Technetium Tc 99m Tilmanocept (Injection)

Technetium Tc 99m Tilmanocept is used to to map and examine the lymph nodes in various areas around the body, and is known under the US brand name Lymphoseek.

Overview

Technetium Tc 99m Tilmanocept, known under US brand name Lymphoseek, is a diagnostic type drug that is injected either subcutaneously, intradermally, subareolarly, or peritumorally in order to map and examine the lymph nodes in various areas around the body.

This injection is a radioactive medication, and should only be handled with appropriate safety measures to minimize radiation exposure. Therefore, this drug can only be administered by an appropriately trained medical professional in a relevant setting to ensure the safety of both the patient and the diagnostic team.

Conditions Treated

Technetium Tc 99m Tilmanocept does not directly treat any medical conditions. This drug is used as a diagnostic tool for lymphatic mapping for the following purposes:

  • Diagnostic mapping utilizing a handheld gamma counter in order to locate lymph nodes draining a primary tumor site
  • Guiding lymph node biopsies utilizing a handheld gamma counter when investigating the oral cavity, or for breast cancer or melanoma.

Type of Medicine

  • Radiopharmaceutical
  • Subcutaneous, Intradermal, Subareolar, or Peritumoral injection

Side Effects

Due to the single-dosage, diagnostic nature of Technetium Tc 99m Tilmanocept, the side effects of this drug are likely to be either short-term or limited to a time around injection.

No specific confirmed side effects have been observed in relation to Technetium Tc 99m Tilmanocept, but the following issues may occur in incidence unknown following the use of this diagnostic tool. If these side effects occur it is strongly recommended that the patient contacts a relevant medical professional as soon as possible:

  • Difficulty with breathing or swallowing
  • Fast heartbeat
  • Skin itching, rash, or redness
  • Swelling of the face, throat, or tongue

In addition to the above side effects, the following effects may occur as a result of this diagnostic drug. These side effects are unlikely to require medical intervention, and are likely to reduce and disappear over time. However, if the patient is concerned about any of the following, they should get in contact with their doctor to discuss their concerns:

  • Pain or irritation at the injection site

Though this medication does not have any consistent or serious side effects, Technetium Tc 99m Tilmanocept, as with any drug, can cause a moderate to severe allergen based reaction within the patient. The symptoms of an allergic reaction can include:

  • Difficulty breathing
  • Hives
  • Swelling of your lips, tongue, face or throat

If any of the above symptoms occur, the patient should notify a medical professional immediately so they can receive support and treatment for the allergic reaction, and in order to prevent any further injections to occur that may cause the allergic reaction to become worse, causing further harm.

If the patient is already known to be allergic to any of the components within Technetium Tc 99m Tilmanocept, the diagnostic team and medical professional involved in the patient's treatment should be advised as soon as possible in order to discuss viable alternatives.

Dosage

When using Technetium Tc 99m Tilmanocept as a diagnostic tool, certain methods should be followed by medical professionals to ensure correct and safe usage of the drug. Because of the radioactive nature of this medication, effective radiation shielding, waterproof gloves and appropriate safety measures should be taken when preparing and handling this diagnostic tool.

The standard dose of Technetium Tc 99m Tilmanocept as radioactivity dose is 18.5 MBq (0.5 mCi), or 50 mcg as a mass dose. This drug should be administered via injection at least 15 minutes prior to lymphatic mapping and biopsy, and any activity that requires the use of the drug should be taken within 15 hours of the initial dose.

The form administration takes will vary on the location of the biopsy area, and may be either one injection or multiple injections in order to get the best possible vision of the area.

Interaction

Many medications are likely to interact with other medicines within the human body. This applies to both those currently being taken and those taken recently. No serious interactions or issues have been observed between Technetium Tc 99m Tilmanocept and other medications, making it safe for use with most drugs.

The following medications may cause a moderate reaction when taken with Technetium Tc 99m Tilmanocept, and it is recommended for the patient to discuss their prescriptions with a relevant medical professional prior to any biopsies if any of the following are on their current treatment plan:

  • Anestacaine (lidocaine)
  • Articadent (articaine / epinephrine)
  • Articaine / epinephrine
  • Baclofen / flurbiprofen / lidocaine topical
  • Bupivacaine
  • Bupivacaine liposome
  • Bupivacaine / epinephrine
  • Bupivacaine / fentanyl
  • Bupivacaine / hydromorphone
  • Bupivacaine / lidocaine / triamcinolone
  • Bupivacaine / sufentanil
  • Carbocaine (mepivacaine)
  • Carbocaine 2% with Neo-Cobefrin (levonordefrin / mepivacaine)
  • Ceftriaxone / lidocaine
  • Chirocaine (levobupivacaine)
  • Chloroprocaine
  • Citanest Forte (epinephrine / prilocaine)
  • Citanest hcl Plain (prilocaine)
  • Clorotekal (chloroprocaine)
  • Decadron with Xylocaine (dexamethasone / lidocaine)
  • Dentipatch (lidocaine)
  • Dexamethasone / lidocaine
  • Dilocaine (lidocaine)
  • Duranest-MPF (etidocaine)
  • Duranest-MPF-Epinephrine (epinephrine / etidocaine)
  • Epinephrine / etidocaine
  • Epinephrine / lidocaine
  • Epinephrine / prilocaine
  • Etidocaine
  • Exparel (bupivacaine liposome)
  • FBL Kit (baclofen / flurbiprofen / lidocaine topical)
  • Fentanyl / ropivacaine
  • Hydromorphone / ropivacaine
  • Isocaine (mepivacaine)
  • Isocaine with Levonordefrin (levonordefrin / mepivacaine)
  • L-Caine (lidocaine)
  • Levobupivacaine
  • Levonordefrin / mepivacaine
  • Lidocaine
  • Lidocaine / oxytetracycline
  • Lidocaine / potassium chloride
  • Lidocaine / sodium bicarbonate
  • Lidoject 1 (lidocaine)
  • Lidoject 2 (lidocaine)
  • Lidosite (epinephrine / lidocaine)
  • Lignospan (epinephrine / lidocaine)
  • Lignospan Forte (epinephrine / lidocaine)
  • Marcaine (bupivacaine)
  • Marcaine hcl (bupivacaine)
  • Marcaine hcl with Epinephrine (bupivacaine / epinephrine)
  • Marcaine Spinal (bupivacaine)
  • Mepivacaine
  • Mericaine (procaine)
  • MLK F2 (bupivacaine / lidocaine / triamcinolone)
  • Naropin (ropivacaine)
  • Naropin Novaplus (ropivacaine)
  • Naropin Polyamp (ropivacaine)
  • Naropin SDV (ropivacaine)
  • Nervocaine (lidocaine)
  • Nesacaine (chloroprocaine)
  • Nesacaine-MPF (chloroprocaine)
  • Niphanoid (tetracaine)
  • Novocain (procaine)
  • Octocaine 100 (epinephrine / lidocaine)
  • Orabloc (articaine / epinephrine)
  • Polocaine (mepivacaine)
  • Polocaine-MPF (mepivacaine)
  • Pontocaine hcl (tetracaine)
  • Prilocaine
  • Procaine
  • Rocephin IM Convenience Kit (ceftriaxone / lidocaine)
  • Ropivacaine
  • Ropivacaine / sufentanil
  • Scandonest L (levonordefrin / mepivacaine)
  • Scandonest Plain (mepivacaine)
  • Sensorcaine (bupivacaine)
  • Sensorcaine with Epinephrine (bupivacaine / epinephrine)
  • Sensorcaine-MPF (bupivacaine)
  • Sensorcaine-MPF Spinal (bupivacaine)
  • Sensorcaine-MPF with Epinephrine (bupivacaine / epinephrine)
  • Septocaine (articaine / epinephrine)
  • Terramycin IM (lidocaine / oxytetracycline)
  • Tetracaine
  • Truxacaine (lidocaine)
  • UAD Caine (lidocaine)
  • Ultacan (articaine / epinephrine)
  • Ultacan Forte (articaine / epinephrine)
  • Vivacaine (bupivacaine / epinephrine)
  • Xylocaine Dental (epinephrine / lidocaine)
  • Xylocaine Dental Cartridges (lidocaine)
  • Xylocaine Duo-Trach Kit (lidocaine)
  • Xylocaine hcl (lidocaine)
  • Xylocaine hcl For Spinal (lidocaine)
  • Xylocaine hcl with Epinephrine (epinephrine / lidocaine)
  • Xylocaine with Epinephrine (epinephrine / lidocaine)
  • Xylocaine with Epinephrine Dental Cartridges (epinephrine / lidocaine)
  • Xylocaine-MPF (lidocaine)
  • Xylocaine-MPF-Epinephrine (epinephrine / lidocaine)
  • Zorcaine (articaine / epinephrine)

Warnings

Due to the nature of Technetium Tc 99m Tilmanocept, this drug may increase the risk of hypersensitivity reactions. This is due to its similarity chemically to dextran. If the patient has previously experienced a hypersensitive reaction to dextran or forms of dextran that are modified, this should be discussed prior to biopsy, and resuscitation equipment should be available during administration.

As with any other product that is radiation-emitting, Technetium Tc 99m Tilmanocept can potentially increase the risk of cancer. This is especially the case in pediatric patients. By strictly adhering to the recommended dosage and ensuring safe handling, this risk can be minimized.

All drugs that are considered radiopharmaceuticals, including the medication, can have the potential to harm a fetus. The only time that Lymphoseek should be given to a pregnant woman is if the potential benefit justifies the potential risk to the fetus. In addition, nursing mothers should discard any milk produced within 60 hours of administration to prevent infant harm.

Storage

Technetium Tc 99m Tilmanocept should be radiolabeled and stored at room temperature in a radiation shielded environment to ensure the risk of radiation is minimized. This drug is only available to medical professionals and should never be available to the general public, and as such should be kept in a secure, locked area.

After preparation, radiolabeled Technetium Tc 99m Tilmanocept should be used within 6 hours of preparation. If unused, the drug should then be discarded by the appropriate measures for radioactive materials set out by the medical center or hospital.

Technetium Tc 99m Tilmanocept medication should solely be used by medical professionals who are qualified through specific training and experience in the safe use and handling of radionuclides. This experience and training should be approved by the appropriate governmental agency, who is authorized to license the use of radionuclides within this environment.

Summary

Technetium Tc 99m Tilmanocept is a diagnostic medication used within a medical environment in order to further examine tumors, particularly within the breast, lymph and skin. As a radiopharmaceutical, this drug is used in a strict, controlled environment by qualified professionals in order to ensure the safety of both the patient and diagnostic team at all times.

Technetium Tc 99m Tilmanocept is injected into the patient either by one injection or by multiple smaller doses in order to get the best possible image of the area for examination. This radioactive material then gathers within lymphatic tissue and from there selectively binds to the mannose-binding receptors (CD206) that are located on the surface of dendritic cells and macrophages, allowing for effective sight of affected areas during diagnosis or treatment.

This medication is not known to cause any specific side effects, though it may trigger an allergic reaction in patients who are intolerant or allergic to some of the components of this drug. In addition, it is not recommended for use when pregnant or exclusively breastfeeding due to the radioactive nature of this drug that may harm both young and unborn infants.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
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