Adverse Reactions and Abnormal Radiopharmaceutical Distribution
Concerns regarding adverse reactions of any type of radiopharmaceutical have been documented over the years in the literature. The list complied below was attained by David L. Laven, NH, CRPh, FASHP, FAPPM.
57 Co-cyanocobalamin : none noted
51 Cr-sodium chromate : none noted
18 F-fluorodeoxyglucose : none noted
67 Ga-gallium citrate : nausea, vomiting, Pruritus, diffuse rash, flushing, urticaria, facial swelling, dyspnea, bronchospasm, syncope, dizziness, tachycardia, salty taste
111 In-indium oxine Labeled leukocytes : fever, diffuse rash, pruritus, urticaria
111 In-indium pentetate (DTPA): fever, nausea, vomiting, drowsiness, anorexia, headache, aseptic meningitis (all from the intrathecal route)
111 In-indium pentetreotide : fever, nausea, flushing, hypotension, bradycardia, hypoglycemia with insulinoma, dizziness, headache, diaphoresis, arthralgia.
111 In-satumomab pendetide : chills, fever, nausea, diarrhea, diffuse rash, flushing, pruritus, chest pain, hypertension, diaphoresis, hypotension, dizziness, headache, arthralgia, asthenia, confusion, anxiety, hypothermia
123 I-ibenguane (MIBG) none in diagnostic doses;
131 I-iodohippurate sodium : nausea, vomiting , urticaria, diffuse rash, pruritus , diaphoresis, hypotension, syncope
131 I-iofetamine : chest pain, hypertension, dizziness
123 I-sodium iodide : nausea, vomiting, diffuse rash Pruritus, urticaria chest pain, tachypnea, tachycardia, headache, faintness
125 I-iodinated albumin : diffuse rash
125 I-iothalamate : none noted
131 I - iobenguane (MIBG) none in diagnostic doses; flushing, hypertension only in therapeutic doses injected rapidly
131 I iodinated albumin : none noted for intravenous route; intrathecally can cause aseptic meningitis
131 I-iodohippurate sodium : nausea, vomiting, urticaria, diaphoresis, hypotension, syncope, facial swelling, anaphylaxis
131 I-sodium iodide : nausea, vomiting, pruritus, urticaria, chest pain, tachycardia, headache
131 I-6-beta-iodomethyl-19-norcholesterol : nausea, vomiting, chest pain, hypertension, hypotension, headache, dyspnea, flushing, dizziness, facial swelling, abdominal pain, metallic taste
81m Kr-krypton : none noted
13 N-ammonia : none noted
32 P-chromic phosphate : chills, fever, nausea, Vomiting, chest pain, dyspnea, abdominal pain (some or most of these reported reactions may be due to the effusions for which chromic phosphate is administered)
32 P-sodium phosphate : nausea, vomiting hypotension, diaphoresis (bone pain as flare response and myelosuppression both from beta radiation, are not direct adverse drug effects but arc due to absorbed radiation)
82 Rb-rubidium : none noted
89 Sr-strontium chloride : chills, fever (see parenthesis under 32P-phosphate)
99m Tc-human serum albumin : chills, fever, flushing, diffuse rash, dyspnea, hypotension, tachycardia, vertigo, facial swelling
99m Tc-albumin colloid : chills, nausea, abdominal cramps, hypotension, tachycardia, dyspnea, anaphylaxis
99m Tc-biscisate hydrochloride : nausea, vomiting, diffuse rash, chest pain, respiratory arrest, seizures, syncope, vertigo, headache, cyanosis
99m Tc-disofenin : none reported
99m Tc-exametazime (HMPAO): fever, dyspnea, rash, hypertension, facial swelling, cyanosis, anaphylaxis, myoclonus (the last symptom could have been due to underlying neurologic disease)
99m Tc-gluceptate : rash, urticaria, headache, nausea, vertigo, pruritus, flushing, diaphoresis, tachycardia, dyspnea, syncope
99m Tc-lidofenin : chills, nausea
99m Tc-macroaggregated albumin (MAA): fever, chills, nausea, erythema, flushing, urticaria, rash, pruritus, chest tightness, tachycardia, hypotension, syncope, dyspnea, wheezing, anaphylaxis, diaphoresis, asthenia, cyanosis, metallic taste
99m Tc-mebrofenin : chills, nausea, pruritus, urticaria,
99m Tc-medronate ( MDP ): headache, chills, fever, nausea, vomiting, rash, pruritus, urticaria, hypotension, anaphylaxis, weakness, dyspnea, vertigo, cardiac arrest
99m Tc-mertiatide (MAG3): nausea, vomiting
99m Tc-oxidronate (HDP): arthralgia, nausea, vomiting, erythema, faintness, diaphoresis
99m Tc-penetrate (DTPA) nausea, chills, dyspnea, hypotension, syncope, hypertension, headache, rash, pruritus,
99m Tc-pyrophosphate (PYP): chills, fever, nausea, vomiting, rash, flushing, pruritus, hypotension, dizziness
99m Tc-sestamibi : rash, flushing, seizure, headache, metallic taste
99m Tc-pertechnetate : chills, nausea, vomiting, rash, pruritus, urticaria, chest pain, hypotension, dizziness, headache, diaphoresis, anaphylaxis
99m Tc-succimer (DMSA): fever, nausea, erythema, rash, flushing, syncope, abdominal pain
99m Tc-sulfur colloid : fever, headache, nausea, vomiting, erythema, rash, flushing, pruritus, Urticaria, bradycardia, tachycardia, chest pain, cardiac arrest, hypertension, cyanosis, diaphoresis, hypotension, dizziness, syncope, wheezing, anaphylaxis, seizure
99m Tc-teboroxime : nausea, hypotension, facial swelling, metallic taste, pain at injection site
201 Tl-thallium chloride : rash, pruritus, hypotension
127 Xe-xenon : none noted
133 Xe-xenon : none noted
In addition, other pharmaceuticals (drugs or diseases) and also interfere with radiopharmaceutical uptake and distribution. The following website documents those abnormalities. The student should visit this site and make note of how different drugs interfere with radiopharmaceutical uptake.
http://nuclearpharmacy.uams.edu/resources/Interactions.htm
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