Technetium Tc 99m Oxidronate

As an injected radiopharmaceutical, Technetium Tc 99m oxidronate is a diagnostic skeletal imaging agent used to demonstrate areas of altered or abnormal bone structure in adult and pediatric patients.

Overview

Technetium Tc 99m oxidronate injections are used to make the patient's bone tissue visible so that doctors can diagnose any bone problems. It may only be used by doctors with specialized training in nuclear medicine (and any staff under their direct supervision). It is available as a kit and Technescan HDP is a commonly used brand name for Technetium Tc 99m oxidronate in the United States.

This medicinal product is for diagnostic use only. After radiolabeling with Sodium pertechnetate (99mTc) solution, the agent may be used to highlight areas of unusual osteogenesis so that a diagnosis can be made.

Type of medicine:

  • Injected radiopharmaceutical imaging agent.

Conditions treated:

Technetium Tc 99m oxidronate helps identify areas of abnormal osteogenesis, such as those that occur with metastatic bone disease. These include:

  • Paget's disease
  • arthritic disease
  • osteomyelitis
  • fractures

Side effects

Side effects of Technetium Tc 99m oxidronate are infrequent and include:

  • hypersensitivity reactions
  • nausea
  • vomiting
  • injection site reactions

This is not a complete list of side effects and others may occur. Patients should call their doctor for medical advice about side effects.

Patients should also check with their doctor or nurse immediately if any of these problems occur while taking oxidronate:

  • Breathing or swallowing difficulties
  • fever
  • hives
  • nausea
  • reddened skin, particularly in the vicinity of the ears
  • swollen eyes, face, or nose
  • tiredness or weakness

Some side effects of Technetium Tc 99m oxidronate may occur that usually do not need medical attention. These side effects may go away during treatment as the patient's body adjusts to the medicine. Health care professionals may also be able to advise the patient about ways to prevent or reduce some of these side effects.

Some side effects of Technetium Tc 99m oxidronate may not be reported. Patients should always consult their doctor or healthcare specialist for medical advice. They may also report side effects to the FDA at 1-800-FDA-1088.

Dosage

The adult dose range is 370 to 740 MBq (10 to 20 mCi), with the recommended dose being 555 MBq (15 mCi). The pediatric dose ranges from 7.4 to 13 MBq (0.20 to 0.35 mCi)/kg, with the recommended dose being 7.4 MBq (0.20 mCi)/kg.

Patients should tell their doctor about all medications and supplements that they are using, as Technetium Tc 99m oxidronate may interact with other drugs.

The risk/benefit ratio for pediatric children and adolescents should be considered carefully, based upon the clinical needs of this patient group. The following formula, based on the 2008 EANM card, was used to caclulate dosages for these age groups:

A[MBq]Administered = Baseline Activity x Multiple (with a baseline activity of 35.0)

There are no special dosage requirements for elderly patients, who can be treated with standard adult doses.

The patient should increase intake of fluids and void frequently following the administration of Technetium Tc 99m oxidronate injection, and for 4 to 6 hours after the imaging procedures are completed, to minimize radiation dose to the bladder.

Interactions

Known interactions include Medronic Acid in patients with Hypocalcemia or Alkalosis. This has a Potential Hazard categorized as Moderate, with Moderate plausibility.

Technetium Tc 99m oxidronate may form complexes with cations such as calcium. Caution is advised when used in patients with or predisposed to hypocalcemia (e.g. alkalosis).

Foscavir (foscarnet) is known to interact with Technetium Tc 99m oxidronate. Each of these medications can decrease the calcium levels in patients' blood and combining them could cause an increased risk of hypocalcemia. Symptoms include numbness or tingling around the mouth, muscle spasms, mental changes (irritability, depression, psychosis), increased pressure on the brain, and irregular heartbeat convulsions. Patients should let their doctor know if they experience these or other unusual symptoms.

The following medicines can also influence or be influenced by Technetium Tc 99m oxidronate:

  • medicines to treat reduced bone density with active substance names ending with "dronate"
  • vincristine, cyclophosphamide, doxorubicin, methotrexate: cytostatics to treat cancer
  • immunosuppressive medicinal products (e.g. cortisone): agents that inhibit or prevent activity of the immune system
  • gentamicin, amphotericin: antibiotics
  • iron based medicines
  • aluminium based stomach acid binding medicines.

Although some specific combinations of medicine should be avoided completely, some medicines may be safe to use together even if an interaction might occur. Patients should consult their doctor for advice on this. Patients should also tell their healthcare professional if they are taking any other medication, whether they are prescription drugs or items purchased without a prescription (including herbal remedies).

Eating food, consuming alcohol, or using tobacco can also cause interactions with certain medications. Patients should consult their healthcare professional for advice about any potential interaction problems in these circumstances.

Warnings

Patients will be exposed to radiation when they are given this medicine, so it is recommended that they raise any concerns about this with their doctor.

There is a potential for hypersensitivity or anaphylactic reactions.

The presence of other medical problems may affect the use of Technetium Tc 99m oxidronate. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alkalosis — May increase risk for hypocalcemia.
  • Hypocalcemia (low calcium levels) — Use with caution. May make this condition worse.
  • Kidney disease — Use with caution. The effects may be increased because the body may take longer to expel the medicine.

As some radiopharmaceuticals may accumulate in the bladder, it is advisable to drink plenty of water and urinate often after certain tests in order to increase the flow of urine and lessen the amount of radiation.

Medical staff are strongly advised to monitor the patient's condition closely while they are using this medication. This will allow the doctor to see if it is working properly and to decide if the treatment should continue.

Patients should tell their doctor if they have ever had any unusual or allergic reaction to Technetium Tc 99m oxidronate or any other medicines. Health care professionals should also be informed of any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, patients should read the label or package ingredients carefully.

Patients should tell their doctor if they are pregnant or plan to become pregnant before using Technetium Tc 99m oxidronate, as it is unknown how it will affect a fetus. Technetium Tc 99m oxidronate passes into breast milk. Breastfeeding while using Technetium Tc 99m oxidronate is not recommended. Formula feedings should be substituted for breast feedings while using Technetium Tc 99m oxidronate. When in doubt, it is important to consult the nuclear medicine doctor who will supervise the procedure. The nuclear medicine doctor will normally only administer Technetium Tc 99m oxidronate during pregnancy if a benefit is expected that would outweigh the risks.

If the patient is breastfeeding, the nuclear medicine doctor may delay treatment until breastfeeding is finished. They may also ask the patient to stop breastfeeding and discard this milk until the radioactivity is no longer in the body.

Storage

Technetium Tc 99m oxidronate should be stored below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. It should be protected from freezing.

This product may be stored at or below room temperature, both prior to and following radiolabeling.

Summary

Technetium Tc 99m oxidronate injection helps doctors see an image of the patient's bone tissue in order to diagnose bone problems. Its use does involve exposure to small amounts of radioactivity, so the patient's doctor and the nuclear medicine doctor must considered that the clinical benefit that the patient will obtain from the procedure with the radiopharmaceutical outweighs the risks from radiation.

Technetium (99m Tc) oxidronate is a solution of the radioactive substance, sodium pertechnetate (99m Tc). When administered into the body, it accumulates in the patient's bones. The radioactive substance can then be photographed from outside the body with diagnostic equipment. This reveals valuable information about the bones, particularly any structural problems that may be present.

Use of Technetium (99m Tc) oxidronate in this way helps to highlight abnormal osteogenesis, such as metastatic bone disease. Typical conditions that may be identified through this procedure include Paget's disease, arthritic disease, osteomyelitis and fractures.

Known interactions include the formation of complexes with cations such as calcium, so caution is advised when used in patients with or predisposed to hypocalcemia (e.g. alkalosis) or kidney problems. Patients should tell their doctor if they are pregnant or plan to become pregnant before using Technetium Tc 99m oxidronate, as it is unknown how the treatment will affect a fetus. Formula feedings should be substituted for breast feeding during the treatment.

It is considered unlikely that Technetium (99m Tc) oxidronate will affect patients' ability to drive or to use machinery.

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Last Reviewed:
December 23, 2017
Last Updated:
December 22, 2017
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