Is Technetium 99m sestamibi compatible with breastfeeding? Do we have alternatives for Technetium 99m sestamibi?

Technetium 99m sestamibi

February 22, 2018 (Low Risk)

Metastable Technetium 99 (99mTc) is a radioactive isotope that emits gamma radiation. Its radioactive decay half-life is 6.0 hours.

After radioactive labelling with sodium pertechnetate (99mTc) solution, the technetium (99mTc) sestamibi solution obtained is used in single photon emission computed tomography (SPECT) for the diagnosis of myocardial, mammary and parathyroid disease.

0.05% of the administered dose is excreted in breast milk (Leide 2016, Liepe 2016).

Breastfeeding interruption or close contact avoidance times are calculated so that the infant is not exposed to more than 1 millisievert (1 mSv = 0.1 rem) of radiation (ICRP 2008, Howe 2008, Stabin 2000). An adult receives between 5 and 10 mSv annually from environmental radiation.

The main regulatory agencies which manage radioactive substances and experts consider that breastfeeding can occur immediately after a diagnostic test with Tc 99m sestamibi (ARSAC 2016, ICRP 2008, Howe 2008, Stabin 2000, Rubow 1994 and 1991).

Some agencies (ARSAC 2016, ICRP 2008) consider it more prudent to discontinue breastfeeding for about 4 hours, expressing breast milk and instead offering milk previously expressed and stored in a refrigerator prior to testing.
Milk expressed after feeding can be frozen and used after 10 radioactive half lives: 10 x 6.0 = 60 hours = 3 days (Hale 2017, p.1919).

Close contact with the infant need not be avoided (Mountford 1999).


See below the information of this related product:

Alternatives

We do not have alternatives for Technetium 99m sestamibi.

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Synonyms

  • Tc 99m hexakis-methoxyisobutylisonitrile
  • Tc 99m methoxyisobutylisonitrile
  • Tc 99m sestamibi

Writings

  • Tc 99m MIBI (Abbreviation)

Drug trade names

References

  1. Hale TW, Rowe HE. Medications & Mothers' Milk. A Manual of Lactation Pharmacology. Springer Publishing Company. 2017
  2. Liepe K, Becker A. Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. Eur J Nucl Med Mol Imaging. 2016Abstract Full text (in our servers)
  3. ARSAC: Administration of Radioactive Substances Advisory Committee. Notes for Guidance on the Clinical Administration of Radiopharmaceuticals and Use of Sealed Radioactive Sources. Section 7 Conception, Pregnancy and Breastfeeding, p. 25-30. ARSAC Support Unit. Centre for Radiation, Chemical and Environmental Hazards. Public Health England. 2016Abstract Full text (link to original source) Full text (in our servers)
  4. Leide-Svegborn S, Ahlgren L, Johansson L, Mattsson S. Excretion of radionuclides in human breast milk after nuclear medicine examinations. Biokinetic and dosimetric data and recommendations on breastfeeding interruption. Eur J Nucl Med Mol Imaging. 2016Abstract
  5. ICRP. Radiation dose to patients from radiopharmaceuticals. Addendum 3 to ICRP Publication 53. ICRP Publication 106. Annex D. Recommendations on breast-feeding interruptions, p. 163-165. Ann ICRP. 2008Abstract Full text (link to original source) Full text (in our servers)
  6. Howe DB, Beardsley M, Bakhsh S. U.S. Nuclear Regulatory Commission Office of Nuclear Material Safety and Safeguards. Consolidated guidance about materials licenses. Program-specific guidance about medical use licenses. Final report. Appendix U, Table U.3. NUREG-556. Vol.9, Rev 2. 2008 Full text (link to original source) Full text (in our servers)
  7. Stabin MG, Breitz HB. Breast milk excretion of radiopharmaceuticals: mechanisms, findings, and radiation dosimetry. J Nucl Med. 2000Abstract Full text (link to original source) Full text (in our servers)
  8. Mountford PJ, O'Doherty MJ. Exposure of critical groups to nuclear medicine patients. Appl Radiat Isot. 1999Abstract
  9. Rubow S, Klopper J, Wasserman H, Baard B, van Niekerk M. The excretion of radiopharmaceuticals in human breast milk: additional data and dosimetry. Eur J Nucl Med. 1994Abstract
  10. Rubow SM, Ellmann A, le Roux J, Klopper J. Excretion of technetium 99m hexakismethoxyisobutylisonitrile in milk. Eur J Nucl Med. 1991Abstract