Technetium Tc 99m Medronate (Intravenous)

Technetium Tc 99m Medronate, known by the brand names MPI MDP, CIS-MDP and Osteolite, is an intravenous radiopharmaceutical used in the detection and treatment of bone and organ disorders.

Overview

Technetium Tc 99m Medronate injections belong to a group of substances known as radiopharmaceuticals, which are used to detect and treat specific bone or organ disorders and to study their function. Otherwise known under the US brand names MPI MDP, CIS-MDP and Osteolite, Technetium Tc 99m Medronate injections are commonly used to illuminate bone problems by helping physicians to see bones more clearly. Only physicians specially trained in giving nuclear medicine are permitted to administer radiopharmaceuticals.

The kit for Technetium Tc 99m Medronate is a vial containing the non-radioactive, non-pyrogenic, sterile ingredients that produce Technetium Tc 99m Medronate when a sterile oxidant-free Sodium Pertechnetate Tc 99m solution is introduced into the vial before injection into the patient.

Conditions treated

  • Used to aid the diagnosis of altered osteogenesis as a bone imaging agent.

Type of medicine

  • Radiopharmaceuticals

Side effects

All medicines carry the risk of providing undesired effects alongside their desired effects. Patients may experience a single side effect or a combination of the below. Medical attention should be sought if the side effects persist, become bothersome, or are listed as extremely rare or significant below.

You should seek medical attention immediately if you experience any of the following:

  • Chest pain or discomfort
  • Confusion
  • Unconsciousness
  • Dizziness
  • Slow, fast or irregular heart rate
  • Blurred or clouded vision
  • Unusual fatigue or weakness
  • Chills
  • Lightheadedness, fainting or dizziness on standing
  • Fainting
  • Itchy or red hives
  • Nausea and vomiting
  • Fever
  • No pulse or blood pressure, or the heart stopping
  • Rapid pulse
  • Sweating

Patients may experience a range of other, less serious side effects which do not require immediate medical attention. Patients may experience a lessening of these side effects as treatment progresses, but a physician should be consulted if they persist or become particularly bothersome. Doctors can also advise patients on how to reduce the impact of side effects.

  • Blistering or burning
  • Skin discolouration
  • Skin coldness, redness or numbness
  • Inflammation and a feeling of pressure
  • Bleeding
  • Itching, rash, tingling or skin warmth at the injection site
  • Infection, lumps, redness, stinging, scarring, ulceration or tenderness

Some patients will experience other side effects, which should be reported to a physician.

Dosage

Technetium Tc 99m Medronate is provided as a 10ml multi-dose vial, which comprises: 20mg medronic acid, 1mg ascorbic acid, 0.13mg stannous fluoride, and a maximum of 0.38mg tin (as stannous fluoride in lyophilized form). Only a trained specialist should give a dose to patients, using a needle placed intravenously just before a scan of the bones.

Patients should be made aware that they will need to urinate immediately after dosage, and regularly and often for up to six hours after the initial injection. They should be given plenty of fluids to drink in the hours before and after the dose to prevent dehydration.

Major drug interactions

Some medicines should never be used in combination; others may be used together but may increase the risk of certain undesired side effects. If this is likely, a physician should take a decision on whether to adjust the dose of one or more of the medicines, or put in place other precautions. It's important that patients are completely honest with their physician about any medication or substances they may be taking, including non-prescription (over the counter), herbal remedies and narcotics.

There are no significant known contraindications. As with any medicine, patients should be informed of the potential impact of food and drink on the outcome of tests involving Technetium Tc 99m Medronate. Using alcohol or tobacco products is also not advised and should be discussed before the procedure with a physician.

Warnings

A decision to undertake any diagnostic test should be based on a careful balance of the risks against the benefits to the patient. Physicians and doctors will weigh this up, as well as the likelihood of accurate test results that could bring about a beneficial diagnosis of an underlying condition that can't be detected in other ways.

In addition to a full list of medicines and substances currently being taken and any allergies, the patient should fully inform their physician about their medical history, including their existing health problems. Patients with calcium disorders (such as alkalosis) should be monitored closely after treatment as the compounds produced in the solution may further hypocalcemia. Patients with kidney disease should also be closely observed during dosage and throughout the half-life of Technetium Tc 99m Medronate. Patients with obesity may present problems for the clarity of images produced as part of the subsequent scan.

The effects on pregnant women and unborn fetuses are unknown, and animal and human studies have not been completed. In breastfeeding mothers, some of the compounds have been found in lactation. Technetium Tc 99m Medronate is therefore not advised for pregnant or breastfeeding women unless clearly needed. Similarly, no studies on use in pediatric care have been conducted, so levels of efficacy and safety have not been established for use with children under the age of 16. Similarly, no age-specific studies have been conducted on elderly patients to establish the effects of Technetium Tc 99m Medronate in geriatric care. It is also thought, however, that the scan quality in elderly patients would probably be compromised.

Patients should inform their physician about any allergic reactions they may have suffered in the past to any medicine, even if they think it is non-related. They should also tell their physician about any allergic reactions they have experienced from dyes, food, animals or preservatives.

Patients should be fully informed that they will be taking a substance which may expose them to radiation, and their concerns should be acknowledged and addressed as early as possible before the procedure. Physicians should closely monitor their patients before and after the dose is given to ensure the Technetium Tc 99m Medronate is operating well, and to see whether a further dose is needed.

Patients should also inform any other doctors about any dose of Technetium Tc 99m Medronate if they are having further diagnostic tests run. The results of some tests (such as MRIs or brain imaging scans) may be compromised by the presence of the substance.

Storage

The preparation kit to make Technetium Tc 99m Medronate injections comes in packs of five or thirty non-pyrogenic, sterile vials. The pH is altered with either sodium hydroxide, hydrochloric acid, or a combination of the two, before lyophilization. As the vial does not include any preservatives, at the point of manufacture, it is carefully lyophilized and sealed under nitrogen.

Each five vial kit also includes a package insert and ten warning of radiation labels to meet safety standards. In each thirty vial kit, healthcare professionals will find one package insert and a total of sixty warning of radiation labels to mark the made up batches of Technetium Tc 99m Medronate.

The supplied kits should be stored at room temperature (which is roughly 20°C but no more than 25°C). After mixing to make the radioactive solution, it should also be stored at that temperature. After being mixed, it should be used within a maximum of six hours from the time of preparation. Wherever possible, the time between preparation and dose given to the patient should be minimized to ensure the best results.

The kit and other related substances should be carefully stored and only handled by healthcare professionals approved to handle radiopharmaceuticals, according to Section 120.547, Code of Massachusetts Regulation 105, or under the equivalent license of an Agreement State or the US Nuclear Regulatory Commission.

Summary

Technetium Tc 99m Medronate is a pharmaceutical substance which belongs to a group of medicines known as the radiopharmaceuticals. Comprised of medronic acid (a kind of bisphosphonate) combined with a technetium ion, it is used to reveal bone abnormalities in nuclear medicine imaging. Medronic acid binds with hydroxyapatite crystals found within the bones of osteoporosis patients, revealing areas of altered osteogenesis. After a patient is injected with the prepared Technetium Tc 99m Medronate solution, specialist physicians perform single photon emission computed tomography (SPECT) to locate gamma rays which are emitted when Technetium 99m decays into Technetium 99.

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Last Reviewed:
December 22, 2017
Last Updated:
April 05, 2018
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