What are radiopharmaceuticals?

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Radiopharmaceuticals are drugs that carry a limited degree of radioactivity and are usually used in nuclear medicine as an alternative to standard radiation for the treatment of some cancers, as well as a diagnostic tool to allow for a better internal representation of some organs and arteries. They are usually only able to focus on a particular part of the body, which can make treatment much more effective – not to mention much more targeted – than regular radiation, which tends to focus on the whole body. Drugs in this class are usually very specialized and require a lot of equipment and experience to use. Most of the time, people only take them under the strict guidance of a doctor or health care provider, and they usually need to be monitored for as long as the drug is in the body. There are some risks and safety concerns, but when used correctly, these types of pharmaceuticals generally achieve good patient outcomes in most situations.

How do they work

This class of drugs is usually quite complex to manufacture since it requires not only a live radioactive element but also a targeted delivery mechanism. In most cases they are built around a radioactive isotope that can be safely injected into the body, which is then coupled with a carrier molecule to deliver that isotope in response to certain nerve or other signals in the body.

Once radiopharmaceuticals enter the body and travel to an organ, they begin to interact with that organ’s processes. Radioactivity is detected by cameras or computers and used to map the process. For example, an ultrasound can show a picture of an organ and reveal whether it has a tumor or other abnormality. Nuclear medicine can show how the process of glucose metabolism works in the organ.

Production basics

One popular nuclear ingredient is an isotope called technetium (Tc), the lightest known radioactive element, which is used in a variety of nuclear tests. Thallium-201 is used for cardiac stress testing. Other common nuclear components used include indium-111, gallium-67, iodine-123, iodine-131 and venom-133. These types of drugs usually have to be manufactured in specialized laboratories, but the radioactive portions that actually appear in individual doses are relatively small. Some degree of care and special handling is usually required during transit or shipping, but in most cases they are not considered a hazard.

As a diagnostic tool

Most nuclear medicine involves diagnostic tests. When radiopharmaceuticals are injected into the body, they give off radiation which can be tracked with special cameras or computers. The amount of radiation a patient is subjected to is about the same as a regular x-ray, but the information gathered is significantly different. Non-nuclear diagnostic methods, such as X-rays and ultrasounds, show the size and shape of a bone, organ, or tumor. Nuclear medicine allows a doctor to see how an organ works.

The drugs can affect almost any organ in the body and are common in brain scans, bone scans, heart stress tests and thyroid studies. Before testing, the radiopharmaceutical is administered to the patient orally, intravenously, or inhaled. Radioactive material is short-lived and either converts to a non-radioactive substance or passes through the body quickly.
In cancer treatments
These types of drugs are also often used for some cancer treatments, particularly when the disease is detected in its early stages. Part of this is because the radiation from these drugs does not harm cells that are growing at a normal rate, but it can destroy rapidly growing cells. When injected into tumors or growths they can kill harmful cells without disturbing their surroundings, for example, and a compound known as radioactive iodine (I-131) has traditionally been very effective in treating thyroid cancer since it can destroy the thyroid gland. growths without damaging anything else in the body. This is a stark contrast to standard radiation treatment, which typically affects all healthy cells.

In some cases, drugs can also be used to relieve pain associated with chronic conditions such as cancer, often by responding to internal nerve signals. A drug called Quadramet® is given intravenously to relieve pain caused by bone cancer, for example.
Necessary equipment
One of the biggest benefits of radioactive drugs is the way they show diagnosticians and healthcare professionals exactly what is going on inside a patient’s body in a very focused and limited way. Two of the most commonly used pieces of nuclear imaging equipment in this endeavor are positron emission tomography (PET) scans and single photon emission computed tomography (SPECT) scans. PET scanning uses cameras and computers to build three-dimensional images of the area being examined, while SPECT scanning creates cross-sectional images of an area. PET scanning typically emits gamma rays, while SPET emits photons which are converted into gamma rays. In both cases, patients are usually hooked up to a machine and monitored closely throughout the course of treatment.

Risks and worries
Drugs in this class tend to have more severe side effects and adverse reactions than most regular pharmaceuticals, but much of this goes hand in hand with the nature of what the drug is trying to do. Sensitivity of the skin, low red blood cell count, and general fatigue are some of the more common reactions, although more serious things like allergies have been reported, particularly when given intravenously. Swelling at the injection site and nausea are also common. In most cases pregnant women are discouraged from undergoing this type of treatment to avoid risks to their unborn babies.

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