Iobenguane I-123
An injectable tracer that mimics a stress hormone and gets taken up by certain nerve-related tumours, such as pheochromocytoma and childhood neuroblastoma, so a scan afterwards can show where they are.
Overview
AdreView (Iobenguane I 123 Injection) was approved by FDA in 2008 for detection of primary or metastatic pheochromocytoma or neuroblastoma as an adjunct to other diagnostic tests, and gained a second, unrelated cardiac indication in 2013 (assessment of myocardial sympathetic innervation in heart failure via the heart-to-mediastinum ratio). The adult dose is 10 mCi (370 MBq) IV, and patients require thyroid-blocking medication beforehand to prevent free iodine-123 accumulating in the thyroid.
The most common adverse reactions in the pivotal trials -- dizziness, rash, pruritus, flushing, headache and injection-site haemorrhage -- occurred in under 1.3% of patients, and the product is contraindicated only in known hypersensitivity to iobenguane or iobenguane sulfate. It contains benzyl alcohol as a preservative, which carries a specific warning against use in premature or low-birth-weight infants ("gasping syndrome"). In oncology, 123I-MIBG scintigraphy remains part of SNMMI/EANM guideline workups for pheochromocytoma/paraganglioma and paediatric neuroblastoma, though 18F-FDOPA and 68Ga-DOTATATE PET have overtaken it in sensitivity for many indications, and 131I-MIBG is the therapeutic counterpart used once MIBG uptake is confirmed.
PubChem holds the molecule with stable iodine; the products carry I-123 or I-131 at the same position.
Iobenguane (meta-iodobenzylguanidine, MIBG) is structurally related to noradrenaline and is taken up by the noradrenaline transporter into sympathetic neurons and neuroendocrine cells derived from the neural crest, including pheochromocytoma, paraganglioma and neuroblastoma cells. Labelling with the gamma emitter iodine-123 allows whole-body gamma-camera or SPECT imaging.
1.Iobenguane I-123 slips into a pocket on its target.
- Route
- Intravenous injection over 1-2 minutes
- Schedule
- 10 mCi (370 MBq) for patients >=16 years or <16 years and >=70 kg; weight-scaled dose otherwise; thyroid blockade required beforehand
Source: www.accessdata.fda.gov/drugsatfda_docs/label/2020/022290s005lbl.pdf. Doses are for orientation; the current label governs.
Approvals
| Region | Year | Indication |
|---|---|---|
| US | 2008 | Detection of primary or metastatic pheochromocytoma or neuroblastoma as an adjunct to other diagnostic tests |
| US | 2013 | Scintigraphic assessment of myocardial sympathetic innervation in NYHA class II/III heart failure with LVEF <=35% (non-oncology indication) |
| Adverse event | Any grade | Grade 3+ |
|---|---|---|
| Dizziness, rash, pruritus, flushing, headache or injection-site haemorrhage (combined) | 1.3% | - |
Rates read from the source. Blank cells mean the figure was not sourced, not that it is zero.
Trials
topTrials recruiting now
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Latest papers
topQuery for this drug: (TITLE:"Iobenguane I-123" OR ABSTRACT:"Iobenguane I-123" OR TITLE:"AdreView" OR ABSTRACT:"AdreView" OR TITLE:"123I-MIBG" OR ABSTRACT:"123I-MIBG" OR TITLE:"Iobenguane I 123 Injection" OR ABSTRACT:"Iobenguane I 123 Injection") AND (radiopharmaceutical OR radioligand OR radionuclide OR theranostic OR "nuclear medicine" OR "molecular imaging" OR radiotracer OR scintigraphy OR cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Iobenguane I-123, not a curated reading list.
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