# Sodium fluoride F-18

Source: https://nuclide.cc/drugs/f-18-naf/  
Nuclide record `f-18-naf` (Agent). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

A radioactive form of fluoride that collects in areas of bone rebuilding. A PET scan after the injection shows those hot spots, which can be cancer that has spread to bone or something harmless like a healed fracture.

## Summary

Sodium fluoride F-18 is one of the oldest PET radiopharmaceuticals: it was first approved by FDA in 1972 (NDA 17-042, held by the predecessor of GE Healthcare) as a bone-imaging agent, then re-approved under a newer label format in 2011 (NDA 22-494, sponsor National Cancer Institute) after the original product had lapsed commercially. Both approvals cover PET imaging of bone to define areas of altered osteogenic activity; neither approval is oncology-specific, but the agent's principal modern use is detecting osteoblastic bone metastases, most often from prostate and breast cancer, where it offers higher sensitivity and better spatial resolution than technetium-99m bone scintigraphy.

The recommended adult dose is 300-450 MBq (8-12 mCi) intravenously, with imaging optimally at one to two hours; no adverse reactions have been established in the FDA label, and the main safety statement concerns cumulative radiation exposure rather than a pharmacological toxicity. Because uptake is a marker of bone turnover, not malignancy, degenerative disease, fracture healing and other benign remodelling can be false positives, and correlation with CT or MRI is standard practice.

## Fields

- Kind: Agent
- Status: approved
- Last checked: 2026-09-22
- Also known as: 18F-NaF; Na18F; Fluoride F-18
- Tags: bone imaging; PET; generic
- Modality: PET tracer
- Mechanism: Fluoride ion exchanges with hydroxyl groups on the hydroxyapatite crystal surface of bone, concentrating wherever bone turnover (osteoblastic activity) is high. Uptake reflects blood flow and new bone formation rather than tumour cells directly, so it lights up both malignant and benign remodelling.
- Approvals: US 1972: Diagnostic PET imaging of bone to define areas of altered osteogenic activity (NDA 17-042); US 2011: Diagnostic PET imaging of bone to define areas of altered osteogenic activity (NDA 22-494, current labelling)
- Dosing: Intravenous injection; 300-450 MBq (8-12 mCi) in adults; imaging can begin 1-2 hours after administration, optimally at one hour

## Sources

- FDA label: Sodium Fluoride F 18 Injection (DailyMed): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d867a881-108e-41fa-91ab-dc4df00cbb55
- FDA approval letter, NDA 22-494 (2011): https://www.accessdata.fda.gov/drugsatfda_docs/nda/2011/022494Orig1s000Approv.pdf

## Connected records

- isotopes: [Fluorine-18](https://nuclide.cc/isotopes/f-18/), [Technetium-99m](https://nuclide.cc/isotopes/tc-99m/)
- indications: [Prostate cancer](https://nuclide.cc/indications/prostate/)
- technologies: [PET (positron emission tomography)](https://nuclide.cc/technologies/pet/), [PET/CT](https://nuclide.cc/technologies/pet-ct/)
- companies: [GE HealthCare](https://nuclide.cc/companies/ge-healthcare/)
- drugs: [Technetium Tc-99m medronate (MDP)](https://nuclide.cc/drugs/tc-99m-mdp/)

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