The Basics
What is Technetium Tc 99m Exametazime?
Used to detect altered regional cerebral perfusion in stroke and other cerebrovascular diseases.
Brand names for Technetium Tc 99m Exametazime
N/A
How Technetium Tc 99m Exametazime is classified
Radiopharmaceuticals, Technetium Compounds, Diagnostic Agents
Technetium Tc 99m Exametazime During Pregnancy
Technetium Tc 99m Exametazime pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Technetium Tc 99m Exametazime while pregnant
Limited available data with technetium Tc 99m exametazime use in pregnant women are insufficient to inform any drug associated risks for major birth defects and miscarriage. Technetium Tc 99m exametazime is transferred across the placenta . Animal reproduction studies with technetium Tc 99m exametazime have not been conducted. However, all radiopharmaceuticals have the potential to cause fetal harm depending on the fetal stage of development and the magnitude of the radiation dose. If considering technetium Tc 99m exametazime administration to a pregnant woman, inform the patient about the potential for adverse pregnancy outcomes based on the radiation dose from technetium Tc 99m exametazime and the gestational timing of exposure. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15- 20%, respectively.
Taking Technetium Tc 99m Exametazime While Breastfeeding
What are recommendations for lactation if you're taking Technetium Tc 99m Exametazime?
Information in this record refers to the use of technetium Tc 99m exametazime (Tc 99m-hexamethylpropyleneamine oxime; Tc 99m HPAO; Tc 99m HMPAO) as a diagnostic agent. Breastfeeding need not be interrupted after administration of technetium Tc 99m exametazime in doses up to 500 MBq (15 mCi) to a nursing mother.[1][2][3] However, to follow the principle of keeping exposure as low as reasonably achievable , some experts recommend nursing the infant just before administration of the radiopharmaceutical and interrupting breastfeeding for 3 to 6 hours after the dose, then expressing the milk completely once and discarding it. If the mother has expressed and saved milk prior to the examination, she can feed it to the infant during the period of nursing interruption.[3][4][5] Mothers need not refrain from close contact with their infants after usual clinical doses.[1] For white blood cells labeled with technetium Tc 99m exametazime 180 to 400 MBq, the International Atomic Energy Agency recommends that breastfeeding should be interrupted for 12 hours.[5] Mothers concerned about the level of radioactivity in their milk could ask to have it tested at a nuclear medicine facility at their hospital. When the radioactivity is at a safe level she may resume breastfeeding. A method for measuring milk radioactivity and determining the time when a mother can safely resume breastfeeding has been published.[6] For nursing mothers who work with Tc 99m substances in their workplace, there is no need to take any precautions other than those appropriate for general radiation protection.[7]
Maternal / infant drug levels
Information in this record refers to the use of technetium Tc 99m exametazime (Tc 99m-hexamethylpropyleneamine oxime; Tc 99m HPAO; Tc 99m HMPAO) as a diagnostic agent. Breastfeeding need not be interrupted after administration of technetium Tc 99m exametazime in doses up to 500 MBq (15 mCi) to a nursing mother.[1][2][3] However, to follow the principle of keeping exposure as low as reasonably achievable , some experts recommend nursing the infant just before administration of the radiopharmaceutical and interrupting breastfeeding for 3 to 6 hours after the dose, then expressing the milk completely once and discarding it. If the mother has expressed and saved milk prior to the examination, she can feed it to the infant during the period of nursing interruption.[3][4][5] Mothers need not refrain from close contact with their infants after usual clinical doses.[1] For white blood cells labeled with technetium Tc 99m exametazime 180 to 400 MBq, the International Atomic Energy Agency recommends that breastfeeding should be interrupted for 12 hours.[5] Mothers concerned about the level of radioactivity in their milk could ask to have it tested at a nuclear medicine facility at their hospital. When the radioactivity is at a safe level she may resume breastfeeding. A method for measuring milk radioactivity and determining the time when a mother can safely resume breastfeeding has been published.[6] For nursing mothers who work with Tc 99m substances in their workplace, there is no need to take any precautions other than those appropriate for general radiation protection.[7]
Possible effects of Technetium Tc 99m Exametazime on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Technetium Tc 99m Exametazime
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Mountford PJ, O’Doherty MJ. Exposure of critical groups to nuclear medicine patients. Appl Radiat Isot. 1999;50:89-111. PMID: 10028630
2. Marshall DSC, Newberry NR, Ryan PJ. Measurement of the secretion of technetium-99m hexamethylpropylene amine oxime into breast milk. Eur J Nucl Med. 1996;23:1634-5. PMID: 8929318
3. National Radiation Protection Board (UK). Administration of radioactive substances advisory committee. Notes for guidance on the clinical administration of radiopharmaceuticals and use of sealed radioactive sources. 2019. https://assets.publishing.service.gov.uk/government/…/file/…/ARSAC_NfG_2019.pdf
4. Mountford PJ, Coakley AJ. A review of the secretion of radioactivity in human breast milk: data, quantitative analysis and recommendations. Nucl Med Commun. 1989;10:15-27. PMID: 2645546
5. International Atomic Energy Agency. Radiation Protection and Safety in Medical Uses of Ionizing Radiation, IAEA Safety Standards Series No. SSG-46, IAEA, Vienna. 2018. https://www.iaea.org/publications/11102/radiation-protection-and-safety-in-medical-uses-of-ionizing-radiation
6. Stabin MG, Breitz HB. Breast milk excretion of radiopharmaceuticals: mechanisms, findings, and radiation dosimetry. J Nucl Med. 2000;41:863-73. PMID: 10809203
7. Almen A, Mattsson S. Radiological protection of foetuses and breast-fed children of occupationally exposed women in nuclear medicine – Challenges for hospitals. Phys Med. 2017;43:172-7. PMID: 28882410
8. Howe DB, Beardsley M, Bakhsh S. Appendix U. Model procedure for release of patients or human research subjects administered radioactive materials. In, NUREG-1556. Consolidated guidance about materials licenses. Program-specific guidance about medical use licenses. Final report. U.S. Nuclear Regulatory Commission Office of Nuclear Material Safety and Safeguards. 2008;9, Rev. 2. http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2/
9. Leide-Svegborn S, Ahlgren L, Johansson L et al. Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. Eur J Nucl Med Mol Imaging. 2016;43:808-21. PMID: 26732471
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
