technetium Tc-99m oxidronate

Action and Spectrum

Actions and spectrum: 

technetium Tc-99m oxidronate, also known as 99mTc-oxidronate, is a radiopharmaceutical used in nuclear medicine imaging procedures. It is used to assess bone health and diagnose various bone-related conditions. The spectrum of technetium Tc-99m oxidronate’s actions primarily involves its ability to localize in areas of increased bone turnover and mineralization.

It emits gamma radiation that can be detected by a gamma camera, allowing for non-invasive imaging of bone tissue. This radiopharmaceutical is particularly useful in bone scans for detecting bone metastases, fractures, infections, and other skeletal abnormalities. The uptake of technetium Tc-99m oxidronate in bone tissue is reflective of bone metabolism and can help clinicians diagnose and monitor bone-related disorders. 

Drug Interaction

Adverse Reaction

Frequency defined 

Less than 1%: 

Hypersensitivity reaction 

nausea 

injection site reaction 

vomiting 

Black Box Warning

Black Box Warning:  

There is no specific black box warning associated with the use of technetium Tc-99m oxidronate. 

Contraindication / Caution

Contraindication/Caution: 

Contraindication: 

• Hypersensitivity: Individuals with a known hypersensitivity to technetium Tc-99m oxidronate or any of its components should not receive this radiopharmaceutical. 
• Pregnancy and Breastfeeding: Radiopharmaceuticals like technetium Tc-99m oxidronate may have a risk to the developing fetus or breastfeeding infants. The decision to use this agent in pregnant or breastfeeding individuals should be carefully weighed against the potential benefits. 
• Severe Renal Impairment: The use of technetium Tc-99m oxidronate may be contraindicated in patients with severe renal impairment or end-stage renal disease, as it involves renal excretion and could further affect renal function. 
• Inability to Cooperate: Patients who are unable to cooperate or remain still during the imaging procedure may not be suitable candidates for technetium Tc-99m oxidronate scans, as this could affect the quality of the images obtained.

Caution: 

• Radiation Exposure: technetium Tc-99m oxidronate is a radioactive substance, and exposure to radiation is inherent during diagnostic imaging procedures.  
• Allergic Reactions: Although allergic reactions to technetium Tc-99m oxidronate are rare, healthcare providers should be vigilant for any signs of hypersensitivity, such as rash, itching, or difficulty breathing, and be prepared to manage such reactions if they occur. 
• Interference with Other Diagnostic Tests: technetium Tc-99m oxidronate bone imaging may interfere with the interpretation of other diagnostic tests. It is important to inform healthcare providers about any recent radiopharmaceutical procedures when undergoing other medical tests. 
• Drug Interactions: technetium Tc-99m oxidronate imaging may be affected by certain medications or therapies. Healthcare providers should be aware of any medications the patient is taking to ensure accurate imaging results. 
• Patient Communication: Patients should be informed about the nature of the procedure, including its radioactive nature and potential risks.

Comorbidities: 

• Pregnancy and Breastfeeding: technetium Tc-99m oxidronate is a radioactive substance, and its use should be avoided during pregnancy and breastfeeding. Pregnant individuals and nursing mothers should discuss the risks and benefits with their healthcare providers. 
• Allergic Reactions: While allergic reactions to technetium Tc-99m oxidronate are rare, individuals with a history of hypersensitivity to radiopharmaceuticals or contrast agents may be at a slightly higher risk. Careful consideration and monitoring are advised for these patients. 
• Pediatric and Geriatric Patients: Pediatric and geriatric patients may have unique considerations when undergoing bone imaging with technetium Tc-99m oxidronate. Age-related factors and potential differences in response should be considered. 
• Bone Disorders and Metabolic Conditions: Certain bone disorders and metabolic conditions may affect the distribution and interpretation of bone imaging using technetium Tc-99m oxidronate. Healthcare providers should be aware of these conditions and how they might influence the imaging results. 

Pregnancy / Lactation

Pregnancy consideration: Pregnancy Category: unknown 

Lactation: Excreted into human milk: yes  

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.   
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women. 
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

technetium Tc-99m oxidronate, also known by its trade name “Tc-99m MDP” (methylene diphosphonate), is a radiopharmaceutical used in nuclear medicine for bone imaging. It is primarily used in procedures like bone scans (technetium Tc-99m MDP bone scintigraphy) to assess bone health, detect bone abnormalities, and diagnose various bone-related conditions. technetium Tc-99m oxidronate is a radiopharmaceutical that contains a radioisotope (Tc-99m) attached to a bone-seeking molecule (oxidronate or methylene diphosphonate).  

Pharmacodynamics: 

• Radioactive Decay: technetium Tc-99m is a radioactive isotope that emits gamma radiation. It decays over time by emitting gamma rays, which can be detected by specialized imaging equipment such as gamma cameras. 
• Bone Uptake: technetium Tc-99m oxidronate is administered intravenously. After injection, the radiopharmaceutical is rapidly taken up by bone tissue due to its chemical affinity for hydroxyapatite. 
• Gamma Emission: Once localized in bone tissue, technetium Tc-99m emits gamma radiation. 
• Imaging Interpretation: The distribution and intensity of gamma emissions captured by the gamma camera provide valuable information about bone metabolism, density, and structural abnormalities. Areas of increased or decreased uptake of technetium Tc-99m oxidronate can indicate various bone conditions, such as fractures, infections, tumors, and metastatic lesions.

Pharmacokinetics: 

Absorption 

technetium Tc-99m oxidronate is administered intravenously, typically as an injection into a vein. As such, it enters the bloodstream directly and is rapidly distributed throughout the body. 

Distribution 

Once in the bloodstream, technetium Tc-99m oxidronate has higher affinity for hydroxyapatite crystals in bone. It selectively accumulates in areas of active bone turnover, inflammation, infection, or tumor growth. 

Metabolism 

Unlike traditional drugs, technetium Tc-99m oxidronate is not metabolized in the body in the same way. The radiopharmaceutical remains chemically stable and does not undergo significant metabolic processes. Its primary purpose is to emit gamma radiation for imaging purposes. 

Elimination and excretion 

technetium Tc-99m oxidronate is primarily excreted from the body via the kidneys into the urine. The short half-life of Tc-99m (approximately 6 hours) means that the radioactivity decreases rapidly over time. This allows for imaging procedures to be performed within a relatively short time frame after administration. 

Adminstartion

Administration: 

• Preparation: The radiopharmaceutical is prepared in a clinical setting by a qualified nuclear medicine technologist or radio pharmacist. The technologist carefully measures the appropriate dose of Tc-99m oxidronate and prepares it for injection. 
• Injection: The prepared Tc-99m oxidronate is injected into a vein, typically in the arm. The injection process is like receiving any other intravenous medication or contrast agent. 
• Patient Preparation: Depending on the specific imaging protocol and the area being evaluated, there might be certain patient preparation instructions. These could include fasting before the procedure or avoiding certain medications.  
• Imaging Process: After the injection, the patient will wait for a time period to allow the Tc-99m oxidronate to distribute and accumulate in the bones. This waiting period might range from a couple of hours to several hours, depending on the imaging protocol and the specific clinical question being addressed. 
• Completion: Once the imaging procedure is complete, the radiopharmaceutical has served its purpose, and the patient’s exposure to radiation diminishes rapidly due to the short half-life of Tc-99m. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: technetium Tc-99m oxidronate 

Pronounced: (tek-NEE-shee-um-Tc-99m-ox-i-DROE-nate) 

Why do we use technetium Tc-99m oxidronate? 

• Bone Scintigraphy (Bone Scan): technetium Tc-99m oxidronate is widely used in bone scintigraphy, a nuclear medicine imaging technique. It allows for the visualization of bone structures and helps identify various bone-related conditions.  
• Evaluation of Bone Metabolism: Tc-99m oxidronate imaging provides insights into bone metabolism, bone turnover, and areas of increased or decreased blood flow to bones. This information can be valuable for diagnosing and monitoring various bone disorders. 
• Monitoring Treatment Response: In cancer patients, bone scintigraphy using Tc-99m oxidronate can help monitor the response to cancer treatments and assess disease progression in the bones over time. 
• Research and Education: Tc-99m oxidronate bone scans are also utilized for research purposes, such as studying bone physiology, evaluating new treatments, and furthering our understanding of bone diseases.