Jacobson Arnold F, Travin Mark I
Diagram Consulting, 10 Lio Poele Place, Kihei, HI, 96753, USA.
Division of Nuclear Medicine, Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA.
J Nucl Cardiol. 2015 Oct;22(5):980-93. doi: 10.1007/s12350-015-0170-z. Epub 2015 May 15.
A critical review of the literature on drug interactions with mIBG uptake was performed to allow formulation of contemporary guidance regarding withholding medications prior to clinical imaging studies.
Published information was extracted on the experimental system used, the quantitative characteristics of the measurements, and whether any data directly examining cardiac tissues were included. Level of evidence for each medication category was assessed on a qualitative scale of very low, low, medium, or high. Strength of medication effect for inhibition of mIBG uptake was judged as none, weak, moderate, or strong.
The only medications for which level of evidence was judged high were labetalol and reserpine. Level of evidence was judged medium for tricyclic antidepressants, calcium channel blockers, and antiarrhythmics (specifically amiodarone). Evidence was judged sufficient to recommend withholding labetalol and the tricyclic antidepressants prior to mIBG cardiac imaging. Mechanistic evidence was sufficient to suggest consideration of withdrawal of sympathomimetic amines and serotonin-norepinephrine reuptake inhibitors (SNRIs).
As there is strong evidence for inhibition of mIBG uptake in only a small number of compounds, clinical decisions regarding withdrawal of concomitant medications should be individualized by considering the potential consequences of a false-positive (artificially low cardiac uptake) imaging result.
对有关药物与间碘苄胍（mIBG）摄取相互作用的文献进行了批判性综述，以便制定关于在临床影像研究前停用药物的当代指南。
提取已发表信息，内容包括所使用的实验系统、测量的定量特征以及是否包含直接检测心脏组织的数据。对每个药物类别证据水平的评估采用极低、低、中或高的定性量表。判断药物对抑制mIBG摄取的作用强度为无、弱、中度或强。
证据水平被判定为高的唯一药物是拉贝洛尔和利血平。三环类抗抑郁药、钙通道阻滞剂和抗心律失常药（特别是胺碘酮）的证据水平被判定为中等。有足够证据建议在mIBG心脏成像前停用拉贝洛尔和三环类抗抑郁药。机制证据足以表明应考虑停用拟交感神经胺和5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）。
由于仅有少数化合物有强有力的证据表明会抑制mIBG摄取，关于停用伴随用药的临床决策应通过考虑假阳性（人为降低心脏摄取）成像结果的潜在后果来个体化制定。
