Luminity is a preparation containing Perflutren lipid microspheres that are used as an ultrasound contrast agent for better evaluation.

Luminity (Perflutren lipid microspheres) Uses:

• Cardiovascular imaging:

  • Opacification of the left ventricular chamber and improvement of delineation of the left ventricular endocardial border in patients with suboptimal echocardiograms

• Use: Off-Label: Adult

  • Focal liver lesion evaluation

Luminity (Perflutren lipid microspheres) Dose in Adults

Luminity (Perflutren lipid microspheres) Dose in Cardiovascular imaging:

• Dose should be given following baseline performing non contrast echocardiography.
• Imaging should begin immediately the following dose and should be compared to non-contrast images.
• Mechanical index for the ultrasound device should be set at ≤0.8.

IV bolus:

• 10 microliters (mcL)/kg of activated product, followed by 10 mL normal saline flush;
• The dose may be repeated in 30 minutes (followed by 10 mL saline flush) if needed (maximum dose per imaging study: 2 bolus doses)

IV infusion:

• Initial: at 4 mL/minute (or 240 mL/hour) of prepared infusion;
• titrate to achieve optimal image (maximum dose per imaging study: 1 IV infusion)

Luminity (Perflutren lipid microspheres) Dose in the evaluation of focal liver lesions:

• IV bolus:
  • 0.1 to 0.6 mL per injection followed by a 5 mL saline flush;
  • The dose may be repeated at a minimum of every 5 minutes (ie, when most microbubbles have vanished) up to a total dose of 10 microliters (mcL)/kg.

Luminity (Perflutren lipid microspheres) Dose in Childrens

Not indicated in children.

Pregnancy Risk Category B

• Due to the very short half-life, administration to pregnant women is not expected to result in clinically relevant fetal exposure.

Perflutren lipid use during breastfeeding:

• It is not known if perflutren lipid microspheres are present in breast milk.
• According to the drug manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
• The very short half-life should limit exposure to breast milk.

Luminity (Perflutren lipid microspheres) Dose in Kidney Disease:

• There are no dosage adjustments provided in the drug manufacturer's labeling.

Luminity (Perflutren lipid microspheres) Dose in Liver Disease:

• There are no dosage adjustments provided in the drug manufacturer's labeling (has not been studied).

Side Effects of Luminity (Perflutren lipid microspheres):

• Cardiovascular:

  • Flushing

• Central nervous system:

  • Headache

• Gastrointestinal:

  • Nausea

• Neuromuscular & skeletal:

  • Back pain

• Renal:

  • Renal pain

Contraindication to Luminity (Perflutren lipid microspheres):

• Hypersensitivity/Allergy to perflutren or to any component of the formulation.

Warnings and Precautions

• Anaphylactoid reactions:

  • Postmarketing reports of anaphylactoid reactions (eg, shock, hypersensitivity, bronchospasm, throat tightness, angioedema, edema [oropharyngeal, palatal, peripheral, and localized], swelling [face, eye, lip, tongue, upper airway], facial hypoesthesia, rash, urticaria, pruritus, flushing, and erythema) have been reported in patients with no prior exposure.
  • Monitor for signs and symptoms of anaphylactoid reactions.

• Serious cardiopulmonary reactions: [US Boxed Warning]:

  • Serious cardiopulmonary reactions (including fatalities) have been noted during or following administration; most serious reactions occur within 30 minutes of administration.
  • Assessment of all patients for the presence of any condition that can preclude administration.
  • Equipment for resuscitation and trained personnel experienced in handling medical emergencies should always be available on hand.
  • The risk of serious reactions may be increased in patients with unstable cardiopulmonary conditions (eg, acute MI, acute coronary artery syndromes, worsening or unstable HF, serious ventricular arrhythmias).
  • However, multiple retrospectives and prospective studies involving the use of perflutren-based ultrasound contrast agents have suggested that these may be safe for use in patients with significant cardiopulmonary disease (ie, acute coronary syndromes, heart failure, COPD, pulmonary hypertension) or critical illness.

• Ventricular arrhythmias:

  • High ultrasound mechanical indices with or without end-systolic triggering may cause microsphere cavitation or rupture and lead to ventricular arrhythmias.
  • Safety of activated perflutren lipid microspheres with mechanical indices >0.8 or use of end-systolic triggering has not been established.

• Cardiac shunts:

  • Assessment of patients with cardiac shunts should be done for embolic phenomena following administration;
  • perflutren lipid microspheres can bypass filtering by the lung and enter the arterial circulation.
  • Patients with small degrees of right-to-left shunting through patent foramen ovales (those that result in the transient appearance of saline contrast in the left atrium or ventricle and do not fill the left atrial or LV cavity) are not supposed to be at an increased risk for microvascular occlusion with perflutren-based ultrasound contrast agents.

Monitoring Parameters:

• Cardiopulmonary reactions (rare);
• signs and symptoms of anaphylactoid reactions (rare).
• Monitor patient as appropriate depending upon patient clinical disposition;
• specific monitoring parameters that are based upon perflutren lipid microspheres administration are not important.

How to administer Luminity (Perflutren lipid microspheres)?

• IV bolus (undiluted):

  • Cardiovascular imaging:

    • Administer only after activation in the Vialmix apparatus.
    • Administer within 30 to 60 seconds of activation;
    • follow each injection with a 10 mL normal saline flush.

  • Focal liver lesion evaluation (off-label use):

    • Administer only after activation in the Vialmix apparatus.
    • Follow each injection with a 5 mL normal saline flush.

IV bolus (diluted):

• Administer only after activation in the Vialmix apparatus.
• Administer slowly up to 3 mL of the solution;
• subsequent boluses of 1 to 2 mL may be used as required.

IV infusion rate:

• Initially, at 4 mL/minute (or 240 mL/hour) up to 10 mL/minute (or 600 mL/hour);
• adjust flow rate for optimal image enhancement.

Mechanism of action of Luminity (Perflutren lipid microspheres):

• Activated perflutren lipid microspheres give contrast enhancement of the endocardial borders while performing echocardiography.

The onset of action:

• Immediate

Duration:

• IV bolus: 3.4 minutes; IV infusion: 7.1 minutes

Metabolism:

• Octafluoropropane gas (OFP): Not metabolized;
• Phospholipid component: Metabolized to free fatty acids

Half-life elimination:

• OFP:
  • 1.3 minutes (healthy patients);
  • 1.9 minutes (patients with COPD)

International Brands of Perflutren lipid microspheres:

• Definity
• Luminity
• Lumminity

Perflutren lipid microspheres Brand Names in Pakistan:

No Brands Available in Pakistan.