Rhenium (Sup186/Supre) Etidronic Acid

What it is and how it works

Rhenium-186 etidronate (186Re-HEDP) is a phosphonate complex that localises in bone at sites of increased osteoblastic activity, such as skeletal metastases. Rhenium-186 emits beta particles that irradiate the metastatic sites and gamma photons that allow imaging; its half-life is about 3.7 days.

Indications

Palliation of pain from osteoblastic bone metastases (e.g. prostate and breast cancer) confirmed by bone scintigraphy.

Dosage and administration (summary)

Dosing is individualised by the nuclear medicine specialist according to protocol; given as a single slow intravenous injection, which may be repeated after haematological recovery.

Contraindications

Pregnancy and breast-feeding, severe bone marrow suppression, severe renal impairment and spinal cord compression or pathological fractures requiring other treatment.

Warnings and precautions

Causes transient myelosuppression (mainly thrombocytopenia), so monitor blood counts for several weeks; a transient flare of bone pain may occur. Patients should be well hydrated and empty the bladder frequently to reduce radiation dose; radiation-protection measures apply.

Pregnancy

Therapeutic radiopharmaceuticals are contraindicated in pregnancy; pregnancy must be excluded before administration.

Storage and supply

Store in appropriate lead shielding in accordance with national regulations for radioactive materials and the manufacturer’s instructions; use within the stated shelf-life after calibration.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.