Somatropin Dosage

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Usual Adult Dose for Adult Human Growth Hormone Deficiency

0.006 mg/kg/day (ideal body weight, rounded to nearest 0.01 mg, dose: minimum - 0.2 mg, maximum - 0.75 mg) subcutaneously or IM every day. The subcutaneous route is preferred because it is less painful and the patient can be taught to self-inject somatropin at home.

Dosages should be titrated based on patient response and tolerance. The dosage may be increased to a maximum of 0.0125 mg/kg/day (ideal body weight). Initiating therapy with higher dosages has resulted in edema in some adult patients.

Studies have shown increased efficacy in the total weekly dosage of recombinant human growth hormone when given in equally divided doses once a day versus 3 times a week. Additionally, smaller studies suggest that evening administration of recombinant human growth hormone may be more beneficial because it mimics the circadian rhythm leading to an increased anabolic response.

Usual Adult Dose for Burns, Nitrogen Retention

0.006 mg/kg/day (ideal body weight, rounded to nearest 0.01 mg, dose: minimum - 0.2 mg, maximum - 0.75 mg) subcutaneously or IM every day. The subcutaneous route is preferred because it is less painful and the patient can be taught to self-inject somatropin at home.

Dosages should be titrated based on patient response and tolerance. The dosage may be increased to a maximum of 0.0125 mg/kg/day (ideal body weight). Initiating therapy with higher dosages has resulted in edema in some adult patients.

Studies have shown increased efficacy in the total weekly dosage of recombinant human growth hormone when given in equally divided doses once a day versus 3 times a week. Additionally, smaller studies suggest that evening administration of recombinant human growth hormone may be more beneficial because it mimics the circadian rhythm leading to an increased anabolic response.

Usual Adult Dose for Cachexia

AIDS-related wasting or cachexia:

Serostim: subcutaneously once daily at bedtime:
less than 35 kg: 0.1 mg/kg
35 kg to 44 kg: 4 mg
45 kg to 55 kg: 5 mg
greater than 55 kg: 6 mg

Usual Adult Dose for Short Bowel Syndrome

Short bowel syndrome:
Zorbtive:
0.1 mg/kg subcutaneously once daily. Maximum 8 mg daily. Treatment longer than 4 weeks has not been studied adequately. Excessive fluid retention or arthralgias may be treated symptomatically or by a 50% dosage reduction; stop therapy for up to 5 days prior to lowering dosage if symptoms are severe; if symptoms do not resolve after 5 days or recur with the lowered dosage, discontinue treatment.

Usual Pediatric Dose for Pediatric Growth Hormone Deficiency

Genotropin and Omnitrope:
0.16 to 0.24 mg/kg/week subcutaneously- divided into equal doses given either 6 or 7 times a week.
Growth failure due to Prader-Willi syndrome: 0.24 mg/kg/week subcutaneously - divided into equal doses given either 6 or 7 times a week.
Growth failure in children who were born small for gestational age: 0.48 mg/kg/week subcutaneously - divided into equal doses given either 6 or 7 times a week.

Humatrope:
0.18 mg/kg per week subcutaneously - divided into equal doses given either on alternate days or 6 times a week. Maximum weekly dose is 0.3 mg/kg)
Growth failure in children who were born small for gestational age: 0.47 mg/kg/week subcutaneously - divided into equal doses given either 6 or 7 times a week.

Norditropin:
0.024 to 0.034 mg/kg subcutaneously 6 or 7 times a week.
Growth failure in children who were born small for gestational age: 0.469 mg/kg/week subcutaneously - divided into equal doses given 7 times a week.

Nutropin and Nutropin AQ:
0.3 mg/kg per week subcutaneously - divided into daily injections. In pubertal patients, dosage may be increased to 0.7 mg/kg per week - divided into daily injections.

Nutropin Depot:
1.5 mg/kg subcutaneously once a month (given on the same day of each month). Patients more than 15 kg will require more than one injection.
-or-
0.75 mg/kg subcutaneously twice a month (given on the same days of each month - e.g. days 1 and 15 of each month). Patients more than 30 kg will require more than one injection.

Saizen:
0.06 mg/kg by subcutaneous injection 3 times per week.

Tev-Tropin:
0.1 mg/kg by subcutaneous injection 3 times per week.

Usual Pediatric Dose for Turner's Syndrome

Genotropin:
0.33 mg/kg subcutaneously per week - divided into equal daily doses or on 3 alternate days.
Norditropin:
up to 0.067 mg/kg/day
Nutropin and Nutropin AQ:
Up to 0.375 mg/kg subcutaneously per week - divided into equal doses 3 to 7 times per week.

Usual Pediatric Dose for Idiopathic Short Stature

Genotropin:
0.47 mg/kg weekly subcutaneously divided into equal doses 6 to 7 days/week
Humatrope:
Up to 0.37 mg/kg per week subcutaneously divided into 6 or 7 equal doses
Nutropin and Nutropin AQ:
Up to 0.3 mg/kg subcutaneously per week divided into daily doses

Usual Pediatric Dose for Growth Retardation - Chronic Renal Failure

Nutropin and Nutropin AQ:
0.35 mg/kg per week subcutaneously. May be continued until time of transplantation.

Dosage recommendations in patients treated for Chronic Renal Failure who require dialysis:
Hemodialysis: Administer dose at night prior to bedtime or at least 3 to 4 hours after hemodialysis to prevent hematoma formation from heparin.
CCPD: Administer dose in the morning following dialysis
CAPD: Administer dose in the evening at the time of overnight exchange

Usual Pediatric Dose for Noonan's Syndrome

Norditropin:
up to 0.066 mg/kg/day

Usual Pediatric Dose for Short Stature for Age

Short stature born SGA (short for gestational age) with no catch-up growth by age 2-4 years:
Norditropin: Up to 0.067 mg/kg/day administered subcutaneously.
Humatrope: Up to 0.067 mg/kg/day (0.47 mg/kg/week) administered subcutaneously.

Short stature or growth failure in children with short stature homeobox-containing gene (SHOX) deficiency:
Humatrope: 0.050 mg/kg/day (0.35 mg/kg/week) administered subcutaneously.

Usual Pediatric Dose for Cachexia

AIDS-related wasting or cachexia:
Serostim: 0.04-0.07 mg/kg/day subcutaneously for 4 weeks (limited information).

Renal Dose Adjustments

Patients with severe renal impairment may have a diminished responsiveness to somatropin due to lowered protein binding. It is not known if dosage adjustments are required in patients with renal disease. Because somatropin is partly metabolized in the kidney, doses should be titrated to effect in patients with kidney disease.

Liver Dose Adjustments

It is not known if dosage adjustments are required in patients with liver disease. Because somatropin is partly metabolized in the liver, doses should be titrated to effect in patients with hepatic disease.

Precautions

Growth hormone is contraindicated in patients with Prader-Willi syndrome who are severely obese or have severe respiratory impairment. Fatalities have occurred in pediatric patients with Prader-Willi syndrome who have had one or more of the following risk factors: severe obesity, history of respiratory impairment or sleep apnea, or unidentified respiratory infection.

Growth hormone should not be used for growth promotion in pediatric patients with closed epiphyses.

Some preparations contain metacreasol, glycerin or benzyl alcohol.

Dialysis

Hemodialysis: administer at night just prior to sleep and at least 3 to 4 hours after dialysis.

Chronic cyclic peritoneal dialysis: administer in the morning after dialysis.

Chronic ambulatory peritoneal dialysis: administer in the evening at the time of the overnight exchange.

Other Comments

Pediatric patients: Failure to increase growth rate after one year of therapy should prompt assessment of compliance and evaluation of other causes of growth failure.

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