1. Name Of The Medicinal Product
ProHance
2. Qualitative And Quantitative Composition
Gadoteridol 279.3mg/ml (0.5M)
3. Pharmaceutical Form
Sterile solution for intravenous injection
4. Clinical Particulars
4.1 Therapeutic Indications
Using Magnetic Resonance Imaging (MRI), ProHance provides contrast enhancement of the brain, spine and surrounding tissues resulting in improved visualization (compared with unenhanced MRI) of lesions with abnormal vascularity or those thought to cause a disruption of the normal blood-brain barrier.
ProHance can also be used for whole body MRI including the head, neck, liver, breast, muscoloskeletal system and soft tissue pathologies.
4.2 Posology And Method Of Administration
Adults
The recommended dose of ProHance for imaging most brain and spinal pathologies is 0.1 mmol/kg. However, doses of 0.3 mmol/kg have been shown to be useful in patients suspected of having cerebral metastases or other poorly enhancing lesions.
The recommended dose for whole body MRI is 0.1 mmol/kg.
Children (2 years and above)
The recommended dose of ProHance for brain imaging and spine pathologies is 0.1 mmol/kg (0.2 ml/kg).
ProHance has been used in only a limited number of children aged between 6 months and 2 years. If an MRI procedure must be performed in this group, particular caution should be exercised.
The safety and efficacy of doses higher than 0.1 mmol/kg and sequential or repeat procedures have not been established.
To ensure complete injection of the contrast medium, the injection should be followed by a 5 ml normal saline flush. The imaging procedure should be completed within 1 hour after injecting ProHance.
Special Populations
Impaired renal function
ProHance should only be used in patients with severe renal impairment (GFR < 30 ml/min/1.73m2) and in patients in the perioperative liver transplantation period after careful risk/benefit assessment and if the diagnostic information is essential and not available with non-contrast enhanced MRI (see section 4.4). If it is necessary to use ProHance, the dose should not exceed 0.1 mmol/kg body weight. More than one dose should not be used during a scan. Because of the lack of information on repeated administration, ProHance injections should not be repeated unless the interval between injections is at least 7 days.
Infants from 6 months to 1 year of age
Due to immature renal function in infants up to 1 year of age, ProHance should only be used in patients 6 to 12 months of age after careful consideration at a dose not exceeding 0.1 mmol/kg body weight. More than one dose should not be used during a scan. Because of the lack of information on repeated administration, ProHance injections should not be repeated unless the interval between injections is at least 7 days.
Use of ProHance is not recommended in children less than 6 months of age.
Use for whole body MRI is not recommended in children less than 18 years of age
Elderly (aged 65 years and above)
No dosage adjustment is considered necessary. Caution should be exercised in elderly patients (see section 4.4).
4.3 Contraindications
A history of previous hypersensitivity to ProHance, its constituents or other gadolinium-based contrast. ProHance is contraindicated in children under 6 months of age.
4.4 Special Warnings And Precautions For Use
Anaphylactic reactions have been observed following the use of gadoteridol. Appropriate drugs and instruments for emergency measures must be readily available.
Transitory changes in serum iron (within normal range in the majority of cases) have been observed in some patients after administration of ProHance and these changes were shown not to be clinically significant.
Since Gadoteridol is renally cleared from the body, caution should be exercised in patients with severely impaired renal function.
Impaired renal function
Prior to administration of ProHance, it is recommended that all patients are screened for renal dysfunction by obtaining laboratory tests.
There have been reports of nephrogenic systemic fibrosis (NSF) associated with use of some gadolinium-containing contrast agents in patients with acute or chronic severe renal impairment (GFR < 30 ml/min/1.73m2). Patients undergoing liver transplantation are at particular risk since the incidence of acute renal failure is high in this group. As there is a possibility that NSF may occur with ProHance, it should therefore only be used in patients with severe renal impairment and in patients in the perioperative liver transplantation period after careful risk/benefit assessment and if the diagnostic information is essential and not available with non-contrast enhanced MRI.
Haemodialysis shortly after ProHance administration may be useful at removing ProHance from the body. There is no evidence to support the initiation of haemodialysis for prevention or treatment of NSF in patients not already undergoing haemodialysis.
Infants from 6 months to 1 year of age
Due to immature renal function in infants up to 1 year of age, ProHance should only be used in patients 6 to 12 months of age after careful consideration.
Elderly
As the renal clearance of gadoteridol may be impaired in the elderly, it is particularly important to screen patients aged 65 years and older for renal dysfunction.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
There are no known drug interactions with gadoteridol. No clinically significant changes or trends in laboratory tests were seen in clinical trials with ProHance.
4.6 Pregnancy And Lactation
Pregnancy
There are no data from the use of gadoteridol in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity (see section 5.3). ProHance should not be used during pregnancy unless the clinical condition of the woman requires use of gadoteridol.
Lactation
Gadolinium containing contrast agents are excreted into breast milk in very small amounts (see section 5.3). At clinical doses, no effects on the infant are anticipated due to the small amount excreted in milk and poor absorption from the gut. Continuing or discontinuing breast feeding for a period of 24 hours after administration of ProHance, should be at the discretion of the doctor and lactating mother.
4.7 Effects On Ability To Drive And Use Machines
There are no known effects of ProHance on the ability to drive or operate machinery.
4.8 Undesirable Effects
The accepted safety considerations and procedures that are required for Magnetic Resonance Imaging are applicable when ProHance is used for contrast enhancement.
Side effects: Taste disturbance (primarily metallic taste) nausea, urticaria, pain at injection site, convulsions and hypotension have been reported. Headache and chest pain have been rarely reported. These occurrences were transient and resolved without residual effect. The occurrences were not related to age, gender, rate of injection or dose administered.
Isolated cases of nephrogenic systemic fibrosis (NSF) have been reported with ProHance, most of which were in patients co-administered other gadolinium-containing contrast agents (see section 4.4).
4.9 Overdose
There have been no cases of overdose reported to date, consequently, neither signs nor symptoms of overdosage have been identified. In the event of overdosage occurring, the patient should be observed and treated symptomatically.
ProHance can be removed by haemodialysis. However there is no evidence that haemodialysis is suitable for prevention of nephrogenic systemic fibrosis (NSF).
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Gadoteridol is a non-ionic paramagnetic contrast medium for Magnetic Resonance Imaging.
When placed in a magnetic field, gadoteridol decreases T1 relaxation times in targeted areas. At recommended doses, the effect is observed with greatest sensitivity in the T1-weighted sequences.
Gadoteridol does not cross the intact blood-brain barrier and, therefore, does not accumulate in normal brain or in lesions that have a normal blood-brain barrier, e.g. cysts, mature post-operative scars, etc. However, disruption of the blood-brain barrier or normal vascularity allows penetration of gadoteridol into lesions such as neoplasms, abscesses, and subacute infarcts.
5.2 Pharmacokinetic Properties
The pharmacokinetics of intravenously administered gadoteridol in normal subjects conforms to a two- compartment open model with mean distribution and elimination half-lives (reported as mean ± SD) of about 0.20 ± 10.04 hours and 1.57 ± 10.08 hours, respectively.
Gadoteridol is exclusively eliminated in the urine with 94.4 ± 4.8% (mean ± SD) of the dose excreted within 24 hours post injection. There is no detectable biotransformation or decomposition of gadoteridol.
The renal and plasma clearance rates (1.41 ± 0.33 ml/min/kg and 1.50 ± 0.35 ml/min/kg, respectively) of gadoteridol are essentially identical, indicating no alteration in elimination kinetics on passage through the kidneys and that the drug is essentially cleared through the kidney. The volume of distribution (204 ± 58 ml 1 kg) is equal to that of extra cellular water, and clearance is similar to that of substances which are subject to glomerular filtration.
No serum protein binding was detected in rats.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Calteridol Calcium
Tromethamine USP
Hydrochloric Acid Ph Eur
Sodium Hydroxide Ph Eur
Water for Injections Ph Eur
6.2 Incompatibilities
ProHance should not be admixed with any other drug.
6.3 Shelf Life
36 months
6.4 Special Precautions For Storage
Store at room temperature (15-30°C.), protect from light. ProHance should not be frozen.
6.5 Nature And Contents Of Container
Vials: Type 1 glass vials with grey butyl stoppers and aluminium seals containing 5,10, 15 or 20ml.
6.6 Special Precautions For Disposal And Other Handling
The peel-off tracking label on the vials should be stuck onto the patient record to enable accurate recording of the gadolinium contrast agent used. The dose used should also be recorded.
7. Marketing Authorisation Holder
Bracco International B.V.
Strawinskylaan 3051
1077 ZX Amsterdam
The Netherlands
8. Marketing Authorisation Number(S)
14447/0001
9. Date Of First Authorisation/Renewal Of The Authorisation
29/10/1992
10. Date Of Revision Of The Text
28/09/2010
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