Adult Dosing
Growth hormone deficiency (GHD)
- Weight-based dosing
- Start 0.006 mg/kg/day SC; titrate gradually as needed to a max of 0.0125 mg/kg/day
- Max: 0.0125 mg/kg/day
- Non-weight-based dosing for obese individuals
- Start 0.2 mg/day (range: 0.15-0.30 mg/day) SC; may gradually increase dose q1-2 months by increments of approximately 0.1-0.2 mg/day
Notes:
- 1 mg of somatropin is equivalent to approximately 3 IU
- Rotate the site of injections regularly to help prevent lipoatrophy
- Consider a lower starting dose and smaller dose titration in elderly patients
Pediatric Dosing
Growth hormone deficiency (GHD)
- 0.18-0.30 mg/kg/wk SC divided 6-7 days/wk; discontinue when epiphyses close or when patient reaches satisfactory height
- Max: 0.043 mg/kg/day
Short stature associated with Turner Syndrome
- Up to 0.375 mg/kg/wk SC divided 6-7 days/wk; discontinue when epiphyses close or when patient reaches satisfactory height
- Max: 0.054 mg/kg/day
SHOX deficiency
- 0.35 mg/kg/wk divided 6-7 days/wk; discontinue when epiphyses close or when patient reaches satisfactory height
- Max: 0.050 mg/kg/day
Idiopathic short stature
- Up to 0.37 mg/kg/wk SC divided 6-7 days/wk; discontinue when epiphyses close or when patient reaches satisfactory height
- Max: 0.053 mg/kg/day
SGA-associated growth failure (for children who fail to manifest catch-up growth by 2-4 yrs)
- Up to 0.47 mg/kg/wk SC divided 6-7 days/wk; discontinue when epiphyses close or when patient reaches satisfactory height
- May gradually decrease dose to 0.033 mg/kg/day if substantial catch-up growth is noted during the first few years of therapy
- Start: 0.033 mg/kg/day in younger SGA children <4 yrs of age with less severe short stature and titrate the dose as needed
- Max: 0.067 mg/kg/day
Notes:- 1 mg of somatropin is equivalent to approximately 3 IU
- Rotate the site of injections regularly to help prevent lipoatrophy
[Outline]
See Supplemental Patient Information
- Therapy should be directed by physicians who are well trained in the diagnosis and management of pediatric patients with growth hormone deficiency, Turner syndrome, SGA, SHOX deficiency, ISS, or adults with childhood-onset or adult-onset GHD
- Somatropin therapy increases mortality in patients with acute critical illness due to complications following open heart surgery, abdominal surgery, acute respiratory failure, or multiple accidental trauma. The potential benefit of treatment continuation with somatropin in patients experiencing acute critical illnesses should be weighed against the potential risk
- Fatalities have been reported following therapy initiation in pediatric patients with Prader-Willi syndrome (PWS) having one or more of the following risk factors: severe obesity, unidentified respiratory infection, or history of upper airway obstruction or sleep apnea; male patients with one or more of these factors are more prone to such fatalities
- Evaluate patients with PWS for signs of upper airway obstruction and sleep apnea before treatment initiation with somatropin; interrupt therapy if such signs develop during treatment
- Effective weight control measures should be considered in patients with PWS treated with somatropin. Monitor for signs of respiratory infection, which should be diagnosed at the earliest and treated aggressively
- Routinely examine patients with preexisting tumors or growth hormone deficiency secondary to an intracranial lesion for progression or recurrence of the underlying disease process. Increased risk of a second neoplasm has been reported in childhood cancer survivors treated with somatropin following their first neoplasm. Intracranial tumors, particularly meningiomas, have occurred in patients treated with radiation to the head for their first neoplasm. Carefully monitor patients for any malignant transformation of skin lesions
- Therapy may decrease insulin sensitivity, particularly at higher doses in susceptible patients. Monitor glucose levels periodically in all patients receiving therapy, especially in those with risk factors for diabetes mellitus, including obesity, Turner syndrome, or a family history of diabetes mellitus
- Closely monitor patients with preexisting type 1 or type 2 diabetes mellitus or impaired glucose tolerance; if required, adjust doses of antihyperglycemic drugs when somatropin therapy is initiated in these patients
- Intracranial hypertension (IH) with papilledema, visual changes, headache, and other signs have been reported with somatropin therapy; perform funduscopic examination before initiating treatment to exclude preexisting papilledema and periodically during the course of somatropin therapy
- Discontinue treatment if papilledema is observed by funduscopy and restart at a lower dose after IH-associated signs and symptoms have resolved
- Patients with Turner syndrome are more susceptible for the development of IH
- Fluid retention may occur frequently in adult patients during somatropin replacement therapy
- Closely monitor patients with hypopituitarism (multiple pituitary hormone deficiencies) during somatropin treatment
- Undiagnosed/untreated hypothyroidism may prevent an optimal response to somatropin, particularly, the growth response in children. Patients with Turner syndrome posses an increased risk of developing autoimmune thyroid disease and primary hypothyroidism
- Periodically perform thyroid function tests during therapy; initiate thyroid hormone replacement therapy or appropriately adjust the dose when indicated
- Pediatric patients with the onset of a limp or complaints of hip or knee pain during somatropin therapy should be carefully evaluated, as slipped capital femoral epiphyses may occur more frequently in patients with endocrine disorders or in patients undergoing rapid growth
- Patients with a history of scoliosis who are treated with somatropin should be monitored for progression of scoliosis as somatropin increases growth rate. Scoliosis is commonly seen in untreated patients with PWS; hence, physicians should be alert to these abnormalities, which may manifest during therapy
- Therapy may be associated with an increased risk of ear and hearing disorders. Therefore, patients with Turner syndrome should be evaluated carefully for otitis media and other ear disorders
- Closely monitor patients with Turner syndrome for cardiovascular disorders such as stroke, hypertension, and aortic aneurysm as they are at an increased risk for these conditions
- Rare cases of pancreatitis have been reported in children and adults receiving therapy; girls with Turner syndrome are more susceptible to this risk
- Local or systemic allergic reactions may occur during therapy. Inform parents/patients that such reactions are possible and prompt medical attention should be sought on occurrence of these allergic reactions
- Rotate the injection site of somatropin as it can cause tissue atrophy if administered subcutaneously at the same site over a long period of time
- Serum levels of inorganic phosphorus, alkaline phosphatase, parathyroid hormone (PTH) and IGF-I may increase after somatropin therapy
Cautions: Use cautiously in:
- Neonates
- Geriatric patients
Supplemental Patient Information
- Inform patients and caregivers about the potential benefits and risks associated with somatropin therapy
- Instruct patients and caregivers regarding the importance of proper disposal of used needles and syringes; strongly recommend a puncture-resistant container for the disposal of such materials
Pregnancy Category:C
Breastfeeding: Safety unknown. Limited data indicate that exogenous somatropin is not expected to cause any adverse effects in breastfed infants of mothers who receive somatropin. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 1 February 2011). Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Humatrope 5 MG SOLR [Vial] (LILLY)
1 mg = $402.96
3 mg = $1175.91 - Humatrope 6 MG SOLR [Cartridge] (LILLY)
1 mg = $486
3 mg = $1427.03 - Humatrope 12 MG SOLR [Cartridge] (LILLY)
1 mg = $980.02
3 mg = $2900.07 - Humatrope 24 MG SOLR [Cartridge] (LILLY)
1 mg = $1960.05
3 mg = $5596.85
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
