Sodium Fluoride F 18: Package Insert and Label Information

SODIUM FLUORIDE F 18- sodium fluoride f-18 injection, solution
Triad Isotopes, Inc.

1 INDICATIONS AND USAGE

Sodium Fluoride F 18 Injection USP is indicated for diagnostic positron emission tomography (PET) imaging of bone to define areas of altered osteogenic activity.

2 DOSAGE AND ADMINISTRATION

2.1 Radiation Safety — Drug Handling

  • Wear waterproof gloves and effective shielding when handling Sodium Fluoride F 18 Injection. Use appropriate safety measures, including shielding, consistent with proper patient management to avoid unnecessary radiation exposure to the patient, occupational workers, clinical personnel, and other persons.
  • Radiopharmaceuticals should be used by or under the control of physicians who are qualified by specific training and experience in the safe use and handling of radionuclides, and whose experience and training have been approved by the appropriate governmental agency authorized to license the use of radionuclides.
  • Use aseptic technique to maintain sterility during all operations involved in the manipulation and administration of Sodium Fluoride F 18 Injection.
  • The dose of Sodium Fluoride F 18 Injection should be minimized consistent with the objectives of the procedure, and the nature of the radiation detection devices employed.
  • The final dose for the patient should be calculated using proper decay factors from the time of End of Synthesis (EOS), and measured by a suitable radioactivity calibration system before administration [see Description (11.2)].

2.2 Radiation Safety — Patient Preparation

  • To minimize the radiation-absorbed dose to the bladder, encourage adequate hydration. Encourage the patient to ingest at least 500 mL of fluid immediately prior and subsequent to the administration of Sodium Fluoride F 18 Injection.
  • Encourage the patient to void one-half hour after administration of Sodium Fluoride F 18 Injection and as frequently thereafter as possible for the next 12 hours.

2.3 Drug Preparation and Administration

  • Calculate the necessary volume to administer based on calibration time and dose.
  • Inspect Sodium Fluoride F 18 Injection visually for particulate matter and discoloration before administration, whenever solution and container permit.
  • Do not administer Sodium Fluoride F 18 Injection containing particulate matter or discoloration; dispose of these unacceptable or unused preparations in a safe manner, in compliance with applicable regulations.
  • Aseptically withdraw Sodium Fluoride F 18 Injection from its container.

2.4 Recommended Dose for Adults

Administer 300–450 MBq (8–12 mCi) as an intravenous injection.

2.5 Recommended Dose for Pediatric Patients

In reported clinical experience in approximately 100 children, weight based doses (2.1 MBq/kg) ranging from 19 MBq–148 MBq (0.5 mCi–4 mCi) were used.

2.6 Radiation Dosimetry

The age/weight- based estimated absorbed radiation doses (mGy/MBq) from intravenous injection of Sodium Fluoride F 18 Injection are shown in Table 1. These estimates were calculated based on human data and using the data published by the Nuclear Regulatory Commission [1] and the International Commission on Radiological Protection for Sodium Fluoride Injection [2]. The bone, bone marrow and urinary bladder are considered target and critical organs.

Table 1: Estimated Absorbed Radiation Doses after Intravenous Administration of Sodium Fluoride F 18 Injection
Organ Estimated Radiation Dose mGy/MBq
Adult
70 kg [1]
15 year
56.8 kg [2]
10 year
33.2 kg [2]
5 year
19.8 kg [2]
1 year
9.7 kg [2]
Adrenals 0.0062 0.012 0.018 0.028 0.052
Brain 0.0056 N/A N/A N/A N/A
Bone
surfaces
0.060 0.050 0.079 0.13 0.30
Breasts 0.0028 0.0061 0.0097 0.015 0.030
GI Gallbladder wall 0.0044 N/A N/A N/A N/A
Stomach wall 0.0038 0.008 0.013 0.019 0.036
Small intestine 0.0066 0.012 0.018 0.028 0.052
Upper large intestine wall 0.0058 0.010 0.016 0.026 0.046
Lower large intestine wall 0.012 0.016 0.025 0.037 0.063
Heart wall 0.0039 N/A N/A N/A N/A
Kidneys 0.019 0.025 0.036 0.053 0.097
Liver 0.0040 0.0084 0.013 0.021 0.039
Lungs 0.0041 0.0084 0.013 0.020 0.039
Muscle 0.0060 N/A N/A N/A N/A
Ovaries 0.011 0.016 0.023 0.036 0.063
Pancreas 0.0048 0.0096 0.015 0.023 0.044
Red marrow 0.028 0.053 0.088 0.18 0.38
Skin 0.0040 N/A N/A N/A N/A
Spleen 0.0042 0.0088 0.014 0.021 0.041
Testes 0.0078 0.013 0.021 0.033 0.062
Thymus 0.0035 N/A N/A N/A N/A
Thyroid 0.0044 0.0084 0.013 0.020 0.036
Urinary bladder wall 0.25 0.27 0.4 0.61 1.1
Uterus 0.019 0.023 0.037 0.057 0.099
Other tissue N/A 0.010 0.015 0.024 0.044
Effective Dose Equivalent mSv/MBq 0.027 0.034 0.052 0.086 0.17

[1] Data from Nuclear Regulatory Commission Report, Radiation Dose Estimates for Radiopharmaceuticals, NUREG/CR-6345, page 10, 1996.

[2] Data from ICRP publication 53, Radiation Dose to Patients from Radiopharmaceuticals, Ann ICRP, Volume 18, pages 15 and 74, 1987

2.7 Imaging Guidelines

  • Imaging of Sodium Fluoride F 18 Injection can begin 1–2 hours after administration; optimally at 1 hour post administration.
  • Encourage the patient to void immediately prior to imaging the fluoride F18 radioactivity in the lumbar spine or bony pelvis.

3 DOSAGE FORMS AND STRENGTHS

Multiple-dose vial containing 370–7,400 MBq/mL (10–200 mCi/mL) at EOS reference time of no-carrier-added sodium fluoride F18 in aqueous 0.9% sodium chloride solution. Sodium Fluoride F 18 Injection is a clear, colorless, sterile, pyrogen-free and preservative-free solution for intravenous administration.

4 CONTRAINDICATIONS

None.

5 WARNINGS AND PRECAUTIONS

5.1 Allergic Reactions

As with any injectable drug product, allergic reactions and anaphylaxis may occur. Emergency resuscitation equipment and personnel should be immediately available.

5.2 Radiation Risks

Sodium Fluoride F 18 Injection may increase the risk of cancer. Carcinogenic and mutagenic studies with Sodium Fluoride F18 injection have not been performed. Use the smallest dose necessary for imaging and ensure safe handling to protect the patient and health care worker [see Dosage and Administration (2.1)].

6 ADVERSE REACTIONS

No adverse reactions have been reported for Sodium Fluoride F 18 Injection based on a review of the published literature, publicly available reference sources, and adverse drug reaction reporting systems. However, the completeness of these sources is not known.

7 DRUG INTERACTIONS

The possibility of interactions of Sodium Fluoride F 18 Injection with other drugs taken by patients undergoing PET imaging has not been studied.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category C

Any radiopharmaceutical including Sodium Fluoride F 18 Injection has a potential to cause fetal harm. The likelihood of fetal harm depends on the stage of fetal development, and the radionuclide dose. Animal reproductive and developmental toxicity studies have not been conducted with Sodium Fluoride F 18 Injection. Prior to the administration of Sodium Fluoride F 18 Injection to women of childbearing potential, assess for presence of pregnancy. Sodium Fluoride F 18 Injection should be given to a pregnant woman only if clearly needed.

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