Drug - Radiopharmaceutical Drug Interactions Return to Home
The following is a compilation of reported instances in which the biodistribution of a radiopharmaceutical (RP) has been (or could be ) modified by the administration of a therapeutic non-radioactive drug or contrast agent in such a way as to potentially interfere with the interpretation of the nuclear medicine study in question. These lists are not meant to represent all possible interactions that exists.
Tc-99m Labelled Colloids | Tc-99m Labelled Iminodiacetic Acid Derivatives | Tc-99m Labelled Phosphates & Phosphonates Tc-99m Labelled Gluceptate | Tc-99m Labelled DMSA | Tc-99m Labelled MAA | Tc-99m Pertechnetate | Tc-99m Labelled Red Blood Cells | I-123 & I-131 | Tl-201| Radiocyanocobalamin | In-111 Labelled DTPA & Yb-169 Labelled DTPA | In-111 Labelled White Blood Cells | In-111 Labelled Platelets | Radioxenon| Gallium-67 Citrate | Miscellaneous Gastric Emptying Imaging Agents | Miscellaneous Brain Imaging Agents | Miscellaneous Renal Function Imaging Agents
MIBG Interactions - Cincinnati Childrens Hospital
MIBG Interactions - European Journal of Nuclear Medicine and Molecular Imaging
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
|
liver/spleen scintigraphy |
|
| Antacids; Virulizing Androgen therapy |
liver/spleen scintigraphy bone marrow scintigraphy |
Diffuse pulmonary accumulation |
| General anesthetic agents e.g., halothane |
liver/spleen scintigraphy | Shift of RP from liver to spleen |
| Thorium Dioxide | liver/spleen scintigraphy | Absence of spleen localization |
Tc-99m Labeled Iminodiacetic Acid Derivatives
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Narcotic analgesics; Pentobarbital |
cholescintigraphy | Delayed biliary to bowel transit time with RP remaining in the gallbladder or in the common bile duct and not released into the duodenum |
|
cholescintigraphy | Poor extraction and elimination of RP |
| Total parenteral nutrition | cholescintigraphy | Absent or delayed visualization of gallbladder (in patients with no gallbladder disease) |
|
hepatobiliary scintigraphy | no visualization of gallbladder |
Tc-99m Labeled Phosphates & Phosphonates
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Iron containing compounds; Phospho-Soda |
skeletal scintigraphy | Decreased osseous uptake of bone imaging agents, and increased intravascular activity |
| Iron containing compounds; Amphotericin B; Gentamicin; Cyclophosphamide; Vincristine; Doxorubicin |
skeletal scintigraphy | Increased renal retention of RP |
| Cytotoxic cancer chemotherapy | skeletal scintigraphy | Diffuse activity around the calvarium, termed "Sickle Sign" |
| Aluminum Containing Antacids | skeletal scintigraphy | Appearance of liver |
| Sodium diatrazole | skeletal scintigraphy | Marked renal and hepatic localization of RP |
|
skeletal scintigraphy | Extraosseous accumulation of RP |
| DES, Estrogens | skeletal acintigraphy | Accumulation of RP in breast tissue |
| Corticosteroids | skeletal acintigraphy | Decreased or absent uptake of RP in bone, especially at major joints |
| E-Amino Caproic Acid | skeletal scintigraphy | Increased RP uptake in muscle |
| Diphosphonate | avid infarct scintigraphy (PPI) |
Decreased uptake in infarcted myocardium, and increased uptake in normal myocardium |
| Doxorubicin | avid infarct scintigraphy (PPI) |
Diffuse uptake of RP in myocardium |
Tc-99m Gluceptate
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Penicillin; Acetaminophen; Sulfamethoxazole/Trimetoprim |
Renal scintigraphy | Enhanced excretion of RP through hepatobiliary system |
Tc-99m Dimercaptosuccinic Acid (DMSA)
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON STUDY |
| Aluminum Chloride | renal scintigraphy | Decreased renal distribution, and increased hepatic distribution |
| Sodium bicarbonate; Mannitol | renal scintigraphy | Increased RP in kidney |
| Captopril | renal scintigraphy | In patients with hypertension and unilateral artery stenosis, there may be decreased renal uptake by the affected kidney |
Tc-99m Labelled Macroaggregated Albumin & Albumin Microspheres
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON STUDY |
| Heparin | Pulmonary perfusion scintigraphy | Appearance of perfusion image that is typically observed with pulmonary emboli |
Tc-99m Pertechnetate
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Aluminum containing antacids; Sulfonamides; Stannous ion containing drugs & RPs |
brain scintigraphy; thyroid scintigraphy; Meckel's diverticulum |
Failure of RP to leave vascular space; Increased blood pool activity |
Tc-99m Labeled Red Blood Cells
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| B-Adrenergic Blockers; Calcium Channel Blockers; Nitrates |
radionuclide ventriculography | normal exercise radionuclide ventriculograms, evin in presence of signifigant coronary artery disease |
| Heparin; Methyldopa; Hydralazine; Quinine; Digoxin; Prazocin; Propranolol; Doxorubicin; Iodinated Contrast Media |
radionuclide ventriculography; GI blood loss scintigraphy |
Poor labelling of RBC or post-labelling dissociation of Tc-99m; Deterioriation of distinctness of cardiac chamber border on ventriculograms; Free Tc-99m will appear as gastric or bowel activity on GI bleed studies |
| Doxorubicin | radionuclide ventriculography | Abnormal ejection fraction; Decreased left ventricular function |
In-111 Labelled DTPA & Yb-169 Labelled DTPA
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Acetazolamide | cisternography | Delayed parasagittal migration of RP with reflux of tracer into ventricles |
In-111 Labeled White Blood Cells
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Antibiotics; Corticosteroids; Hyperalimentation; Lidocaine; Procainamide |
inflammatory process scintigraphy | Decreased or absent uptake of RP into abscess |
| Antibiotics, e.g., Penicillin | inflammatory process scintigraphy | Visualization of colon |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Heparin | pulmonary embolus scintigraphy | failure of In-111 labeled platelets to identify sites of pulmonary emboli |
| INTERFERING DRUG | WITHOLD | STUDY AFFECTED | EFFECT ON IMAGE |
| Antithyroid Medications (PTU, tapazole) |
1 week | Thyroid Uptake Study | Decreased Radioiodine Uptake |
| Thyroid Preparations (levothyroxine, Armour) |
2-3 weeks | ||
| Expectorants, Vitamins |
2 weeks | ||
| Phenylbutazone | 1-2 weeks | ||
| Salicylates | 1 week | ||
| Steroids | 1 week | ||
| Sodium Nitroprusside | 1 week | ||
| Miscellaneous: Anticoagulants
|
1 week | ||
| Benzodiazapines | 4 weeks | ||
| Topical Iodides | 1-9 months | ||
| IV contrast agents | 1-2 months | ||
| Oral Cholecystographic Agents | 6-9 months | ||
| Oil-Based Iodinated Contrast Agents:
|
6-12 months 2-10 years |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Spironolactone; Other Diuretics |
Adrenal cortex scintigraphy | Bilateral uptake of RP in patients with unilateral disease |
| Oral Contraceptives | Adrenal cortex scintigraphy | Early bilateral visualization of the adrenals is observed in patients with no disease or unilateral disease only despite dexamethasone depression |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Tricyclic Antidepressants; Reserpine; Sympathomimetic Amines |
Adrenal medullary scintigraphy |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Beta Blockers; Nitrates | Myocardial perfusion scintigraphy | Decreases the number and size of exercise-induced Tl-201 perfusion defects |
| Vasopressin | Myocardial perfusion scintigraphy | Appearance of myocardial defects in patients without coronary artery disease |
| Propranolol; Cardiac Glycosides; Procainamide; Lidocaine; Phenytoin; Doxorubicin |
Myocardial perfusion scintigraphy | Decreased myocardial localization and increased liver localization |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Parenteral Vitamin B12; Colchicine; Neomycin; p-Amino salicylic acid; Calcium chelators; Biguanides; Anticonvulsants; Potassium; Cholestyramine; Cyclohexamide; Dactinomycin; Oral contraceptives |
Schilling Test | Decreased absorption of RP |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Total parenteral nutrition | Pulmonary ventilation scintigraphy | Appearance of radioactivity in liver during washout phase of ventilation study |
| Diazepam in sedative doses; General anesthetic agents |
Pulmonary ventilation scintigraphy | Normal distribution shifted slightly (bottom to top), with more radioactivity in top and less in bottom |
| INTERFERING DRUG | STUDY AFFECTED | EFFECT ON IMAGE |
| Phenytoin | Tumor & abscess localization scintigraphy | Localization of RP in the mediastinum & pulmonary hilar structures (in patients without clinical evidence of lymphadenopathy |
| Amiodarone; Bleomycin; Busulfan; Nitrofurantoin; Bacillus Calmette-Guerin; Chemotherapy; Lymphangiographic Contrast Media; Addictive Drugs of Abuse | Tumor & abscess localization scintigraphy | Diffuse pulmonary localization (sometimes local pulmonary uptake) |
| Metocloperamide; Reserpine; Phenothiazines; Oral Contraceptives; Diethylstilbesterol | Tumor & abscess localization scintigraphy | Localization of RP in breast |
| Methotrexate; Cisplatin; Gallium Nitrate; Mechlorethenamine; Vincristine; Various Chemotherapeutic Agents; Iron | Tumor & abscess localization scintigraphy | a) Increased skeletal uptake b) Increased renal elimination c) Decreased hepatic accumulation d) Decreased tumor or abscess uptake |
| Antibiotics (Clindamycin) | Tumor & abscess localization scintigraphy | Localization of RP in bowel |
| Calcium Gluconate; IM injections | Tumor & abscess localization scintigraphy | Soft tissue accumulation of RP |
| Ampicillin; Sulfonamides; Sulfinpyrazone; Ibuprofen; Cephalosporins; Hydrochlorothiazide; Methicillin; Erythtomycin; Rifampin; Pentamidine; Phenylbutazone; Gold Salts; Allopurinol; Furosemide; Phenazone; Phenobarbital; Phenytoin; Phenindione | Tumor & abscess localization scintigraphy | Increased accumulation of RP in the kidneys |
| Chemotherapeutic Agents; Antibiotics | Tumor & abscess localization scintigraphy | Localization of RP in the Thymus |
| High Dose Heparin Therapy | Renal transplant rejection | Failure of RP to accumulate in transplanted kidney during acute rejection |
| INTERFERING DRUG | EFFECT ON IMAGE |
| Atropine; Propantheline; Levodopa; Albuterol; Isoproterenol; Narcotic Analgesics; Total Parenteral Nutrition; Librax | Delayed Gastric Emptying |
| INTERFERING DRUG | EFFECT ON IMAGE |
| Cancer chemotherapeutic agents | Patchy increased uptake of RP as a result of chemo neurotoxicity |
| Corticosteroids | Decreased uptake into brain lesions |
| Psychotropic Drugs | Rapid accumulation of RP in nasopharyngeal area during arterial or capillary phase (cerebral radionuclide angiography) |
| INTERFERING DRUG | EFFECT ON IMAGE |
| Iodinated Contrast Agents; Aminoglycosides |
Decrease in effective plasma flow values; Decreased glomerular filtration rate |
| Cyclosporine; Cisplatin | Decreased urinary excretion; Decreased tubular function |
| Furosemide | Misleading renogram and flow curves resulting in false positive/negative studies |
| Probenecid | Decreased renal accumulation and accumulation |