Indium In 111 Pentetreotide and Breastfeeding

Summary of use during lactation

Information in this record refers to the use of indium In 111 pentetreotide as a diagnostic agent. Recommendations for use in breastfeeding mothers range from no withholding of breastfeeding necessary[1] to 60 hours after a dose of 100 to 220 MBq.[2,3] In some cases, imaging with indium In 111 pentetreotide is followed shortly by a therapy (peptide receptor radiotherapy; PRRT) that uses yttrium 90 or lutetium 177 compounds to selectively irradiate tumors. These agents may pose additional radiation risk to the nursing infant.[1] Mothers concerned about the level of radioactivity in their milk could ask to have it tested at a nuclear medicine facility at their hospital. When the radioactivity is at a safe level, she may resume breastfeeding. A method for measuring milk radioactivity and determining the time when a mother can safely resume breastfeeding has been published.[4]

Drug levels in milk and infant serum

Indium 111 decays by electron capture with 173 keV and 245 keV gamma emissions and a physical half-life of 2.8 days.[5] The maximum effective half-life of indium In 111 pentetreotide is 10 hours.[3]

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. Balon HR, Brown TL, Goldsmith SJ, et al. The SNM practice guideline for somatostatin receptor scintigraphy 2.0. J Nucl Med Technol 2011;39:317-24.22068564 PubMed
2. International Atomic Energy Agency. Radiation Protection and Safety in Medical Uses of Ionizing Radiation, IAEA Safety Standards Series No. SSG-46, IAEA, Vienna. 2018. https://www.iaea.org/publications/11102/radiation-protection-and-safety-in-medical-uses-of-ionizing-radiation
3. ARSAC notes for guidance: Good clinical practice in nuclear medicine. Notes for guidance on the clinical administration of radiopharmaceuticals and use of sealed radioactive sources. 2020. https://www.gov.uk/government/publications/arsac-notes-for-guidance
4. Stabin MG, Breitz HB. Breast milk excretion of radiopharmaceuticals: Mechanisms, findings, and radiation dosimetry. J Nucl Med 2000;41:863-73.10809203 PubMed
5. Dilsizian V, Metter D, Palestro C, Zanzonico P. Advisory Committee on Medical Uses of Isotopes (ACMUI) Sub-Committee on Nursing Mother Guidelines for the Medical Administration of Radioactive Material. Final report submitted: January 31, 2019. 2019. https://www.nrc.gov/docs/ML1903/ML19038A498.pdf