Ioflupane (123i) Rotop (Ioflupane (123i))

Ioflupane is used in the diagnostic pathway that assesses dopaminergic neuronal integrity in movement‑disorder patients.

• Parkinsonian syndromes: enables visualization of presynaptic dopamine transporter loss to support diagnosis.
• Atypical parkinsonian disorders: assists in distinguishing Parkinson disease from other neurodegenerative movement disorders.
• Neurodegenerative disease assessment: provides quantitative data on dopaminergic neuronal integrity for research and clinical monitoring.

• Ioflupane is a radiolabelled analogue that binds selectively to presynaptic dopamine transporters (DAT) in the striatum. After intravenous injection, the iodine‑123 isotope emits gamma photons that are captured by single‑photon emission computed tomography (SPECT), producing high‑resolution images of DAT density and thereby reflecting the functional status of dopaminergic neurons.

Adverse reactions to Ioflupane are generally related to its radiopharmaceutical nature and the injection procedure.

Common Side Effects

• Headache: transient mild headache reported after injection.
• Nausea: occasional upset stomach or nausea.
• Injection site pain: mild discomfort at the venipuncture site.

Serious or Rare Side Effects

• Allergic reaction: urticaria, bronchospasm, or anaphylaxis requiring immediate medical attention.
• Severe hypotension: marked drop in blood pressure following administration.
• Radiation‑induced thyroid dysfunction: rare alteration of thyroid function due to iodine‑123 exposure.

When using Ioflupane, consider the following safety measures.

• Pregnancy: safety not established; avoid unless benefit outweighs risk.
• Breastfeeding: unknown; consider discontinuing nursing during treatment.
• Renal impairment: reduced clearance may affect image quality; evaluate renal function.
• Thyroid disease: assess thyroid function before use because of iodine load.
• Concomitant iodine‑containing drugs: may interfere with imaging; discontinue when feasible.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Ioflupane may interact with other substances that affect iodine handling or dopamine pathways.

Major Interactions (Avoid)

• Iodine‑containing contrast agents: can block DAT binding and compromise imaging.
• Amiodarone or other high‑iodine medications: may reduce tracer uptake.
• Antipsychotics that block dopamine transporters: interfere with binding and image interpretation.

Moderate Interactions (Monitor Closely)

• MAO‑B inhibitors: may modestly alter DAT availability.
• Levodopa therapy: may affect background signal; timing of administration should be considered.