Description

Simple

A medication used during diagnostic tests to detect injuries in the liver, gallbladder, bile duct, and pancreas.

Clinical

An organ-specific paramagnetic contrast agent indicated for the imaging of the hepatobiliary system and detecting lesions in the liver and pancreas.

Overview

Mangafodipir is a contrast agent used as a diagnostic tool administered intravenously to enhance contrast in magnetic resonance imaging (MRI) of the liver and pancreas. This drug is made up of paramagnetic manganese (II) ions combined with the chelating agent _fodipir_ (dipyridoxyl diphosphate, DPDP). Manganese absorption into the tissues that makes the normal tissue appear brighter in MRI is limited in abnormal or cancerous tissue. Enhanced contrast by mangafodipir improves visualization and detection of lesions of the liver formed from metastatic disease or hepatocellular carcinomas. The contrast agent is present as mangafodipir trisodium marketed under the name Teslascan. Teslascan has been removed from the Drug Product List by FDA in 2003, and withdrawn from the European market in 2012.

Pharmacology

Indication

Indicated for use as an organ-specific paramagnetic contrast agent developed for imaging of the hepatobiliary system and detecting lesions in liver and pancreas.

Pharmacodynamic

Manganese (II) metals exhibit paramagnetic properties that increases contrast between normal liver parenchyma and metastatic liver lesions after uptake into the hepatic or pancreatic parencyma. They serve to increase the signal intensity of liver or pancreas tissue. Enhancement in both organs is nea... Read more

Mechanism of action

After intravenous administration, the chelate dissociates slowly to manganese and organic ligand fodipir (dipyridoxyl diphosphate), and manganese is taken up by the hepatocytes with high affinity and selectivity. The ligand fodipir is distributed to the extracellular fluid and later eliminated via u... Read more

Absorption

Mangafodipir is taken up by the liver and pancreas where the contrast enhancement effect is mediated.

Protein binding

The protein binding of manganese is approximately 27% but negligible for fodipir [8]. Manganese is transported to the liver via α2-macroglobulin and to a lesser e... Read more

Volume of distribution

The volume of distribution for manganese is between 0.5 and 1.5 l/kg, and 0.17 to 0.45 l/kg for fodipir (dipyridoxyl diphosphate) [8]. Fodipir is distributed rapi... Read more

Clearance

The approximate total clearance of radiolabeled mangafodipir is 3.1 mL/min kg in dogs [ Read more

Half life

The mean initial plasma half-life of manganese metals is approximately 20 minutes and 50 minutes for fodipir (dipyridoxyl diphosphate, DPDP) [8].

Route of elimination

Fodipir is predominantly eliminated via urine within 24 hours where up to 25% of administered fodipir is excreted into feces. Manganese is mainly excreted into feces where renal elimination is about 15-20% of the dose [ Read more

Toxicity

Common adverse effects include headache, nausea and feeling of warmth or flushing. Other uncommon side effects include hypersensitivity reactions, fever, diarrhea, vomiting, dizziness, palpitations, paraesthesia, abdominal pain, and taste sensations. There is no identified antidote in case of overdo... Read more

Adverse Effects

Contraindications

Information currently not available.

Food Interactions

    Information currently not available.

Interactions

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  • Paracetamol(acetaminophen)
  • Paxil(paroxetine)
  • Pamelor(nortriptyline)
  • Panadol(acetaminophen)
  • Patanol(olopatadine ophthalmic)
  • Pataday(olopatadine ophthalmic)
  • Parnate(tranylcypromine)
  • Pazeo(olopatadine ophthalmic)
Abacavir
Abacavir may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Acarbose
Acarbose may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Aceclofenac
Aceclofenac may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Acemetacin
Acemetacin may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Acetaminophen
Acetaminophen may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Acetazolamide
Acetazolamide may increase the excretion rate of Mangafodipir which could result in a lower serum level and potentially a reduction in efficacy.
Acetylsalicylic acid
Acetylsalicylic acid may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Aclidinium
Mangafodipir may decrease the excretion rate of Aclidinium which could result in a higher serum level.
Acrivastine
Mangafodipir may decrease the excretion rate of Acrivastine which could result in a higher serum level.
Acyclovir
Acyclovir may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Adefovir
Adefovir may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Adefovir dipivoxil
Adefovir dipivoxil may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Albutrepenonacog alfa
Mangafodipir may decrease the excretion rate of Albutrepenonacog alfa which could result in a higher serum level.
Alclofenac
Alclofenac may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Aldesleukin
Aldesleukin may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Allopurinol
Allopurinol may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Allylestrenol
Allylestrenol may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Almasilate
Mangafodipir may decrease the excretion rate of Almasilate which could result in a higher serum level.
Alminoprofen
Alminoprofen may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
Almotriptan
Almotriptan may decrease the excretion rate of Mangafodipir which could result in a higher serum level.
9 References
  1. 1 . Wang C: Mangafodipir trisodium (MnDPDP)-enhanced magnetic resonance imaging of the liver and pancreas. Acta Radiol Suppl. 1998;415:1-31.PubMed: 9571956
  2. 2 . Hirt D, Richardet JP, Urien S, Poupon J, Sogni P, Batteux F, Laurent A, Pavlovic S, Debray M, Treluyer JM, Weill B: Pharmacokinetic-pharmacodynamic modeling of manganese after a single intravenous infusion of mangafodipir in patients with acute alcoholic hepatitis. Ther Drug Monit. 2009 Oct;31(5):557-65. doi: 10.1097/FTD.0b013e3181affd6d.PubMed: 19834427
  3. 3 . Toft KG, Hustvedt SO, Grant D, Martinsen I, Gordon PB, Friisk GA, Korsmo AJ, Skotland T: Metabolism and pharmacokinetics of MnDPDP in man. Acta Radiol. 1997 Jul;38(4 Pt 2):677-89.PubMed: 9245963
  4. 4 . Hustvedt SO, Grant D, Southon TE, Zech K: Plasma pharmacokinetics, tissue distribution and excretion of MnDPDP in the rat and dog after intravenous administration. Acta Radiol. 1997 Jul;38(4 Pt 2):690-9.PubMed: 9245964
  5. 5 . Eser G, Karabacakoglu A, Karakose S, Eser C, Kayacetin E: Mangafodipir trisodium-enhanced magnetic resonance imaging for evaluation of pancreatic mass and mass-like lesions. World J Gastroenterol. 2006 Mar 14;12(10):1603-6.PubMed: 16570354
  6. 6 . Karabacakoglu A, Adiguzel Y, Karakose S, Kayacetin E, Haykir R: Characterization of focal liver lesions: use of mangafodipir trisodium (MnDPDP)-enhanced MR images. Turk J Gastroenterol. 2006 Sep;17(3):164-71.PubMed: 16941248
  7. 7 . Colet JM, Vander Elst L, Muller RN: Dynamic evaluation of the hepatic uptake and clearance of manganese-based MRI contrast agents: a 31P NMR study on the isolated and perfused rat liver. J Magn Reson Imaging. 1998 May-Jun;8(3):663-9.PubMed: 9626883
  8. 8 . European Medicines Agency (EMA): TESLASCAN Summary of Product Characteristics Link
  9. 9 . European Medicines Agency (EMA): TESLASCAN Scientific Discussion Link