SonoVue

Active Substance: sulphur hexafluoride
Common Name: sulphur hexafluoride
ATC Code: V08DA04
Marketing Authorisation Holder: Bracco International BV
Active Substance: sulphur hexafluoride
Status: Authorised
Authorisation Date: 2001-03-26
Therapeutic Area: Echocardiography Ultrasonography
Pharmacotherapeutic Group: Contrast media

Therapeutic Indication

This medicinal product is for diagnostic use only.

SonoVue is for use with ultrasound imaging to enhance the echogenicity of the blood, which results in an improved signal-to-noise ratio.

SonoVue should only be used in patients where study without contrast enhancement is inconclusive.

Echocardiography

SonoVue is a transpulmonary echocardiographic contrast agent for use in patients with suspected or established cardiovascular disease to provide opacification of cardiac chambers and enhance left-ventricular endocardial border delineation.

What is SonoVue?

SonoVue is a medicine that contains the active substance sulphur hexafluoride (a gas). It is available as a kit including one vial of gas and powder and one prefilled syringe containing 5 ml of solvent. When made up into a solution, SonoVue contains sulphur hexafluoride gas as ‘microbubbles’ in suspension in a liquid.

What is SonoVue used for?

SonoVue is for diagnostic use only. It is a contrast agent (it helps make internal body structures visible during imaging tests). SonoVue is used in tests that measure how ultrasound travels within the body because it improves the ability of the blood to create an echo. It is only used when the results of the test without a contrast agent are inconclusive. SonoVue is used in:

  • echocardiography (a diagnostic test where an image of the heart is obtained). It is used to obtain a clearer scan of the chambers of the heart, especially of the left ventricle, in patients with suspected or confirmed coronary artery disease.
  • Doppler (a diagnostic test that measures the speed of blood flow). SonoVue can be used in Doppler tests for large blood vessels, such as those in the head, those leading to the head or the main vein to the liver, or for smaller blood vessels such as those in lesions (areas of disease) in the breast or liver.

The medicine can only be obtained with a prescription.

How is SonoVue used?

SonoVue should only be used by doctors who have experience in diagnostic ultrasound imaging. It is injected intravenously (into a vein) before the test is carried out, as a 2- or 2.4-ml dose depending on which test is being carried out. The dose can be repeated.

How does SonoVue work?

The active substance in SonoVue, sulphur hexafluoride, is a gas that is not soluble in the blood. When SonoVue is made up into a suspension, the gas is trapped in tiny bubbles called microbubbles. After injection, the microbubbles travel in the blood, where they reflect ultrasound waves more than the surrounding tissues. This helps to enhance the results of tests that rely on measuring ultrasound, such as echocardiography and Doppler tests. The gas is removed naturally from the body through the lungs.

How has SonoVue been studied?

SonoVue has been studied in a total of 895 patients in six main studies. These included three studies of echocardiography and three studies of Doppler.

The echocardiography studies involved a total of 317 patients, and compared SonoVue with another contrast agent and placebo (a dummy treatment).

The Doppler studies involved 361 patients who were being tested for abnormalities in large blood vessels, and 217 patients being tested for abnormalities in smaller vessels. In these studies, SonoVue was not compared with any other medicine, but the results of the test with SonoVue were compared with the ‘gold standard’, such as angiography (X-rays of blood vessels). The main measure of effectiveness was how clear the images obtained in the test were.

What benefit has SonoVue shown during the studies?

In the echocardiography studies, SonoVue was more effective than the comparator and than placebo in improving the clarity of the image obtained of the left ventricle and left ventricle border.

In the Doppler studies, using SonoVue to measure blood flow in large blood vessels improved the quality of the scan when testing the cerebral arteries (in the head), the carotids (in the neck) and the portal vein (leading to the liver), but not the renal arteries (leading to the kidneys). For the smaller vessels, SonoVue led to better quality scans when looking at the blood flow in breast and liver lesions. However, this was not observed for lesions in the pancreas, kidney, ovary or prostate gland.

What is the risk associated with SonoVue?

The most common side effects with SonoVue (seen in between 1 and 10 patients in 100) are headache, paraesthesia (unusual sensations like pins and needles), dizziness, dysgeusia (taste disturbances), flushing (reddening of the skin), pharyngitis (sore throat), nausea (feeling sick), pruritus (itching), rash, pain, including back and chest pain, chest discomfort, fatigue (tiredness), reactions at the injection site, feeling hot and raised blood sugar levels. For the full list of all side effects reported with SonoVue, see the package leaflet.

SonoVue must not be used in the following patients:

  • patients known to have right-to-left shunts (abnormal movement of blood within the heart), severe pulmonary hypertension (high blood pressure in the pulmonary artery, the blood vessel that leads from the heart to the lungs), uncontrolled hypertension (high blood pressure) or adult respiratory distress syndrome (severe fluid build-up in both lungs);
  • pregnant or breastfeeding women.

SonoVue must also not be used together with the medicine dobutamine (used for heart failure) in patients for whom dobutamine is not suitable.

For the full list of restrictions, see the package leaflet.

Why has SonoVue been approved?

The CHMP decided that SonoVue’s benefits are greater than its risks and recommended that it be given marketing authorisation.

What measures are being taken to ensure the safe and effective use of SonoVue?

A risk management plan has been developed to ensure that SonoVue is used as safely as possible. Based on this plan, safety information has been included in the summary of product characteristics and the package leaflet for SonoVue, including the appropriate precautions to be followed by healthcare professionals and patients.

Other information about SonoVue:

The European Commission granted a marketing authorisation valid throughout the European Union for SonoVue on 26 March 2001.

For more information about treatment with SonoVue, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.

Source: European Medicines Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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