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Xenon - Prescription Drug Labeling

Product NDC Code 11994-127
Drug Name

Xenon

Type Brand
Pharm Class Inhalation Diagnostic Agent [EPC],
Radiopharmaceutical Activity [MoA]
Active Ingredients
Xenon xe-133 10 mci/1
Route RESPIRATORY (INHALATION)
Dosage Form GAS
Application Number NDA017284
Labeler Name Lantheus Medical Imaging, Inc.
Packages
Package NDC Code Description
11994-127-11 1 vial in 1 can (11994-127-11) > 1 gas in 1 vial
11994-127-15 5 vial in 1 can (11994-127-15) > 1 gas in 1 vial

Adverse reactions

Information about undesirable effects, reasonably associated with use of the drug, that may occur as part of the pharmacological action of the drug or may be unpredictable in its occurrence. Adverse reactions include those that occur with the drug, and if applicable, with drugs in the same pharmacologically active and chemically related class. There is considerable variation in the listing of adverse reactions. They may be categorized by organ system, by severity of reaction, by frequency, by toxicological mechanism, or by a combination of these.
ADVERSE REACTIONS: Adverse reactions related to the use of this agent have not been reported to date.

Clinical pharmacology

Information about the clinical pharmacology and actions of the drug in humans.
CLINICAL PHARMACOLOGY: Xenon Xe 133 is a readily diffusible gas which is neither utilized nor produced by the body. It passes through cell membranes and freely exchanges between blood and tissue. It tends to concentrate more in body fat than in blood, plasma, water or protein solutions. In the concentrations used for diagnostic purposes it is physiologically inactive. Inhaled Xenon Xe 133 Gas will enter the alveolar wall and enter the pulmonary venous circulation via the capillaries. Most of the Xenon Xe 133 that enters the circulation from a single breath is returned to the lungs and exhaled after a single pass through the peripheral circulation.

Contraindications

Information about situations in which the drug product is contraindicated or should not be used because the risk of use clearly outweighs any possible benefit, including the type and nature of reactions that have been reported.
CONTRAINDICATIONS: None known.

Description

General information about the drug product, including the proprietary and established name of the drug, the type of dosage form and route of administration to which the label applies, qualitative and quantitative ingredient information, the pharmacologic or therapeutic class of the drug, and the chemical name and structural formula of the drug.
DESCRIPTION: Xenon Xe 133 Gas is supplied in a mixture of xenon gas (5%) in carbon dioxide (95%). It is contained within septum sealed glass vials and is suitable for inhalation in the diagnostic evaluation of pulmonary function and imaging, as well as assessment of cerebral blood flow. Xenon Xe 133 Gas is reactor-produced as a by-product of Uranium U235 fission. Each vial contains the labeled amount of Xenon Xe 133 radioactivity at the time of calibration. The contents of the vial are in gaseous form, contain no preservatives, and are ready for use. Xenon Xe 133 is chemically and physiologically related to elemental Xenon, a non-radioactive monoatomic gas which is physiologically inert except for anesthetic properties at high doses. PHYSICAL CHARACTERISTICS Xenon Xe 133 decays by beta and gamma emissions with a half-life of 5.245 days. Kocher, David C., "Radioactive Decay Data Tables," DOE/TIC-11026, p. 138,1981. Significant radiations which are emitted by the nuclide are listed in Table 1. Table 1. Principal Radiation Emission Data from Xenon-133 Mean Mean % per Radiation Energy (KeV) Disintegration Beta-2 100.6 99.3 Ce-K-2 45.0 53.3 Ce-L-2 75.3 8.1 Ce-M-2 79.8 1.7 Gamma-2 81.0 36.5 K α2 X-ray 30.6 13.6 K α1 X-ray 31.0 25.3 K β X-ray 35.0 9.1 EXTERNAL RADIATION The specific gamma ray constant for Xenon Xe 133 is 3.6 microcoulombs/Kg-MBq-hr (0.51R/hr-mCi) at 1 cm. The first half value thickness of lead is 0.0035 cm. A range of values for the relative attenuation of the radiation emitted by this radionuclide that results from the interposition of various thicknesses of Pb is shown in Table 2. For example, the use of 0.20 cm of Pb will decrease the external radiation exposure by a factor of 1,000. Table 2. Radiation Attenuation by Lead Shielding cm of Pb Radiation Attenuation Factor 0.0035 0.5 0.037 10 -1 0.12 10 -2 0.20 10 -3 0.29 10 -4 To correct for physical decay of this radionuclide, the fractions that remain at selected time intervals after the time of calibration are shown in Table 3. Table 3. Xenon Xe 133 Physical Decay Chart (Half Life 5.245 days) Fraction Fraction Day Remaining Day Remaining 0 Calibration Day 1.000 8 .349 1 .877 9 .302 2 .768 10 .268 3 .674 11 .235 4 .591 12 .206 5 .518 13 .181 6 .452 14 .157 7 .398
Table 1. Principal Radiation Emission Data from Xenon-133
MeanMean % per
RadiationEnergy (KeV)Disintegration
Beta-2100.699.3
Ce-K-245.053.3
Ce-L-275.38.1
Ce-M-279.81.7
Gamma-281.036.5
Kα2X-ray30.613.6
Kα1X-ray31.025.3
KβX-ray35.09.1
Table 2. Radiation Attenuation by Lead Shielding
cm of PbRadiation Attenuation Factor
0.00350.5
0.03710-1
0.1210-2
0.2010-3
0.2910-4
Table 3. Xenon Xe 133 Physical Decay Chart (Half Life 5.245 days)
FractionFraction
DayRemainingDayRemaining
0Calibration Day1.0008.349
1.8779.302
2.76810.268
3.67411 .235
4.59112.206
5.51813.181
6.45214.157
7.398

Dosage and administration

Information about the drug product’s dosage and administration recommendations, including starting dose, dose range, titration regimens, and any other clinically sigificant information that affects dosing recommendations.
DOSAGE AND ADMINISTRATION: Xenon Xe 133 Gas is administered by inhalation from closed respirator systems or spirometers. The suggested activity range employed for inhalation by the average adult patient (70 kg) is: Pulmonary function including imaging: 74-1110MBq (2-30mCi) in 3 liters of air. Cerebral blood flow: 370-1110MBq (10-30mCi) in 3 liters of air. The patient dose should be measured by a suitable radioactivity calibration system immediately prior to administration. RADIATION DOSIMETRY The estimated absorbed radiation doses Method of Calculation: A Schema for Absorbed-Dose Calculation for Biologically Distributed Radionuclides, Supplement No. 1, MIRD pamphlet No. 1, J. Nucl. Med., p.7 (1968). to an average patient (70 kg) for pulmonary perfusion and cerebral blood flow studies from a maximum dose of 1110 MBq (30mCi) of Xenon Xe 133 in 3 liters of air are shown in Table 4. Table 4. Radiation Doses Effective Whole Half-Time Lungs 99% of activity is in lungs. Brain Body mGy/1110MBq (rads/30mCi) Pulmonary Perfusion 2 min. 2.5(0.25) 0.014(0.0014) 0.027(0.0027) Cerebral Blood Flow 5 min. 6.3(0.63) 0.035(0.0035) 0.068(0.0068)
Table 4. Radiation Doses
EffectiveWhole
Half-TimeLungs99% of activity is in lungs.BrainBody
mGy/1110MBq (rads/30mCi)
Pulmonary Perfusion 2 min. 2.5(0.25) 0.014(0.0014) 0.027(0.0027)
Cerebral Blood Flow 5 min. 6.3(0.63) 0.035(0.0035) 0.068(0.0068)

Indications and usage

A statement of each of the drug products indications for use, such as for the treatment, prevention, mitigation, cure, or diagnosis of a disease or condition, or of a manifestation of a recognized disease or condition, or for the relief of symptoms associated with a recognized disease or condition. This field may also describe any relevant limitations of use.
INDICATIONS AND USAGE: Inhalation of Xenon Xe 133 Gas has proved valuable for the evaluation of pulmonary function and for imaging the lungs. It may also be applied to assessment of cerebral flow.

Spl product data elements

Usually a list of ingredients in a drug product.
Xenon Xenon XE-133 XENON XE-133 XENON XE-133 CARBON DIOXIDE Xenon Xenon XE-133 XENON XE-133 XENON XE-133 CARBON DIOXIDE

Carcinogenesis and mutagenesis and impairment of fertility

Information about carcinogenic, mutagenic, or fertility impairment potential revealed by studies in animals. Information from human data about such potential is part of the warnings field.
Carcinogenesis, Mutagenesis, Impairment of Fertility No long term animal studies have been performed to evaluate carcinogenic potential or whether Xenon Xe 133 affects fertility in males or females.

Package label principal display panel

The content of the principal display panel of the product package, usually including the product’s name, dosage forms, and other key information about the drug product.
PRINCIPAL DISPLAY PANEL - 10mCi Vial Label 515129-0811 370 Lantheus Medical Imaging Xenon Xe 133 Gas One Dose Vial Exp. Date 10 Days After Calibration 370 MBq (10mCi) Vial Stopper Contains Dry Natural Rubber Latex CAUTION: RADIOACTIVE MATERIAL PRINCIPAL DISPLAY PANEL - 10mCi Vial Label PRINCIPAL DISPLAY PANEL - 20mCi Vial Label 515130-0811 740 Lantheus Medical Imaging Xenon Xe 133 Gas One Dose Vial Exp. Date 10 Days After Calibration 740 MBq (20mCi) Vial Stopper Contains Dry Natural Rubber Latex CAUTION: RADIOACTIVE MATERIAL PRINCIPAL DISPLAY PANEL - 20mCi Vial Label

Spl unclassified section

Information not classified as belonging to one of the other fields. Approximately 40% of labeling with effective_time between June 2009 and August 2014 have information in this field.
PRECAUTIONS: General Xenon Xe 133, as well as other radioactive drugs, must be handled with care and appropriate safety measures should be used to minimize radiation exposure to clinical personnel. Also, care should be taken to minimize radiation exposure to patients consistent with proper patient management. Exhaled Xenon Xe 133 Gas should be controlled in a manner that is in compliance with the appropriate regulations of the government agency authorized to license the use of radionuclides. Radiopharmaceuticals should be used only by physicians who are qualified by training and experience in the safe use and handling of radionuclides and whose experience and training have been approved by the appropriate government agency authorized to license the use of radionuclides. Carcinogenesis, Mutagenesis, Impairment of Fertility No long term animal studies have been performed to evaluate carcinogenic potential or whether Xenon Xe 133 affects fertility in males or females. Pregnancy Animal reproductive studies have not been conducted with Xenon Xe 133 Gas. It is also not known whether Xenon Xe 133 Gas can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Xenon Xe 133 Gas should be given to a pregnant woman only if clearly needed. Ideally, examination using radiopharmaceuticals, especially those elective in nature in a woman of childbearing capability, should be performed during the first few (approximately 10) days following the onset of menses. Nursing Mothers It is not known whether Xenon Xe 133 is excreted in human milk. Many drugs are excreted in human milk, therefore formula feedings should be substituted for breast feeding, because of the potential for adverse reactions in nursing infants. Pediatric Use Safety and effectiveness in the pediatric population has not been established. Geriatric Use Clinical studies of Xenon Xe 133 Gas did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosage range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Geriatric use

Information about any limitations on any geriatric indications, needs for specific monitoring, hazards associated with use of the drug in the geriatric population.
Geriatric Use Clinical studies of Xenon Xe 133 Gas did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosage range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Nursing mothers

Information about excretion of the drug in human milk and effects on the nursing infant, including pertinent adverse effects observed in animal offspring.
Nursing Mothers It is not known whether Xenon Xe 133 is excreted in human milk. Many drugs are excreted in human milk, therefore formula feedings should be substituted for breast feeding, because of the potential for adverse reactions in nursing infants.

Pediatric use

Information about any limitations on any pediatric indications, needs for specific monitoring, hazards associated with use of the drug in any subsets of the pediatric population (such as neonates, infants, children, or adolescents), differences between pediatric and adult responses to the drug, and other information related to the safe and effective pediatric use of the drug.
Pediatric Use Safety and effectiveness in the pediatric population has not been established.

Pregnancy

Information about effects the drug may have on pregnant women or on a fetus. This field may be ommitted if the drug is not absorbed systemically and the drug is not known to have a potential for indirect harm to the fetus. It may contain information about the established pregnancy category classification for the drug. (That information is nominally listed in the teratogenic_effects field, but may be listed here instead.)
Pregnancy Animal reproductive studies have not been conducted with Xenon Xe 133 Gas. It is also not known whether Xenon Xe 133 Gas can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Xenon Xe 133 Gas should be given to a pregnant woman only if clearly needed. Ideally, examination using radiopharmaceuticals, especially those elective in nature in a woman of childbearing capability, should be performed during the first few (approximately 10) days following the onset of menses.

How supplied

Information about the available dosage forms to which the labeling applies, and for which the manufacturer or distributor is responsible. This field ordinarily includes the strength of the dosage form (in metric units), the units in which the dosage form is available for prescribing, appropriate information to facilitate identification of the dosage forms (such as shape, color, coating, scoring, and National Drug Code), and special handling and storage condition information.
HOW SUPPLIED: The Xenon Xe 133 Gas is supplied as part of the Calidose™ system, consisting of 3ml unit dose vials and the Calidose™ dispenser for shielded dispensing. Normally vials containing either 370 or 740MBq (10 or 20mCi)/vial, packed 1 vial or 5 vials per shield tube, are supplied. The NDC number for: 10mCi vial is 11994-127; 20mCi vial is 11994-128. Store at room temperature. This radiopharmaceutical is approved for distribution to persons licensed pursuant to the Code of Massachusetts Regulations 105 CMR 120.100 for the uses listed in 105 CMR 120. 547 or 120.552 or under equivalent regulations of the U.S. Nuclear Regulatory Commission, an Agreement State, or a Licensing State. The contents of the vial are radioactive. Adequate shielding and handling precautions must be maintained. Lantheus Medical Imaging, Inc. 331 Treble Cove Rd., N. Billerica, MA 01862 USA For Ordering Tel. Toll Free 800-299-3431 (For Massachusetts & International, Call 978-667-9531) All Other Business 800-362-2668 Patent: http://www.lantheus.com/patents/index.html Printed in U.S.A. 515083-0719 July 2019

General precautions

Information about any special care to be exercised for safe and effective use of the drug.
General Xenon Xe 133, as well as other radioactive drugs, must be handled with care and appropriate safety measures should be used to minimize radiation exposure to clinical personnel. Also, care should be taken to minimize radiation exposure to patients consistent with proper patient management. Exhaled Xenon Xe 133 Gas should be controlled in a manner that is in compliance with the appropriate regulations of the government agency authorized to license the use of radionuclides. Radiopharmaceuticals should be used only by physicians who are qualified by training and experience in the safe use and handling of radionuclides and whose experience and training have been approved by the appropriate government agency authorized to license the use of radionuclides.

Warnings

Information about serious adverse reactions and potential safety hazards, including limitations in use imposed by those hazards and steps that should be taken if they occur.
WARNINGS: Xenon Xe 133 Gas delivery systems, i.e., respirators or spirometers, and associated tubing assemblies must be leakproof to avoid loss of radioactivity into the environs not specifically protected by exhaust systems. Xenon Xe 133 adheres to some plastics and rubber and should not be allowed to stand in tubing or respirator containers. The unrecognized loss of radioactivity from the dose for administration may render the study non-diagnostic. The vial stopper contains dry natural rubber latex and may cause allergic reactions in providers or patients who are sensitive to latex.

Disclaimer: Do not rely on openFDA to make decisions regarding medical care. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: OpenFDA, Healthporta Drugs API