the bladder, ureters, and kidneys during filling and voiding of the bladder.

Pregnancy & lactation

• Studies on animal reproduction have shown negative effects.

Use during breastfeeding:

• It is unknown whether breast milk contains any Sulfur Hexafluoride Lipid-type A microspheres.
• According to the manufacturer, breastfeeding should be considered during therapy.
• This includes the risks to infants, benefits to mothers and the benefits to breastfeeding. Sulfur hexafluoride undergoes rapid clearance.
• Breast milk should be pumped before it is used.

Dose in Kidney Disease:

No dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

No dosage adjustments provided in the manufacturer’s labeling.

Side effects of Sulfur hexafluoride lipid microspheres (Lumason):

• Cardiovascular:

  • Atrial Fibrillation
  • Bradycardia
  • Cardiac Arrest
  • Flushing
  • Hypertension
  • Hypotension
  • Ischemia
  • Shock
  • Supraventricular Tachycardia
  • Syncope
  • Tachycardia
  • Ventricular Fibrillation
  • Ventricular Tachycardia

• Central Nervous System:

  • Convulsions
  • Loss Of Consciousness

• Dermatologic:

  • Erythema
  • Skin Rash
  • Urticaria

• Hypersensitivity:

  • Anaphylactic Shock
  • Anaphylactoid Reaction
  • Anaphylaxis
  • Hypersensitivity Reaction

• Respiratory:

  • Dyspnea
  • Hypoxia
  • Pharyngeal Edema
  • Respiratory Distress
  • Stridor
  • Wheezing

Contraindications to Sulfur hexafluoride lipid microspheres (Lumason):

• Hypersensitivity to sulfur hexafluoride microspheres of lipid-type A or any other component of the formulation

SonoVue [Canadian Product]:

• Hypersensitivity to sulfur hexafluoride and any other component of the formulation
• There are known right-to-left cardiac Shunts
• Severe pulmonary hypertension (pulmonary pressure >90mm Hg).
• Systemic hypertension uncontrolled
• ARDS (adult respir distress syndrome)

Warnings and precautions

• Cardiopulmonary reactions: [US-Bound Warning]

  • These can cause fatal cardiopulmonary reactions. These reactions are rarer after or soon after the administration of ultrasound contrast agents such as sulfur hexafluoride microspheres. The majority of serious reactions occur within half an hour after administration.
  • Every patient should be evaluated for any conditions that may prevent administration.
  • Make sure you have the right equipment and personnel to perform resuscitation.
  • An increased risk is posed by unstable cardiopulmonary conditions (acute MI), acute coronary artery syndromes and worsening/unstable CHF.
  • Acute reactions should be observed in all patients.

• Hypersensitivity

  • Hypersensitivity reactions may include skin erythema and rash, urticaria or flushing. These reactions are rare.
  • Assure immediate access to treatment for hypersensitivity reactions while using.
  • Acute reactions should be observed in all patients.

Monitoring parameters:

• Cardiopulmonary reactions
• Heart rhythm
• Signs and symptoms of anaphylactoid reactions
• Pulse rate
• Respiratory rate
• Pulse oximetry (during and for half an hour after infusion);
• Patients with cardiac shunts should be assessed for embolic phenomena after administration

How to administer Sulfur hexafluoride lipid microspheres (Lumason)?

IV:

• An IV bolus should be given; avoid intra-arterial administration.
• IV flushing with NS mL should be done after each injection.

SonoVue [Canadian product]:

• An IV bolus should be given; avoid intra-arterial administration.
• Should be given at a rate of 1.2 mL over a period of 1 second during Doppler ultrasound; however, during transcranial Doppler administer at a slower rate of 2-3 seconds to reduce blooming artifacts. IV flushing with NS mL should be done after each injection.

Intravesical:

• The bladder should be emptied of urine and then filled with NS to ~33% to 50% of the predicted total volume.
• Sulfur hexafluoride lipid microspheres should be administered as an intravesical bolus injection through a 6 to 8 french urinary catheter.
• Continuously inject NS into the bladder until the patient has the urge to micturate or the sign of backpressure appears.
• Immediately after the first voiding, may refill the bladder with NS only for the second cycle of voiding and imaging.

Mechanism of action of Sulfur hexafluoride lipid microspheres (Lumason):

Ultrasound contrast agent to aid in cardiovascular imaging, hepatic, and urinary tract ultrasonography.

Time:

• Cardiovascular imaging from 1.7 to 3.0 minutes (useful contrast effect).

Distribution:

• V : Sulfur hexafluoride (SF-6): 341 L (0.03 mL/kg dose); 710 L (0.3 mL/kg dose)

Metabolism:

• Very little or very few

Half-life elimination:

• Terminal: SF-6 - 10 mins (0.3 mL/kg dosing; half-life couldn't be calculated at 0.03 mL/kg dosage)

Plasma peak time:

• SF-6: 1 to 2-minutes; up to 4-minutes for pulmonary impairment

Excretion:

• SF-6: Excretion via Lungs (88% unchanged).

International Brand Names of Sulfur hexafluoride lipid microspheres:

• Lumason
• SonoVue
• SonoVUe

Sulfur hexafluoride lipid microspheres Brand Names in Pakistan:

No Brands Available in Pakistan.