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EDICIS 2 MG KIT FOR RADIOPHARMACEUTICAL PREPARATION

Active substance(s): ETHYLENE DICYSTEINE

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SUMMARY OF PRODUCT CHARACTERISTICS
1

NAME OF THE MEDICINAL PRODUCT
Edicis 2 mg kit for radiopharmaceutical preparation

2

QUALITATIVE AND QUANTITATIVE COMPOSITION
Each Edicis vial contains 2 mg of ethylenedicysteine.
The radionuclide is not part of the kit.
Excipients with known effect
Each Edicis vial contains 3.5 mg of sodium.
Each buffer vial contains 5.2 mg of potassium.
For the full list of excipients, see section 6.1.

3

PHARMACEUTICAL FORM
Kit for radiopharmaceutical preparation
Edicis (red strip): White or slightly yellow powder
Reducing agent (yellow strip): White or slightly yellow powder, to be reconstituted.
Buffer (green strip): White or yellow paste, to be reconstituted.

4
4.1

CLINICAL PARTICULARS
Therapeutic indications
This medicinal product is for diagnostic use only.
After radiolabelling with sodium pertechnetate (99mTc) solution and reconstitution, the
solution of technetium (99mTc) - ethylenedicysteine obtained, is indicated in adults for
dynamic scintigraphy, in the following settings:
- Evaluation of nephropathies and uropathies especially for assessing relative kidney
function, renal morphology, and renal perfusion
- Drainage of the upper urinary tract.

4.2

Posology and method of administration
This medicinal product is intended for use in designated nuclear medicine facilities
only, and should only be handled by authorised personnel.
Posology
Adults
The recommended activity for a patient of 70 kg average body weight is between
90 MBq and 120 MBq.
Elderly population
No adaptation is recommended.
Renal impairment / hepatic impairment
There is no need to adapt the activity in these patients.
Paediatric population
The safety and efficacy of Edicis in children and adolescents have not yet been
established.
Method of administration
Multidose use.
This medicinal product should be reconstituted before administration to the patient.
The radiolabelled solution should be administered intravenously as a single bolus into
the brachial vein.
For instructions on extemporaneous preparation, of the medicinal product before
administration, see section 12.
For patient preparation, see section 4.4.
Image acquisition
The specific procedure (position of the patient during administration and acquisition,
and the type of camera, sequence and number of images) depends on the indication of
the exploration.
The scintigraphic examination begins immediately after injection of the product. The
total duration of the examination is approximately 30 minutes.

When elimination of the product is slow, the number of images can be higher.
Administering furosemide to the patient can increase elimination.

4.3

Contraindications
Hypersensitivity to the active substance, to any of the excipients listed in section 6.1
or to any of the components of the labelled radiopharmaceutical.

4.4

Special warnings and precautions for use
Potential for hypersensitivity or anaphylactic reactions
If hypersensitivity or anaphylactic reactions occur, the administration of the
medicinal product must be discontinued immediately and intravenous treatment
initiated, if necessary. To enable immediate action in emergencies, the necessary
medicinal products and equipment such as endotracheal tube and ventilator must be
immediately available.
Individual benefit/risk justification
For each patient, the radiation exposure must be justifiable by the likely benefit. The
activity administered should in every case be as low as reasonably achievable to
obtain the required diagnostic information.
Patient preparation
When a scintigraphy with other technetium (99mTc)-labelled agents was previously
performed in the last 2 days before the examination, the physician should be informed
and should estimate the indication.
In order to obtain valuable images for the evaluation of the drainage of the upper
urinary tract and to reduce the radiation exposure of the bladder, patients should be
encouraged to drink plenty of water from the time of arrival in the department to the
actual injection of tracer (unless medically contraindicated) and empty their bladder
prior to, and frequently for six hours after the imaging procedure.
After the procedure
Close contact with infants and pregnant women should be restricted during 24h.
Specific warnings
This medicinal product contains less than 1 mmol of sodium (23 mg) per vial, i.e. is
essentially ‘sodium- free’.
This medicinal product contains less than 1 mmol of potassium (39 mg) per vial, i.e.
is essentially potassium free’.

Precautions with respect to environmental hazard see section 6.6.

4.5

Interaction with other medicinal products and other forms of interaction
No interaction studies have been performed.
Administered contrast media may impair tubular renal excretion and thereby
influence the technetium (99mTc) - ethylenedicysteine clearance.
Probenecid inhibits the tubular secretion of technetium (99mTc) - ethylenedicysteine.
Chronic administration of diuretics may lead to volume depletion resulting in a
decrease in specificity. If possible they should be stopped several days before the
study (unless medically contraindicated).

4.6

Fertility, pregnancy and lactation
Women of childbearing potential
When an administration of radiopharmaceuticals to a woman of childbearing potential
is intended, it is important to determine whether or not she is pregnant. Any woman
who has missed a period should be assumed to be pregnant until proven otherwise. If
in doubt about her potential pregnancy (if the woman has missed a period, if the
period is very irregular, etc.), alternative techniques not using ionising radiation (if
there are any) should be offered to the patient.
Pregnancy

Radionuclide procedures carried out on pregnant women also involve radiation dose
to the foetus. Only essential investigations should therefore be carried out during
pregnancy, when the likely benefit far exceeds the risk incurred by the mother and
foetus.
Breastfeeding
Before administering radiopharmaceuticals to a mother who is breastfeeding,
consideration should be given to the possibility of delaying the administration of
radionuclide until the mother has ceased breastfeeding, and to what is the most
appropriate choice of radiopharmaceuticals, bearing in mind the secretion of activity
in breast milk.
If the administration is considered necessary, breastfeeding should be interrupted for
24 hours and the expressed feeds discarded.
Close contact with infants should be restricted during this period.

4.7

Effects on ability to drive and use machines
Edicis has no or negligible influence on the ability to drive and use machines.

4.8

Undesirable effects
No undesirable effect has been reported to date.
Exposure to ionising radiation is linked with cancer induction and a potential for
development of hereditary defects.
As the effective dose is 1.19 mSv (unilateral renal obstruction) when the maximal
recommended activity of 120 MBq is administered, these adverse reactions are
expected to occur with a low probability.
Reporting suspected adverse reactions after authorisation of the medicinal product is
important. It allows continued monitoring of the benefit/risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via:
Yellow Card Scheme
Website: www.mhra.gov.uk/yellowcard.

4.9

Overdose
No case of overdose has been reported.
In the event of administration of a radiation overdose with technetium (99mTc)
ethylenedicysteine, the absorbed dose to the patient should be reduced where possible
by increasing the elimination of the radionuclide from the body by forced diuresis and
frequent bladder voiding. It might be helpful to estimate the effective dose that was
applied.
If the whole content of the vial containing the labelled substance is administered to
one patient by mistake 2 mg of technetium (99mTc) - ethylenedicysteine is introduced
in the body. Preclinical toxicity studies have shown that clinical symptoms are not
expected at this dose level (see section 5.3).

5

PHARMACOLOGICAL PROPERTIES

5.1

Pharmacodynamic properties
Pharmacotherapeutic group: Diagnostic Radiopharmaceuticals, ATC code: V09CA06
Mechanism of action

Technetium (99mTc) - ethylenedicysteine is a renal tubular agent with similar
pharmacokinetic properties to ortho-iodohippurate and (99mTc)-MAG3. It is excreted
from the kidneys by active transport mechanism and has a renal clearance which is
closer to that of ortho-iodohippurate as compared to (99mTc)-MAG3.
Technetium (99mTc) - ethylenedicysteine has negligible hepatobiliary localisation and
a high kidney-to-background ratio which improves the renal delineation and provides
better image quality even in patients with severe renal failure.
Pharmacodynamic effects
At the chemical concentrations used for diagnostic examinations, technetium (99mTc) ethylenedicysteine does not appear to have any pharmacodynamic activity.

5.2

Pharmacokinetic properties
Distribution
Following intravenous injection of technetium (99mTc) - ethylenedicysteine, plasma
protein-bound fraction is 30% and plasma clearance has been reported to be around
75% of ortho-iodohippurate (OIH) clearance both in normal individuals and patients.
The distribution volume of technetium (99mTc) - ethylenedicysteine is 20% of bodyweight.
Organ uptake
Blood cell binding has been reported to be 5.7%. There is a negligible uptake in the
liver and intestines.
Elimination
Technetium (99mTc) - ethylenedicysteine is excreted from the kidneys by active
transport mechanism.
Within 1 hour, 70% of technetium (99mTc) - ethylenedicysteine is excreted in urine.

5.3

Preclinical safety data
Toxicological studies with mice have demonstrated that with a single intravenous
injection of the tested reconstituted kit containing ethylenedicysteine overloaded with
20% of impurities at 25 mg/kg, no deaths were observed.
This corresponds to 875 times the human dose of 0.028 mg/kg for adults (70 kg)
resulting from the administration of a whole content of a reconstituted vial.
This medicinal product is not intended for regular or continuous administration.

Mutagenicity studies, long term carcinogeniticity studies have not been carried out.

6

PHARMACEUTICAL PARTICULARS

6.1

List of excipients
Edicis:
Disodium phosphate dihydrate (E339)
D-mannitol (E421)
Ascorbic acid (E300)
Disodium edetate dihydrate
Reducing agent:
Stannous chloride dihydrate (E512)
Tartaric acid (E334)
Ascorbic acid (E300)
Buffer:
Potassium dihydrogen phosphate (E340)
Ascorbic acid (E300)

6.2

Incompatibilities
This medicinal product must not be mixed with other medicinal products except those
mentioned in section 12.

6.3

Shelf life
1 year.
After radiolabelling: 8 hours. Do not store above 25°C after radiolabelling.

6.4

Special precautions for storage
Store in a refrigerator (2 °C – 8 °C).
Keep in the outer carton tightly closed in order to protect from light.

For storage conditions after radiolabelling of the medicinal product, see section 6.3.
Storage of radiopharmaceuticals should be in accordance with national regulation on
radioactive materials.

6.5

Nature and contents of container
6 ml, type I, colourless glass vial, closed with chlorobutyl rubber stopper and crimped
with an aluminium seal with lid. Vials are provided with a colour coded labels: red
strip for Edicis (multidose vial), yellow strip for the reducing agent and green strip for
the buffer.
Pack size:
Kit of 4 Edicis, 4 reducing agent and 4 buffer vials.

6.6

Special precautions for disposal
General warning
Radiopharmaceuticals should be received, used and administered only by authorised persons
in designated clinical settings. Their receipt, storage, use, transfer and disposal are subject
to the regulations and/or appropriate licences of the competent official organisation.

Radiopharmaceuticals should be prepared in a manner which satisfies both radiation
safety and pharmaceutical quality requirements. Appropriate aseptic precautions
should be taken.
Contents of the vials are intended only for use in the preparation of
technetium (99mTc) -ethylenedicysteine and are not to be administered directly to the
patient without first undergoing the preparative procedure.
For instructions on extemporaneous preparation of the medicinal product before
administration, see section 12.
If at any time in the preparation of this product the integrity of the vial is
compromised it should not be used.
Administration procedures should be carried out in a way to minimise risk of
contamination of the medicinal product and irradiation of the operators. Adequate
shielding is mandatory.

The content of the kit before extemporaneous preparation is not radioactive.
However, after sodium pertechnetate (99mTc) Injection, Ph. Eur. is added, adequate
shielding of the final preparation must be maintained.
The administration of radiopharmaceuticals creates risks for other persons from
external radiation or contamination from spill of urine, vomiting, etc. Radiation
protection precautions in accordance with national regulations must therefore be
taken.
Any unused medicinal product or waste material should be disposed of in accordance
with local requirements.

7

MARKETING AUTHORISATION HOLDER
CIS bio international
RN 306 - Saclay
BP 32
F-91192 GIF-sur-YVETTE Cedex

8

MARKETING AUTHORISATION NUMBER(S)
PL 11876/0021

9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION
13/09/2013

10

DATE OF REVISION OF THE TEXT
13/09/2013

11

DOSIMETRY
Technetium (99mTc) is produced by means of a (99Mo/99mTc) generator and decays
with the emission of gamma radiation with a mean energy of 140 keV and a half-life
of 6.02 hours to technetium (99Tc) which, in view of its long half-life of
2.13 x 105 years can be regarded as quasi stable.
The data listed below are from ICRP (International Commission of Radiological
Protection, Publication 106) and are calculated according to the following
assumptions: the effective dose has been calculated by using the absorbed doses
determined for each individual organ, taking into account the weighting factors
(radiation and tissue).

Table 1: Absorbed dose after injection of technetium (99mTc) ethylenedicysteine:
normal renal function

Organ

Adrenals
Bladder
Bone surfaces
Brain
Breasts
Gall bladder
Gastrointestinal tract:
Stomach
Small intestine
Colon
(Upper Large Intestine
(Lower Large Intestine
Heart
Kidneys
Liver
Lungs
Muscles

Absorbed dose per unit
activity administered
(mGy/MBq)
Adult
0.0005
0.0950
0.0014
0.0002
0.0002
0.0007
0.0005
0.0022
0.0032
0.0017
0.0052
0.0003
0.0034
0.0005
0.0003
0.0014

Oesophagus
Ovaries
Pancreas
Red marrow
Skin

0.0003
0.0049
0.0006
0.0010
0.0005

Spleen
Testes
Thymus
Thyroid
Uterus

0.0005
0.0034
0.0003
0.0003
0.0110

Remaining organs

0.0014

Effective dose
(mSv/MBq)

0.0063

Bladder wall contributes 76% of the effective dose.
The effective dose resulting from the administration of an activity of 120 MBq for an
adult weighing 70 kg with a normal renal function is about 0.76 mSv.
For an administered activity of 120 MBq the typical radiation dose to the target organ
(kidneys) is 0.41 mGy and the typical radiation dose to the critical organs are: bladder
11.40 mGy, uterus 1.32 mGy.

Table 2: Absorbed dose after injection of technetium (99mTc) ethylenedicysteine:
abnormal renal function

Organ

Adrenals
Bladder
Bone surfaces
Brain
Breasts
Gall bladder
Gastrointestinal tract:
Stomach
Small intestine
Colon
(Upper Large Intestine
(Lower Large Intestine
Heart
Kidneys
Liver
Lungs
Muscles

Absorbed dose per unit
activity administered
(mGy/MBq)
Adult
0.0026
0.0440
0.0036
0.0015
0.0013
0.0027
0.0022
0.0031
0.0034
0.0028
0.0043
0.0021
0.0110
0.0028
0.0018
0.0021

Oesophagus
Ovaries
Pancreas
Red marrow
Skin

0.0018
0.0043
0.0026
0.0021
0.0013

Spleen
Testes
Thymus
Thyroid
Uterus

0.0023
0.0029
0.0018
0.0018
0.0069

Remaining organs

0.0022

Effective dose
(mSv/MBq)

0.0046

The effective dose resulting from the administration of an activity of 120 MBq for an
adult weighing 70 kg -with renal impairment -is about 0.55 mSv.
For an administered activity of 120 MBq, the typical radiation dose to the target
organ (kidneys) is 1.32 mGy and the typical radiation dose to the critical organs,
bladder and uterus are 5.3 mGy and 0.83 mGy respectively.

Table 3: Absorbed dose after injection of technetium (99mTc) ethylenedicysteine:
acute unilateral renal blockage

Organ

Adrenals
Bladder
Bone surfaces
Brain
Breasts
Gall bladder
Gastrointestinal tract:
Stomach
Small intestine
Colon
(Upper Large Intestine
(Lower Large Intestine

Absorbed dose per unit
activity administered
(mGy/MBq)
Adult
0.0110
0.0490
0.0031
0.0001
0.0004
0.0064
0.0040
0.0043
0.0038
0.0040
0.0035

Heart
Kidneys
Liver
Lungs
Muscles

0.0014
0.2000
0.0046
0.0011
0.0022

Oesophagus
Ovaries
Pancreas
Red marrow
Skin

0.0004
0.0036
0.0077
0.0030
0.0008

Spleen
Testes
Thymus
Thyroid
Uterus

0.0100
0.0018
0.0004
0.0002
0.0065

Remaining organs

0.0022

Effective dose
(mSv/MBq)

0.0099

The effective dose resulting from the administration of an activity of 120 MBq for an
adult weighing 70 kg-with an acute unilateral renal blockage- is 1.19 mSv.
For an administered activity of 120 MBq, the typical radiation dose to the target
organ (kidneys) is 24 mGy and the typical radiation dose to the critical organs,
bladder and uterus, are 5.9 mGy and 0.78 mGy respectively.

12

INSTRUCTIONS FOR PREPARATION OF
RADIOPHARMACEUTICALS
Withdrawals should be performed under aseptic conditions. The vials must not be
opened before disinfecting the stopper, the solution should be withdrawn via the
stopper using a single dose syringe fitted with suitable protective shielding and a
disposable sterile needle or using an authorised automated application system.
If the integrity of this vial is compromised, the product should not be used.
This product contains no bacteriostatic preservative.
Method of preparation
Before any step of solution withdrawal and transfer, the surface of the rubber stopper
should be disinfected and allowed to air dry.
1. Put a vial Edicis (redstrip) into an appropriate lead shielded container. Using a
syringe, introduce through the rubber stopper 2 ml of sterile sodium pertechnetate
(99mTc) corresponding to a range of activity of 0.8-1.6 GBq. Shake.
2. Take a reducing agent vial (yellow strip). Using a syringe, introduce through the
rubber stopper 2 ml of sterile 9 mg/ml sodium chloride solution. Shake until complete
dissolution.
Transfer 0.5 ml of the solution of reducing agent with a syringe into a Edicis vial.
Allow the Edicis vial to stand for 15 minutes while it is shaken once or twice.
3. Take a buffer vial (green strip). Using a syringe, introduce through the rubber
stopper 1 ml of sterile 9 mg/ml sodium chloride solution. Shake until complete
dissolution.
Transfer the whole solution of the buffer with a syringe into the Edicis vial. Shake.
4. Fill in the enclosed label and fix it to the radiolabelled solution vial.
The reconstituted product should not be further diluted.
After radiolabelling with sodium pertechnetate (99mTc) injection and reconstitution
with the reducing and buffering agents provided, the resulting solution for injection of
technetium (99mTc) - ethylenedicysteine should be clear and colourless, free from
visible particles with a pH of 5 – 8, otherwise it should be discarded.
Quality control

The radiochemical purity of the final radiolabelled preparation can be tested
according to the following procedure:

a) Method
Paper chromatography (1st system) and thin layer chromatography (2nd system).
b) Procedure
1st system: Determination of free pertechnetate
Adsorbent: strips for paper chromatography (1 x 10 cm), type Whatman No. ET-31
Solvent: Acetone
Draw a starting line at 2 cm from the bottom of the strip and a front line at 1 cm of
the top.
Apply 10 – 15 μl of the labelled product onto the starting line of the paper strip.
Let dry and develop the chromatogram in acetone for 10 minutes. The labelled
complex and reduced-hydrolyzed technetium remain at the starting line (Rf ~ 0) while
free pertechnetate moves with the solvent front (Rf ~ 1).
Remove the strip with the forceps.
Record the chromatograms using a gamma scanner or cut the strip at 5 cm from the
bottom and measure the activity of the 2 parts in an appropriate dose calibrator.
5. Calculate the relative amount of free pertechnetate (FT, %) corresponding to the
activity at the solvent front by the total activity (starting and front solvent line).
Where, % free technetium (99mTc) =

Activity of strip at (Rf ~ 0.1) x 100
Total activity of strip

2nd system: Determination of reduced-hydrolyzed technetium
Adsorbent: strips for thin layer chromatography (1.0 x 10 cm) coated with silica gel,
type Kieselgel 60,
Solvent: Ethanol 96% (v/v) corresponding to 758 g/l.
6. Draw a starting line at 2 cm from the bottom of the strip and a front line at 1 cm of
the top.

7. Apply 5 µl of the labelled solution onto the starting line of the paper strip.
8. Do not let dry and start immediately to develop the chromatogram in ethanol for
30 minutes.
The reduced-hydrolysed technetium remains near to the starting line (Rf ~ 0.1) while
the labelled complex and free pertechnetate move up to Rf ~ 0.6 (30 min is not long
enough to separate the labelled complex from free pertechnetate).
9. Remove the strip with the forceps.
Record the chromatograms using a gamma scanner or cut the strip at 4 cm from the
bottom and measure the activity of the 2 parts in an appropriate dose calibrator.
10. Calculate the relative amount of reduced-hydrolysed technetium (RHT, %)
corresponding to the activity at start divided by the total activity (starting and front
line).
Where, % reduced-hydrolysed technetium (99mTc) = Activity of strip at (Rf ~ 0.1) x 100
Total activity of strip

Calculate the radiochemical purity (RCP) of the labelled product as follows:
RCP (%) = 100% – FT(%) – RHT(%)
11. The radiochemical purity should be more than or equal to 95 %, otherwise the
preparation should be discarded.
Any unused product or waste material should be disposed of in accordance with local
requirements.
Detailed information on this medicinal product is available on the website of the
MHRA.

+ Expand Transcript

Source: Medicines and Healthcare Products Regulatory Agency

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