gallium Ga 68 dotatate (Rx)

Brand and Other Names:Netspot

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

single-dose kit

  • Reaction vial (lyophilized powder): 40mcg dotatate
  • Buffer vial: 1mL of reaction buffer solution

Neuroendocrine Tumors

Radioactive diagnostic agent after radiolabeling with Ga 68; indicated for use with positron-emission tomography (PET) for localization of somatostatin receptor-positive neuroendocrine tumors (NETs) in adults and children

2 MBq/kg of body weight (0.054 mCi/kg) up to 200 MBq (5.4 mCi) administered as an IV bolus injection

Dosage Forms & Strengths

single-dose kit

  • Reaction vial (lyophilized powder): 40mcg dotatate
  • Buffer vial: 1mL of reaction buffer solution

Neuroendocrine Tumors

Radioactive diagnostic agent after radiolabeling with Ga 68; indicated for use with positron-emission tomography (PET) for localization of somatostatin receptor-positive neuroendocrine tumors (NETs) in adults and children

2 MBq/kg of body weight (0.054 mCi/kg) up to 200 MBq (5.4 mCi) administered as an IV bolus injection

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Interactions

Interaction Checker

and gallium Ga 68 dotatate

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                Monitor Closely (3)

                • lanreotide

                  lanreotide decreases effects of gallium Ga 68 dotatate by receptor binding competition. Modify Therapy/Monitor Closely. Somatostatin analogs competitively bind to the same somatostatin receptors as Ga 68 dotatate and may affect imaging. Image patients with Ga 68 dotatate PET just prior to dosing with long-acting somatostatin analogs. Short-acting somatostatin analogs can be used up to 24 hr before imaging with Ga 68 dotatate.

                • octreotide

                  octreotide decreases effects of gallium Ga 68 dotatate by receptor binding competition. Modify Therapy/Monitor Closely. Somatostatin analogs competitively bind to the same somatostatin receptors as Ga 68 dotatate and may affect imaging. Image patients with Ga 68 dotatate PET just prior to dosing with long-acting somatostatin analogs. Short-acting somatostatin analogs can be used up to 24 hr before imaging with Ga 68 dotatate.

                • pasireotide

                  pasireotide decreases effects of gallium Ga 68 dotatate by receptor binding competition. Modify Therapy/Monitor Closely. Somatostatin analogs competitively bind to the same somatostatin receptors as Ga 68 dotatate and may affect imaging. Image patients with Ga 68 dotatate PET just prior to dosing with long-acting somatostatin analogs. Short-acting somatostatin analogs can be used up to 24 hr before imaging with Ga 68 dotatate.

                Minor (0)

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                  Adverse Effects

                  Postmarketing Reports

                  Gastrointestinal disorders: Nausea and vomiting

                  General disorders and administration site conditions: Injection site pain and burning sensation

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                  Warnings

                  Contraindications

                  None

                  Cautions

                  Radiation risk

                  • Avoid close contact with infants and pregnant women during first 12 hours after administration of Ga 68 dotatate
                  • Contributes to a patient’s overall long-term cumulative radiation exposure; long-term cumulative radiation exposure associated with increased cancer risk
                  • Ensure safe handling and preparation procedures to protect patients and healthcare workers from unintentional radiation exposure

                  Risk for image misinterpretation

                  • Uptake of Ga 68 dotatate reflects somatostatin receptor density in NETs
                  • Uptake can also be seen in a variety of other tumor types (eg, those derived from neural crest tissue)
                  • Increased uptake might be seen in sites of splenosis or other pathologic conditions (eg, thyroid disease or subacute inflammation) or might occur as a normal physiologic variant (eg, uncinate process of the pancreas)
                  • PET images with Ga 68 dotatate should be interpreted visually and the uptake may need to be confirmed by histopathology or other assessments to confirm NET diagnosis
                  • A negative scan after administration of Ga 68 dotatate in patients who do not have history of NETs, including in patients suspected of ectopic ACTH-secreting tumors, does not rule out the presence of NETs

                  Drug interaction overview

                  • Nonradioactive somatostatin analogs competitively bind to the same somatostatin receptors as Ga 68 dotatate
                  • Image patients with Ga 68 dotatate PET just prior to dosing with long-acting analogs of somatostatin
                  • Short-acting analogs of somatostatin can be used up to 24 hr before imaging with Ga 68 dotatate
                  • Corticosteroids can down-regulate somatostatin subtype 2 receptors; repeated administration of high doses of glucocorticoid prior to Ga 68 dotatate administration may result in false negative imaging
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                  Pregnancy & Lactation

                  Pregnancy

                  There are no studies in pregnant women to inform any drug-associated risks; however, all radiopharmaceuticals have the potential to cause fetal harm

                  Lactation

                  There is no information on the presence of Ga 68 dotatate in human milk, the effect on the breastfed infant, or the effect on milk production

                  Advise breastfeeding women to interrupt breastfeeding and pump and discard breast milk for 12 hr after administration to minimize radiation exposure to a breastfed infant

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Ga 68 dotatate binds to somatostatin receptors with highest affinity for subtype 2 receptors (sstr2); dota-tate, also known as DOTA-0-Tyr3-Octreotate, is a cyclic 8 amino acid peptide with a covalently bound chelator (dota)

                  It binds to cells that express somatostatin receptors, including malignant cells, which overexpress sstr2 receptors

                  Gallium 68 (68Ga) is a beta-emitting radionuclide with an emission yield that allows positron-emission tomography (PET) imaging

                  Distribution

                  Distributes to all sstr2-expressing organs such as pituitary, thyroid, spleen, adrenals, kidney, pancreas, prostate, liver, and salivary glands

                  No uptake in the cerebral cortex or in the heart, and usually thymus and lung uptakes are low

                  Elimination

                  12% of the injected dose is excreted in urine in the first 4 hr postinjection

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                  Administration

                  IV Preparation

                  See full prescribing information for drug preparation using a lead glass shield for radioprotection purposes

                  Drug handling

                  • After reconstitution and radiolabeling, handle injection with appropriate safety measures to minimize radiation exposure
                  • Use waterproof gloves, effective radiation shielding, and appropriate safety measures when preparing and handling Ga 68 dotatate injection
                  • Radiopharmaceuticals should be used by or under the control of physicians and nuclear pharmacists who are qualified by specific training and experience in the safe use and handling of radionuclides, and whose experience and training have been approved by the appropriate governmental agency authorized to license the use/preparation of radionuclides

                  Patient preparation

                  • Instruct patients to drink a sufficient amount of water to ensure adequate hydration prior to administration of Ga 68 dotatate

                  IV Administration

                  Verify injected radioactivity by measuring the radioactivity of vial with a dose calibrator before administration to the patient

                  Ensure that the injected radioactivity is within ±10% of the recommended dose

                  Inject as an IV bolus

                  Patients must drink and void frequently during the first hours following administration to reduce radiation exposure

                  Image acquisition

                  • For Ga 68 dotatate PET imaging, the acquisition must include a whole body acquisition from skull to mid thigh
                  • Images can be acquired 40-90 minutes after IV bolus
                  • Adapt imaging acquisition delay and duration according to the equipment used, and the patient and tumor characteristics, in order to obtain the best image quality possible

                  Storage

                  Radionuclide is not part of the kit

                  Before reconstitution and radiolabelling with Ga 68, contents of this kit are not radioactive

                  For prolonged storage, store kit in its original packaging at room temperature <25ºC

                  Do not freeze

                  After reconstitution and radiolabeling

                  • Keep injection upright with an appropriate shielding to protect from radiation, at a temperature <25ºC (do not freeze) for a maximum of 4 hr
                  • Storage of the radiolabelled product must comply with regulatory requirements for radioactive materials
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                  Images

                  No images available for this drug.
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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

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                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.