title: Pitfalls with radiopharmaceuticals.
abstract: BACKGROUND
  There is a considerable body of evidence describing that the pharmacokinetics and pharmacodynamics of radiopharmaceuticals may be changed by a variety of drugs, disease states and in some cases, surgical procedures.
  
  
  OBJECTIVE
  : To systematically search the medical literature and review the published evidence on adverse reactions to radiopharmaceuticals.
  
  
  METHODS
  MEDLINE, EMBASE, International Pharmaceutical Abstracts and Science Citation Index were searched for studies reporting adverse reactions to radiopharmaceuticals. Controlled trials, cohort studies, case-control studies and case series published in major Western languages were considered for the review. Each study included in the present review was described in a narrative way, and major components of each study were reported (ie, research design, patient characteristics, types of drugs and radiopharmaceuticals, dosing information and adverse reactions).
  
  
  RESULTS
  The majority of adverse reactions to radiopharmaceuticals described in the literature required little or no treatment, and their negative effects were generally mild and self-limited. Large longitudinal greater than 5-year studies reported prevalence rates of adverse reactions due to radiopharmaceuticals ranging from 0 to 25 cases per 100,000 administrations. Case studies on the use of technetium reported mild adverse reactions; however, some led to potentially harmful complications. Similarly, studies involving fluorodeoxyglucose reported more severe adverse reactions.
  
  
  CONCLUSIONS
  The literature on radiopharmaceuticals adverse effects is scarce, and just a few studies were conducted to investigate the association between radiopharmaceuticals and adverse reactions. Despite relatively mild and self-limited symptoms, the current widespread use of radiopharmaceuticals requires constant monitoring for adverse reactions.
authors.affiliation: Division of Radiopharmacy, Nuclear Engineering Institute, Rio de Janeiro RJ 21941906, Brazil. roliveira@ien.gov.br
authors.forename: Ralph
authors.initials: R
authors.lastname: Santos-Oliveira
authors.forename: Márcio
authors.initials: M
authors.lastname: Machado
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000009:adverse effects*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013667:Technetium / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D013667:Technetium