Uses of Technetium Tc-99m Sestamibi

As an Imaging Agent

1. Myocardial Perfusion Imaging:

   • Detection of coronary artery disease.

   • Used with exercise stress testing or pharmacologic stress testing to identify:

     • Reversible myocardial ischemia.

     • Myocardial infarction (with or without ischemia).

2. Planar Breast Imaging:

   • A second-line diagnostic tool after mammography.

   • Assists in evaluating breast lesions in patients with:

     • Abnormal mammograms.

     • Palpable breast masses.

        

Technetium Tc-99m sestamibi Dose in Adults

Dose in the treatment of Breast imaging:

• IV (based on 70 kg patient): 20 to 30 mCi (740 to 1,110 MBq)

Dose in the treatment of Myocardial imaging:

• IV (based on 70 kg patient): 10 to 30 mCi (370 to 1,110 MBq)

Technetium Tc-99m Sestamibi: Use During Pregnancy and Breastfeeding

Pregnancy

• Lack of Reproductive Studies:

  • No animal reproduction studies were conducted.

  • Technetium Tc-99m can be detected in fetal tissue; the extent depends on the formulation, administration route, and pregnancy stage (Adelstein, 1999).

• Fetal Risk Considerations:

  • Harm depends on the radiopharmaceutical dose and pregnancy stage.

  • High doses used in therapeutic procedures pose a higher risk.

  • Modifications to diagnostic procedures can reduce fetal risks if medically necessary.

  • Elective diagnostic procedures should be deferred until after delivery (Adelstein, 1999; ICRP, 2000; Parker, 2004).

• Pregnancy Testing:

  • Women of childbearing potential should confirm pregnancy status prior to use (Parker, 2004).

Breastfeeding

• Presence in Breast Milk:

  • Technetium 99m is excreted in breast milk, but data on Technetium Tc-99m sestamibi specifically is unavailable.

• Manufacturer Recommendations:

  • Substitute formula feeding until radioactivity clears from breast milk.

  • Women with an established milk supply may resume breastfeeding after radiopharmaceutical administration.

• Colostrum Considerations:

  • Technetium Tc-99m presence in colostrum varies; limited data complicates recommendations for early breastfeeding (Mountford, 1989; Rubow, 1995).

• Elective Procedures:

  • Elective diagnostic procedures are best delayed until after breastfeeding cessation (Parker, 2004).

• Regulatory Compliance:

  • Depending on the dose, recordkeeping and patient instructions may be required (US NRC, 1997).

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Side Effects of Technetium Tc-99m sestamibi Include:

• Cardiovascular:

  • Angina Pectoris

  • Chest Pain

  • ST Segment Changes On ECG

• Gastrointestinal:

  • Dysgeusia

• Genitourinary:

  • Mastalgia

Contraindications to Technetium Tc-99m sestamibi Include:

The manufacturer's labeling does not contain any contraindications.

Warnings and Precautions for Technetium Tc-99m Sestamibi

1. Serious Adverse Events with Stress Imaging

• Risk factors:

  • Pharmacologic stress agents used in conjunction with imaging may lead to:

    • Arrhythmias.

    • Bronchoconstriction.

    • Cerebrovascular events.

    • Hypotension or hypertension.

    • Myocardial injury (MI).

• Precaution:

  • Ensure resuscitation measures are readily available during the procedure.

2. Hypersensitivity Reactions

• Rare events:

  • Severe allergic or anaphylactic-type reactions, including:

    • Angioedema.

    • Urticaria.

• Action:

  • Seek immediate emergency treatment if a hypersensitivity reaction occurs.

3. Coronary Artery Disease

• Monitoring:

  • Continuous monitoring is essential for patients with suspected or known coronary artery disease during diagnostic evaluation.

• Precaution:

  • Emergency cardiac treatment must be readily accessible.

How to administer Technetium Tc-99m sestamibi?

Intravenous Administration of Technetium Tc-99m Sestamibi

Key Administration Guidelines

• Not for Direct IV Injection:

  • Only use properly reconstituted technetium Tc-99m sestamibi for intravenous administration.

  • Refer to the manufacturer’s prescribing information for detailed preparation and administration procedures.

Imaging Protocol

• Breast Imaging:

  • Begin imaging 5 minutes after IV administration.

Handling Precautions

• Radiopharmaceutical Safety:

  • Follow appropriate safety measures for handling and disposal of radiopharmaceuticals.

• Personal Protective Equipment:

  • Use waterproof gloves and apply shielding during handling and administration.

Mechanism of action of Technetium Tc-99m sestamibi:

• Protein Binding:

  • Less than 1%.

• Half-life Elimination:

  • Physical half-life: 6.02 hours.

• Excretion:

  • Urine: 27% of the injected activity within 48 hours.

  • Feces: 33% of the injected activity within 48 hours

International Brands of Technetium Tc-99m sestamibi:

• Cardiolite

• Cardio-Spect

• Cardiolite

• Sammibi

• Stamicis

• Technescan Sestamibi

Technetium Tc-99m sestamibi Brands Names in Pakistan:

No Brands Available in Pakistan.