Institute of Nuclear Medicine, School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 May;17(10):1326-33.
(123)I-metaiodo-benzylguanidine (MIBG) scintigraphy is considered a valid imaging test to evaluate the cardiac sympathetic nervous system. However, scientific literature showed that some drugs are able to or are expected to interfere with MIBG uptake. Thirty years after introduction of the method and over 15 years since the appearance of the first document on pharmacological interference with MIBG, an update on this issue has become necessary.
The aims of this review paper are: (1) to identify the pharmacological basis of interference of a variety of substances with MIBG uptake; and (2) to update the list of drugs that definitely interfere with MIBG on the grounds of evidence in the literature.
A MEDLINE search was conducted. Scientific studies, case report and review articles were collected. Papers published demonstrating drugs interfering with MIBG uptake were evaluated.
Drugs may interact with MIBG uptake by 5 mechanism: (1) type-1 uptake inhibition; (2) inhibition of active transport to vesicles; (3) competition in transport to vesicles; (4) depletion of neurosecretory vesicle content; (5) calcium-mediated mechanism. We find that drugs like cocaine, antidepressants, some antipsychotic, tramadol, labetalol, sympatho-mimetics, reserpine and some calcium antagonists (as diltiazem, verapamil and nifedipine) do interfere with MIBG uptake. On the other hand, we find that controversial data are available on scientific literature regarding digoxin and amiodarone.
A compiled statement of MIBG interfering medicines is now recommended to help nuclear medicine physicians in clinical practice to avoid potential pitfalls and improve the efficacy of (123)I-MIBG scintigraphy as a diagnostic tool.
（123）碘代苄胍（MIBG）闪烁显像被认为是评估心脏交感神经系统的有效影像学检查方法。然而，科学文献表明，一些药物能够或预计会干扰 MIBG 的摄取。该方法问世 30 年后，也是第一份关于 MIBG 药理学干扰文件发表 15 年之后，有必要对这个问题进行更新。
本文旨在：（1）确定各种物质干扰 MIBG 摄取的药理学基础；（2）根据文献中的证据，更新肯定会干扰 MIBG 的药物清单。
进行了 MEDLINE 检索。收集了科学研究、病例报告和综述文章。评估了发表的证明药物干扰 MIBG 摄取的论文。
药物可能通过 5 种机制与 MIBG 摄取相互作用：（1）类型 1 摄取抑制；（2）主动转运至囊泡的抑制；（3）竞争转运至囊泡；（4）神经分泌囊泡内容物耗竭；（5）钙介导机制。我们发现可卡因、抗抑郁药、一些抗精神病药、曲马多、拉贝洛尔、拟交感神经药、利血平以及一些钙拮抗剂（如地尔硫卓、维拉帕米和硝苯地平）等药物会干扰 MIBG 的摄取。另一方面，我们发现关于地高辛和胺碘酮的科学文献中有争议的数据。
现在推荐一份 MIBG 干扰药物的综合说明，以帮助核医学医师在临床实践中避免潜在的陷阱，并提高（123）I-MIBG 闪烁显像作为诊断工具的功效。
