INTRODUCTION:

1,1,1,2,2,3,3,3-octafluoropropane

Chemical structure of Perflutren:

The difference in density between the gas-filled bubbles and the blood around them creates an increased level of contrast visible in the resulting ultrasound image. During echocardiography, activated Perflutren enhances images of the inner edges or borders of the heart, producing an improved image that may enable physicians to better diagnose patients.

Perflutren is a fluorinated hydrocarbon and gaseous substance used as an imaging contrast agent. After administration in microsphere form, perflutren exhibits lower acoustic impedance than blood and improves ultrasound signaling.

Perflutren is a Contrast Agent for Ultrasound Imaging. The mechanism of action of perflutren is as an Ultrasound Contrast Activity.⁽^1,2)

Pharmacodynamics:

Perflutren, a diagnostic drug that is intended to be used for contrast enhancement during the indicated echocardiographic procedures, comprised of lipid-coated microspheres filled with octafluoropropane (OFP) gas. It provide contrast enhancement of the endocardial borders during echocardiography. The perflutren lipid microspheres exhibit lower acoustic impedance than blood and enhance the intrinsic backscatter of blood.

Mechanism of action:

Perflutren is comprised of gas-filled microspheres that are injected or infused into the body. When exposed to ultrasound waves, the microspheres resonate and "echo" strong signals back to the ultrasound machine. The difference in density between the gas-filled bubbles and the blood around them creates an increased level of contrast visible in the resulting ultrasound image. During echocardiography, activated Perflutren enhances images of the inner edges or borders of the heart, producing an improved image that may enable physicians to better diagnose patients.⁽^1,2)

Indication:

Used as an ultrasound contrast imaging in cardiology and radiology.

Metabolism:

OFP is not metabolized. The phospholipid components of the microspheres are thought to be metabolized to free fatty acids.

Half life:

The mean half-life of OFP in blood 1.9 minutes.

Toxicity:

There is new temporal evidence that perflutren may be associated with new-onset seizure activity following perflutren microbubble contrast injection during dobutamine-atropine stress echocardiography. [PMID: 23432576].⁽^1,2,3,)

Side effects:

Get emergency medical help if you have any of these signs of an allergic reaction: hives, skin redness, itching; warmth, redness, numbness, or tingly feeling; wheezing, trouble breathing, tight feeling in your chest or throat; swelling of your face, lips, tongue, or throat.

In rare cases, serious or fatal reactions may occur during the injection or shortly afterward. Tell your caregivers right away if you have:

· A light-headed feeling, like you might pass out;

· Severe dizziness, or a cold sweat;

· Chest pain, wheezing, trouble breathing;

· Fast or slow heartbeats;

· Severe headache, blurred vision, pounding in your neck or ears, anxiety, confusion; or

· Slow heart rate, weak pulse, fainting, weak or shallow breathing.

You may be more likely to have a serious reaction if you have severe or uncontrolled heart problems (congestive heart failure, a recent heart attack, serious heart rhythm disorder).

Common side effects may include:

· Headache, dizziness;

· Flushing (warmth, redness, or tingly feeling);

· Nausea;

· Chest pain;

· Pain in your side or lower back; or

· Pain, swelling, or irritation where the injection was given.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.⁽^1,2)

Uses:

Perflutren is an ultrasound contrast agent that is used to improve the quality of an echocardiogram (ultrasound of the heart). Perflutren works by changing the way ultrasound waves travel within your heart. This helps the ultrasound portray a sharper image of your heart.

Perflutren is used to allow certain segments of the heart to be seen more clearly on an echocardiogram.

Perflutren may also be used for purposes not listed in this medication guide.

Before taking this medicine:

You should not be treated with perflutren if you are allergic to it, or if you have: a genetic heart condition called "cardiac shunt"; or if you are allergic to blood products or to a medicine that contains albumin. To make sure perflutren is safe for you, tell your doctor if you have:

· A congenital heart defect;

· A lung condition that has recently become worse; or

· If you have ever had an allergic reaction during a blood transfusion.

It is not known whether perflutren will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether perflutren passes into breast milk or if it could harm a nursing baby. However, if you are breast-feeding a baby, use a breast pump to empty your milk supply one time after you are treated with perflutren. Throw out the milk you collect during this time and do not feed it to your baby.

Perflutren is made from human plasma (part of the blood) which may contain viruses and other infectious agents. Donated plasma is tested and treated to reduce the risk of it containing infectious agents, but there is still a small possibility it could transmit disease. Talk with your doctor about the risks and benefits of using this medication.⁽^1,2)

CONCLUSIONS:

Perflutren, a diagnostic drug that is intended to be used for contrast enhancement during the indicated echocardiographic procedures, is comprised of lipid-coated microspheres filled with octafluoropropane(OFP) gas. When exposed to ultrasound waves, the microspheres resonate and "echo" strong signals back to the ultrasound machine. The difference in density between the gas-filled bubbles and the blood around them creates an increased level of contrast visible in the resulting ultrasound image. During echocardiography, activated Perflutren enhances images of the inner edges or borders of the heart, producing an improved image that may enable physicians to better diagnose patients.⁽^1,2)

REFERENCES:

1. Quinones A, Benenstein R, Saric M: New-onset seizure after perflutren microbubble injection during dobutamine stress echocardiography. Echocardiography. 2013 Apr; 30(4):E95-7. doi: 10.1111/echo.12149. Epub 2013 Feb 22. [PubMed:23432576]

2. https://www.drugbank.ca/drugs/DB00799

3. James L. Webster, Steven H. Swearingen, Douglas W. Bruhnke, Leo E. Manzer, Elrey L. McCann, "Synthesis of perfluoropropane." U.S. Patent US5220083, issued August, 1967.US5220083

4. Fowler RD, Buford III WB, Hamilton Jr JM, Sweet RG, Weber CE, Kasper JS, Litant I (1947)."Synthesis of Fluorocarbons". Ind. Eng. Chem. 39 (3): 292–298. doi:10.1021/ie50447a612.

5. Coburn, J. W. (1982). "Plasma-assisted etching". Plasma Chemistry and Plasma Processing. 2 (1): 1–41. doi:10.1007/BF00566856.

6. D. Rogers (17–21 October 2005). Studies in the Future of Experimental Terraforming (PDF). 56th International Astronautical Congress of the International Astronautical Federation. Fukuoka, Japan: International Academy of Astronautics, and the International Institute of Space Law.

Received on 27.05.2019 Accepted on 30.06.2019

Asian J. Pharm. Res. 2019; 9(3):190-192.

DOI: 10.5958/2231-5691.2019.00030.3