Flyrcado Dosage

Generic name: FLURPIRIDAZ F-18 55mCi in 1mL
Dosage form: injection

Medically reviewed by Drugs.com. Last updated on Feb 6, 2025.

Radiation Safety – Drug Handling

Handle FLYRCADO with appropriate safety measures to minimize radiation exposure. Use waterproof gloves and effective shielding, including lead-glass syringe shields, when handling and administering FLYRCADO.

Radioactive drugs should be used by or under the control of healthcare providers who are qualified by specific training and experience in the safe use and handling of radionuclides, and whose experience and training have been approved by the appropriate governmental agency authorized to license the use of radionuclides.

Recommended Dosage, Preparation, and Administration Instructions

Recommended Dosage

The recommended activity for each type of examination is presented in Table 1.
Administer two doses by intravenous injection, one for rest imaging and one for stress imaging, using either pharmacologic or exercise stress, in either a 1-day or 2-day protocol.
If performing a combined exercise/pharmacologic stress protocol, administer the recommended activity for pharmacologic stress.
When rest and stress imaging are performed on the same day, the recommended minimum stress activity is 2-fold the rest activity for pharmacologic stress and 3-fold the rest activity for exercise stress to provide adequate image quality and obscure residual signal from the first acquisition.
The recommended maximum total volume administered in one day is 6.1 mL.

Table 1 – Recommended Administered Activities of FLYRCADO in Adults for Rest and Stress Imaging Using Pharmacologic or Exercise Stress in a 1-Day or 2-Day Protocol
Length of Protocol	Activity for Rest Imaging	Activity for Stress Imaging
Length of Protocol	Activity for Rest Imaging	Pharmacologic	Exercise
1 day	93 MBq to 111 MBq (2.5 mCi to 3 mCi)	222 MBq to 241 MBq (6 mCi to 6.5 mCi)	333 MBq to 352 MBq (9 mCi to 9.5 mCi)
2 days	93 MBq to 111 MBq (2.5 mCi to 3 mCi)	93 MBq to 111 MBq (2.5 mCi to 3 mCi)	93 MBq to 111 MBq (2.5 mCi to 3 mCi)

Patient Preparation

Instruct patients to drink water to ensure adequate hydration prior to administration of FLYRCADO and to continue drinking and voiding frequently during the first hours following administration to reduce radiation exposure.

Drug Preparation

Use aseptic technique and radiation shielding to withdraw and administer FLYRCADO.
Calculate the necessary volume to administer based on calibration time and activity using a suitably calibrated instrument.
Visually inspect FLYRCADO for particulate matter and discoloration prior to administration and do not use if either is observed.
Ensure the correct syringe is used and has adequate volume (at least 1 mL to 2 mL) so that the activity in the syringe can be administered without excessive dead volume loss.
Measure patient dose using a dose calibrator immediately before administration.
Do not use and discard FLYRCADO 8 hours after end of synthesis or when the activity falls below the activity requirement at the time of injection, whichever is earlier.
FLYRCADO may be diluted aseptically with 0.9% Sodium Chloride Injection, USP. Diluted product should be used within 8 hours after end of synthesis or when the activity falls below the activity requirement at the time of injection, whichever is earlier.
Dispose of unused product in a safe manner and in compliance with applicable regulations.

Administration Instructions

Administer FLYRCADO via intravenous injection as a bolus lasting less than 10 seconds and immediately follow with a flush of 0.9% Sodium Chloride Injection, USP.
The minimum time between rest and stress dose administration is:
- 30 minutes when using pharmacologic stress
- 60 minutes when using exercise stress
When using pharmacologic stress, administer FLYRCADO at the time of peak vasodilation according to the prescribing information for the stress agent, using an intravenous port different from the one used for the stress agent.
When using exercise stress, administer FLYRCADO after the patient reaches at least 85% of their age-predicted maximum heart rate or exhibits ischemic signs or symptoms. The patient should then continue to exercise for approximately 1 minute to 2 minutes after the injection. If the patient cannot achieve the target heart rate, the examination may be converted to pharmacologic stress.

Image Acquisition Instructions

For rest and stress imaging, image reconstruction should include attenuation correction.

Rest Imaging

Begin the PET acquisition 5 minutes after FLYRCADO administration and acquire images for 10 minutes using a scanner in 3D mode.

Pharmacologic Stress Imaging

Begin the PET acquisition 5 minutes after FLYRCADO administration and acquire images for 10 minutes using a scanner in 3D mode.

Optionally, dynamic imaging may be performed, starting immediately prior to the injection of FLYRCADO.

Exercise Stress Imaging

Once the patient has been positioned on the scanner and respiration has begun to return to normal, begin image acquisition (about 15 minutes to 25 minutes after administration of FLYRCADO). Acquire images for 10 minutes using a scanner in 3D mode.

Radiation Dosimetry

Table 2 shows the estimated radiation absorbed doses per unit of injected activity.

Table 2 – Estimated Radiation Absorbed Doses in Organs/Tissues from Intravenous Administration of FLYRCADO in Adults
Organ	Absorbed Dose per Unit of Administered Activity (mGy/MBq)
Organ	Rest	Pharmacologic Stress*	Exercise Stress
* The pharmacologic stress agent used was adenosine.
Adrenals	0.016	0.016	0.014
Bone surfaces	0.019	0.019	0.02
Brain	0.025	0.022	0.011
Breasts	0.009	0.009	0.01
Gallbladder Wall	0.017	0.018	0.015
Gastrointestinal Tract
Stomach Wall	0.04	0.033	0.024
Small Intestine Wall	0.013	0.012	0.014
Upper Large Intestine Wall	0.013	0.012	0.014
Lower Large Intestine Wall	0.012	0.011	0.014
Heart Wall	0.048	0.09	0.039
Kidneys	0.066	0.057	0.027
Liver	0.039	0.044	0.015
Lungs	0.011	0.012	0.012
Muscle	0.01	0.01	0.012
Ovaries	0.012	0.012	0.014
Pancreas	0.016	0.016	0.015
Red Marrow	0.016	0.018	0.015
Salivary Glands	0.035	0.076	0.007
Skin	0.008	0.008	0.009
Spleen	0.016	0.012	0.013
Testes	0.009	0.009	0.011
Thymus	0.011	0.012	0.013
Thyroid	0.032	0.036	0.014
Urinary Bladder Wall	0.023	0.021	0.016
Uterus	0.012	0.012	0.014
Total Body	0.012	0.012	0.012
Effective Dose (mSv/MBq)	0.019	0.019	0.015

The whole-body effective dose resulting from the administration of maximal activity of FLYRCADO of 111 MBq at rest, 241 MBq during pharmacological stress, and 352 MBq during exercise stress is, respectively, 2.1 mSv, 4.6 mSv, and 5.3 mSv. Under the same conditions, the absorbed dose to the target organ (heart wall) is 5.3 mGy, 22 mGy, and 14 mGy for each administered activity, respectively.

The use of a CT scan to calculate attenuation correction for the reconstruction of FLYRCADO PET images (as done in PET/CT imaging) will add radiation exposure.