Technetium Tc-99m sestamibi

Identification

Summary

Technetium Tc-99m sestamibi is a radiopharmaceutical diagnostic agent used in nuclear medicine imaging tests to detect coronary artery disease and evaluate myocardial function.

Brand Names
Cardiolite
Generic Name
Technetium Tc-99m sestamibi
DrugBank Accession Number
DB09161
Background

Technetium Tc-99m sestamibi (commonly sestamibi) is a pharmaceutical agent used in nuclear medicine imaging. The drug is a coordination complex consisting of the radioisotope technetium-99m bound to six methoxyisobutylisonitrile (MIBI) ligands, hence the name sesta (6) MIBI.. Following intravenous injection of the drug, Technetium Tc-99m sestamibi is taken up by the myocardium, parathyroid, and/or breast tissue. The mechanism by which sestamibi localizes to these tissues has not been established. Single photon emission computed tomography (SPECT) is then performed to detect the gamma ray emmitted by the decay of Technetium-99m to Technetium-99.

Currently available within a preparation kit for injection, Technetium Tc 99m Sestamibi is indicated for: 1) detecting coronary artery disease by localizing myocardial ischemia (reversible defects) and infarction (non-reversible defects); and 2) evaluating myocardial function and developing information for use in patient management decisions.

Type
Small Molecule
Groups
Approved, Investigational
Structure
Thumb
Weight
Average: 775.96
Monoisotopic: 775.5
Chemical Formula
C36H66N6O6Tc
Synonyms
  • 99m Tc-sestamibi
  • 99m-Tc sestamibi
  • 99mTc sestamibi
  • 99mTc-sestamibi
  • Sestamibi
  • Technetium (99m Tc) sestamibi
  • Technetium (99mTc) sestamibi
  • Technetium Tc 99m sestamibi

Pharmacology

Indication

Technetium Tc 99m Sestamibi is indicated for: 1) detecting coronary artery disease by localizing myocardial ischemia (reversible defects) and infarction (non-reversible defects); and 2) evaluating myocardial function and developing information for use in patient management decisions.

Pharmacology
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Associated Conditions
Contraindications & Blackbox Warnings
Contraindications
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Pharmacodynamics

Not Available

Mechanism of action
Not Available
Absorption

At five minutes post injection about 8% of the injected dose remains in circulation. Myocardial uptake which is coronary flow dependent is 1.2% of the injected dose at rest and 1.5% of the injected dose at exercise.

Volume of distribution

Not Available

Protein binding

There is less than 1% protein binding of Technetium Tc 99m Sestamibi in plasma.

Metabolism

The agent is excreted without any evidence of metabolism.

Route of elimination

The major pathway for clearance of Tc 99m Sestamibi is the hepatobiliary system. Activity from the gall bladder appears in the intestines within one hour of injection. Twenty-seven percent of the injected dose is excreted in the urine, and approximately thirty-three percent of the injected dose is cleared through the feces in 48 hours.

Half-life

Technetium Tc 99m decays by isomeric transition with a physical half-life of 6.02 hours. Blood clearance studies indicate that the fast clearing component clears with a t½ of 4.3 minutes at rest, and clears with a t½ of 1.6 minutes under exercise conditions. The myocardial biological half-life is approximately six hours after a rest or exercise injection. The biological half-life for the liver is approximately 30 minutes after a rest or exercise injection.

Clearance

The effective half-life of clearance (which includes both the biological half-life and radionuclide decay) for the heart is approximately 3 hours, and for the liver is approximately 30 minutes, after a rest or exercise injection.

Adverse Effects
Adverseeffects
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Toxicity

The following adverse reactions have been reported in > 0.5% of patients: signs and symptoms consistent with seizure occurring shortly after administration of the agent; transient arthritis; angioedema, arrhythmia, dizziness, syncope, abdominal pain, vomiting, and severe hypersensitivity characterized by dyspnea, hypotension, bradycardia, asthenia, and vomiting within two hours after a second injection of Technetium Tc 99m Sestamibi. A few cases of flushing, edema, injection site inflammation, dry mouth, fever, pruritis, rash, urticaria and fatigue have also been attributed to administration of the agent.

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
AbemaciclibThe serum concentration of Abemaciclib can be increased when it is combined with Technetium Tc-99m sestamibi.
AfatinibThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Afatinib.
AmbrisentanThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Ambrisentan.
AmiodaroneThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Amiodarone.
ApalutamideThe serum concentration of Technetium Tc-99m sestamibi can be decreased when it is combined with Apalutamide.
ApixabanThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Apixaban.
Arsenic trioxideThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Arsenic trioxide.
AsunaprevirThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Asunaprevir.
AvanafilThe serum concentration of Technetium Tc-99m sestamibi can be increased when it is combined with Avanafil.
AvatrombopagThe serum concentration of Avatrombopag can be increased when it is combined with Technetium Tc-99m sestamibi.
Interactions
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Food Interactions
No interactions found.

Products

Products2
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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
Technetium Tc 99m SestamibiInjection1 mg/10mLIntravenousJubilant HollisterStier General Partnership2009-07-012018-01-23US flag
Generic Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
Kit for the Preparation of Technetium Tc99m SestamibiInjection, powder, lyophilized, for solution1 mg/5mLParenteralCardinal Health 414, Llc2010-06-01Not applicableUS flag
Kit for the Preparation of Technetium Tc99m SestamibiInjection1 mg/10mLIntravenousSun Pharmaceutical Industries, Inc.2009-07-10Not applicableUS flag
Technetium Tc 99m SestamibiInjection, powder, for solution1 mg/1mLIntravenousJubilant Draximage (Usa) Inc.2009-07-01Not applicableUS flag
Technetium Tc 99m SestamibiInjection1 mg/1mLIntravenousMallinckrodt Inc.2011-10-312017-07-01US flag

Categories

ATC Codes
V09GA01 — Technetium (99mtc) sestamibi
Drug Categories
Classification
Not classified
Affected organisms
Not Available

Chemical Identifiers

UNII
971Z4W1S09
CAS number
109581-73-9
InChI Key
ZBTQTVSNLRPJHI-UHFFFAOYSA-N
InChI
InChI=1S/6C6H11NO.Tc/c6*1-6(2,8-4)5-7-3;/h6*5H2,1-2,4H3;/q;;;;;;+1
IUPAC Name
technetium(1+) ion hexakis(1-isocyano-2-methoxy-2-methylpropane)
SMILES
[Tc+].COC(C)(C)C[N+]#[C-].COC(C)(C)C[N+]#[C-].COC(C)(C)C[N+]#[C-].COC(C)(C)C[N+]#[C-].COC(C)(C)C[N+]#[C-].COC(C)(C)C[N+]#[C-]

References

General References
  1. Hendrikse NH, Franssen EJ, van der Graaf WT, Meijer C, Piers DA, Vaalburg W, de Vries EG: 99mTc-sestamibi is a substrate for P-glycoprotein and the multidrug resistance-associated protein. Br J Cancer. 1998;77(3):353-8. [Article]
  2. Ma Q, Chen B, Gao S, Ji T, Wen Q, Song Y, Zhu L, Xu Z, Liu L: 99mTc-3P4-RGD2 scintimammography in the assessment of breast lesions: comparative study with 99mTc-MIBI. PLoS One. 2014 Sep 24;9(9):e108349. doi: 10.1371/journal.pone.0108349. eCollection 2014. [Article]
  3. Tiling R, Tatsch K, Sommer H, Meyer G, Pechmann M, Gebauer K, Munzing W, Linke R, Khalkhali I, Hahn K: Technetium-99m-sestamibi scintimammography for the detection of breast carcinoma: comparison between planar and SPECT imaging. J Nucl Med. 1998 May;39(5):849-56. [Article]
KEGG Drug
D01060
PubChem Compound
22617237
PubChem Substance
310265074
ChemSpider
58829659
RxNav
1482913
ChEBI
9423
ChEMBL
CHEMBL2074398
RxList
RxList Drug Page
Drugs.com
Drugs.com Drug Page
Wikipedia
Technetium_(99mTc)_sestamibi
FDA label
Download (4.09 MB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
4CompletedDiagnosticCoronary Artery Disease (CAD) / Type 1 Diabetes Mellitus1
4CompletedDiagnosticCoronary Artery Restenosis / Type 2 Diabetes Mellitus1
4CompletedDiagnosticDiabetes1
4CompletedDiagnosticMyocardial Infarction1
3CompletedDiagnosticCoronary Artery Disease (CAD)2
3CompletedDiagnosticMucocutaneous Lymph Node Syndrome1
2CompletedDiagnosticMalignancies1
1, 2CompletedDiagnosticMucocutaneous Lymph Node Syndrome1
0Not Yet RecruitingDiagnosticBreast Cancer1
0RecruitingDiagnosticEstrogen Receptor Negative / HER2/Neu Negative / Progesterone Receptor Negative / Triple Negative Breast Carcinoma1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Injection, powder, lyophilized, for solutionIntravenous0.12 mg
Injection, powder, lyophilized, for solutionParenteral1 mg/5mL
Kit500 mcg
Kit
Kit1 mg
InjectionIntravenous1 mg/1mL
InjectionIntravenous1 mg/10mL
Injection, powder, for solutionIntravenous1 mg/1mL
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
Not Available
Predicted Properties
PropertyValueSource
Water Solubility0.00465 mg/mLALOGPS
logP5.44ALOGPS
logP-1.3ChemAxon
logS-5.2ALOGPS
pKa (Strongest Acidic)16.14ChemAxon
pKa (Strongest Basic)-4.2ChemAxon
Physiological Charge1ChemAxon
Hydrogen Acceptor Count1ChemAxon
Hydrogen Donor Count0ChemAxon
Polar Surface Area13.59 Å2ChemAxon
Rotatable Bond Count12ChemAxon
Refractivity41.61 m3·mol-1ChemAxon
Polarizability12.7 Å3ChemAxon
Number of Rings0ChemAxon
Bioavailability0ChemAxon
Rule of FiveNoChemAxon
Ghose FilterNoChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleNoChemAxon
Predicted ADMET Features
Not Available

Spectra

Mass Spec (NIST)
Not Available
Spectra
Not Available

Transporters

Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Xenobiotic-transporting atpase activity
Specific Function
Energy-dependent efflux pump responsible for decreased drug accumulation in multidrug-resistant cells.
Gene Name
ABCB1
Uniprot ID
P08183
Uniprot Name
Multidrug resistance protein 1
Molecular Weight
141477.255 Da
References
  1. Hendrikse NH, Franssen EJ, van der Graaf WT, Meijer C, Piers DA, Vaalburg W, de Vries EG: 99mTc-sestamibi is a substrate for P-glycoprotein and the multidrug resistance-associated protein. Br J Cancer. 1998;77(3):353-8. [Article]
Kind
Protein
Organism
Humans
Pharmacological action
No
Actions
Substrate
General Function
Transporter activity
Specific Function
Mediates export of organic anions and drugs from the cytoplasm. Mediates ATP-dependent transport of glutathione and glutathione conjugates, leukotriene C4, estradiol-17-beta-o-glucuronide, methotre...
Gene Name
ABCC1
Uniprot ID
P33527
Uniprot Name
Multidrug resistance-associated protein 1
Molecular Weight
171589.5 Da
References
  1. Hendrikse NH, Franssen EJ, van der Graaf WT, Meijer C, Piers DA, Vaalburg W, de Vries EG: 99mTc-sestamibi is a substrate for P-glycoprotein and the multidrug resistance-associated protein. Br J Cancer. 1998;77(3):353-8. [Article]

Drug created on October 02, 2015 20:20 / Updated on October 09, 2021 02:48