FDA Drug Safety Podcast for Healthcare Professionals: Update- Preliminary findings from ongoing investigations of CardioGen-82

Narrator: Welcome to the FDA Drug Safety Podcast for Healthcare Professionals from the Division of Drug Information. Today's topic: Update on the Preliminary findings from ongoing investigations of CardioGen-82.

This update is in follow-up to the Drug Safety Communication entitled, FDA alerts healthcare professionals to stop performing heart scans with CardioGen-82 due to potential for increased radiation exposure in patients² issued on 7/26/2011.

Lesley Navin, a Consumer Safety Officer in the Division, will provide you with additional information about this Communication.
Guest Speaker: On January 12, 2012, the Food and Drug Administration issued a Drug Safety Communication updating healthcare professionals and the public about preliminary findings from ongoing investigations following the voluntary recall of CardioGen-82 on 7/25/2011 by the manufacturer, Bracco Diagnostics, Inc. CardioGen-82 consists of a generator that is used at clinical sites to produce rubidium (Rb)-82 chloride injection. A CardioGen-82 positron emission tomography scan is one of a variety of nuclear medicine scans that use radioactive drugs to evaluate the heart.
The preliminary information from the investigations suggests that improper usage of CardioGen-82 at certain clinical sites is responsible for the exposure of some patients to more radiation than is typically associated with a CardioGen-82 scan. This increased radiation exposure was due to the administration of CardioGen-82 generator eluates that contained excessive concentrations of strontium-82 (Sr-82) and strontium-85 (Sr-85). This excessive release of Sr-82 and Sr-85 in generator eluates is known as "strontium breakthrough." FDA believes it is unlikely that this excessive exposure posed significant risks to patients, though exposure to any excessive radiation is undesirable.

In its 7/26/2011 Drug Safety Communication³, FDA stated that it had identified deficiencies with the manufacturing procedures for CardioGen-82. To date, these deficiencies do not appear to have been related to the excessive radiation exposure detected in some patients. The recalled CardioGen-82 generators that were functional following shipping were tested by the manufacturer to identify potential structural or functional causes of strontium breakthrough. None of the tested generators showed signs of breakthrough. FDA continues to work with the manufacturer to resolve their manufacturing deficiencies.

The manufacturer is currently conducting studies of clinical sites across the nation to help assess the extent to which patients may have been exposed to excessive radiation. Participation in this study is voluntary and the preliminary data show that, of 375 patients who were surveyed at 43 clinical sites, 54 patients were planned for further radiation testing because of abnormal screening test results. All 54 patients are from two clinical sites. Both sites appear to have insufficient documentation of compliance with the CardioGen-82 labeling recommendations for strontium breakthrough testing.
FDA continues to work with the manufacturer and other federal agencies to better characterize the problems that led to excessive radiation exposure to patients at certain clinical sites. FDA is also working with the manufacturer to revise the CardioGen-82 labeling to better describe how to use the generator and to implement a plan for the return of CardioGen-82 to the market. FDA will update the public when additional information becomes available.

Additional information can also be found on the manufacturer's website at http://www.cardiogen.com/⁴

⁵and the United States Nuclear Regulatory Commission website at http://www.nrc.gov/⁶.

Narrator: Thank you for listening. The FDA is committed to keeping healthcare professionals informed of the latest safety information. A link to this communication can be found at http://www.fda.gov/Drugs/DrugSafety/ucm199082.htm⁷. If you have drug questions, you can reach us at druginfo@fda.hhs.gov.