The Basics
What is Technetium Tc 99m Sestamibi?
Indicated for: 1) detecting coronary artery disease and infarction; and 2) evaluating myocardial function.
Brand names for Technetium Tc 99m Sestamibi
Cardiolite
How Technetium Tc 99m Sestamibi is classified
Radiopharmaceuticals, Technetium Compounds, Diagnostic Agents
Technetium Tc 99m Sestamibi During Pregnancy
Technetium Tc 99m Sestamibi 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 Sestamibi while pregnant
N/A
Taking Technetium Tc 99m Sestamibi While Breastfeeding
What are recommendations for lactation if you're taking Technetium Tc 99m Sestamibi?
Information in this record refers to the use of technetium Tc 99m sestamibi (Tc 99m-methoxyisobutylisonitrile; Tc 99m MIBI) as a diagnostic agent. The United States Nuclear Regulatory Commission and other agencies state that breastfeeding need not be interrupted after administration of technetium Tc 99m sestamibi in doses up to 1000 MBq (30 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 4 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.[4][5][6] Mothers need not refrain from close contact with their infants after usual clinical doses.[7] 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.[8] 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.[9]
Maternal / infant drug levels
Information in this record refers to the use of technetium Tc 99m sestamibi (Tc 99m-methoxyisobutylisonitrile; Tc 99m MIBI) as a diagnostic agent. The United States Nuclear Regulatory Commission and other agencies state that breastfeeding need not be interrupted after administration of technetium Tc 99m sestamibi in doses up to 1000 MBq (30 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 4 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.[4][5][6] Mothers need not refrain from close contact with their infants after usual clinical doses.[7] 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.[8] 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.[9]
Possible effects of Technetium Tc 99m Sestamibi on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Technetium Tc 99m Sestamibi
Technetium Tc 99m Tetrofosmin.
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. 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/
2. Mattsson S, Johansson L, Leide Svegborn S et al. Radiation dose to patients from radiopharmaceuticals: A compendium of current information related to frequently used substances. Annex D. Recommendations on breast-feeding interruptions. Ann ICRP. 2015;44 (2 Suppl):319-21. PMID: 26069086
3. Mitchell KB, Fleming MM, Anderson PO et al. ABM Clinical Protocol #30: Radiology and Nuclear Medicine Studies in Lactating Women. Breastfeed Med. 2019;14:290-4. 31107104
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. 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
7. Mountford PJ, O’Doherty MJ. Exposure of critical groups to nuclear medicine patients. Appl Radiat Isot. 1999;50:89-111. PMID: 10028630
8. Stabin MG, Breitz HB. Breast milk excretion of radiopharmaceuticals: mechanisms, findings, and radiation dosimetry. J Nucl Med. 2000;41:863-73. PMID: 10809203
9. 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
10. 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.
