lanreotide


Also found in: Wikipedia.

lanreotide

(lan-ree-o-tide) ,

Somatuline Depot

(trade name)

Classification

Therapeutic: hormones
Pharmacologic: somatostatin analogues
Pregnancy Category: C

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

ROUTEONSETPEAKDURATION
Subcutunknownfirst 24 hr1 mo

Contraindications/Precautions

Contraindicated in: Obstetric: Lactation.
Use Cautiously in: Diabetic patients; Underlying heart disease, especially bradycardia; Obstetric: Use only if maternal benefit outweighs risk to fetus; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Cardiovascular

  • bradycardia
  • hypertension

Gastrointestinal

  • pancreatitis (life-threatening)
  • abdominal pain (most frequent)
  • diarrhea (most frequent)
  • gallstones (most frequent)

Endocrinologic

  • hyperglycemia
  • hypoglycemia

Hematologic

  • anemia

Local

  • injection site reactions (most frequent)

Interactions

Drug-Drug interaction

↑ 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

Subcutaneous (Adults) 90 mg every 4 week for 3 mo, 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—↑ 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

Subcutaneous (Adults) Moderate to severe hepatic or renal impairment—60 mg every 4 wk; further adjustments are made on the basis of GH and IGF1 levels.

Availability

Semi-solid in pre-filled syringes: 60 mg, 90 mg, 120 mg

Nursing implications

Nursing assessment

  • 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 mo.
    • 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

  • Subcutaneous: 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.
  • Instruct 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 Rx, OTC, or herbal products.
  • 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).

lanreotide

A somatostatin analogue drug used to treat the growth disorder acromegaly prior to surgery on the pituitary gland. Somatostatin is a hormone produced by the hypothalamus of the brain, which inhibits the release of the natural growth hormone, somatotropin as well as of other pituitary gland-stimulating hormones. Brand name: Somatuline LA.
References in periodicals archive ?
Based on the drug type, the global neuroendocrine cancer market can be segmented into Everolimus, Sunitinib Malate, Lanreotide, Octreotide, and others.
Somatuline, Autogel (lanreotide) for non-functional gastroenteropancreatic neuroendocrine tumour (GEP-NETs) is being extended to include access through community pharmacy in addition to hospitals.
54 Somatostatin receptor analogues (SSAs) such as octreotide or lanreotide also have an impact on progression-free survival and are used as first-line in low grade NETs.
The long-acting somatostatin analogues, octreotide and lanreotide are currently considered for first line treatment.
Anti-tumour effects of lanreotide for pancreatic and intestinal neuroendocrine tumours: the CLARINET open-label extension study.
The effect of the somatostatin analogue lanreotide on the prevention of urethral strictures in a rabbit model.
He also highlighted the efficacy of Lanreotide in acromegaly besides monotherapy with SSA.
An antiproliferative effect of another long-acting somatostatin analogue lanreotide was demonstrated in a study of more than 200 patients with somatostatin receptor-positive enteropancreatic neuroendocrine tumors with Ki-67 values of less than 10% [18].
Three months after initiation of long-acting SSA treatment, octreotide LAR, 20 mg every 4 weeks (N = 42), and lanreotide SR, 40 mg every 2 weeks (N = 22), patients were reevaluated.
Liao, "Slow-release lanreotide in graves' ophthalmopathy: a double-blind randomized, placebo-controlled clinical trial," Journal of Endocrinological Investigation, vol.
There are three main different groups of medical therapies available: somatostatin analogues (octreotide, lanreotide), molecularly targeted treatment (everolimus, sunitinib), and chemotherapy with cytostatic/cytotoxic drugs (5-fluorouracil (5-FU), capecitabine, dacarbazine, oxaliplatin, streptozotocin, and temozolomide).
Lanreotide is also a synthetic octapeptide and it can be adminstered every 28 days.