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Secretin

Pronunciation

(SEE kr tin)

Index Terms

  • Secretin Acetate (Human)
  • Secretin, Human
  • Secretin, Porcine

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Intravenous:

ChiRhoStim: 16 mcg (1 ea)

SecreFlo: 16 mcg (1 ea)

Brand Names: U.S.

  • ChiRhoStim
  • SecreFlo

Pharmacologic Category

  • Diagnostic Agent

Pharmacology

Human secretin is a synthetic peptide hormone produced by cells in the duodenum in response to acidification; it stimulates pancreatic ductal cells to secrete pancreas fluid in large volumes that contain bicarbonate; may also work through vagal-vagal neural pathways since stimulation of the efferent vagus nerve stimulates bicarbonate.

Distribution

Vd: 2.7 L

Excretion

Clearance: 580.9 ± 51.3 mL/minute

Half-Life Elimination

45 minutes

Use: Labeled Indications

Diagnosis of gastrinoma: Stimulation of gastrin secretion to aid in the diagnosis of gastrinoma.

Diagnosis of pancreatic dysfunction: Stimulation of pancreatic secretions, including bicarbonate, to aid in the diagnosis of pancreatic exocrine dysfunction.

Endoscopic retrograde cholangiopancreatography: Stimulation of pancreatic secretions to facilitate in the identification of the ampulla of Vater and accessory papilla during endoscopic retrograde cholangiopancreatography.

Contraindications

There are no contraindications listed in the manufacturer's labeling.

Dosing: Adult

Diagnosis of gastrinoma: IV: 0.4 mcg/kg as a single dose

Diagnosis of pancreatic dysfunction/Endoscopic retrograde cholangiopancreatography: IV: 0.2 mcg/kg as a single dose

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Reconstitution

Add 8 mL NS to the 16 mcg vial to yield concentration of 2 mcg/mL; add 10 mL NS to the 40 mcg vial to yield a concentration of 4 mcg/mL; shake vigorously to ensure dissolution and use immediately. Discard any unused product.

Administration

Administer by IV injection slowly over 1 minute.

Dietary Considerations

Patients should fast 12 to 15 hours prior to beginning the test.

Storage

Prior to reconstitution, store at -20°C (-4°F). Protect from light.

Drug Interactions

Anticholinergic Agents: May diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Consider therapy modification

Histamine H2 Receptor Antagonists: May diminish the diagnostic effect of Secretin. Specifically, use of H2-Antagonists may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of histamine H2-antagonists (H2RAs) and secretin. Discontinue H2RAs at least 2 days prior to secretin administration. Consider therapy modification

Proton Pump Inhibitors: May diminish the diagnostic effect of Secretin. Specifically, use of PPIs may cause a hyperresponse in gastrin secretion in response to secretin stimulation testing, falsely suggesting gastrinoma. Management: Avoid concomitant use of proton pump inhibitors (PPIs) and secretin, and discontinue PPIs several weeks prior to secretin administration, with the duration of separation determined by the specific PPI. See full monograph for details. Consider therapy modification

Adverse Reactions

1% to 10%: Gastrointestinal: Nausea (2%)

<1%, postmarketing, and/or case reports: Abdominal distress, flushing, vomiting

Warnings/Precautions

Disease-related concerns:

• Hepatic impairment: Use with caution in patients with hepatic impairment (including ethanol-induced disease); may be hyperresponsive to secretin stimulation and mask the presence of coexisting pancreatic disease. Consider additional testing and clinical assessments to aid in diagnosis.

• Inflammatory bowel disease: Patients who have inflammatory bowel disease may be hyporesponsive to secretin stimulation falsely suggesting pancreatic disease; consider additional testing and clinical assessments for aid in diagnosis.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Other warnings/precautions:

• Vagotomy: Patients who have undergone vagotomy may be hyporesponsive to secretin stimulation falsely suggesting pancreatic disease; consider additional testing and clinical assessments for aid in diagnosis.

Monitoring Parameters

Peak bicarbonate concentration of duodenal fluid aspirate (chronic pancreatitis); serum gastrin (gastrinoma). Refer to protocols for collection of pancreatic secretion and/or serum gastrin.

Pregnancy Considerations

Animal reproduction studies have not been conducted.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience abdominal pain, flushing, vomiting, or nausea (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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