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    • Why does stability matter?

    A GBCA with proven efficacy

    • Incidence of immediate allergic reactions with gadoterate meglumine

    Package and ordering information

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    Supporting Materials

    1. Port M, Idée JM, Medina C, Robic C, Sabatou M, Corot C. Efficiency, thermodynamic and kinetic stability of marketed gadolinium chelates and their possible clinical consequences: a critical review. Biometals. 2008;21(4):469-490.
    2. Frenzel T, Lengsfeld P, Schirmer H, Hütter J, Weinmann HJ. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C. Invest Radiol. 2008;43(12):817-828.
    3. Data on File. GE Healthcare Clariscan Status; October 2020
    4. Data on File, GE Healthcare Investment 2018
    5. Lersy F, Boulouis G, Clément O, et al. Consensus Guidelines of the French Society of Neuroradiology (SFNR) on the use of Gadolinium-Based Contrast agents (GBCAs) and related MRI protocols in Neuroradiology. J Neuroradiol. 2020;47(6):441-449.
    6. Eisele P, Alonso A, Szabo K, et al. Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis: An observational study. Medicine (Baltimore). 2016;95(39):e4624.
    7. Radbruch A, Weberling LD, Kieslich PJ, et al. Intraindividual Analysis of Signal Intensity Changes in the Dentate Nucleus After Consecutive Serial Applications of Linear and Macrocyclic Gadolinium-Based Contrast Agents. Invest Radiol. 2016;51(11):683-690.
    8. Radbruch A, Weberling LD, Kieslich PJ, et al. High-Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Images: Evaluation of the Macrocyclic Gadolinium-Based Contrast Agent Gadobutrol. Invest Radiol. 2015;50(12):805-810.
    9. Clariscan [prescribing information]. Marlborough, MA GE Healthcare;2020.
    10. Maravilla KR, San-Juan D, Kim SJ, et al. Comparison of Gadoterate Meglumine and Gadobutrol in the MRI Diagnosis of Primary Brain Tumors: A Double-Blind Randomized Controlled Intraindividual Crossover Study (the REMIND Study). AJNR Am J Neuroradiol. 2017;38(9):1681-1688.
    11. Behzadi AH, Zhao Y, Farooq Z, Prince MR. Immediate Allergic Reactions to Gadolinium-based Contrast Agents: A Systematic Review and Meta-Analysis. Radiology. 2018 Feb;286(2):731. doi: 10.1148/radiol.2017174037. Erratum for: Radiology. 2018 Feb;286(2):471-482. PMID: 29356629.
    12. Marshall G. Sharps injuries among radiographers: Dangers associated with opening bottles of contrast agent. Radiography (Lond). 2008; 14(2): 128-134.
    13. Data on file. GE Healthcare Inspection; 2018
    14. Data on file. GE Healthcare Quality; 2018

     

    Case study images courtesy of Lawrence N. Tanenbaum, MD FACR and RadNet. Dr.Tanenbaum is a consultant of GE Healthcare.

    GE, the GE Monogram, and Clariscan are trademarks of General Electric Company.
    Any third-party trademarks are the property of their respective owners.

    JB00313US |  JUNE 2021 

    IMPORTANT SAFETY INFORMATION ABOUT CLARISCAN™

    WARNING: NEPHROGENIC SYSTEMIC FIBROSIS (NSF)
    Gadolinium-based contrast agents (GBCAs) increase the risk for NSF among patients with impaired elimination of the drugs. Avoid use of GBCAs in these patients unless the diagnostic information is essential and not available with non-contrasted MRI or other modalities. NSF may result in fatal or debilitating fibrosis affecting the skin, muscle, and internal organs.
    • The risk for NSF appears highest among patients with:
      • Chronic, severe kidney disease (GFR <30 mL/min/1.73 m2), or
      • Acute kidney injury
    • Screen patients for acute kidney injury and other conditions that may reduce renal function. For patients at risk for chronically reduced renal function (e.g. age > 60 years, hypertension, diabetes), estimate the glomerular filtration rate (GFR) through laboratory testing.
    • For patients at highest risk for NSF, do not exceed the recommended Clariscan dose and allow a sufficient period of time for elimination of the drug from the body prior to any re-administration.

     

    CONTRAINDICATIONS
    History of clinically important hypersensitivity reactions to Clariscan.

    Warnings and precautions

    • Nephrogenic Systemic Fibrosis (NSF): 
      • NSF has occurred in patients with impaired elimination of GBCAs. Higher than recommended dosing or repeat dosing appear to increase the risk.
         
    • Hypersensitivity reactions:  
      • Anaphylactic and anaphylactoid reactions have been reported with gadoterate meglumine, involving cardiovascular, respiratory, and/or cutaneous manifestations. Some patients experienced circulatory collapse and died. In most cases, initial symptoms occurred within minutes of gadoterate meglumine administration and resolved with prompt emergency treatment.
      • Before Clariscan administration, assess all patients for any history of a reaction to contrast media, bronchial asthma and/or allergic disorders. These patients may have an increased risk for a hypersensitivity reaction to Clariscan.
      • Administer Clariscan only in situations where trained personnel and therapies are promptly available for the treatment of hypersensitivity reactions, including personnel trained in resuscitation.

    • Gadolinium retention:   
      • Gadolinium is retained for months or years in several organs. The highest concentrations have been identified in the bone, followed by brain, skin, kidney, liver and spleen. The duration of retention also varies by tissue and is longest in bone. Linear GBCAs cause more retention than macrocyclic GBCAs.
      • Consequences of gadolinium retention in the brain have not been established. Adverse events involving multiple organ systems have been reported in patients with normal renal function without an established causal link to gadolinium retention.
         
    • Acute kidney injury:  
      • In patients with chronically reduced renal function, acute kidney injury requiring dialysis has occurred with the use of GBCAs. The risk of acute kidney injury may increase with increasing dose of the contrast agent; administer the lowest dose necessary for adequate imaging.
          
    • Extravasation and injection site reactions:  
      • Ensure catheter and venous patency before the injection of Clariscan. Extravasation into tissues during Clariscan administration may result in tissue irritation.
    • Pre-filled syringes must not be frozen. Frozen syringes should be discarded.

    Pharmacy Bulk Package Preparation: 

    • Do not use the Pharmacy Bulk Package for direct intravenous infusion.
    • Do not use if tamper-evident ring is broken or missing.
    • Perform the transfer of Clariscan from the Pharmacy Bulk Package in an aseptic work area, such as laminar flow hood and using aseptic technique and suitable transfer device. Penetrate the closure only one time.
    • Once the container closure is punctured, do not remove the Pharmacy Bulk Package from the aseptic work area.
    • The Pharmacy Bulk Package is used as a multiple dose container with an appropriate transfer device for filling empty sterile syringes.
    • Use each individual dose of Clariscan promptly following withdrawal from the Pharmacy Bulk Package.
    • Use the contents of the Pharmacy Bulk Package within 24 hours after initial puncture.
    Adverse reactions
    • The most common adverse reactions (≥ 0.2%) associated with gadoterate meglumine in clinical trials were nausea, headache, injection site pain, injection site coldness and rash.
    • Serious adverse reactions in the postmarketing experience have been reported with gadoterate meglumine. These serious adverse reactions include but are not limited to: arrhythmia, cardiac arrest, respiratory arrest, pharyngeal edema, laryngospasm, bronchospasm, coma and convulsion.

    Use in specific populations

    • Pregnancy: Because of the potential risks of gadolinium to the fetus, use Clariscan only if imaging is essential during pregnancy and cannot be delayed. Advise pregnant women of the potential risk of fetal exposure to GBCAs.
    • Lactation: While no data is available for gadoterate meglumine, published lactation data on other GBCAs indicate that 0.01 to 0.04% of the maternal gadolinium dose is present in breast milk.
    • Pediatric Use: The safety and efficacy of gadoterate meglumine at a single dose of 0.1 mmol/kg have been established in pediatric patients from birth (term neonates ≥ 37 weeks gestational age) to 17 years of age based on clinical data in 133 pediatric patients 2 years of age and older, and clinical data in 52 pediatric patients birth to less than 2 years of age that supported extrapolation from adult data. Safety of gadoterate meglumine has not been established in preterm neonates.

    Please read the full Prescribing Information for Clariscan including Boxed Warning and the full Prescribing Information including Boxed Warning for Clariscan Pharmacy Bulk Package, which includes the patient Medication Guide for additional important safety information.

    To report SUSPECTED ADVERSE REACTIONS, contact GE Healthcare at 800-654-0118 or the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

    *This pointer statement may change based on how the material is being presented

     

    CLARISCAN™ (gadoterate meglumine) injection for intravenous use

    PRODUCT INDICATIONS AND USE: 
    CLARISCAN™ (gadoterate meglumine) is a gadolinium-based contrast agent indicated for intravenous use with magnetic resonance imaging (MRI) in brain (intracranial), spine, and associated tissues in adult and pediatric patients (including term neonates) to detect and visualize areas with disruption of the blood brain barrier (BBB) and/or abnormal vascularity.