CLINICAL PHARMACOLOGY SECTION.

CLINICAL PHARMACOLOGY. Following intravenous injection of technetium Tc 99m mertiatide, the appearance, concentration, and excretion of the tracer in the kidney can be monitored to assess renal function. Although technetium Tc 99m mertiatide is highly plasma protein bound following intravenous injection, the protein binding is reversible and the tracer is rapidly excreted by the kidneys via active tubular secretion and glomerular filtration. Following intravenous injection of technetium Tc 99m mertiatide in normal volunteers, 89% of the tracer was plasma protein bound. In healthy subjects with normal renal function (mean serum creatinine 1.2 mg/dL) technetium Tc 99m mertiatide was rapidly cleared from the blood. The plasma clearance was approximately 0.3 liters/minute and the amount of technetium Tc 99m mertiatide excreted in the urine in three hours was nearly 90% of the dose. In study performed in three patients with renal impairment (serum creatinine greater than 6.3 mg/dL), there was decreased blood clearance and decrease in the amount excreted in the urine over three hours. In these patients, 78% of the tracer was plasma protein bound after intravenous injection. The mean plasma clearance of technetium Tc 99m mertiatide was 0.03 liters/minute and 21.3% was excreted in three hours on average. In both healthy subjects and patients with renal impairment, the plasma concentration-time profile showed biexponential decline.

DESCRIPTION SECTION.

DESCRIPTION. Technescan MAG3(TM) is kit for the preparation of technetium Tc 99m mertiatide, diagnostic radiopharmaceutical. It is supplied as sterile, nonpyrogenic, lyophilized powder. Each vial contains betiatide (N-[N-[N-[(benzoylthio) acetyl]glycyl]glycyl]-glycine). After reconstitution with sterile sodium pertechnetate Tc 99m injection, the technetium Tc 99m mertiatide (disodium[N-[N-[N-(mercaptoacetyl) glycyl]glycyl] glycinato (2-) N,N,N,S]oxotechnetate (2-)) which is formed is suitable for intravenous administration.Each 10 milliliter vial contains milligram betiatide, 0.05 milligram (minimum) stannous chloride dihydrate (SnCl2o2H2O) and 0.2 milligram (maximum) total tin expressed as stannous chloride dihydrate (SnCl2o2H2O), 40 milligrams sodium tartrate dihydrate (Na2C4H2O6o2H2O), and 20 milligrams lactose monohydrate. Prior to lyophilization, sodium hydroxide or hydrochloric acid may be added for pH adjustment. The pH of the reconstituted drug is between 5.0 and 6.0. No bacteriostatic preservative is present. The contents are sealed under argon. Betiatide is light sensitive and must be protected from light. Betiatide and technetium Tc 99m mertiatide have the following structural formulas: chemical structure. chemical structure.

DOSAGE & ADMINISTRATION SECTION.

DOSAGE AND ADMINISTRATION. The suggested dose range employed in the average adult patient (70 kg) for renal function and imaging studies is 185 MBq (5 mCi) to 370 MBq (10 mCi). In pediatric patients the recommended dose range is 2.6 MBq/kg (70 uCi/kg) to 5.2 MBq/kg (140 uCi/kg) with minimum dose of 37 MBq (1 mCi).The patient dose should be measured by suitable radioactivity calibration system immediately prior to administration.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.Aseptic procedures and shielded syringe should be employed in withdrawing doses for administration to patients. The user should wear waterproof gloves during the administration procedure.

GENERAL PRECAUTIONS SECTION.

General. The contents of this kit are not radioactive. However, after sodium pertechnetate Tc 99m is added, adequate shielding of the final preparation must be maintained.Contents of the reaction vial are intended only for use in the preparation of technetium Tc 99m mertiatide and are NOT to be administered directly to the patient.To help reduce the radiation dose to the bladder, as well as other target organs, the patient should increase his or her fluid intake (unless medically contraindicated) and void as often as possible after the injection of technetium Tc 99m mertiatide for six hours after the imaging procedure.Technetium Tc 99m mertiatide should not be used more than six hours after preparation.The components of the kit are sterile and nonpyrogenic. It is essential that the user follow the directions carefully and use aseptic procedures normally employed in making additions and withdrawals from sterile, nonpyrogenic containers during the addition of pertechnetate solution and the withdrawal of doses for patient administration.The technetium Tc 99m labeling reactions involved in preparing Technescan MAG3 depend on maintaining the stannous ion in the reduced state. Any oxidant present in the sodium pertechnetate Tc 99m may adversely affect the quality of the radiopharmaceutical. Therefore, sodium pertechnetate Tc 99m containing oxidants should not be employed.As in the use of any other radioactive material, care should be taken to ensure minimum radiation exposure to the patient and to occupational workers.Radiopharmaceuticals should be used only by physicians who are qualified by specific training in the safe use and handling of radionuclides.. The contents of this kit are not radioactive. However, after sodium pertechnetate Tc 99m is added, adequate shielding of the final preparation must be maintained.. Contents of the reaction vial are intended only for use in the preparation of technetium Tc 99m mertiatide and are NOT to be administered directly to the patient.. To help reduce the radiation dose to the bladder, as well as other target organs, the patient should increase his or her fluid intake (unless medically contraindicated) and void as often as possible after the injection of technetium Tc 99m mertiatide for six hours after the imaging procedure.. Technetium Tc 99m mertiatide should not be used more than six hours after preparation.. The components of the kit are sterile and nonpyrogenic. It is essential that the user follow the directions carefully and use aseptic procedures normally employed in making additions and withdrawals from sterile, nonpyrogenic containers during the addition of pertechnetate solution and the withdrawal of doses for patient administration.. The technetium Tc 99m labeling reactions involved in preparing Technescan MAG3 depend on maintaining the stannous ion in the reduced state. Any oxidant present in the sodium pertechnetate Tc 99m may adversely affect the quality of the radiopharmaceutical. Therefore, sodium pertechnetate Tc 99m containing oxidants should not be employed.. As in the use of any other radioactive material, care should be taken to ensure minimum radiation exposure to the patient and to occupational workers.. Radiopharmaceuticals should be used only by physicians who are qualified by specific training in the safe use and handling of radionuclides.

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL.

PRINCIPAL PANEL DISPLAY A096V0. Technescan MAG3(TM)Kit for the Preparation of Technetium Tc 99m Mertiatide DiagnosticVial contains:1 mg Betiatide0.05 mg (minimum) Stannous Chloride Dihydrate (SnCl2 2H2O)40 mg Sodium Tartrate Dihydrate0.2 mg (maximum) Total Tin as Stannous Chloride Dihydrate (SnCl2 2H2O)20 mg Lactose MonohydratePrior to lyophilization, sodium hydroxide or hydrochloric acid may be added for pH adjustment. The pH of the reconstituted drug is between 5.0 and 6.0. The contents are sealed under argon. Sterile, non-pyrogenic. For intravenous use after drug preparation. See package insert for directions for use. Store at 20 to 25C (68 to77F) and protect from light. Do not use sodium pertechnetate Tc 99m solutions containing an oxidizing agent. Rx onlyManufactured by:Curium US LLCMaryland Heights, MO 63043Made in USACURIUMTM A096V0 R12/2018. Panel Display A096VO.

PRECAUTIONS SECTION.

PRECAUTIONS. General. The contents of this kit are not radioactive. However, after sodium pertechnetate Tc 99m is added, adequate shielding of the final preparation must be maintained.Contents of the reaction vial are intended only for use in the preparation of technetium Tc 99m mertiatide and are NOT to be administered directly to the patient.To help reduce the radiation dose to the bladder, as well as other target organs, the patient should increase his or her fluid intake (unless medically contraindicated) and void as often as possible after the injection of technetium Tc 99m mertiatide for six hours after the imaging procedure.Technetium Tc 99m mertiatide should not be used more than six hours after preparation.The components of the kit are sterile and nonpyrogenic. It is essential that the user follow the directions carefully and use aseptic procedures normally employed in making additions and withdrawals from sterile, nonpyrogenic containers during the addition of pertechnetate solution and the withdrawal of doses for patient administration.The technetium Tc 99m labeling reactions involved in preparing Technescan MAG3 depend on maintaining the stannous ion in the reduced state. Any oxidant present in the sodium pertechnetate Tc 99m may adversely affect the quality of the radiopharmaceutical. Therefore, sodium pertechnetate Tc 99m containing oxidants should not be employed.As in the use of any other radioactive material, care should be taken to ensure minimum radiation exposure to the patient and to occupational workers.Radiopharmaceuticals should be used only by physicians who are qualified by specific training in the safe use and handling of radionuclides.. The contents of this kit are not radioactive. However, after sodium pertechnetate Tc 99m is added, adequate shielding of the final preparation must be maintained.. Contents of the reaction vial are intended only for use in the preparation of technetium Tc 99m mertiatide and are NOT to be administered directly to the patient.. To help reduce the radiation dose to the bladder, as well as other target organs, the patient should increase his or her fluid intake (unless medically contraindicated) and void as often as possible after the injection of technetium Tc 99m mertiatide for six hours after the imaging procedure.. Technetium Tc 99m mertiatide should not be used more than six hours after preparation.. The components of the kit are sterile and nonpyrogenic. It is essential that the user follow the directions carefully and use aseptic procedures normally employed in making additions and withdrawals from sterile, nonpyrogenic containers during the addition of pertechnetate solution and the withdrawal of doses for patient administration.. The technetium Tc 99m labeling reactions involved in preparing Technescan MAG3 depend on maintaining the stannous ion in the reduced state. Any oxidant present in the sodium pertechnetate Tc 99m may adversely affect the quality of the radiopharmaceutical. Therefore, sodium pertechnetate Tc 99m containing oxidants should not be employed.. As in the use of any other radioactive material, care should be taken to ensure minimum radiation exposure to the patient and to occupational workers.. Radiopharmaceuticals should be used only by physicians who are qualified by specific training in the safe use and handling of radionuclides.. Carcinogenesis, Mutagenesis, Impairment of Fertility. No long term animal studies have been performed to evaluate carcinogenic or mutagenic potential, or whether this drug affects fertility in males or females.. Pregnancy. Pregnancy Category C.Animal reproduction studies have not been conducted with technetium Tc 99m mertiatide. It is also not known whether this drug can cause fetal harm when administered to pregnant woman or can affect reproduction capacity. Technetium Tc 99m mertiatide should be given to pregnant woman only if clearly needed.. Nursing Mothers. Technetium Tc 99m is excreted in human milk during lactation, therefore, formula feedings should be substituted for breast feeding.. Pediatric Use. Safety and effectiveness in pediatric patients under the age of 30 days have not been established.

SPL UNCLASSIFIED SECTION.

PHYSICAL CHARACTERISTICS. Technetium Tc 99m decays by isomeric transition with physical half-life of 6.02 hours.Kocher, David C., Radioactive Decay Tables, DOE/TIC-11026, 108 (1981).The principal photon that is useful for detection and imaging is listed in Table 1.Table 1. Principal Radiation Emission Data RadiationM Mean perDisintegration Energy(keV) Gamma-2 89.07 140.5The specific gamma ray constant for Technetium Tc 99m is 0.78 R/mCi-hr at cm. The first half-value thickness of lead (Pb) for Technetium Tc 99m is 0.017 cm. range of values for the relative attenuation of the radiation emitted by this radionuclide that results from interposition of various thicknesses of Pb is shown in Table 2. For example, the use of 0.25 cm of Pb will decrease the external radiation exposure by factor of about 1000.Table 2. Radiation Attenuation by Lead Shielding Shield Thickness(Pb) cm Coefficient of Attenuation 0.017 0.5 0.08 10-1 0.16 10-2 0.25 10-3 0.33 10-4 To correct for physical decay of the radionuclide, the fractions that remain at selected time intervals after the time of calibration are shown in Table 3.Table 3. Physical Decay Chart: Technetium Tc 99m, Half-life 6.02 Hours Calibration Time Hours FractionRemaining Hours FractionRemaining 1.000 0.447 0.891 0.398 0.794 0.355 0.708 10 0.316 0.631 11 0.282 0.562 12 0.251 0.501.

STORAGE AND HANDLING SECTION.

STORAGE. Technescan MAG3 should be stored at controlled room temperature 20 to 25C (68 to 77F) and protected from light until use. The reconstituted vial should be stored at room temperature (15 to 30C) and must be used within six hours of preparation.Table 4. Radiation Dose Estimates for Tc 99m MertiatideCalculated by Oak Ridge Associated Universities, based upon the pediatric phantom series of Christy and Eckerman of Oak Ridge National Laboratories. The adult radiation absorbed doses were calculated based on data from ten normal volunteers using the Medical Internal Radiation Dose Committee (MIRD) schema.Radioactive doses for 1-, 5-, and 10-year olds are based on maximum dose of 7.4 MBq/kg (200 uCi/kg). 8-day Old 1-year Old 5-year Old 10-year Old 15-year Old Adult Assumed Weight (kg) 3.4 9.8 19 32 57 70 Tc 99m Mertiatide Dose 37 MBq(1 mCi) 72.52 MBq(1.96 mCi) 140.6 MBq(3.8 mCi) 236.8 MBq(6.4 mCi) 370 MBq(10 mCi) 370 MBq(10 mCi) Organ mSv rem mSv rem mSv rem mSv rem mSv rem mSv rem Gallbladder Wall 2.701 0.27 2.466 0.235 1.547 0.160 1.658 0.166 1.961 0.200 1.628 0.160 Lower Large Intestine Wall 1.739 0.17 1.595 0.161 2.250 0.220 2.368 0.237 4.070 0.400 3.256 0.330 Small Intestine 0.518 0.052 0.5439 0.055 1.195 0.122 1.397 0.141 2.035 0.200 1.628 0.160 Upper Large Intestine Wall 0.962 0.096 0.943 0.096 1.828 0.186 2.0365 0.205 2.442 0.250 1.887 0.190 Kidneys 1.406 0.14 1.088 0.112 1.308 0.129 1.5155 0.154 1.739 0.180 1.443 0.140 Liver 0.3219 0.032 0.3046 0.031 0.394 0.038 0.4262 0.0435 0.481 0.048 0.3626 0.036 Ovaries 0.592 0.058 0.6164 0.061 1.322 0.133 1.5392 0.154 3.330 0.330 2.5900 0.260 Red Marrow 0.1628 0.016 0.1595 0.0161 0.281 0.0277 0.3552 0.0352 0.629 0.063 0.4810 0.050 Testes 0.518 0.051 0.5294 0.053 1.0826 0.110 1.1840 0.122 2.368 0.240 1.628 0.160 Urinary Bladder Wall 11.470 1.1 9.428 0.921 21.090 2.090 23.680 2.368 59.20 6.00 48.1000 4.80 Total Body 0.2405 0.024 0.2176 0.022 0.3656 0.0365 0.4026 0.0410 0.814 0.081 0.6660 0.065.