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|Strontium-89 Chloride

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Strontium-89 Chloride

Pronouncation: (STRAHN-shee-uhm 89 KLOR-ide)
Class: Radiopharmaceutical

Trade Names:
Metastron
- Injection 148 MBq, 4 mCi

Mechanism of Action

Pharmacology

Following IV injection, soluble strontium compounds behave like their calcium analogs, clearing rapidly from blood and selectively localizing in bone mineral. Uptake of strontium by bone occurs preferentially in sites of active osteogenesis. Selectively irradiates sites of primary metastatic bone involvement with minimal effect on soft tissues distant from bone lesions.

Indications and Usage

Painful skeletal metastases.

Contraindications

None well documented.

Dosage and Administration

Painful Skeletal Metastases
Adults

IV 148 MBq, 4 mCi given by slow IV injection (1 to 2 min). Alternatively, a dose of 1.5 to 2.2 MBq/kg, 40 to 60 mcCi/kg may be used. Repeat doses are generally not recommended at intervals of less than 90 days.

Storage/Stability

The vial is shipped in a transportation shield with an approximately 3 mm lead wall thickness. Store the vial and its contents inside its transportation container at room temperature (59° to 77°F).

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Miscellaneous

Fatal septicemia following neutropenia; transient increase in bone pain at 36 to 72 hr after injection; chills and fever 12 hr after injection without long-term sequelae.

Precautions

Pregnancy

Category D .

Lactation

It is recommended that nursing be discontinued by mothers.

Children

Safety and efficacy in children less than 18 yr have not been established.

Carcinogenesis

It is a potential carcinogen.

Bone metastases

Not indicated for use in patients with cancer not involving bone. Confirm presence of bone metastases prior to therapy.

Radiopharmaceuticals

Only health care providers who are qualified by training and experience in the safe use and handling of radionuclides and whose experience and training have been approved by the appropriate government agency authorized to license the use of radionuclides should use radiopharmaceuticals.

Flushing sensation

A calcium-like flushing sensation has been observed following a rapid (less than 30 sec injection) administration.

Patient Information

The patient may feel a slight increase in pain for 2 or 3 days beginning 2 or 3 days after injection. The health care provider may suggest a temporary increase in the dose of pain medication until the pain is under control. After ≈ 1 to 2 wk, the pain should begin to diminish.
The patient can eat and drink normally and there is no need to avoid alcohol or caffeine unless already advised to do so. The health care provider may want to carry out periodic, routine blood tests.
Advise patients to tell any health practitioner who is giving them medical treatment that they have received strontium-89.
During the first week after injection, strontium-89 will be present in the blood and urine. It is therefore important to consider the following precautions for 1 wk: 1) Where a normal toilet is available, use in preference to a urinal. Flush the toilet twice; 2) Wipe up any spilled urine with a tissue and flush it away; 3) Always wash hands after using the toilet; 4) Immediately wash any linen or clothes that become stained with urine or blood. Wash them separately from other clothes, and rinse thoroughly; 5) If any urine collection device is used, follow instructions on its use; 6) Wash away any spilled blood if a cut occurs.
In many people who receive strontium-89, the effect lasts for several months. If pain returns, consult the health care provider.

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