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Impact of medications on mIBG uptake, with specific attention to the heart: Comprehensive review of the literature

  • Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

A critical review of the literature on drug interactions with mIBG uptake was performed to allow formulation of contemporary guidance regarding withholding medications prior to clinical imaging studies.

Methods

Published information was extracted on the experimental system used, the quantitative characteristics of the measurements, and whether any data directly examining cardiac tissues were included. Level of evidence for each medication category was assessed on a qualitative scale of very low, low, medium, or high. Strength of medication effect for inhibition of mIBG uptake was judged as none, weak, moderate, or strong.

Results

The only medications for which level of evidence was judged high were labetalol and reserpine. Level of evidence was judged medium for tricyclic antidepressants, calcium channel blockers, and antiarrhythmics (specifically amiodarone). Evidence was judged sufficient to recommend withholding labetalol and the tricyclic antidepressants prior to mIBG cardiac imaging. Mechanistic evidence was sufficient to suggest consideration of withdrawal of sympathomimetic amines and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Conclusions

As there is strong evidence for inhibition of mIBG uptake in only a small number of compounds, clinical decisions regarding withdrawal of concomitant medications should be individualized by considering the potential consequences of a false-positive (artificially low cardiac uptake) imaging result.

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Abbreviations

HF:

Heart failure

H/M:

Heart/mediastinum ratio

mHED:

Meta-hydroxyephedrine

mIBG:

Meta-iodobenzylguanidine

NE:

Norepinephrine

NET:

Norepinephrine transporter

PET:

Positron emission tomography

SNRI:

Serotonin-norepinephrine reuptake inhibitor

SSRI:

Selective serotonin reuptake inhibitor

WR:

Washout rate

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  1. Diagram Consulting, 10 Lio Poele Place, Kihei, HI, 96753, USA

    Arnold F. Jacobson MD, PhD

  2. Division of Nuclear Medicine, Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA

    Mark I. Travin MD

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Jacobson, A.F., Travin, M.I. Impact of medications on mIBG uptake, with specific attention to the heart: Comprehensive review of the literature. J. Nucl. Cardiol. 22, 980–993 (2015). https://doi.org/10.1007/s12350-015-0170-z

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