Perflutren

Perflutren is a diagnostic agent used in suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border.

• Perflutren is available under the following different brand names: Definity RT, Optison, Definity.

Common side effects of Perflutren include:

• injection site reactions
• back and chest pain
• headache
• dizziness
• nausea
• flushing
• fatigue
• fever
• hot flashes
• fainting
• fast or slow heart rate
• palpitations
• high or low blood pressure
• indigestion
• dry mouth
• toothache
• abdominal pain
• diarrhea
• vomiting
• joint pain
• leg cramps
• spinning sensation (vertigo)
• numbness and tingling
• cough
• sore throat
• runny or stuffy nose
• shortness of breath
• itching
• rash
• hives
• increased sweating
• dry skin

Serious side effects of Perflutren include:

• lightheadedness
• severe dizziness, or a cold sweat
• chest pain, wheezing, trouble breathing
• fast or slow heartbeats
• severe headache, blurred vision, pounding in your neck or ears, anxiety, confusion
• slow heart rate, weak pulse, fainting, weak or shallow breathing

Rare side effects of Perflutren include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, coordination loss, unsteady, very stiff muscles, high fever, profuse sweating, or tremors.
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Injectable suspension

• 5-8 x10^8/mL (Optison); 2 and 3 mL vials
• 1.2 x10^10/mL (Definity); concentration after mixing

Echocardiography

Adult dosage

• Definitiy
  • Do not use without activating the product
  • IV Bolus: 10 mcL/kg over 30-60 sec, then 10 mL saline flush, if necessary, repeat a second time (dose and flush) after 30 min
  • IV Infusion: 1.3 mL in 50 mL NS0.9% NaCl (preservative-free); initiate IV at 4 mL/min, titrate as needed, not to exceed infusion rate of 10 mL/min
• Optison
  • 0.5 mL IV bolus; slowly infuse IV into peripheral vein slowly at a rate no more than 1 mL/sec, flush with 0.9% NaCl or D5W
  • May give additional 0.5 mL doses to enhance imaging quality
  • Not to exceed a cumulative dose of 5 mL in a 10-min period
  • Not to exceed cumulative dose/study of 8.7 mL per patient

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Perflutren has no noted severe interactions with any other drugs
• Perflutren has no noted serious interactions with any other drugs
• Perflutren has no noted moderate interactions with any other drugs
• Perflutren has no noted minor interactions with any other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your healthcare professional or doctor for additional medical advice, health questions, or concerns.

Contraindications

• Hypersensitivity to Perflutren to lipid microsphere or components; Optison brand also warns for hypersensitivity to blood, blood products, or albumin

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Perflutren?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Perflutren?”

Cautions

• For IV use only; do not administer by intra-arterial injection
• Chronic pulmonary vascular disorder
• Serious cardiopulmonary reactions, including fatalities, have occurred uncommonly during or shortly following administration
• In patients with cardiac shunts, perflutren-containing microspheres can bypass the pulmonary particle-filtering mechanisms and directly enter the arterial circulation resulting in microvascular embolization that may cause occlusion and ischemia; assess patients with shunts for embolic phenomena following administration
• QT prolongation reported
  • Therapy not recommended for use at mechanical indices above 0.8
  • Assess patients for the presence of conditions that preclude therapy administration; always have cardiopulmonary resuscitation personnel and equipment readily available before administration and monitor all patients for acute reactions
  • Pain episodes in sickle cell disease
  • Acute pain episodes shortly following therapy administration reported in patients with sickle cell disease (SCD); pain episodes included moderate to severe back pain and vaso-occlusive crisis; if a patient with sickle cell disease experiences new or worsening pain, discontinue therapy
• Hypersensitivity reactions
  • Anaphylaxis, with manifestations that may include death, shock, bronchospasm, throat tightness, angioedema, edema (pharyngeal, palatal, mouth, peripheral, localized), swelling (face, eye, lip, tongue, upper airway), facial hypoesthesia, rash, urticaria, pruritus, flushing, and erythema; these reactions have occurred in patients with no prior exposure to perflutren-containing microsphere products
  • Product contains polyethylene glycol (PEG); there may be an increased risk of serious reactions including death in patients with prior hypersensitivity reaction(s) to PEG
  • Clinically assess patients for prior hypersensitivity reactions to products containing PEG, such as certain colonoscopy bowel preparations and laxatives
  • Always have cardiopulmonary resuscitation personnel and equipment readily available before product administration and monitor all patients for hypersensitivity reactions

Pregnancy and Lactation

• Available data from case reports with use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
• This drug has a very short half-life; therefore, administration to a pregnant woman is not expected to result in clinically relevant fetal exposure
• Lactation
  • There are no data on the presence of human milk, its effects on the breastfed infant, or milk production; developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for therapy and any potential adverse effects on the breastfed infant from treatment or underlying maternal condition