SUMMARY OF PRODUCT CHARACTERISTICS for Renoscint MAG3, kit for radiopharmaceutical preparation 1. NAME OF THE MEDICINAL PRODUCT Renoscint MAG3 1 mg kit for radiopharmaceutical preparation 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each vial contains Betiatide, 1 mg It has to be reconstituted with sodium (99mTc) pertechnetate solution (not included in this kit) for the preparation of the diagnostic radiopharmaceutical: Technetium (99mTc) tiatide solution. Excipient with known effect: Each vial contains 4 mg sodium ions. For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Kit for radiopharmaceutical preparation The vial contains a sterile, white lyophilized powder. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications This medicinal product is for diagnostic use only. After reconstitution and labelling with sodium (99mTc) pertechnetate solution, the diagnos- tic agent technetium (99mTc) tiatide may be used intravenously for the evaluation of neph- rological and urological disorders in particular for the study of morphology, perfusion, and function of the kidney and characterisation of urinary outflow. 4.2 Posology and method of administration Posology Adults and the elderly 37-185 MBq, depending on the pathology to be studied and the method to be used. Studies of renal blood flow or transport through the ureters generally require a larger dose than studies of intra-renal transport, whereas renography requires smaller activities than sequen- tial scintigraphy. 1/13 Pediatric population Although Renoscint MAG3 may be used in paediatric patients, formal studies have not been performed. Clinical experience indicates that for pediatric use the activity should be reduced. Because of the variable relationship between the size and body weight of patients it is sometimes more satisfactory to adjust activities to body surface area. The activity to be administered in children and adolescents is determined according to the EANM dosage card (2016) using the following formula: The activity to be administered A[MBq] = Baseline activity (of 11.9 MBq ) x Multiple The activities to be applied are listed in the following table: Weight (kg) Activity Weight (kg) Activity Weight (kg) Activity (MBq) (MBq) (MBq) 3 15 22 36 42 52 4 15 24 38 44 54 6 18 26 40 46 55 8 20 28 41 48 57 10 23 30 43 50 58 12 26 32 45 52-54 60 14 28 34 46 56-58 62 16 30 36 48 60-62 65 18 32 38 50 64-66 67 20 34 40 51 68 69 In very young children, a minimum dose of 15 MBq is necessary in order to obtain images of sufficient quality. The administration of a diuretic or an ACE inhibitor during the diagnostic procedure is sometimes used for differential diagnosis of nephrological and urological disorders. The scintigraphic investigation is usually performed immediately after administration Method of administration This medicinal product should be reconstituted and radioactively labelled before admin- istration to the patient. For intravenous use. For multidose use. The scintigraphic investigation is usually performed immediately after administration. For instructions on reconstitution and labelling of the medicinal product before administra- tion, see section 12. For patient preparation, see section 4.4. 4.3 Contraindications Hypersensitivity to the active substance or to any of the excipients listed in section 6.1. 4.4 Special warnings and precautions for use Potential for hypersensitivity or anaphylactic reaction 2/13 If hypersensitivity or anaphylactic reactions occurs, the administration of the medicinal product must be discontinued immediately and intravenous treatment initiated, if neces- sary. 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, exposure to ionising radiation must be justifiable on the basis of likely benefit. The activity administered must be such that the resulting radiation dose is as low as reasonably achievable bearing in mind the need to obtain the intended diagnostic infor- mation. Pediatric population The use in children has to be considered carefully, based upon clinical needs and assessing the risk/benefit ratio in this patient group. For information on the use in the pediatric population, see section 4.2. Careful consideration of the indication is required since the effective dose per MBq is higher than in adults (see section 11). Patient preparation The patient should be well hydrated before the start of the examination and urged to void as often as possible during the first hours after the examination in order to reduce radiation. Specific warnings The agent is not suited for exact monitoring of effective renal plasma flow respectively blood flow in patients with seriously impaired renal function. Small amounts of 99mTc-labelled impurities may be present and/or are formed during the labelling process. As some of these impurities are distributed to the liver and excreted via the gall bladder they may influence the late phase (after 30 minutes) of a dynamic renal study due to the overlap of kidney and liver in the region of interest. Inadvertent or accidental subcutaneous administration of technetium (99mTc) tiatide should be avoided as perivascular inflammation has been described. Excipients This medicinal product contains less than 1 mmol sodium (23mg) per vial, that is to say es- sentially ‘sodium free’. Depending on the time when you administer the injection, the content of the sodium given to the patient may in some cases be greater than 1 mmol. This should be taken into ac- count in patient on low sodium diet. 4.5 Interaction with other medicinal products and other forms of interaction Technetium (99mTc) tiatide has not been described to interfere with agents commonly pre- scribed to or given to patients requiring investigations with Technetium (99mTc) tiatide (e.g. antihypertensives and medicinal products used to treat or prevent organ transplant rejec- tion). However, the single administration of a diuretic or ACE inhibitor is sometimes used in the differential diagnosis of nephrological and urological disorders. 3/13 Administered contrast media may impair tubular renal excretion and thereby influence the technetium (99mTc) tiatide clearance. 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 doses 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 the foetus. Breast-feeding 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 radiophar- maceutical, bearing in mind the secretion of activity in breast milk. If the administration is considered necessary, breastfeeding should be interrupted for 4 hours and the expressed feeds discarded. 4.7 Effects on ability to drive and use machines No studies on the effects on the ability to drive and use machines have been performed. 4.8 Undesirable effects The frequencies of undesirable effects are defined as follows: Very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data) Nervous system disorders Not known (cannot be estimated from the Cerebral convulsion1. available data) Immune system disorders Anaphylactoid reactions such as urticarial Very rare (<1/10,000) rash, swelling of eyelids and coughing. 1 Seen in a 15 days old child. Causal relationship not established. 4/13 Exposure to ionising radiation is linked with cancer induction and a potential for develop- ment of hereditary defects. For diagnostic nuclear medicine investigations the current evi- dence suggests that these adverse effects will occur with low frequency because of the low radiation doses incurred. For most diagnostic investigations using nuclear medicine procedures the radiation dose delivered (Effective Dose Equivalent, EDE) is less than 20 mSv. Higher doses might be justified in some clinical circumstances Reporting suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is im- portant. It allows continued monitoring of the benefit/risk balance of the medicinal prod- uct. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V 4.9 Overdose The risk of an excessive technetium (99mTc) tiatide dose is largely theoretical and most likely to be due to excessive radiation exposure. In such circumstances the radiation to the body (kidney, bladder and gall bladder) can be reduced by forced diuresis and frequent bladder voiding. 5. PHARMACOLOGICAL PROPERTIES 5.1 Pharmacodynamic properties Pharmacotherapeutic