Lanreotide
Class: Somatostatin Agonists
- Somatostatin Analogs
Chemical Name: [cyclo S-S]-3-(2-naphthyl)-d-alanyl-l-cysteinyl-l-tyrosyl-d-tryptophyl-l-lysyl-l-valyl-l-cysteinyl-l-threoninamide acetate (salt)
CAS Number: 127984-74-1
Brands: Somatuline Depot
Medically reviewed by Drugs.com. Last updated on Nov 17, 2020.
Introduction
Synthetic octapeptide pharmacologically related to somatostatin.1 6 8
Uses for Lanreotide
Acromegaly
Long-term treatment of acromegaly in patients who have had inadequate responses to or are not candidates for surgical resection and/or radiotherapy (designated an orphan drug by FDA for this use).1 2
Goal of therapy is to normalize concentrations of growth hormone (GH) and insulin-like growth factor 1 (IGF-1).1
Improves certain manifestations of acromegaly (asthenia, joint pain, swelling of extremities, excessive perspiration, headache).4
Lanreotide Dosage and Administration
General
-
Individualize dosage based on patient’s response (GH and IGF-1 levels, clinical symptoms); monitor serum GH and IGF-1 concentrations and adjust dosage accordingly.1 9
Administration
Sub-Q Administration
Administer by deep sub-Q injection into the upper outer quadrant of the buttock; alternate injection sites every 4 weeks between the right and left buttock.1 5
Allow product to reach room temperature by removing sealed pouch from refrigerator 30 minutes prior to administration.1 Keep pouch sealed until time of administration.1
Insert the needle rapidly to its full length at an angle perpendicular to the skin; the skin should not be folded prior to administration.1
Dosage
Available as lanreotide acetate; dosage expressed in terms of lanreotide.1
Adults
Acromegaly
Sub-Q
Initially, 90 mg once every 4 weeks for 3 months.1
After 3 months, adjust subsequent dosages based on response (GH and IGF-1 concentrations and clinical response) (see Table 1).1
Response |
Dosage Adjustment |
---|---|
GH concentration >1 to 2.5 ng/mL, normal IGF-1 concentration, and controlled clinical symptoms |
Maintain dosage at 90 mg once every 4 weeks1 |
GH concentration ≤1 ng/mL, normal IGF-1 concentration, and controlled clinical symptoms |
Reduce dosage to 60 mg once every 4 weeks1 |
GH concentration >2.5 ng/mL, elevated IGF-1 concentration, and/or uncontrolled clinical symptoms |
Increase dosage to 120 mg once every 4 weeks1 |
Special Populations
Hepatic Impairment
Acromegaly
Sub-Q
In patients with moderate to severe hepatic impairment, initially, 60 mg once every 4 weeks for 3 months.1 Subsequent dosages are determined based on GH and IGF-1 concentrations and clinical response.1
Renal Impairment
Acromegaly
Sub-Q
In patients with moderate to severe hepatic impairment, initially, 60 mg once every 4 weeks for 3 months.1 Subsequent dosages are determined based on GH and IGF-1 concentrations and clinical response.1
Geriatric Patients
Dosage adjustments not required.1
Cautions for Lanreotide
Contraindications
-
None.1
Warnings/Precautions
Sensitivity Reactions
Latex Sensitivity
The needle cover of the prefilled syringe contains dry natural rubber (latex).1
Biliary Effects
Biliary abnormalities (e.g., cholelithiasis, biliary sludge) occur commonly,1 possibly due to decreased gallbladder motility, inhibited gallbladder contractility, and decreased bile secretion.1 Incidence may be related to dose and duration of therapy.1 Perform gallbladder studies periodically.1
Endocrine Effects
Hypoglycemia or hyperglycemia can occur as a result of inhibition of insulin and glucagon secretion.1 Monitor blood glucose concentrations when lanreotide therapy is initiated or dosage adjusted in patients with diabetes mellitus.1 10 Adjust dose of antidiabetic agents as necessary.1 (See Interactions.)
Slight decreases in thyroid function possible; hypothyroidism reported rarely.1 Assess thyroid function when indicated.1
Cardiovascular Effects
Sinus bradycardia, bradycardia, and hypertension reported.1 Exercise care when initiating therapy in patients with bradycardia.1
Specific Populations
Pregnancy
Category C.1
Lactation
Not known whether lanreotide is distributed into milk. 1 Discontinue nursing or the drug. 1
Pediatric Use
Safety and efficacy not established.1
Geriatric Use
No substantial differences in safety and efficacy relative to younger adults, but increased sensitivity cannot be ruled out.1
Hepatic Impairment
Clearance may be decreased; dosage adjustment recommended for patients with moderate to severe hepatic impairment.1 (See Hepatic Impairment under Dosage and Administration and see Special Populations under Pharmacokinetics.)
Renal Impairment
Clearance may be decreased; dosage adjustment recommended for patients with moderate to severe renal impairment.1 (See Renal Impairment under Dosage and Administration and see Special Populations under Pharmacokinetics.)
Common Adverse Effects
Diarrhea, abdominal pain, nausea, constipation, flatulence, vomiting, cholelithiasis, injection site reactions, arthralgia, headache.1
Interactions for Lanreotide
Drugs Metabolized by Hepatic Microsomal Enzymes
Substrates of CYP isoenzyymes: Potential pharmacokinetic interaction (decreased substrate clearance).1 Caution advised if used concomitantly with CYP3A4 substrates with a low therapeutic index.1
Drugs Associated with Bradycardia
Possible additive effect on heart rate reduction; dosage adjustment of the concomitantly administered drug may be necessary.1
Effects on GI Absorption of Drugs
Possible decreased absorption of concomitant drugs.1
Specific Drugs
Drug |
Interaction |
Comments |
---|---|---|
Antidiabetic therapy |
Possible hypoglycemia or hyperglycemia1 |
Monitor blood glucose concentrations when lanreotide is initiated or dose altered; adjust dose of insulin and/or antidiabetic agent as necessary1 |
β-Adrenergic blocking agents |
Possible additive bradycardia1 |
Dosage adjustment of β-blocker may be necessary 1 |
Bromocriptine |
Increased bioavailability of bromocriptine1 |
|
Cyclosporine |
Possible decreased cyclosporine concentrations1 |
Adjust cyclosporine dosage as required1 |
Quinidine |
Possible increased quinidine concentrations1 |
Use with caution1 |
Vitamin K |
No effect on vitamin K absorption1 |
Lanreotide Pharmacokinetics
Absorption
Bioavailability
Mean bioavailability was 73.4, 69, and 78.4% following sub-Q administration of single 60-, 90-, and 100-mg dosages, respectively.1 A drug depot is formed at the injection site allowing for sustained release.1
Peak levels obtained during the first day following sub-Q administration.1
Duration
Serum concentrations slowly decline over 28 days with low peak to trough fluctuation noted at steady state.1
Distribution
Extent
Not known whether lanreotide is distributed into milk. 1
Elimination
Elimination Route
<5% excreted in urine; <0.5% recovered unchanged in feces, indicating some biliary excretion.1
Half-life
23–30 days following single-dose administration to healthy subjects.1
Special Populations
In healthy geriatric individuals, half-life was increased by 85%.1
End-stage renal disease requiring dialysis decreases clearance twofold and doubles half-life.1 (See Renal Impairment under Dosage and Administration.)
Moderate to severe hepatic impairment reduces clearance by 30%.1 (See Hepatic Impairment under Dosage and Administration.)
Stability
Storage
Parenteral
Injection
2–8°C in original package; protect from light.1
Actions
-
Inhibits basal secretion of several gastric enzymes (e.g., motilin, gastric inhibitory peptide, pancreatic polypeptide) and postprandial secretion of pancreatic polypeptide, gastrin, and cholecystokinin.1 8
-
Has high affinity for somatostatin receptors (SSTR) 2 and 5 in the anterior pituitary and pancreas.1 6 8
Advice to Patients
-
Provide copy of manufacturer’s patient information.1
-
Importance of advising patients to closely adhere to the schedule for return visits and lanreotide injections in order to maintain steady control of GH and IGF-1 levels.5
-
Importance of informing clinician if allergy to latex exists.5
-
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1 5
-
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 1 5
-
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes |
Dosage Forms |
Strengths |
Brand Names |
Manufacturer |
---|---|---|---|---|
Parenteral |
Injection, extended-release |
60 mg (of lanreotide) |
Somatuline Depot (available in disposable prefilled syringe) |
Tercica |
90 mg (of lanreotide) |
Somatuline Depot (available in disposable prefilled syringe) |
Tercica |
||
120 mg (of lanreotide) |
Somatuline Depot (available in disposable prefilled syringe) |
Tercica |
AHFS DI Essentials™. © Copyright 2021, Selected Revisions November 27, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
References
1. Tercica. Somatuline Depot (lanreotide) injection prescribing information. Brisbane, CA; 2007 Aug.
2. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414). Rockville, MD; 2007 Oct 3. From FDA web site. Accessed 2008 Jan 25 http://www.fda.gov/ForIndustry/DevelopingProductsforRareDiseasesConditions/HowtoapplyforOrphanProductDesignation/default.htm
3. AACE Acromegaly Guidelines Task Force. AACE medical guidelines for clinical practice for the diagnosis and treatment of acromegaly. Endocr Pract. 2004; 10:213-25. http://www.ncbi.nlm.nih.gov/pubmed/15382339?dopt=AbstractPlus
4. Chanson P, Barson-Chazott, Kuhn JM et al. Control of IGF-I levels with titrated dosing of lanreotide autogel over 48 weeks in patients with acromegaly. Clin Endocrinol (OXF). 2008; 69:299-305. http://www.ncbi.nlm.nih.gov/pubmed/18248639?dopt=AbstractPlus http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2610402&blobtype=pdf
5. Ipsen Pharma Biotech. Somatuline Depot (lanreotide) injection patient labeling. Signes, France; 2007 Aug.
6. Croxtall JD, Scott LJ. Lanreotide Autogel: a review of its use in management of acromegaly. Drugs. 2008; 68:711-23. http://www.ncbi.nlm.nih.gov/pubmed/18370450?dopt=AbstractPlus
7. Murray RD, Melmed S. A critical analysis of clinically available somatostatin analog formulations for therapy of acromegaly. Clin Endocrinol Metab. 2008; 93:2957-68.
8. Croxtall JD, Scott LJ. Spotlight on lanreotide autogel in acromegaly. Biodrugs. 2008; 22:275-7. http://www.ncbi.nlm.nih.gov/pubmed/18611070?dopt=AbstractPlus
9. Melmed S. Acromegaly. N Engl J Med. 2006; 355:2558-73. http://www.ncbi.nlm.nih.gov/pubmed/17167139?dopt=AbstractPlus
10. Terica, Brisbane, CA: Personal communication.
More about lanreotide
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