lanreotide

REMS

Long-term management of acromegaly that cannot be treated by or has not responded to surgery and/or radiation therapy.
Unresectable, well- or moderately differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Carcinoid syndrome.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Lactation: Lactation.

Use Cautiously in:

Diabetes;
Underlying heart disease, especially bradycardia;
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, hypertension

Endo: hyperglycemia, hypoglycemia, hypothyroidism

GI: abdominal pain, cholelithiasis, diarrhea, abdominal bloating, cholecystitis, fat malabsorption, PANCREATITIS, steatorrhea, stool discoloration

Hemat: anemia

Local: injection site reactions

Metab: weight loss

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

↑risk of bradycardia with other drugs that may cause heart rate, including beta blockers.
May ↓ absorption of cyclosporine (dose adjustment may be necessary).
May alter the effects of antidiabetic agents (monitor blood sugar).
May ↓ activity or CYP450 enzyme system; use cautiously with drugs metabolized by that system, including quinidine.

Availability ⬆ ⬇

(Generic available)

Semisolid for injection (prefilled syringes): 60 mg/0.2 mL; 60 mg/0.5 mL; 90 mg/0.3 mL; 90 mg/0.5 mL; 120 mg/0.5 mL

Route/Dosage ⬆ ⬇

Acromegaly

SC (Adults ): 90 mg every 4 wk for 3 mo; further adjustments are made on the basis of GH and IGF-1 levels as follows: GH > 1 to ≤2.5 ng/mL, IGF-1 normal with good symptom control: maintain dose at 90 mg every 4 wk;GH >2.5 ng/mL, IGF-1 elevated and/or uncontrolled symptoms: ↑dose to 120 mg every 4 wk; GH ≤1 mg/mL, IGF-1 symptoms currently controlled : ↓dose to 60 mg every 4 wk.

Hepatic/Renal Impairment

SC (Adults ): CCr <60 mL/min or moderate to severe hepatic impairment: 60 mg every 4 wk; further adjustments are made on the basis of GH and IGF-1 levels.

GEP-NETs and Carcinoid Syndrome

SC (Adults ): 120 mg every 4 wk.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Acts as an analog of somatostatin, inhibiting growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in patients with acromegaly. Also inhibits secretion of variety of other hormones secreted throughout gastrointestinal tract, including motilin, gastric inhibitory peptide, pancreatic polypeptide, gastrin, and cholecystokinin, which could be fueling tumor growth.

Therapeutic effects:

Decreased levels of GH and IGF-1 in patients with acromegaly resulting in decreased manifestations of acromegaly.
Improve progression-free survival in patients with GEP-NETs.
↓need for short-acting somatostatin analog rescue therapy.

Classifications ⬆ ⬇

Therapeutic Classification: hormones

Pharmacologic Classification: somatostatin analogues

Pharmacokinetics ⬆ ⬇

Absorption: Following SUBQ administration, lanreotide precipitates in body tissues acting as a depot formulation from which drug is slowly released (75% bioavailability).

Distribution: Unknown.

Metabolism/Excretion: Minimal renal/fecal excretion, some biliary excretion.

Half-Life: 23–30 days.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
SUBQ	unknown	first 24 hr	1 mo

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before receiving first injection and before each monthly injection in case of changes. If an injection is missed, consult health care professional.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient to notify health care professional if signs and symptoms of gallstones, hyperglycemia, hypoglycemia, thyroid dysfunction, or irregular heartbeat occur.
Advise patient to notify health care professional immediately if hypersensitivity reactions (swelling of face, lips, mouth, or tongue; breathing problems; fainting; dizziness; feeling lightheaded; itching; flushing or redness of skin; rash; hives) occur.
Advise patient to notify health care professional if they experience new or worsening symptoms of fat in their stool, stool discoloration, loose stools, abdominal bloating, or weight loss.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy and for 6 mo after last dose. May ↓ fertility in females.

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Indications ⬇