Iobenguane I-131 is a radioactive therapeutic agent indicated for the treatment of iobenguane scan-positive unresectable, locally advanced, or metastatic pheochromocytoma or paraganglioma in patients aged 12 years and older who require systemic anticancer therapy. Myelosuppression and renal toxicity have been reported; monitoring of complete blood counts and renal function is recommended.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
CAUTION: Iobenguane I-131 is a radiopharmaceutical; handle with appropriate safety measures (e.g., waterproof gloves and effective radiation shielding). Minimize radiation exposure in patients, medical personnel, and household contact in accordance with good radiation safety practices.
Route-Specific Administration
Injectable Administration
Visually inspect parenteral products for particular matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
-Iobenguane I-131 is available as a single-use vials containing 555 Megabecquerel (MBq)/mL (15 Millicuries (mCi)/mL) supplied in dosimetric (2 mL) and therapeutic (22.5 mL) dose presentations.
-Vials are shipped in a lead shielded container placed in a re-sealable plastic bag on dry ice in a USA DOT Type A Radioactive package; the product shelf-life is 6 days post calibration time.
-Discard if the temperature recording device displays an alarm icon indicating that the temperature exceeded -70 degrees C (-94 degrees F) during shipment or if the shelf-live has exceeded 144 hours post calibration time.
-Confirm the amount of radioactivity in the radiopharmaceutical vial with an appropriate dose calibrator prior to and after iobenguane I-131 administration.
-Refer to the manufacturer prescribing information for the mean estimated radiation absorbed doses in target organs.
Dosimetric Dose
-Thaw the vial to room temperature in a lead pot, swirling gently to ensure homogeneity; do not heat or refreeze.
-Vent the vial (using a needle, 0.2-micron sterile filter, and a charcoal filter) to avoid pressurizing the contents during dilution; swirl gently.
-Add a sufficient quantity of 0.9% Sodium Chloride injection to the 1,110 MBq (30 mCi) vial to yield a concentration of 37 MBq/mL (1 mCi/mL); swirl gently.
-Draw the dose into a 10-mL shielded syringe and place in the dose calibrator to ensure that the activity is within 10% of the dose; discard unused vial contents in accordance with local and federal laws.
-Store at room temperature; administer within 8 hours of retrieval from frozen storage.
Intravenous (IV) injection:
-Administer IV over 60 seconds.
Therapeutic Dose
-Thaw the appropriate number of vials to room temperature in a lead pot, swirling gently to ensure homogeneity; do not heat or refreeze.
-Vent each vial to avoid pressurizing the contents during dilution; swirl gently.
-Vent a sterile 50-mL glass vial and transfer the entire contents of therapeutic vials into a 50-mL glass vial.
-Measure the radioactivity in the 50-mL glass vial. If the radioactivity exceeds the therapeutic dose, withdraw and discard the appropriate volume using a shielded syringe; if the radioactivity is less than the therapeutic dose, use a shielded syringe to withdraw the appropriate volume from another iobenguane I-131 vial and add to the 50-mL glass vial.
-Add a sufficient quantity of 0.9% Sodium Chloride injection in the 50-mL glass vial to a total volume of 50 mL; swirl gently.
-Remove the venting unit and place the 50-mL vial in the dose calibrator to ensure that the activity is within 10% of the therapeutic dose; discard unused contents in accordance with local and federal laws.
-Store at room temperature; administer within 8 hours of retrieval from frozen storage.
IV Infusion:
-Prior to therapeutic dose administration, verify line patency by infusing 250 mL of 0.9% Sodium Chloride for injection (primary IV line) at a rate of 200 mL/hour.
-Insert a venting unit into the 50-mL glass vial containing the therapeutic dose.
-Assemble a second IV line using a 19-gauge x 5-inch aspirating needle, 24-inch M-M arterial pressure tubing, and a primary set specific connector.
-Clamp the second IV line and connect it to the primary IV line using the primary set specific connector.
-Flush the second IV line by releasing the clamp and then re-clamp the second IV line.
-Insert the needle of the second IV line into the 50-mL glass vial containing the therapeutic dose; ensure the needle reaches the bottom of the glass vial without touching the sides of the vial.
-Clamp the primary IV line just above the second IV line and remove the clamp from the secondary IV line.
-Administer IV over 30 minutes (rate of 100 mL/hour) for adults and IV over 60 minutes (rate of 50 mL/hour) for pediatric patients 12 years and older; clamp the secondary IV line when the first air bubbles form.
-Following the therapeutic dose administration, remove the clamp from the primary IV line; flush the line with at least 50 mL of 0.9% Sodium Chloride injection.
-Remove the clamp from the secondary IV line to flush any residual drug in the secondary IV line into the 50-mL glass vial.
Hematologic adverse events have been reported in patients who received iobenguane I-131 in clinical trials. Monitor complete blood cell counts weekly for up to 12 weeks or until blood counts return to baseline or to within the normal range. Therapy interruption and a dose reduction may be necessary in patients who have severe myelosuppression. Lymphopenia (96%; grade 3 or 4, 78%), anemia (93%; grade 3 or 4, 24%), thrombocytopenia (91%; grade 3 or 4, 50%), neutropenia (84%; grade 3 or 4, 59%), and febrile neutropenia (5%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88). In one study, patients who had grade 4 neutropenia reached neutrophil nadir levels at a median of 36 days (range, 27 to 55 days) following the first therapeutic dose and at a median of 43 days (range, 38 to 47 days) following the second therapeutic dose; the median nadir durations were 12 days (range, 8 to 22 days) and 18.5 days (range, 8 to 31 days) following the first and second therapeutic doses.
Nephrotoxicity has been reported in patients who received iobenguane I-131 in clinical trials. Patients should increase their fluid intake to 2 liters or more daily starting at least 1 day before and continuing for 1 week after each dose. Monitor renal function during and after iobenguane I-131 therapy in all patients; evaluate renal function more frequently in patients with mild or moderate renal impairment. Iobenguane I-131 has not been studied in patients with severe renal impairment (creatinine clearance of less than 30 mL/min) or end-stage renal disease. Decreased glomerular filtration rate (measured at 6 or 12 months) (22%), proteinuria (9%), and renal failure (unspecified) or acute kidney injury (7%) was reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Gastrointestinal adverse events have been reported in patients who received iobenguane I-131 in clinical trials. Administer antiemetic agents 30 minutes prior to each dose. Nausea (78%; grade 3 or 4, 16%), vomiting (58%; grade 3 or 4, 10%), xerostomia (48%; grade 3 or 4, 2%), sialadenitis (39%; grade 3 or 4, 1%), decreased appetite/anorexia (30%; grade 3 or 4, 5%), diarrhea (25%; grade 3 or 4, 3%), abdominal pain (23%; grade 3 or 4, 6%), constipation (19%; grade 3 or 4, 7%), oropharyngeal pain (14%), dyspepsia (10%), dysphagia (7%), abdominal distension (6%), gastroesophageal reflux disease (6%), and stomatitis (3%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88). The term sialadenitis included sialoadenitis, salivary gland pain, and salivary gland enlargement.
Endocrine adverse events have been reported in patients who received iobenguane I-131 in clinical trials. Thyroid blockage with inorganic iodine should begin at least 24 hours before and continue for 10 days after each dose. Monitor thyroid-stimulating hormone (TSH) levels prior to starting iobenguane I-131 therapy and then annually thereafter. Decreased TSH levels (5%) and hypothyroidism (3.4%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88). The time to worsening hypothyroidism was 4 months in 1 patient; the time to development of hypothyroidism was less than 1 month in 1 patient and 18 months in 1 patient.
New or worsening hypertension has been reported in patients who received iobenguane I-131 in clinical trials; all cases of worsening hypertension occurred within the first 24 hours of drug infusion. Monitor blood pressure frequently for 24 hours after each therapeutic dose. Hypertension/increased blood pressure was reported in 20% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88); grade 3 or 4 hypertension occurred in 11% of patients. Worsening hypertension, defined as an increase in systolic blood pressure to 160 mmHg or higher with an increase of 20 mmHg or an increase in diastolic blood pressure to 100 mmHg or higher with an increase of 10 mmHg, occurred in 11% of patients.
Cardiac adverse events including hypotension (24%; grade 3 or 4, 4%), sinus tachycardia (10%; grade 3 or 4, 3%), orthostatic hypotension (9%), palpitations (9%), syncope/presyncope (8%), and chest pain (unspecified) (6%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
One patient enrolled in an expanded access program experienced fatal pneumonitis 9 weeks following a single dose of iobenguane I-131. Monitor patients for signs and symptoms of pneumonitis; administer appropriate treatment in patients who develop pneumonitis. Do not administer the second iobenguane I-131 therapeutic dose if pneumonitis is diagnosed after the first therapeutic dose. Other respiratory adverse events including cough (18%), dyspnea (18%; grade 3 or 4, 7%), and nasal congestion (7%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Infection including upper respiratory tract infection (16%; grade 3 or 4, 2%), urinary tract infection (11%; grade 3 or 4, 1%), and candidiasis (6%) was reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88). The term upper respiratory tract infection included sinusitis, rhinorrhea, upper-airway cough syndrome, and naso-pharyngitis.
Dehydration was reported in 16% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88); grade 3 or 4 dehydration occurred in 4% of patients.
Weight loss was reported in 16% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88); grade 3 or 4 weight loss occurred in 1% of patients.
Musculoskeletal adverse events including back pain (17%; grade 3 or 4, 2%), extremity pain (15%), arthralgia (8%), neck pain (8%), jaw pain (7%), and muscle cramps/spasms (6%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Nervous system adverse events including dizziness (34%; grade 3 or 4, 13%), headache (32%; grade 3 or 4, 6%), and dysgeusia (24%; grade 3 or 4, 1%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88). The term dysgeusia term included hypogeusia and ageusia.
Increased international normalized ratio (INR) was reported in 85% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received iobenguane I-131 in a clinical study (n = 68); grade 3 or 4 increased INR occurred in 18% of patients. Epistaxis (9%) and prolonged bleeding time including prolonged prothrombin time (9%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Dermatologic adverse events including hyperhidrosis (10%), injection site reaction/pain (10%), alopecia (10%), xerosis (8%), rash (8%), and petechiae (7%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Pulmonary embolism was reported in 3% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Fever (14%; grade 3 or 4, 2%) and chills (8%) were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Fatigue/asthenia was reported in 71% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88); grade 3 or 4 fatigue/asthenia occurred in 26% of patients.
Insomnia was reported in 9% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
Elevated hepatic enzymes including increased AST (50%; grade 3 or 4, 2%), ALT (43%; grade 3 or 4, 2%), and alkaline phosphatase (53%; grade 3 or 4, 5%) levels were reported in patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88).
New primary malignancy including myelodysplastic syndrome (MDS) or acute leukemia was reported in 6.8% of patients with recurrent or unresectable, locally advanced or metastatic pheochromocytoma or paraganglioma who received at least 1 therapeutic dose of iobenguane I-131 in pooled results from 2 studies (n = 88); the time to malignancy development ranged from 1 to 7 years. Additionally, 1 patient developed colon cancer at 18 months following the first therapeutic dose and 1 patient developed lung cancer at 27 months following the first therapeutic dose.
Because iobenguane I-131 is a radiopharmaceutical and radiation exposure may result in a new primary malignancy, use requires an experienced clinician with training in the safe use and handling of radiopharmaceuticals; additionally, clinicians must have experience and training that is approved by governmental agencies that license the use of radiopharmaceuticals. Radiation-associated risks may be higher in adolescents and children who receive iobenguane I-131 compared with adults due to greater radiation absorption and a longer life expectancy. Weigh the risks versus benefits of administering iobenguane I-131 therapy in pediatric patients.
Severe and prolonged bone marrow suppression (e.g., anemia, neutropenia, and thrombocytopenia) has been reported with iobenguane I-131 use. Monitor complete blood cell counts weekly for up to 12 weeks or until blood counts return to baseline or to within the normal range. Therapy interruption and a dose reduction may be necessary in patients who have severe myelosuppression.
New or worsening hypothyroidism has been reported with iobenguane I-131 therapy; therefore, use this agent with caution in patients with a history of thyroid disease. Thyroid blockage with inorganic iodine should begin at least 24 hours before and continue for 10 days after each dose to reduce the risk of hypothyroidism or thyroid neoplasia. Monitor thyroid-stimulating hormone (TSH) levels prior to starting iobenguane I-131 therapy and then annually thereafter.
Worsening hypertension has been reported in patients with pre-existing hypertension who received iobenguane I-131; all cases occurred within the first 24 hours of drug infusion. Monitor blood pressure frequently for 24 hours after each therapeutic dose.
Patients with pre-existing renal impairment may be at increased risk of nephrotoxicity with iobenguane I-131 therapy; renal failure, acute kidney injury, and decreased glomerular filtration rate have been reported. Monitor renal function during and after iobenguane I-131 therapy in all patients; evaluate renal function more frequently in patients with mild or moderate renal impairment. Iobenguane I-131 has not been studied in patients with severe renal impairment (creatinine clearance of less than 30 mL/min) or end-stage renal disease.
Monitor patients for signs and symptoms of pneumonitis (e.g., cough, shortness of breath); fatal pneumonitis has been reported with iobenguane I-131 use. Do not administer the second iobenguane I-131 therapeutic dose if pneumonitis is diagnosed after the first therapeutic dose.
Iobenguane I-131 may cause fetal harm when administered during pregnancy, based on its mechanism of action. There are no data on the use of iobenguane I-131 in pregnant women or in animals.
Counsel patients about the reproductive risk and contraception requirements during iobenguane I-131 treatment. Pregnancy testing should be performed prior to starting iobenguane I-131 in female patients of reproductive potential. These patients should use effective contraception and avoid pregnancy during and for 7 months after the last iobenguane I-131 dose. Women who become pregnant while receiving iobenguane I-131 should be apprised of the potential hazard to the fetus. Additionally, male patients with a female partner of reproductive potential should use effective contraception during and for 4 months the last iobenguane I-131 dose due to the risk of male-mediated teratogenicity. Infertility may occur in males and female patients due to the radiation exposure associated with iobenguane I-131. The radiation absorbed by reproductive organs (i.e., testes and ovaries) during iobenguane I-131 therapy is within the range that causes temporary or permanent infertility after external beam radiotherapy.
It is not known if iobenguane I-131 is secreted in human milk or if it has effects on the breast-fed infant or on milk production. Due to the risk of serious adverse reactions in nursing infants, women should discontinue breast-feeding during iobenguane I-131 therapy and for 80 days after the last dose.
For the treatment of iobenguane scan-positive unresectable, locally advanced, or metastatic pheochromocytoma or paraganglioma in patients who require systemic anticancer therapy:
NOTE: Iobenguane I-131 has been designated an orphan drug by the FDA for the treatment of neuroendocrine tumors.
Intravenous dosage:
Adults, Adolescents, and Children 12 years of age: Therapy consists of a dosimetric dose followed by 2 therapeutic doses given at least 90 days apart. Thyroid blockage with inorganic iodine should begin at least 24 hours before and for 10 days after each dose. Administer antiemetic agents 30 minutes prior to each dose. Additionally, patients should increase their fluid intake to 2 liters or more daily starting at least 1 day before and continuing for 1 week after each dose. Dosimetric dose: administer 185 to 222 Megabecquerel (MBq) (5 to 6 Millicuries (mCi)) IV in patients weighing greater than 50 kg; administer 3.7 MBq/kg (0.1 mCi/kg) IV in patients weighing 50 kg or less. Calculate the therapeutic dose after performing a dosimetry and biodistribution assessment; the therapeutic dose is determined based on weight and may be reduced based on critical organ limits determined during dosimetry. Weight-based dose per therapeutic cycle: administer 18,500 MBq (500 mCi) IV in patients weighing greater than 62.5 kg; administer 296 MBq/kg (8 mCi/kg) IV in patients weighing 62.5 kg or less. In a single-arm phase 2 trial (n = 68), 25% of patients who received iobenguane I-131 therapy had a 50% or greater reduction of all antihypertension medications for at least 6 months (primary endpoint). The overall response rate (evaluated using RECIST criteria) was 22%.
Therapeutic Drug Monitoring:
NOTE: Following the Dosimetric dose, obtain anterior/posterior whole body gamma camera images within 1 hour and prior to patient voiding (day 0; scan 1). Obtain additional images on day 1 or 2 following patient voiding (scan 2) and between days 2 to 5 following patient voiding (scan 3). Calculate the radiation dose estimates to normal organs and tissues per unit activity [D (organ)] of administered dose using data extracted from these 3 images. Calculate in accordance with the Medical Internal Radiation Dose (MIRD) schema or related methodology. Whenever possible, use patient-specific organ masses (estimated from imaging).
Therapeutic Dosage
Therapeutic dose reduction based on critical organ limits:
Calculate the estimated critical organ absorbed-dose by multiplying the dosimetry-derived radiation absorbed-dose per unit activity [D (organ)] by weight-based therapeutic total activity (Aw).
-If resulting estimated critical organ absorbed-dose is less than the threshold absorbed-dose (T): No dose adjustment is necessary.
-If resulting estimated critical organ absorbed-dose exceeds the threshold absorbed-dose (T): Calculate the reduced therapeutic total activity (i.e., the cumulative activity that would be administered in 2 therapeutic cycles) using the following equation:
Reduced Therapeutic Total Activity = Aw x [T divided by {Aw x D (organ)}]
Threshold absorbed-dose (T):
Red marrow - 12 gray (Gy)
Lungs - 16.5 Gy
Kidneys - 18 Gy
Liver - 31 Gy
Small intestine - 40 Gy
Dosage Guidance Due to Treatment-Related Toxicity
Myelosuppression
First therapeutic dose:
Do not administer the dose if the platelet count is less than 80,000 cells/microliter (mcL) or the absolute neutrophil count (ANC) is less than 1,200 cells/mcL.
Second therapeutic dose:
Do not administer the dose until the platelet count and ANC return to baseline or to the normal range. Reduce the second therapeutic dose for the following: platelet count less than 25,000 cells/mcL, ANC less than 500 cells/mcL, or life-threatening anemia for more than 7 days; febrile neutropenia; or platelet count less than 50,000 cells/mcL with active bleeding. If the first therapeutic dose was weight-based, reduce the iobenguane I-131 dose to 425 mCi in patients weighing greater than 62.5 kg; reduce the iobenguane I-131 dose to 7 mCi/kg in patients weighing 62.5 kg or less. If the first therapeutic dose was reduced based on critical organ limits, reduce the iobenguane I-131 dose to 85% of the first dose.
Pneumonitis
Do not administer the second therapeutic dose if pneumonitis is diagnosed after the first therapeutic dose.
Maximum Dosage Limits:
-Adults
Weight greater than 62.5 kg: 18,500 Megabecquerel (MBq) (500 Millicuries (mCi)) IV.
Weight 62.5 kg or less: 296 MBq/kg (8 mCi/kg) IV.
-Geriatric
Weight greater than 62.5 kg: 18,500 MBq (500 mCi) IV.
Weight 62.5 kg or less: 296 MBq/kg (8 mCi/kg) IV.
-Adolescents
Weight greater than 62.5 kg: 18,500 MBq (500 mCi) IV.
Weight 62.5 kg or less: 296 MBq/kg (8 mCi/kg) IV.
-Children
Children 12 years of age: 296 MBq/kg (8 mCi/kg) IV.
Children less than 12 years of age: Safety and efficacy not established.
-Infants
Safety and efficacy not established.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available. Patients with renal impairment may have decreased renal clearance; Iobenguane I-131 has not been studied in patients with severe renal impairment (creatinine clearance of less than 30 mL/min) or end-stage renal disease.
*non-FDA-approved indication
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Chlorpheniramine; Phenylephrine : (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Dextromethorphan; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Dextromethorphan; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Guaifenesin; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acetaminophen; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Acrivastine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Amitriptyline: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Amphetamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Amphetamine; Dextroamphetamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Articaine; Epinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Atomoxetine: (Major) Discontinue selective norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart selective norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as selective norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Benzphetamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Brimonidine; Timolol: (Major) Discontinue timolol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart timolol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as timolol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Brompheniramine; Dextromethorphan; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Brompheniramine; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Brompheniramine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Brompheniramine; Pseudoephedrine; Dextromethorphan: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Bupivacaine; Epinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Bupropion: (Major) Discontinue bupropion for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart bupropion until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as bupropion, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Bupropion; Naltrexone: (Major) Discontinue bupropion for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart bupropion until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as bupropion, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Carvedilol: (Major) Discontinue carvedilol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart carvedilol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as carvedilol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Celecoxib; Tramadol: (Major) Discontinue tramadol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tramadol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tramadol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Cetirizine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlordiazepoxide; Amitriptyline: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlorpheniramine; Dextromethorphan; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlorpheniramine; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Chlorpheniramine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Cholera Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the live cholera vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to cholera bacteria after receiving the vaccine.
Clomipramine: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Codeine; Guaifenesin; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Codeine; Phenylephrine; Promethazine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dengue Tetravalent Vaccine, Live: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the dengue virus vaccine. When feasible, administer indicated vaccines at least 2 weeks prior to initiating immunosuppressant medications. If vaccine administration is necessary, consider revaccination following restoration of immune competence. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure after receiving the vaccine.
Desipramine: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Desloratadine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Desvenlafaxine: (Major) Discontinue serotonin norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart serotonin norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as serotonin norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dexbrompheniramine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dexmethylphenidate: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dextroamphetamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dextromethorphan; Bupropion: (Major) Discontinue bupropion for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart bupropion until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as bupropion, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dextromethorphan; Diphenhydramine; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dextromethorphan; Guaifenesin; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dextromethorphan; Guaifenesin; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Diethylpropion: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Diphenhydramine; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dobutamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dopamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Dorzolamide; Timolol: (Major) Discontinue timolol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart timolol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as timolol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Doxapram: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Doxepin: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Duloxetine: (Major) Discontinue serotonin norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart serotonin norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as serotonin norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Ephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Ephedrine; Guaifenesin: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Epinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Fexofenadine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Guaifenesin; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Guaifenesin; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Ibuprofen; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Imipramine: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Isocarboxazid: (Major) Discontinue monoamine oxidase inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart monoamine oxidase inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as monoamine oxidase inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Isoproterenol: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Labetalol: (Major) Discontinue labetalol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart labetalol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as labetalol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Levomilnacipran: (Major) Discontinue serotonin norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart serotonin norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as serotonin norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Lidocaine; Epinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Linezolid: (Major) Discontinue linezolid for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart linezolid until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as linezolid, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Lisdexamfetamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Loratadine; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Maprotiline: (Major) Discontinue maprotiline for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart maprotiline until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as maprotiline, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Methamphetamine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Methylphenidate: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Midodrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Milnacipran: (Major) Discontinue serotonin norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart serotonin norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as serotonin norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Mirtazapine: (Major) Discontinue mirtazapine for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart mirtazapine until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as mirtazapine, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Monoamine oxidase inhibitors: (Major) Discontinue monoamine oxidase inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart monoamine oxidase inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as monoamine oxidase inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Nadolol: (Major) Discontinue nadolol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart nadolol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as nadolol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Naproxen; Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Norepinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Nortriptyline: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Perphenazine; Amitriptyline: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Phendimetrazine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Phenelzine: (Major) Discontinue monoamine oxidase inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart monoamine oxidase inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as monoamine oxidase inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Phentermine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Phentermine; Topiramate: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Pindolol: (Major) Discontinue pindolol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart pindolol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as pindolol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Prilocaine; Epinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Promethazine; Phenylephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Propranolol: (Major) Discontinue propranolol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart propranolol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as propranolol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Protriptyline: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Pseudoephedrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Pseudoephedrine; Triprolidine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Racepinephrine: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
SARS-CoV-2 (COVID-19) vaccines: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the SARS-CoV-2 virus vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine.
SARS-CoV-2 Virus (COVID-19) Adenovirus Vector Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the SARS-CoV-2 virus vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine.
SARS-CoV-2 Virus (COVID-19) mRNA Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the SARS-CoV-2 virus vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine.
SARS-CoV-2 Virus (COVID-19) Recombinant Spike Protein Nanoparticle Vaccine: (Moderate) Patients receiving immunosuppressant medications may have a diminished response to the SARS-CoV-2 virus vaccine. When feasible, administer indicated vaccines prior to initiating immunosuppressant medications. Counsel patients receiving immunosuppressant medications about the possibility of a diminished vaccine response and to continue to follow precautions to avoid exposure to SARS-CoV-2 virus after receiving the vaccine.
Selective norepinephrine reuptake inhibitors: (Major) Discontinue selective norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart selective norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as selective norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Selegiline: (Major) Discontinue monoamine oxidase inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart monoamine oxidase inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as monoamine oxidase inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Serdexmethylphenidate; Dexmethylphenidate: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Serotonin norepinephrine reuptake inhibitors: (Major) Discontinue serotonin norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart serotonin norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as serotonin norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
St. John's Wort, Hypericum perforatum: (Major) Discontinue St. John's Wort for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart St. John's Wort until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as St. John's Wort, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Sympathomimetics: (Major) Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart sympathomimetics until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Timolol: (Major) Discontinue timolol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart timolol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as timolol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Tramadol: (Major) Discontinue tramadol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tramadol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tramadol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Tramadol; Acetaminophen: (Major) Discontinue tramadol for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tramadol until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tramadol, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Tranylcypromine: (Major) Discontinue monoamine oxidase inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart monoamine oxidase inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as monoamine oxidase inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Tricyclic antidepressants: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Trimipramine: (Major) Discontinue tricyclic antidepressants for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart tricyclic antidepressants until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as tricyclic antidepressants, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Tuberculin Purified Protein Derivative, PPD: (Moderate) Immunosuppressives may decrease the immunological response to tuberculin purified protein derivative, PPD. This suppressed reactivity can persist for up to 6 weeks after treatment discontinuation. Consider deferring the skin test until completion of the immunosuppressive therapy.
Venlafaxine: (Major) Discontinue serotonin norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart serotonin norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as serotonin norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Viloxazine: (Major) Discontinue selective norepinephrine reuptake inhibitors for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I-131. Do not restart selective norepinephrine reuptake inhibitors until at least 7 days after each iobenguane I-131 dose. Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as selective norepinephrine reuptake inhibitors, may interfere with iobenguane I-131 uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I-131 efficacy.
Iobenguane I-131 is a radioactive therapeutic agent that releases radiation resulting from radioactive decay of I-131 causing cell death and tumor necrosis. Iobenguane has a similar structure to the neurotransmitter norepinephrine. It is taken up by the norepinephrine transporter in adrenergic nerve terminals and accumulates in adrenergically innervated tissues (i.e., heart, lungs, adrenal medulla, salivary glands, liver, and spleen) as well as tumors of neural crest origin, such as pheochromocytomas and paragangliomas. These neuroendocrine tumors express high levels of the norepinephrine transporter on their cell surfaces.
Iobenguane I-131 is administered intravenously (IV). It is 61% to 63% bound to human plasma proteins. Iobenguane I-131 has a mean volume of distribution of 2,893 +/- 592 mL/kg (with a distribution half-life of 0.37 +/- 0.22 hours), a mean clearance of 62 +/- 24 mL/hour/kg, and a mean terminal blood half-life of 35 +/- 14 hours. Iobenguane I-131 does not undergo hepatic metabolism. The non-radioactive form of iobenguane does not inhibit CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, or CYP3A and does not induce CYP1A, CYP2B6, CYP2C9, CYP2C19, or CYP3A; it is not a substrate of inhibitor of P-glycoprotein. Iobenguane I-131 is mostly eliminated in the kidney with a mean cumulative excretion of 50% +/- 10% within 24 hours and 80% +/- 10% within 120 hours following drug administration. The average unchanged I-131 radioactivity was 94% at 0 to 6 hours and 93% at 6 to 24 hours post administration. Minor metabolites that were detected in some patients include free I-131, meta-iodohippuric acid (MIHA), and meta-iodobenzyl bisguanidine (MMIBG).
I-131 decays with beta and gamma emissions; it has a physical half-life of 8.021 days. The principal beta emission has a mean energy of 191 kiloelectron volts (keV); the principal gamma emission has energy of 364.5 keV. The specific gamma ray constant for I-131 is 2.2 R/Millicuries hour at 1 centimeter (cm); a 2.55 cm thickness of Pb (lead) will attenuate the radiation emitted by a factor of approximately 1,000. Refer to the manufacturer prescribing information for the radioactive decay properties of I-131.
-Route-Specific Pharmacokinetics
Intravenous Route
Following a dosimetric dose of iobenguane I-131, the mean blood AUC value was 1 microcuries x hour/mL (coefficient of variance (CV), 33%) and the mean Cmax value was 0.06 microcuries/mL (CV, 36%) in patients with malignant paragangliomas or other malignancies.
-Special Populations
Renal Impairment
Therapeutic dose reductions (based on radiation dose estimates to critical organs exceeding Emami limits of absorbed renal dose greater than 23 gray) were required in 19% of patients with mild or moderate renal impairment (n = 42; creatinine clearance (CrCl), 30 to 89 mL/min). Pharmacokinetic parameters of iobenguane I-131 have not been evaluated in patients with severe renal impairment (CrCl less than 30 mL/min) or end-stage renal disease.