- Withdraw antagonist medications: Labetalol, Reserpine, Calcium Channel blockers, Amitriptyline + derivatives, Imipramine + derivatives, Doxepin, Amoxapine, Loxapine, Maprotiline, Trazodone, Phenylephrine, Phenylpropanolamine, Pseudoephedrine, ephedrine, Cocaine, Bethanidine, debrisoquine, Bretylium, Guanethidine, Phenothiazines, Thioxanthenes, Butyrophenones, Amphetamine + related compounds, Beta-sympathomimetics, Dobutamine, Dopamine, Metaraminol, doxazosin mesilate. (See mechanism
).- Make sure WBC > 2400/ul or Granulocytes > 2000/ul and Platelets > 60.000/ul. Exclude DIC (disseminated intravascular coagulation).
- Administer lugol’s solution 1 drop 2-3 times a day, 3 days before and 7 days after injecting the MIBG to prevent free iodine uptake by the thyroid gland.
- If required, treat hypertension with propranolol or angiotensin-converting enzyme inhibitors or fenoxibenzamine.
References:
Diez L, Mitjavila M, Tumores Neuroendocrinos: estudios con meta-yodo-bencil-guanidina, p: 549-561 in: Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.