Indications
Long-term management of acromegaly which cannot be treated by or has not responded to surgery and/or radiation therapy.
Action
Acts as an analog of somatostatin, inhibiting growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in patients with acromegaly.
Therapeutic Effects:
Decreased levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) in acromegalic patients resulting in decreased manifestations of acromegaly.
Pharmacokinetics Absorption: Following subcut administration, lanreotide precipitates in body tissues acting as a depot formulation from which drug is slowly released (75% bioavailability).
Distribution: Unknown.
Metabolism and Excretion: Minimal renal/fecal excretion, some biliary excretion.
Half-life: 23–30 days.
TIME/ACTION PROFILE
ROUTE
ONSET
PEAK
DURATION
Subcut
unknown
first 24 hr
1 mo
Contraindications/Precautions Contraindicated in: OB: Lactation. Use Cautiously in:
Diabetic patients;
Underlying heart disease, especially bradycardia;
OB: Use only if maternal benefit outweighs risk to fetus;
Pedi: Safe use in children has not been established.
Adverse Reactions/Side Effects*
*CAPITALS indicate life threatening; underlines indicate most frequent.
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.
Route/Dosage Subcut (Adults): 90 mg every 4 week for 3 mos, further adjustments are made on the basis of GH and IGF1 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— increase to 120 mg every 4 wk; GH £1 mg/mL, IGF-1 symptoms currently controlled—decrease dose to 60 mg every 4 wk.
Renal/Hepatic Impairment Subcut (Adults):Moderate to severe hepatic or renal impairment— 60 mg every 4 wk; further adjustments are made on the basis of Growth Hormone (GH) and insulin growth factor-1(IGF1) levels.
Assess for GI side effects (diarrhea, abdominal pain, nausea, gas, constipation); usually decrease with continued treatment.
Lab Test Considerations:
Monitor serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels every 3 months
May cause hyperglycemia or hypoglycemia. Monitor blood glucose when therapy is initiated and when dose is altered and adjust antidiabetic treatment accordingly.
May cause slight ↓ thyroid function; monitor as clinically indicated.
May cause anemia.
Potential Nursing Diagnoses Risk for disproportionate growth (Indications). Deficient knowledge, related to medication regimen (Patient/Family Teaching).
Implementation
Subcut: Store in refrigerator and protect from light. Remove sealed pouch from refrigerator 30 min prior to injection; allow to reach room temperature. Keep pouch sealed until injection. Administer deep into subcutaneous tissue of superior external buttock. Do not fold skin; insert needle perpendicular to skin, rapidly to full length. Alternate injection between right and left side. May cause injection site reactions (pain, injection site mass); decrease with continued therapy. Syringe is for single use; do not use after expiration date.
Patient/Family Teaching
Explain purpose of lanreotide to patient. Advise patient to read Patient Information before receiving first injection and before each monthly injection in case of new information. If an injection is missed, consult health care professional.
Instruct patient to notify health care professional if unusual symptoms develop or known symptoms persist or worsen.
Advise patient to consult health care professional before taking any Rx, OTC, or herbal products with lanreotide.
Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
Evaluation/Desired Outcomes
Decreased levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1).