ioflupane: clinical use

Prescribing considerations

• Diagnostic use only in adults referred by clinicians experienced in movement disorders or dementia.
• Review medicines and recreational substances that bind dopamine transporters; balance interruption against withdrawal or clinical deterioration.
• Confirm thyroid blocking, hydration and radiation justification, keeping exposure as low as reasonably achievable.
• Ensure resuscitation facilities are available and administration occurs in an appropriately licensed nuclear medicine setting.

Contraindications and cautions

• Pregnancy
• Hypersensitivity to ioflupane or any excipient

Monitoring

• Establish pregnancy and breastfeeding status before administration.
• Check for significant renal or hepatic impairment; formal studies are unavailable and use is not recommended when impairment is moderate to severe.
• Observe for hypersensitivity and injection-site reactions.
• Interpret images visually alongside clinical assessment; validated semi-quantification may support but not replace this.

Clinical pharmacology

Ioflupane is a cocaine analogue with high affinity for presynaptic dopamine transporters and lower affinity for serotonin transporters. Its iodine-123 label permits SPECT visualisation of striatal transporter integrity. It clears rapidly from blood and is eliminated mainly in urine.

Formulation and product differences

• A clear, colourless solution for slow intravenous injection, used undiluted.
• Supplied in single-dose glass vials with different fill volumes; contains ethanol, acetate-buffer components and water for injections.