|Year : 2016 | Volume
| Issue : 2 | Page : 89-92
Pharmacovigilance in radiopharmaceuticals
Rishi Kumar1, Vivekanandan Kalaiselvan2, Rakesh Kumar1, Ravendra Verma2, Gyanendra Nath Singh2
1 Pharmacovigilance Division, Indian Pharmacopoeia Commission, National Coordination Centre-Pharmacovigilance Programme of India, India
2 Pharmacovigilance Division, Indian Pharmacopoeia Commission, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||9-Mar-2016|
Indian Pharmacopoeia Commission, National Coordination Centre-Pharmacovigilance Programme of India, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Indian Pharmacopoeia Commission is Committed for maintaining the standards of drugs including Radiopharmaceuticals (RPs) by publishing Indian Pharmacopoeia. These RPs are being used in India for diagnostic or therapeutic purpose. RPs though contain relatively small quantities of active ingredient and administered in small volumes could cause some adverse reactions to the patients. The objective of presenting this article is to introduce the system of adverse drug reaction reporting to the nuclear medicine fraternity who are dealing with RPs.
Keywords: Adverse drug reactions, pharmacovigilance, radiopharmaceuticals
|How to cite this article:|
Kumar R, Kalaiselvan V, Kumar R, Verma R, Singh GN. Pharmacovigilance in radiopharmaceuticals. Indian J Nucl Med 2016;31:89-92
|How to cite this URL:|
Kumar R, Kalaiselvan V, Kumar R, Verma R, Singh GN. Pharmacovigilance in radiopharmaceuticals. Indian J Nucl Med [serial online] 2016 [cited 2020 Sep 24];31:89-92. Available from: http://www.ijnm.in/text.asp?2016/31/2/89/178252
| Introduction|| |
Radiopharmaceuticals (RPs) are unique medicinal formulations containing radioisotopes, which are used in a variety of clinical conditions for diagnosis and/or therapy. The facilities and procedures for the production, use, and storage of RPs are subject to licensing by national and/or regional authorities. This licensing includes compliance with regulations governing RP preparations and those governing radioactive materials. Additional regulations may apply for issues such as transportation or dispensing of RPs. 
Pharmacovigilance (PV) process is defined as the science and activity relating to the detection, assessment, understanding, and prevention of adverse effects, or any other drug-related problem came into existence to monitor the Adverse Drug Reactions (ADRs) throughout the life period of a drug.  In India, the Ministry of Health and Family Welfare (MoHFW), Government of India, launched a nationwide Pharmacovigilance Programme of India (PvPI) in the year 2010 to monitor the safety of all drugs including topical medicines. Indian Pharmacopoeia Commission (IPC) under the MoHFW functions as National Coordination Centre (NCC) for PvPI. NCC identified 179 ADRs monitoring centres (AMCs) across the country to monitor, identify, and report ADRs to NCC. , ADR is response to a drug which is noxious and unintended and which occurs at doses normally used in human for the prophylaxis, diagnosis or treatment of a disease, or for the modification of physiological function can be reported to AMC-PvPI. A dedicated and trained team at AMC collects, manages, and assesses the report before submitting to NCC. ADRs reporter (healthcare professionals) who is not a part of AMC can report ADRs with all medicines including RPs whether known or unknown, serious or nonserious, and frequent or rare by filling the suspected ADR reporting form and submitting it to a nearby AMC [Figure 1] and [Figure 2] (also available in www.ipc.gov.in). A dedicated helpline (1800 180 3024) system is also available to provide assistance in ADRs reporting.  The obtained information is entered in the drug safety database, analyzed and assessed by the experts to identify new signals. This is also used as the main source for identifying and reducing the risks associated with the drugs used as RPs and others. ,,
The IPC has initiated efforts to include RPs, used in the field of nuclear medicine, as tracers in the diagnosis and treatment of various diseases including cancer, in the Indian Pharmacopoeia (IP) for the 2 nd time in the Addendum-2015 to IP in the year 2014 (IP-2014) and continuously working on other nuclear substances to include in the IP's next Addendum-2016.
The effort of IPC is to keep pace with emerging and contemporary areas for addressing the issues of healthcare requirements, in tandem with the regulatory developments in the global pharma sector.
The RPs are already included in advanced pharmacopoeias in developed countries. The World Health Organization has also provided more importance to the radioisotopes in its International Pharmacopoeia, of late. The IPC's efforts to address the segment are to keep the IP on par with these standards.
There were 19 monographs of RPs published in IP-2014. These are as follows:
Fluorodeoxyglucose ( 18 F) injection, ( 131 I) meta-iodobenzyl guanidine injection for diagnostic use, ( 131 I) meta-Iodobenzyl guanidine injection for therapeutic use, samarium ( 153 Sm) ethylene diamine tetramethylene phosphonate injection, sodium fluoride ( 18 F) injection, sodium iodide ( 131 I) capsules for diagnostic use, sodium iodide ( 131 I) capsules for therapeutic use, sodium iodide ( 131 I) solution, sodium pertechnetate ( 99m Tc) injection (Fission), sodium pertechnetate ( 99m Tc) injection (Nonfission), sodium phosphate ( 32 P) injection, technetium ( 99m Tc) DMSA injection, technetium ( 99m Tc) DTPA Injection, technetium ( 99m Tc) EC injection, technetium ( 99m Tc) ECD injection, technetium ( 99m Tc) glucoheptonate injection, technetium ( 99m Tc) mebrofenin injection, technetium ( 99m Tc) medronate complex injection, and technetium ( 99m Tc) MIBI injection. 
The 10 RP monographs that were included in the Addendum-2015 are as follows: Gallium citrate ( 67 Ga) injection, strontium ( 89 Sr) chloride injection, technetium ( 99m Tc) colloidal rhenium sulfide injection, technetium ( 99m Tc) exametazime injection, technetium ( 99m Tc) HYNIC-TOC injection, technetium ( 99m Tc) macrosalb injection, technetium ( 99m Tc) mertiatide injection, technetium ( 99m Tc) tetrofosmin complex injection, technetium ( 99m Tc) trodat injection, and urea ( 14 C) capsules. 
| Clinical Use Of Radiopharmaceuticals|| |
The RPs are the substances which are used for specific purpose either therapeutic or diagnostic, their dose and duration of action need to be monitored until the RPs present in the body of patients. During this period, the patient may suffer from some adverse reactions that can be reported to PvPI. So that, a data can be generated that could be useful for nuclear medicine physicians and experts for any regulatory intervention.
| Adverse Drug Reactions Involving Radiopharmaceuticals|| |
Adverse reactions associated with the administration of RPs should be investigated and properly documented. Serious adverse reactions and problems with RPs should be reported to PvPI using any of the method described in the introduction section of this article.
The ADRs that pertains to RPs include faintness, pallor, diaphoresis, hypotension, anaphylactic reactions, dermographism, wheezing, bronchospasm, erythema, and pruritus. Drug interaction is also one of the major criteria that can be monitored or evaluated with the help of PV. The drug interactions that have been reported with RPs include nifedipine, digitalis, stilbestrol, gonadotrophins, phenothiazines, and cimetidine.  Policies and procedures should be developed that ensure that the correct patient receives the correct drug at the correct time, correct dose, and by correct route of administration.
ADRs have been defined by federal and state regulatory agencies and accreditation bodies (e.g., joint commission) and include a requirement for timely reporting. When reporting of such events is required, the report should be made to the appropriate agency within the time frame specified.
| Conclusion|| |
Healthcare professionals are encouraged to report ADRs due to the use of RPs whether they have been used for diagnostic purpose or treatment.
PvPI is playing a leading role for the collection of data for a database on the Indian population due to ADRs of pharmaceuticals. The data related to RPs would help healthcare professionals who are dealing with RPs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Radiopharmaceuticals Final Text for Addition to The International Pharmacopoeia (November 2008) Document QAS/08.262/FINAL; November, 2008.
Arora D. Pharmacovigilance obligations of the pharmaceutical companies in India. Indian J Pharmacol 2008;40 Suppl 1:S13-6.
World Health Organization. The Importance of Pharmacovigilance: Safety Monitoring of Medicinal Products. Geneva: WHO; 2002.
Kalaiselvan V, Mishra P, Singh GN. Helpline facility to assist reporting of adverse drug reactions in India. WHO South-East Asia J Public Health 2014;3:194.
Kalaiselvan V, Thota P, Singh A. Current status of adverse drug reactions monitoring centres under pharmacovigilance programme of India. Indian J Pharm Pract 2014;7:19-22.
Kalaiselvan V, Kumar P, Mishra P, Singh GN. System of adverse drug reactions reporting: What, where, how, and whom to report? Indian J Crit Care Med 2015;19:564-6.
Vivekanandan K, Rishi K, Prasad T, Arunabh T, Singh GN. Status of documentation grading and completeness score for Indian individual case safety reports. Indian J Pharmacol 2015;47:325-7.
Indian Pharmacopoeia-2014. 7 th
ed. Ghaziabad: Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India; 2014.
Addendum-2015 to Indian Pharmacopoeia-2014. 7 th
ed. Ghaziabad: Indian Pharmacopoeia Commission, Ministry of Health and Family Welfare, Government of India; 2015.
Sampson CB. Adverse reactions and drug interactions with radiopharmaceuticals. Drug Saf 1993;8:280-94.
[Figure 1], [Figure 2]