lutetium lu 177 dotatate

Contraindicated in:

OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment;
Severe hepatic impairment;
Hepatic metastases (↑ risk of hepatotoxicity);
Rep: Women of reproductive potential and men with female partners of reproductive potential;
Pedi: Children <12 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, peripheral edema, atrial fibrillation

Derm: alopecia, flushing

Endo: hyperglycemia, hyperuricemia, hypoglycemia, neuroendocrine hormonal crisis

F and E: hyperkalemia, hypernatremia, hypocalcemia, hypokalemia

GI: abdominal pain, constipation, diarrhea, nausea, vomiting, HEPATOTOXICITY

GU: renal failure, ↓fertility

Hemat: anemia, leukopenia, lymphopenia, neutropenia, thrombocytopenia, LEUKEMIA, MYELODYSPLASTIC SYNDROME

Metab: ↓appetite

MS: pain

Neuro: anxiety, dizziness, fatigue, headache, dysgeusia

Resp: cough

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA), fever

Interactions ⬆ ⬇

Drug-drug:

Effectiveness may be ↓ by somatostatin analogs, including octreotide; discontinue long-acting somatostatin analogs ≥4 wk and short-acting somatostatin analogs ≥24 hr before each dose.
Effectiveness may be ↓ by corticosteroids; avoid repeated administration of high-dose corticosteroids during treatment.

Availability ⬆ ⬇

Solution for injection: 10 mCi/mL

Route/Dosage ⬆ ⬇

IV (Adults and Children ≥12 yr): 7.4 GBq (200 mCi) every 8 wk for a total of 4 doses.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Acts as a beta-emitting radionuclide that binds to somatostatin receptors, particularly subtype 2 receptors. Once bound to these receptors, the compound is internalized and then emits beta radiation, which leads to cellular damage in somatostatin receptor-positive cells and in surrounding cells.

Therapeutic effects:

Improvement in progression-free survival.

Classifications ⬆ ⬇

Therapeutic Classification: antineoplastics

Pharmacologic Classification: radiopharmaceuticals

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Extensively distributed to extravascular tissues.

Metabolism/Excretion: Does not undergo hepatic metabolism. Primarily excreted in urine.

Half-Life: 71 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	Up to 30 days

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Emphasize importance of regular lab tests to monitor for side effects. Inform patient that long-term radiation exposure is associated with ↑ risk for cancer. Radiation can be detected in urine for up to 30 days after administration. Provide instructions to patient for follow-up radiation protection at home to minimize radiation exposure of household contacts.
Advise patient to urinate frequently during and after administration to ↓ radiation dose to kidneys.
Advise patient to notify health care professional if signs and symptoms of infection (fever, chills, dizziness, shortness of breath, ↑ bleeding or bruising) and neuroendocrine hormonal crisis occur.
Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Patient should also be cautioned not to drink alcoholic beverages or to take products containing aspirin or NSAIDs; may precipitate GI hemorrhage.
Inform patient of risk for secondary cancers, including myelodysplastic syndrome and acute leukemia.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception during for 7 mo after last dose and to avoid breastfeeding during therapy and for 2.5 mo after last dose. Advise males with female partners of reproductive potential to use effective contraception during and for 4 mo after last dose. May impair male and female fertility.

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Indications ⬇

Contraind./Precautions ⬆ ⬇