SODIUM FLUORIDE F-18
Clinical safety rating: caution
Comprehensive clinical and safety monograph for SODIUM FLUORIDE F-18 (SODIUM FLUORIDE F-18).
Positron-emitting radionuclide used for bone imaging; fluoride ion is incorporated into bone matrix via chemisorption onto hydroxyapatite crystals, reflecting blood flow and osteoblastic activity.
| Metabolism | Not metabolized; excreted unchanged primarily by the kidneys (renal clearance). |
| Excretion | Renal (primarily). Approximately 70% of the administered dose is excreted unchanged in urine within 24 hours. Less than 10% is excreted in feces. |
| Half-life | The terminal elimination half-life is approximately 2-4 hours. Clinically, this allows for imaging within 1-3 hours post-injection. |
| Protein binding | Negligible (<5%). Fluoride-18 is not significantly bound to plasma proteins. |
| Volume of Distribution | Approximately 0.5-0.7 L/kg. This reflects distribution into extracellular fluid and bone, with rapid uptake in hydroxyapatite. |
| Bioavailability | Intravenous: 100%. |
| Onset of Action | Intravenous: No pharmacological effect; used as a radiotracer. Uptake in bone begins within minutes; optimal imaging time is 1-2 hours post-injection. |
| Duration of Action | The radiotracer activity decays with physical half-life of 109.7 minutes. Imaging is typically performed for 10-30 minutes, starting 1-2 hours after administration. |
2-10 mCi (74-370 MBq) intravenous bolus injection, single dose for positron emission tomography (PET) bone imaging.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required; however, tracer clearance may be delayed in severe renal impairment (eGFR <30 mL/min/1.73m2), potentially altering image quality. |
| Liver impairment | No dose adjustment required; hepatic metabolism is negligible. |
| Pediatric use | Administer 0.05-0.14 mCi/kg (1.85-5.18 MBq/kg) intravenous, minimum dose 0.3 mCi (11.1 MBq), maximum 3 mCi (111 MBq) single dose. |
| Geriatric use | No specific dose adjustment; use lowest effective dose per body weight and clinical indication, with attention to renal function for delayed clearance. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for SODIUM FLUORIDE F-18 (SODIUM FLUORIDE F-18).
| Breastfeeding | Excretion unknown; M/P ratio not established. Discontinue breastfeeding for at least 24 hours after administration. |
| Teratogenic Risk | Fetal irradiation risk; no trimester-specific teratogenicity data. Use only if benefit outweighs risk. Avoid in pregnancy unless essential. |
| Fetal Monitoring | Ensure hydration to promote clearance; fetal radiation dose monitoring if inadvertently administered. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to sodium fluoride or any component of the formulation.
| Precautions | Risk of radiation exposure, especially to the bladder; ensure adequate hydration and frequent voiding to reduce radiation dose to bladder mucosa. Use with caution in patients with impaired renal function. |
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| Fertility Effects | Potential gonadal radiation exposure; use with caution in reproductive-age individuals. |